Of Binge Eating, Age, and Distress: Child-Adolescent vs. Adult Onset Binge Eating

I’m embarrassed to say that my knowledge around binge eating disorder (BED) is sorely lacking compared to my understanding of the prevalence, correlates, treatments for, experiences of, and recovery from anorexia nervosa, bulimia nervosa, and OSFED (I still prefer “EDNOS,” but I’ll go with DSM 5 here). I don’t think this knowledge gap is uncommon; I’ve seen BED mentioned as a passing note in many an article, despite a general awareness that BED is relatively common. In order to begin to fill this knowledge gap (allow me a little self-indulgence as I fill this knowledge gap “out loud,” here), I thought I’d do a little reading and writing around BED. I also look forward to engaging in the comments, if you’re more savvy than I in this realm.

We know that BED is relatively common; general prevalence ranges from 0.7-4% (Latner & Clyne, 2008). In certain samples, for example people pursuing obesity treatment, this prevalence rate jumps to 15-50% (Johnson, Spitzer & Williams, 2001) (note, of course, that this large discrepancy might be partially due to the …

Beyond Thinness: Men, Muscularity and Eating Disorders

Eating disorder research tends to focus on girls and women. Which makes sense: eating disorders disproportionately affect women. However, it isn’t just the research on eating disorders that focuses on women: it’s the entire history of eating disorders as a diagnosis. The first descriptions of anorexia nervosa by William Gull and bulimia nervosa by Gerald Russell were both based primarily on observations of female patients (although Russell did include two men). Therefore, it’s possible that our basic construction of eating disorders is based on a specifically female experience.

One example of this is the focus on weight loss as a cardinal component of eating disorders (barring binge eating disorder). This is often attributed to the pursuit of a “thin ideal” created by our culture; however, this thin ideal doesn’t necessarily apply to men. Whilst women encounter pressure to be thin, evidence suggests that men encounter pressure to be more muscular—a drive that by its nature would not necessarily be associated with the pursuit of weight loss (Olivardia, 2001).

The point at which this pursuit of muscularity becomes a …

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 5

We’ve begun to scratch the surface of the vast and growing literature on cultural context and eating disorders in the previous 4 posts in this series. Of course, as I reflected the other day, there could (maybe should?) be a blog solely devoted to this topic- each time I read another study in this area, it pulls me down the rabbit hole into another related area.

In what will be the last part of this series for now, I’ll review a study by Bennett, Sharpe, Freeman, and Carson (2004) on the request of Lisa LaBorde (via Twitter). The authors wanted to learn more about the presence (or lack thereof) of eating disorders in Sub-Saharan Africa, a context that they describe as less driven by the thin-ideal. This was, they suggest, the first thorough exploration of anorexia in sub-Saharan Africa, and so might reveal more about whether and how anorexia nervosa is present in area of the world that is differently positioned on the world stage than Western societies.

THE STUDY

Bennett et al. selected 2 high schools located …

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 4

The more I write about culture and eating disorders, the more I want to know. I keep finding more articles to add to the mix; I know I’m far from the first to be interested in how culture and eating disorders intersect, and for that matter, what counts as “culture.” Still, this has been a fascinating exploration so far! In case you’re curious, this is to be the second last post in the series, for now at least. There will be one more after this, about eating disorders in Ghana (from a Twitter request). In this post, I will continue to explore the “culture boundness” of eating disorders by looking at a study relating to eating disorders in Africa. In this study, Le Grange, Louw, Breen & Katzman (2004) illustrate how eating disorders have emerged in Caucasian and non-Caucasian adolescents in South Africa.

THE STUDY

Le Grange and colleagues set out to complicate the package picture of the eating disorder/culture-of-thinness relationship by exploring the emergence of eating disorders in groups traditionally presumed to be “immune” to eating disorders …

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 3

The articles I’ve looked at so far in this series (Becker, in part 1, and Keel and Klump in part 2) give us some insight into the idea that the link between “Western” societies and eating disorders is more complex than a simple matter of media exposure. But, having read these studies, I was still left a bit wanting in terms of unpacking that black box of “culture” that gets tossed around in scholarly and popular literature. What, exactly, are we talking about when we talk culture in eating disorders?

Rebecca Lester, who is quite a prolific social anthropologist and who has written about eating disorder treatment systems in the USA and Mexico, makes the argument that “culture” is too often used as an umbrella term for semi-related but not-entirely-synonymous factors. This makes me wonder: is it possible that in latching on to the media side of Becker’s findings, for example, there has been too little attention paid to the other systemic factors that are indeed tied to culture- but not culture as it is generally attended to?…

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 2

In this post I’ll continue on the trend of considering the “culture bound” nature of eating disorders by looking at another commonly-cited article about eating disorders and culture. In this article, Keel and Klump (2003) look at the cultural and historical facets of anorexia and bulimia. They looked at whether eating disorders were present in other sociohistorical and cultural contexts in order to determine whether AN and BN are “culture bound.”

Their research, as I alluded to at the end of the first post in this series, suggests that anorexia is not culture bound (i.e., it can occur in the absence of certain aspects of culture), while bulimia is (i.e., it only/primarily appears in certain cultural contexts). As this finding might actually run counter to what popular press would have us believe, looking at this article provides us some interesting insight into how spin can really be everything. While I’m not 100% convinced that AN and BN differ in “culture-bound-ness,” I do think that this study offers us quite a bit to think about when we consider the …

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 1

Often, in writing about eating disorders, you will come across references to how some consider these disorders to be “culture bound.” If you start to unpack what researchers and clinicians are referring to, you might come to the conclusion that “culture bound” means specific to one particular culture or society, for example, modern Western society.

By extension, you might then think that the more “Western” a culture is, the more likely that there will be eating disorders present. You might have seen this logic reproduced in such works as: “Western Media is the Root of all Evil” (note: title does not refer to an actual study/article… I hope).

The way the popular press has taken up the culture boundedness of eating disorders does not always represent the way that it is described in research articles (I know, you’re shocked–not). Generally, and quite predictably, the “culture bound” nature of eating disorders is much more complex than a matter of a transporting cultural values (and thus eating disorders) from one society to another.

So let’s go back. Way back to 1994, when Anne …

Temperament in Eating Disorders

Much research has been done on personality traits associated with eating disorders, and, as I’ve blogged about here and here, on personality subtypes among patients with EDs. For example, researchers have found that individuals with AN tend to have higher levels of neuroticism and perfectionism than healthy controls (Bulik et al., 2006; Strober, 1981). Moreover, some traits, such as anxiety, have been associated with a lower likelihood of recovery, whereas others, such as impulsivity, with a higher likelihood of recovery from AN (see my post here).

Personality refers to “a set of psychological qualities that contribute to an individual’s enduring and distinctive patterns of feeling, thinking and behaviour” (Pervin & Cervone, 2010, as cited in Atiye et al., 2014). Temperament is considered to be a component of personality and refers to, according to one definition,”the automatic emotional responses to experience and is moderately heritable (i.e. genetic, biological) and stable throughout life.”

One popular model for classifying temperamental traits was developed by Cloninger (1987) and consisted of three dimensions (novelty seeking, harm avoidance, and reward dependence). The model has been updated …

Resistance is (not so) Futile? Exploring Treatment Resistance in Eating Disorders

To me, the idea of “treatment resistance” in eating disorders sparks some ill feelings. While many have suggested that treatment resistance is common among those with eating disorders, others have noted how receiving the label of “treatment resistant” can make it more difficult to receive needed support or impact how one is perceived in treatment settings and how one’s behaviours are interpreted (e.g., Gremillion, 2003).

Of course, this is a tricky ground to tread, primarily because sometimes people do resist treatment. Regardless, I think it is important to think about what lies behind the resistance to treatment. Is it the type of treatment? The people doing the treating? The compelling nature of the behaviours (e.g., restricting, binging and purging) at least in the short term?

In any case, to say that treatment resistance occupies a contested place in the eating disorder literature would likely be an understatement. Perhaps for this reason, I’ve more often seen treatment resistance featuring within explorations of other phenomena (e.g., outcome studies, qualitative explorations of the experiences of patients in eating disorder units) than as the …

Smartphone Apps for the Treatment of Eating Disorders

As of January 2014, over 50% of adults in the United States own a smartphone; unsurprisingly, there has been a growth in the number of mobile applications (apps) aimed at providing health care services for various mental (and physical) health problems, including eating disorders. The purpose of mobile health technologies is to utilize the functionality of smartphones to deliver a wide range of health services, including providing psychoeducation, treatment services and/or recovery support.

POTENTIAL BENEFITS OF SMARTPHONE APPS FOR ED TREATMENT

When it comes to the treatment of EDs, there are many potential benefits of smartphone apps. Smartphone apps can potentially help increase access to treatment (if, for example, they link users to ED services), enhance treatment compliance and/or engagement, and support treatment “outside of the therapy office.” Apps may also be able to improve motivation by connecting individuals to others who are recovering from EDs.

Smartphone apps can increase access to treatment since they provide a cheaper (often free) alternative to in-person meetings and transcend geographical barriers. They can also provide customized support in real-time. Finally, they may be preferred by …