Dietary Restraint: Restriction by Another Name?

Please excuse me while I nerd out all over your computer screen. I recently turned a corner on my appreciation of the value of quantitative social science, having taken a structural equation modelling class last winter, and today I’m going to share a little of that with you. While I’m still a qualitative researcher through and through, this course taught me that there is great value in understanding how scales are constructed and what that means about how we can interpret results from survey-takers.

What, you might ask, does any of this have to do with eating disorders? Plenty. A while back, Shiran wrote a post about the issues with the Eating Disorders Examination Questionnaire. Her post didn’t focus on the scale psychometrics – that is, how well the scale measures what it is supposed to measure and how consistent it is – but still reveals how questionnaires … Continue reading →

Psychoeducation for Eating Disorders: Motivational or Distressing?

It’s no secret that I am not a fan of primarily psychoeducational interventions for people with eating disorders (EDs). It irks me that the overall theory in implementing this kind of intervention seems to be: if they only knew what they were doing to their bodies, people with EDs would take better care of themselves. Of course I take issue with this idea – if knowing that EDs were harmful to one’s health was enough to make the changes needed to not have an ED anymore, far fewer people would be struggling.

In case you don’t know what I’m talking about, a psychoeducational program is one that focuses on educating people about a mental illness, including what qualifies as pathology, what the behaviours look like, what the harms are, and what possible interventions exist. To be fair, there are not that many examples of purely psychoeducational interventions for … Continue reading →

Beyond the Muscular Ideal: Talking About Eating Disorders and Masculinity

There’s a growing acknowledgment that women/feminine-presenting people are not the only people who get eating disorders. Increasingly, headlines proclaim that “men get eating disorders too!” and note that the stereotype that eating disorders are a “girl thing” is tired and problematic. This is great – anything that breaks down the well-entrenched notion that only young, rich, skinny, white, cis- and hetero girls are the only ones to get eating disorders is a welcome move in my opinion.

However, are we just reinscribing gender norms and the focus on body image and body ideals in the way we talk about eating disorders in boys and men? I just finished reading an article by Wright, Halse & Levy (2015) asking just this question. The article provides a compelling argument for re-visioning how we talk about eating disorders amongst boys and men.

Discourses

Wright, Halse & Levy explore discourses around eating disorders … Continue reading →

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 6

I thought about writing a post about the factor structure of popular eating disorder scales to celebrate my completion of an advanced statistics course in structural equation modelling. When I sat down to read some articles about that, though, I found myself side-tracked– and thoroughly uninterested in deconstructing scale psychometrics. So with a promise to do that at some point, I return to a favourite topic of mine: culture and eating disorders.

When I was writing about culture and eating disorders for the blog last year, I received quite a few requests for articles about eating disorders in developing countries. I suspect that the desire for this kind of article stems from a need to highlight (for the doubters) that eating disorders are serious mental health issues that can impact anyone who is predisposed, regardless of whether they live in a media-saturated landscape or not. As I noted in … Continue reading →

Let’s Talk about Systems Level Change for Eating Disorders

This past Wednesday, January 27th, was Bell Let’s Talk day in Canada. In case you’re unfamiliar with the campaign, Bell Canada (a telecom company) donates 5 cents to mental health awareness initiatives for every social media post or text with the hashtag #BellLetsTalk. In general, the campaign has been lauded for its contribution to decreasing shame and stigma around mental illness, which is awesome. There are a number of critics, though, who point out that:

Continue reading →

Serious Restrictive Eating Disorders Occur at Any Weight

Although the words “anorexia nervosa” typically conjure up images of emaciated bodies, eating disorders characterized by dietary restriction or weight loss can — and do — occur at any weight. However, precisely because anorexia nervosa is associated with underweight, doctors are less likely to identify eating disorders among individuals who are in the so-called “normal” or above normal weight range, even if they have all the other symptoms of anorexia nervosa.

Clearly, this is a problem.

For one, there is no evidence that eating disorder not otherwise specified (EDNOS) — a diagnosis given to individuals who do not fulfill all of the criteria for anorexia nervosa or bulimia nervosa — is less severe or less dangerous than full syndrome anorexia nervosa. As I’ve blogged about, individuals with EDNOS have comparable mortality rates (see: EDNOS, Bulimia Nervosa, as Deadly as Anorexia Nervosa in Outpatients) and similar (sometimes even more severe) Continue reading →

Cognitive-Behavioural Therapy for Bulimia Nervosa in the “Real World”: What's the Evidence?

Cognitive-behavioural therapy (CBT) is commonly described as the evidence-based treatment for bulimia nervosa. But do the findings from nearly perfectly crafted trials, with stringently followed protocols and “ideal” participants apply to the “real world”? How generalizable are the findings from carefully selected participants to clinical populations where, for one, the prevalence of psychiatric comorbidities is relatively high?

In other words, CBT has been shown to be efficacious (i.e., it works in a controlled experimental research trial setting) but is it effective (i.e., does it work in a clinical setting where clients might have multiple diagnoses and complex needs)?

This is precisely the question that Glenn Waller and colleagues sought to answer. They wanted to see whether CBT would work in a “routine clinical setting, where none of the exclusion-and protocol-based constraints […] apply.”

PARTICIPANTS

Participants were recruited from a publicly-funded outpatient ED service in the UK. The only exclusion criteria … Continue reading →

Nonpurging Bulimia Nervosa: Where Does It Fit?

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 … Continue reading →

Are There Any Meaningful Differences Between Subthreshold and Full Syndrome Anorexia Nervosa?

I see this on a daily basis: patients with subthreshold eating disorders feeling invalidated and “not sick enough.” They are struggling so much, but maybe they still have their periods, or maybe their weight isn’t quite low enough, and so they often (but not always, thankfully) get dismissed by doctors, other healthcare professionals, and insurance companies. Do you think you really need this treatment, maybe you can just focus on eating healthier? You know you are not fat, you are perfectly healthy! Just be happy! Or, Sorry, we can’t cover this psychological treatment because you don’t fit the full diagnostic criteria. 

Why do we draw a line between ‘threshold’ and ‘subthreshold’ at arbitrary numerical criteria?

No doubt numbers are important for medical treatment: someone with a very low BMI might have considerably more physical complications that need to be taken into account during treatment than someone with a not-so-low … Continue reading →

Think You Are Not “Sick Enough” Because You Didn’t Lose Your Period? Read This.

Anonymous asked, “I’ve never lost my period. Weight restored I am naturally thin, but even at a BMI of 15 or so I always got my period (although it wasn’t always regularly). This makes me feel like I’m not actually sick because I hear about everyone losing their period.”

eatruncats replied: “To the anon who asked about losing periods: For all the times she worries about not being sick enough because she never lost her period, there are people who lost their periods at BMIs of 18, 19, and 20 who worry about not being sick enough because they never got to a BMI of 15. If you have an eating disorder, you are “sick enough.” Period.

As it stands now, amenorrhea–or the loss of three consecutive menstrual cycles–is a diagnostic criterion for anorexia nervosa. Individuals who have not lost their periods are diagnosed with eating disorder … Continue reading →