Does Body Dissatisfaction in Children Predict Eating Disorder Symptoms?

Identifying risk factors for eating disorder symptoms may help us develop more evidence-based prevention mentions. Personally not convinced that prevention is really possible with the types of individual-focused programs we have today, I would argue that identifying risk factors may at least help us determine which individuals should be screened in subsequent years. If they do develop eating disorders, they will hopefully be more likely to receive early intervention and treatment.

To identify predictors of eating disorder symptoms, Elizabeth Evans and colleagues (2016) conducted a longitudinal study that measured various putative risk factors at ages 7, 9, and 12 in a group of boys and girls. The authors also wanted to identify correlates of eating disorder symptoms at 12 years of age. They measured eating attitudes and dietary restraint, BMI, body dissatisfaction, and depressive symptoms.

THE STUDY

  • 516 participants; 262 girls and 254 boys
  • all individuals were residents of Gateshead, located
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Why I No Longer Support Genetics Research into Eating Disorders – Part II (Illness and Recovery in a Neoliberal Society)

This is part II of posts on why I am highly skeptical of the argument that we need to understand the genetic basis of eating disorders in order to improve outcomes. If you would like to leave a comment, please read Part I as well.

I worry about the implications of focusing on genetics and neurobiology in identifying causes of and solutions to eating disorders in the context of a neoliberal society.

When I was an adolescent, finding out that eating disorders have a genetic component alleviated my guilt. Coming across Dr. Walter Kaye’s research into the neurobiology of eating disorders — the hypothesis that the drive to restrict may be linked to and reinforced by serotonin systems in the brain (here, here, and here) — provided me with a plausible biological explanation for why restricting made me feel calmer. It meant my eating disorder was … Continue reading →

Why I No Longer Support Studying the Genetics of Eating Disorders – Part I

I no longer support genetics research into eating disorders. Okay, that’s not quite right: I no longer support genetics research into eating disorders under the pretense that it will improve treatment outcomes or prevent eating disorders. I just don’t believe it. Moreover, I think emphasizing the need for a genetic understanding of eating disorders shifts focus away from research and, more importantly, from actions, that can yield much greater benefits much quicker.

It wasn’t always like this. In my third (junior) year of university, I wrote a mini-review on the genetic and neurobiological etiology (cause) of anorexia nervosa. In it, I argued that “in order to improve recovery outcomes, more specific treatments based on genetic and neurobiological evidence need to be developed.” I concluded by writing,

However, with the advent of large-scale genetic databases and worldwide collaboration among researchers resulting in larger sample sizes, the future of AN research

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Incidence of Eating Disorders on the … Decrease?

Reports that eating disorder (ED) rates are rapidly increasing seem nearly ubiquitous, but are rates actually increasing? Are EDs at an “epidemic” level? I came across a recently published study suggesting that this may not be the case; indeed, ED rates might actually be decreasing, at least in the Netherlands.

In the study, Smink and colleagues (2015) followed a group of general practitioners (GPs), servicing roughly 1% of the total population, asking them to record all the newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) between 1985-1989, 1995-1999, and 2005-2009. They were interested in whether incidence rates changed or remained stable over time.

Incidence refers to the number of new cases of a disease or disorder in a population over a certain time period; it is not the same as prevalence, which refers to the total number of individuals suffering from the condition at a given point in time … Continue reading →

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 … Continue reading →

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 … Continue reading →

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).… Continue reading →

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 … Continue reading →

Recovering from an Eating Disorder in a Society that Loves Fat Shaming (and Dieting)

Is ED recovery easier when your body is “normative or stereotypically desirable”? The anon asking the question implied that recovery could be more difficult because “an obese person … will never stop hearing hearing extremely triggering stuff about their body type.” Anon asked, “Have there been any studies on this?” Andrea tackled this question in her last post (it might be helpful to read it first if you haven’t yet); in this post, I will expand on my original answer.

Assuming anon meant, “Have there been anything studies assessing whether recovery is harder for individuals who do not fit the normative body type (because of fat phobia/fat shaming/diet culture)?” Then, my answer is: Not really, or at least I couldn’t find anything evaluating this question directly.

I was only able to find a few studies commenting on the history of overweight or obesity as a predictor of recovery/treatment … Continue reading →

I Need How Many Calories? Caloric Needs in Bulimia Nervosa Patients

In the 1980s, a few studies came out suggesting that patients with bulimia nervosa (BN) require fewer calories for weight maintenance than anorexia nervosa patients (e.g., Newman, Halmi, & Marchi, 1987) and healthy female controls (e.g., Gwirtsman et al., 1989).

Gwirtsman et al. (1989), after finding that patients with bulimia nervosa required few calories for weight maintenance than healthy volunteers, had these suggestions for clinicians:

When bulimic patients are induced to cease their binging and vomiting behavior, we suggest that physicians and dietitians prescribe a diet in which the caloric level is lower than might be expected. Our experience suggests that some patients will tend to gain weight if this is not done, especially when hospitalized. Because patients are often averse to any gain in body weight, this may lead to grave mistrust between patient and physician or dietitian.

Among many things, this ignores the fact … Continue reading →