Science of Eating Disorders

making sense of the latest findings in eating disorder research

Psychiatry

RSS feed for this section

This category contains 26 posts

Pills for Bites: The Alarming Link between Drug Abuse and Eating Disorders

By Shelly ⋅ May 3, 2013 ⋅ 2 comments

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:

Biological factors: Both disorders use on the same reward and motivational systems in the brain, precipitating

…

Factors Associated with Recovery from Anorexia Nervosa

By Tetyana ⋅ April 28, 2013 ⋅ 19 comments

Why do some people recover anorexia nervosa relatively quickly while others seem to struggle for years or decades? Does it depend on the person’s desire to get better? Their willpower? How much they are willing to fight? Is it just that some try harder than others? Some might say yes, but most will correctly realize that the picture is much, much more complex.

We can spend hours talking about barriers to treatment, but in this post I want to talk about something slightly different, something perhaps that is perhaps less “obvious.”

Suppose a group of girls–all roughly the same age, same illness duration, same socioeconomic background and race–enter the same treatment facility. What determines why some will do well in treatment and continue to do well after discharge, whereas others will relapse immediately after discharge, and yet others won’t respond to treatment at all? We know that catching eating disorders early is crucial, but what else is important?

There will never be a treatment that will work for all eating disorder patients. But some types of treatment will work …

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 …

Eating Disorders in the Elderly

By Tetyana ⋅ March 30, 2013 ⋅ One comment

The first published case of a late-onset eating disorder (at the age of 40) was in 1930 by John M. Berkman. In 1936, John A. Ryle published a case study of an eating disorder in a 59-year-old woman. Just how common are eating disorders in late middle-age or elderly individuals?

There aren’t a lot of studies on this topic, but the the above figures illustrate that there’s a significant minority of elderly individuals who struggle with eating disorders or disordered eating.

What causes or precipitates eating disorders in late adulthood? Well first, it is important to keep in mind that a proportion of eating disorders in late-life occur in women who either never recovered from their early onset eating disorder or in those who had a remitting/relapsing ED pattern throughout life. But many do develop eating disorders for the first time in their 50′s, 60′s, and 70′s.

In 2010, Maria Lapid and colleagues published a review paper of all the published case studies of eating disorders in individuals over the age of 50. They found 48 studies. I’ve summarized the …

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

By Tetyana ⋅ March 25, 2013 ⋅ 12 comments

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 …

Chewing and Spitting: A Neglected Symptom in Eating Disorders?

By Shelly ⋅ February 22, 2013 ⋅ 14 comments

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 shelly@scienceofeds.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 …

Personality Traits after Recovery from Eating Disorders: Do Anorexia and Bulimia Patients Differ?

By Tetyana ⋅ February 14, 2013 ⋅ 6 comments

When we think about eating disorders, we tend to think about eating disorder subtypes: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder. A lot of previous work has shown that individuals with AN and BN tend to be anxious, depressed, perfectionistic, and harm-avoidant. Patients with AN also tend to score low on novelty-seeking, impulsivity, and self-directedness, whereas patients with BN score high on novelty-seeking and impulsivity. More recently, however, some researchers began to wonder if there was another way to categorize patients–not according to symptoms, but according to personality traits?

They identified three clusters of personality subtypes that seemed to “cut across” eating disorder diagnoses, outlined below (taken from a previous post):

However, that research was done in ill patients, and so the question remained: Do these personality clusters persist after recovery? This is the question that Angela Wagner and colleagues asked in their study, published in 2006.

Specifically, they asked:

What are the personality traits in individuals who have recovered from an ED?
Are there personality-based clusters in individuals recovered from an ED? And if

…

Is Anorexia Nervosa An Anxiety Disorder?

By Tetyana ⋅ February 4, 2013 ⋅ 6 comments

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) …

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 …

Excessive Exercise in Eating Disorders

By Tetyana ⋅ January 26, 2013 ⋅ 19 comments

Excessive exercise (EE) is common among eating disorder patients. Indeed, in the study I’ll write about today, 39% of patients engaged in EE. Previous studies have tried to find psychopathological and personality correlates of EE but the results have been inconsistent. Some studies have suggested that impulsivity and addictiveness are highly correlated with EE whereas others found that anxious and depressive traits were more closely associated.

In this multi-site study, Shroff and colleagues wanted to examine the prevalence of EE across eating disorder subtypes and the personality traits and clinical variables that were associated with EE in a large sample of women (1,857 in this study).

But first, what exactly is “excessive exercise”?

In this study, participants were deemed to be excessive exercisers when they endorsed at least one of the following with regard to exercise: “(1) severe interference with important activities; (2) exercising more than 3 h/day and distress if unable to exercise; (3) frequent exercise at inappropriate times and places and little or no attempt to suppress the behavior; and (4) exercising despite more serious injury, illness or medical complication.”

PREVALENCE OF EXCESSIVE EXERCISE ACROSS ED …

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

Design modified from Woothemes