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 …

Histamine and Anorexia Nervosa

Most of us have at some point in our lives taken antihistamines–drugs that block the action of histamine (e.g., Claritin, Allegra)–to relieve allergy symptoms. And while histamine is best known for its role in the immune response, it also has many other important roles in the central nervous system.

In the brain, histamine release is important for arousal (this is why antihistamines tend to make us drowsy). It has also been implicated in regulating appetite, taste perception, learning, memory, aggressive behavior, motivation, and emotion, among others (Yoshizawa et al., 2009; see this quick summary).

Alterations in histamine signalling in the brain have been implicated in a variety of disorders, including schizophrenia (Iwabuchi et al., 2005), depression (Kano et al., 2004), and multiple sclerosis (Wikipedia has a nice summary chart; or you can read this open paper for more details, too).

Of particular interest to us here is the role of histamine in food and appetite control (see this open access review paper for a more detailed exploration). As summarized by Yoshizawa …

Making Connections: Peer Support and Eating Disorder Recovery

I feel like a broken record when I say that we continue to lack an evidence base for most “alternative” forms of support for eating disorders. As I’ve noted in prior posts, just because something is not evidence based does not mean it does not work for anyone; often, an evidence base is established when researchers can secure enough funding to run a randomized-controlled trial (RCT) that would act as evidence.

Even when an RCT has been run, it is hard to say that one form of treatment is best for all. People with eating disorders, like people in general, respond to different things, based on personal preference, history, culture, age, gender, and so many other factors. It feels a bit simplistic to write that, but I sometimes think we need a reminder of that fact!

Ultimately, and unsatisfyingly, it can be hard to predict what will work best for someone to support their recovery. This can also change over time, as people’s life circumstances and desires change. Recently, I’ve heard rumblings around the potential to use peer support …

Treating Severe Anorexia Nervosa in the Community

Can treatment for severe anorexia nervosa be delivered safely in a community setting? According to a recent paper by Calum Munro and colleagues (2014, open access), the answer is yes.

In 2001, a systematic review by Meads, Gold, and Burls found that inpatient treatment is not more or less effective than outpatient treatment for individuals with AN. Of course there will always be patients who will require inpatient care, but given the high cost, lack of clear efficacy, and known risks, it is important to ask if there are better options, particularly for a subgroup of individuals who may not need or may not benefit from inpatient care.

In their paper, Munro et al. describe a program that they’ve developed for treating individuals with severe AN in the community. The program is called the Anorexia Nervosa Intensive Treatment Team (ANITT) service. It is one component of a four-tiered system–it is a step below specialist inpatient care and a step above outpatient therapy that includes “group and individual therapy, dietetic and psychiatric treatment.”

This tiered …

Fat Talk Free Zone: What is the Impact of Fat Talk on Body Dissatisfaction?

There has been a veritable explosion of “anti-fat talk” movements in the body image and eating disorder prevention realms over the past few years. Indeed, campaigns like the Tri-Delta Sorority Fat Talk Free week have become relatively well known. Events like the “Southern Smash,” where participants literally smash scales are other iterations of this social phenomenon encouraging a more positive conversation around bodies.

I am, of course, a fan of the idea that we shouldn’t put our bodies down; I’m a huge proponent of the need to avoid putting our own and others’ bodies down. I think that initiatives like Fat Talk Free week are good practice as they help move conversations in more productive directions and help to redirect our focus from bodies as our only source of value.

One of my concerns about these initiatives is that in signing up to do a Fat Talk Free week or smashing a scale, we start to think that we are “doing enough” to prevent eating disorders. Here is where nuance comes in: do I think that these initiatives …