The 2013 International Conference on Eating Disorders (ICED) ended on May 4th. I thought I’d reflect on the experience (short version: it was awesome and I’m so glad I went!). Please note, the following is in no way comprehensive, representative, or scientific.
There were a lot of overlapping events at the conference, which meant that I could only attend a fraction of the events. I highlighted in yellow the workshops/panels/presentations I attended.
In his keynote speech, Dr. David Barlow wondered whether we are “missing the forest for the trees” as he highlighted some of the changes in the upcoming DSM-V (more disorders, more categories, more, as he said, ‘splitting’). Many disorders in the DSM-IV have the same underlying characteristics: high trait anxiety, neuroticism, negative affect, and emotional avoidance. Those of us with eating disorders tend to have difficulties recognizing and experiencing emotions—not just negative emotions, but all kinds of emotions.
I thought of the lyrics from Silverchair’s “Ana’s Song”:
For as long as you’re here, We’re not
You make the sound of laughter
And sharpened nails seem softer
And I need you now, somehow
And from Fiona Apple’s “Paper Pag”:
Might it be more useful to think about what the disorders have in common, as opposed to what differentiates them? The idea is that many mental disorders (OCD, anxiety, EDs, etc) have a common basis and it is the specific differences between individuals that are ultimately responsible for differences in the way these traits manifest.
This idea is not new, but it does have implications for research and for treatment. Importantly, the presence of common features doesn’t mean that treatment should be the same for OCD, depression, anxiety, and EDs, of course, but it might lead to more clues about causes and perhaps give us ideas about effective treatments and what we can borrow from other fields.
During the first oral paper presentation I attended, I learned about the Avoidant and Restrictive Food Intake Disorder (ARFID for short.) You can learn more about it here. An interesting question arose during the Q&A period, which was, what proportion of children/adolescents diagnosed with or fit the criteria for ARFID later go on to develop EDs? Are there some ARFID patients who might be too young to express body image disturbances?
Dr. Jenny Thomas presented an interesting talk titled “Is non-fat-phobic anorexia nervosa an artifact of purposeful symptom denial?” About 20% of AN patients are non-fat phobic (NFP), according to earlier research (though I can’t help but wonder how biased this number is because of the DSM-IV criteria). She hypothesized that NFP AN maybe partly be “an artifact of socially desirable responding.” NFP AN patients scored higher on a scale that measures a person’s tendency to give socially desirable answers than their fat-phobic counterparts. The conclusion that NFP AN might be partly explained by symptom denial because of the desire to answer what the individual thinks is desirable.
I raised the point that maybe what can be happening (at least some of the time) is the opposite of the situation in AFRID. Maybe saying you are dieting/don’t want to get fat is the simplest and most acceptable explanation? Perhaps a subset of FP AN patients cannot express/do not yet understand why they can’t eat (perhaps lack of awareness of the anxiety-reducing effects of restriction or perhaps it is just something that’s nearly impossible to explain to peers) and so they say (and believe) that their AN is, at least in part, perpetuated by fat phobia. That’s my hypothesis. I think the reality is probably a bit of both. FP and NFP are also not necessary static throughout the course of the disorder.
I suspect that for some, the focus on weight and shape is just a convenient scapegoat. A distraction. That’s not to say it is not an important component of the disorder or part of treatment, it can be. Body image is something that affects everyone, regardless of whether you have an eating disorder or not. So, it would be unfair to say it is not a component but I’m not sure it is as central to the disorder as some think. But, perhaps I’m wrong. It is a very interesting topic, though. I wonder if there’s any qualitative research exploring body image and fat phobia in AN, I haven’t searched around for that.
The second plenary session was on Eating Disorders in Men. Some key points:
- We don’t really know the prevalence and incidence of eating disorders in men (numbers vary a lot)
- EDs do not just affect gay or bisexual men, in fact most men with eating disorders are heterosexual
- Our current assessment measures are inadequate in addressing issues that affect males
- We have to be aware of and sensitive to issues that are more specific to male ED sufferers (for example, males are more likely to endorse ‘leannes’ and ‘muscularity’ over ‘thinnes’, they are more likely to binge and exercise, but less likely to abuse laxatives and diet pills, they are also more likely to have premorbid obesity)
- Involvement in sports and not body dissatisfaction seems to be a greater predictor of eating disorders in men
- We have to normalize the idea that men struggle with eating disorders too; males affected by eating disorders are not freaks.
The “Gender Ethnicity & Culture II” paper session had similar takeaways. Mainly, we have to get better at recognizing and assessing eating disorder symptoms in diverse communities. Just as men and women experience disordered eating symptoms differently and talk about them differently, so do different ethnic groups, and we need to be aware of that (for example, even using the term “binge” will have different meanings to different people). It is important so that we know what questions to ask and how to communicate. Men and minorities also face tremendous barriers to treatment at every stage, and we have to begin to remedy that by, in part, raising awareness about the fact that eating disorders cut across race, age, gender, sexuality, socioeconomic status, and so on.
As I mentioned on Twitter, one of my favourite parts of the conference was probably the “Meet the Experts” session. I, along with 3 others, spent about two hours talking to Dr. Michael Strober and Dr. Stephen Touyz about treatment of anorexia nervosa. It was very interesting to be among clinicians, as a patient, and listen to them discuss and answer complex questions about treatment. Two of the participants had questions about their patients and significant amount of time was spent discussing the cases. It was fascinating to see the thought process and approach that Drs. Strober and Touyz took to the cases.
I think part of the reason I enjoyed it was because the cases were complex and likewise, the approach to treatment was complex, too. My impression–and this could be due entirely to the workshops/presentations I chose to attend–was that a lot of the focus on treatment and recovery was centered around adolescents. The patients discussed in these cases were not adolescents, they were around my age. Although the session left me feeling sad (really sad), I was happy to see what I thought was a realistic approach to treatment and recovery that I felt was often missing during when the discussions centered around manualized treatment protocols and/or treating individuals who are sick for a relatively short period of time.
Of course, I completely understand that manualized treatment is not going to be applied in real life the way it is applied in a study. People mix-and-match.
I found it oddly reassuring to hear from Drs. Stober and Touyz that the outcome for one of the patients is not good. I obviously don’t mean it is reassuring that the outcome is not good. It was nice to get a realistic and honest assessment, as opposed to the fluffy ‘Everyone can recover’ rhetoric which is blatantly untrue for a myriad of reasons. Do I think full recovery is possible? Yes. Do I think it is possible for everyone? No.
I think I’ll stop here. This was one of the hardest posts to write, to be honest, but I’ll publish it anyway because I promised I’d write a reflection. I learned a lot of things but I skipped a lot because I’m planning to blog about research that was discussed as opposed to ramble on and on about my own thoughts. If you have any specific questions, just ask in the comments section!
And here’s a photo of me with Dr. Cynthia Bulik: