Science of Eating Disorders

making sense of the latest findings in eating disorder research

Bulimia Nervosa

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Bingeing and Purging: Keeping the “Positives” and Eliminating The Negatives?

By Liz ⋅ May 13, 2013 ⋅ 11 comments

I have been fascinated and perplexed by reports of the seemingly invigorating and anxiety reducing effects of bingeing and purging (purging by self-induced vomiting). Personally, I cringe at the idea of self-induced vomiting and have always wanted to avoid vomiting at all costs, including during food poisoning. The insight from recent blog entries and the subsequent comments has made an impact on me. I see that the motivation to engage in bingeing/purging (b/p-ing) behavior can be intense and can provide an effective way increase positive affect and reduce stress. The ameliorating effects of b/p-ing remind me of drug addiction, with b/p-ing behavior as the “drug.” This made me wonder, what happens in the brain to impart such “addiction-like” reinforcement?

I know there are reports of opiate and endorphin release following purging, but to me, this seemed like an effect meant to counter the intense aversion (and discomfort?) of the act of purging itself. Correct me if I’m wrong, but it seems like the feeling of being “empty” should be reinforcing as well. As someone who used to restrict quite a bit, I certainly found that feeling …

Nonpurging Bulimia Nervosa: Where Does It Fit?

By Tetyana ⋅ April 18, 2013 ⋅ 5 comments

When most people think of bulimia nervosa, they think of binge eating and self-induced vomiting. While that is not incorrect, it is not the full picture either. In the current edition of the Diagnostic and Statistical Manual (DSM-IV), there are two subtypes of bulimia nervosa: purging (BN-P) and nonpurging (BN-NP). The difference lies in the types of compensation methods: patients with BN-P engage in self-induced vomiting, or the misuse of laxatives, diuretics, or enemas whereas patients with BN-NP use fasting or excessive exercise to compensate for binge eating.

How common in BN-NP? It is very hard to say. A small population-based study in Finland (less than 3,000 participants) found that 1.7% of the sample that bulimia nervosa, 24% had BN-NP (or 0.4% of the entire sample) (Keski-Rahkonen et al., 2009). (I couldn’t find much else on prevalence of BN-NP.)

Unfortunately, however, there’s been very little research on BN-NP.

So little, in fact, that many have wondered if it make sense to subtype bulimia nervosa patients into purging and nonpurging groups? And are there differences between patients with BN-NP and …

What’s The Point of Bingeing and Purging? And Why Can’t You Just Stop?

By Tetyana ⋅ April 15, 2013 ⋅ 16 comments

I defended my MSc on Tuesday and I’m not going to lie: I was pretty symptomatic with bulimia in the days prior to my defence. As I explained to my boyfriend: the anxiety-reducing effects of purging are so powerful, and the compulsion to binge and purge (when I’m stressed/anxious/”not okay”) is so strong that it is much easier to do it, get it over with, and continue working (in a much calmer state).

I’ve mentioned before, for me, purging is very anxiety-reducing and in some ways, almost a positive experience. It is so tightly coupled with bingeing that it is hard to separate the two, but the anxiety-reducing effects are strongest when I binge and purge, non-existent when I binge, and weak when I purge a normal meal (which is exceptionally rare/almost never.)

It turns out, of course, that I’m not alone.

Negative emotional states and stressors have long been associated with bingeing and purging (b/ping). In particular, they were thought to precede (or occur before) b/ping events. But of course, anecdotal evidence from clinical practice, while important, is not …

Living in a Large City: A Risk Factor for Bulimia Nervosa?

By Tetyana ⋅ March 3, 2013 ⋅ 5 comments

The link between urban living and mental disorders such as schizophrenia and depression has been known for quite some time (Sundquist et al., 2004). In one study, Sundquist et al found that individuals living in a densely populated area had a 68-77% higher risk of developing psychosis and 12-22% higher risk of developing depression.

The question then arises, do eating disorders follow a similar pattern? And if yes, what are some possible explanations? Certainly we know that both genetic and environmental factors are involved in the development of eating disorders, but what specific factors and to what extent remains unclear.

In this study, Gabrielle E. van Son and colleagues set out to explore whether increasing urbanization was an environmental risk factor for the development of eating disorders.

In order to answer this question, the researchers had a network general practitioners (GPs) record each newly diagnosed case of anorexia or bulimia nervosa between 1985-1989 and 1995-1999. The total number of patients served by the group of GPs was around 1% of the population in the Netherlands.

The researchers then …

Bingeing and Purging Marathons: Repeated Binge/Purge Cycles in Bulimia Nervosa

By Tetyana ⋅ February 10, 2013 ⋅ 5 comments

I used to call them bingeing and purging marathons. If I binged and purged in the morning, chances were, I’d binge and purge throughout the day. The next time I’d eat, I was likely to end up–whether I wanted to or not–bingeing and purging. Not all individuals with bulimia nervosa binge and purge every day (or purge everything they eat, for that matter), but many do, and some binge and purge multiple times a day. In recovery, many people start by trying not to binge and purge before a certain time of the day–because once they binge and purge, it triggers a continuous cycle of bingeing and purging until they become to exhausted or otherwise end up going to bed.

I always wondered why that was, why was it so hard to keep a single episode of bingeing and purging from initiating a repeated cycle of bingeing and purging?

On days I didn’t binge and purge, my eating was fairly normal. I had little trouble eating a normal-sized meal, keeping it down, and recognizing when I was full. I wasn’t too hungry …

Medical Complications of Purging in Bulimia Nervosa

By Tetyana ⋅ February 7, 2013 ⋅ Post a comment

Eating disorders are mental disorders with physical complications. Sometimes lots of them. I’ve blogged before about medical complications that are likely to come up in an emergency room setting, but that was a while ago. So I thought today I’d focus specifically on medical complications that occur in bulimia nervosa (BN) as a result of purging (self-induced vomiting, laxative abuse, and diuretic abuse).

These complications are particularly important because patients with BN often appear healthy and can thus more easily hide their disorder, meaning that treatment is often initiated many years after disorder onset, and the duration of BN is often long, with recovery rates far lower than they should be (in one study, the 5-year recovery rate was a little more than 50%), which means that these complications can persist for many years.

I’ll go through some of the complications of self-induced vomiting, laxative abuse, diuretic abuse, and briefly mention some complications in patients with type 1 diabetes.

I. COMPLICATIONS OF SELF-INDUCED VOMITING

Oral complications of self-induced vomiting:

cheilosis (painful lesions at the corner of the

…

Over-Exercise is Associated With Suicidality in Individuals with Disordered Eating

By Tetyana ⋅ February 2, 2013 ⋅ 6 comments

Last week, I blogged about a study that examined personality traits and clinical variables associated with excessive exercise in eating disorder patients. In that study, 2 out of 5 participants engaged in excessive exercise. Today, I’m going to discuss a study that suggests over-exercise in disordered eating patients is associated with suicide behaviour.

Suicide rates in eating disorder patients are high. One meta-analysis suggested that out of all eating disorder related deaths, 1 in 5 are suicides. (Keep in mind, these numbers are really hard to pin down as they depend a lot on the sample population, sample size, and how the authors did their statistics, among other things.)

Another analysis found that the standardized mortality ratio (ratio of observed deaths in the study sample/expected deaths in the population of the same age but without the disease/disorder you are studying) for suicide in eating disorders was 31 for patients with anorexia nervosa and 7.5 for patients with bulimia nervosa. Moreover, around 25-35% of bulimia nervosa and 3-20% of anorexia nervosa patients attempt suicide at least once in their lifetime (Bulik …

Mobile Therapy: Using Text-Messaging to Treat Bulimia Nervosa

By Tetyana ⋅ January 12, 2013 ⋅ 8 comments

Cognitive-behavioural therapy (CBT) is one of the most commonly used approaches to treat bulimia nervosa, but even CBT (or any treatment) doesn’t work for everyone. Sometimes, even if CBT is helping, a weekly 50 minute therapy session is just not enough. Moreover, like with many other eating disorder treatments, drop-out and relapse rates are high.

What can be done to help the individuals that don’t benefit (or benefit fully) from CBT, or those that relapse after CBT?

Shapiro and colleagues had the idea that maybe using text-messaging (in conjunction with CBT) would increase self-monitoring and accountability of bulimia nervosa patients.

The rationale is that text-messaging might provide an immediate way of engaging with the therapist. The patients are provided feedback and support immediately, and have the knowledge (or a sense of) being held accountable for their actions (i.e., binges and purges).

It is like a daily check-in. It means you don’t have to remember or wait until your next appointment to talk about how a particular day went, or get feedback on your behaviours. You also don’t have to write lengthy diary entries, you …

The “Double Life” of Bulimia Nervosa: Patients’ Perspectives

By Tetyana ⋅ December 24, 2012 ⋅ 26 comments

My psychiatrist once compared my life to Dexter. He said I was living a double life. It was the summer before my final year in undergrad and I was working in a neuroscience lab. Yet things were so bad that at one point I was very close to quitting and doing Day Program treatment. (I didn’t, and things ended up getting better, thankfully.)

This post is going to be more personal than most. One, I can relate well to the topic. Two, I feel that I can give voice to it under my real name. (As opposed to just discuss it abstractly, or anonymously. There’s nothing wrong with being anonymous, but I feel that, for many reasons I am in a position where I don’t feel I have to be anonymous any more.)

I think this is important because there are a lot of myths that surround eating disorders and those who suffer from them, and I want to do my part in crushing those myths. Moreover, while restrictive anorexia nervosa is often, at least partly, associated with positive traits …

Diabulimia: Disordered Eating in Type 1 Diabetic Patients

By Tetyana ⋅ September 18, 2012 ⋅ 13 comments

Type 1 diabetes mellitus (DMT1) is a lifelong chronic disorder that occurs when the body is unable to produce enough insulin – a hormone that is required for carbohydrate metabolism. Patients must learn to manage their disorder by monitoring their blood sugar levels on a regular basis, carefully selecting the foods they eat and how much exercise they do. Before insulin was extracted and purified (at University of Toronto!), type 1 diabetes, which usually occurs in children and adolescents, would very quickly lead to death – the body, unable to take in the very thing it needs to survive.

Unfortunately, patients with type 1 diabetes are at increased risk of developing eating disorders or disordered eating behaviours. Diabulimia refers to an eating disorder in patients with DMT1 who reduce or skip insulin doses to reduce their weight.

The exact prevalence rates vary study by study, depending on the population sample, how disordered eating/EDs are defined and a multitude of other factors. But, nonetheless, some numbers are helpful.

Kelly et al provides a nice overview of the prevalence studies. I’ve summarized some below:

There are …

Science of Eating Disorders by Tetyana Pekar is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

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