Recently, I was browsing the Twittersphere and came across (yet another) tweet about so-called “drunkorexia,” or the phenomenon of drinking to excess coupled with restrictive behaviours around food. After firing off a mildly miffed tweet bemoaning our societal tendency to add the suffix “orexia” to all “new” potentially problematic behaviours around food, I took to Scholar’s Portal to see if academics, too, were using this term. I wondered if “drunkorexia” was piquing scholarly interest, or just circulating in media headlines.
Beyond its problematic moniker, coupling problem drinking and restrictive eating is a phenomenon that might be worth delving into in greater detail, particularly if, as the reports claim, its incidence is rising. Barry & Piazza-Gardner (2012) explored the co-occurrence of weight maintenance behaviours and alcohol consumption, and their article clarifies what people mean when they say “drunkorexia.” I’ll get more into my issues with this terminology following a brief overview of the authors’ study.
Alcohol and “Weight Management” Behaviours
Barry & Piazza-Gardner begin their article with reference to an interesting trend observed by those studying problem drinking in …
Excessive exercise played a big role in my eating disorder and, predictably, I am drawn to studies that look at the role excessive exercise plays in eating disorder symptomatology, course and outcome. This topic has captured the interest of many eating disorder researchers, with studies revealing that up to 80% of individuals with anorexia nervosa may exercise excessively (Davis et al., 1997), though others suggest more modest statistics, around 39% (Shroff et al., 2006; Tetyana wrote a post about this article here).
Scholars have also noted the potentially obsessive and compulsive nature of exercise among some individuals with eating disorders and have made the natural transition toward examining whether links exist between excessive exercise and obsessive-compulsive disorder (OCD) and/or obsessive-compulsive personality disorder (OCPD) traits (If you are confused about the difference between OCD and OCPD, click here). Young, Rhode, Touyz & Hay (2013) conducted a rigorous systematic review to synthesize and draw conclusions from the results of such studies.
The authors aimed to clarify the links between both OCPD traits and OCD …
Women with bulimia nervosa are three times more likely to struggle with PTSD than women without eating disorders, according to a study by Dansky and colleagues (1997). In that study, 37% of individuals with bulimia nervosa had lifetime PTSD, compared to 12% of women without eating disorders. That’s almost two in five.
Treating eating disorders is hard, but treating eating disorders with comorbid conditions is way harder. There is no consensus, it seems, as to what disorder(s) to treat first, or whether they should be treated simultaneously:
The issue is quite complex,
Personally, I don’t think there needs to be a consensus. The answer will vary for every person. (The gut reaction that EDs must be treated first because of their physical consequences doesn’t apply to everyone. Certainly, substance dependence can be more dangerous.) But there’s no doubt that in most cases, even if the treatment of one disorder is prioritized initially, in the end, treatment needs to be comprehensive and deal with everything.
Wouldn’t it be great, though, if one treatment or therapy could help both …
Posttraumatic stress disorder (PTSD) is 3-5 times more prevalent in individuals with bulimia nervosa (BN) than those without (Dansky et al., 1997). However, the relationship between PTSD and BN–in particular, how PTSD might affect or moderate bulimic symptoms–remains largely unexplored. In a recent study, Trisha Karr and colleagues followed 119 women (20 with PTSD and BN, and 99 with BN only) for a 2 week period to investigate whether participants with comorbid PTSD + BN differed from those with BN only on the:
They used the ecological momentary assessment (EMA) tool to track behaviours and emotional states close to when they occur. I’ve blogged about a study using EMA before (‘What’s The Point of Bingeing/Purging? And Why Can’t You Just Stop?’), but briefly,
Participants were prompted to recording their mood and behaviour(s) at 6 semirandom times each day, over a two-week period. The authors then looked at the …
Is anorexia nervosa a subtype of body dysmorphic disorder (BDD)? Well, probably not, but don’t click the close button just yet. In this post, I’ll explore the relationship between anorexia nervosa and BDD, and discuss how understanding this relationship might help us develop better treatments for both disorders.
Despite the fact that there are obvious similarities between the disorders, studies exploring the relationship between BDD and AN are few and far between. In a recent paper, published in the Clinical Psychology Review, Andrea Hartmann and colleagues summarized the current state of knowledge in the field. The review compared clinical, personality, demographic, and treatment outcome features of AN and BDD. I’ll summarize the key points of the paper in this post.
(I will be focusing on the relationship between AN and BDD, as opposed to EDs and BDD, because that’s the scope of the review article.)
First, what is body dysmorphic disorder?
Approximately 1/3 of individuals do NOT recognize that the beliefs about their appearance are due to a mental disorder and 2/3 believe that other people are laughing/staring …
The association between drug abuse and eating disorders (EDs) is not new. Since the 1970s, doctors have reported higher incidents of self-medication and drug abuse in a subset of eating disorder patients. Drugs, in this context, cover everything from laxatives and diet pills, to alcohol and street drugs.
The association between drug use and EDs is not shocking; however, the extent of the problem is likely overlooked.
In a report detailing the most comprehensive review on the topic, the National Center on Addiction and Substance Abuse concluded: “Individuals with eating disorders are up to five times likelier to abuse alcohol or illicit drugs and those who abuses alcohol or illicit drugs are up to 11 times likelier to have eating disorders.”
The report is freely available online and I highly recommend reading the entire document.
Here are some of the MAIN FINDINGS:
EDs and substance abuse share many risk factors and this may explain the high rate of co-occurrence. Risk factors include:
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 …
I see this on an 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 BMI. But do these arbitrary weight and numerical criteria really say as much as we think they do? Is BMI or menstruation really a valid way of demarcating between full …
Dear Science of Eating Disorders readers, please welcome Shelly, our newest contributor! Shelly is a PhD Candidate in Neuroscience at the University of British Columbia. You can find out more about Shelly on the ‘About Shelly‘ page. Check out her neuro(science) blog, Neurorexia and follow her on Twitter. Email firstname.lastname@example.org to get in touch.
Just a note, do keep in mind that I (Tetyana) try to give as much freedom as possible to guest writers and contributors to write about their own interests and viewpoints. That means that we don’t all necessary agree; there is no joint agenda. My primary reason for wanting more contributors is to widen the content, vary the writing styles, and negate the individual biases we all have. Our desire to understand, translate, and summarize peer-reviewed ED literature is what we all share in common.
Eating disorders come in all shapes and sizes, but all of them are characterized by the same goal: to avoid weight gain or induce weight loss. While behaviours such as food restriction, purging, and laxative abuse are relatively well …
Anxiety disorders (ADs) are common among patients with eating disorders. In one study of female inpatients, around 50-65% had a comorbid anxiety disorder (see my post here). Anxiety disorders in patients with anorexia nervosa (AN) typically begin before the eating disorder and often persist after weight restoration and recovery (Bulik et al., 1997; Casper, 1990). Moreover, previous twin studies have suggested that there’s a “correlation between eating disorders and certain anxiety and depressive disorders, suggesting they comprise a spectrum of inherited phenotypes” (Hudson et al., 2003; Mangweth et al., 2003).
In this paper, Michael Strober and colleagues hypothesized that anxiety disorders and anorexia nervosa share common genetic, neural, and/or behavioural mechanisms. As such, they sought to investigate the association of AN with ADs by studying the prevalence of ADs in first-degree relatives of AN patients and comparing it to the prevalence of ADs in first-degree relatives of healthy controls.
Their rationale was that,
Just to note, this study only investigated the relatives of restrictive-type AN patients, and in addition to ADs, they included obsessive compulsive personality disorder (OCPD) …