Psychiatry
This category contains 29 posts

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) levels of psychopathology (see: Are There Any Meaningful Differences Between Subthreshold and Full Syndrome Anorexia Nervosa? and, to a lesser extent, Think You Are Not “Sick Enough” Because You Didn’t Lose Your Period? Read This.)

In one …

Attention Deficit Hyperactivity Disorder & Eating Disorders: Is There a Link?

Attention deficit hyperactivity disorder (ADHD), characterized by inattention, hyperactivity, and impulsivity, is a common childhood disorder. ADHD can often persist into adolescence and adulthood. The prevalence of ADHD is thought to be between 6-7% among children and adolescents and ~5% among adults (Willcutt, 2012).

Increasingly, evidence from multiple studies has pointed to comorbidity between ADHD and eating disorders (EDs). For example, one study found that young females with ADHD were 5.6 times more likely to develop clinical (i.e., diagnosable according to DSM-5) or subthreshold (i.e., sub-clinical) bulimia nervosa (BN) (Biederman et al., 2007). Another study found that found that 21% of female inpatients at an ED unit had six or more ADHD symptoms (Yates et al., 2009).

However, most previous studies are limited by the fact that they assessed comorbidity between ADHD and EDs among patients. This limits our ability to generalize these findings to community samples, where many may experience symptoms of the disorders at subthreshold levels. Moreover, most studies focused on bingeing/purging behaviours and did not investigate differences between ADHD subtypes.

In the current study, Jennifer Bleck and colleagues …

Enraged by Sounds: Misophonia in Eating Disorder Patients (Clinicians, Listen Up)

Few people would claim to like the sound of chewing, lip smacking, or pen clicking. But while disliking these noises is commonplace, experiencing anxiety, panic and/or rage in response to them–a condition called misophonia (hatred of sound)–is not.

Well, truth be told, we don’t actually know how common it is: Searching “misophonia” in PubMed returns just 14 results. Seven were published in 2013/2014, and only three were published prior to 2010. (Searching “selective sensory sensitivity syndrome,” another name for “misophonia” wasn’t particularly fruitful either.)

Interestingly, the most recent paper on misophonia investigated the phenomenon in eating disorder patients. Timely, I thought, given that a few months ago someone had asked me about this very thing on Tumblr. At the time, I came up with nothing. Now I had something. So I posted it on the SEDs Tumblr. The response was almost immediate (click here to read some of the responses). To be honest, I was surprised: I had no idea so many people could relate.

So I thought, it would be important to blog …

Problematic Labelling: The Case of “Drunkorexia”

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, Obsessive, Compulsive? The Links Between OCD, OCPD and Excessive Exercise in Anorexia Nervosa

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 …

Comorbid PTSD and Eating Disorders: Can Treating One Improve The Other?

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:

Brewerton (2004) suggests that eating problems should be addressed prior to treating PTSD because bingeing and purging contribute to a state of physical and emotional dysregulation. Fairburn (2008), however, suggests that significant comorbid disorders be treated prior to beginning CBT for eating disorders.

The issue is quite complex,

For example, the presence of severe depression, of which hopelessness and difficulty concentrating are core criteria, may present a barrier to treatment of the eating disorder. Furthermore, if eating is used to escape from or avoid intrusive memories or strong emotions, it

Posttraumatic Stress Disorder in Women with Bulimia Nervosa

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:

  1. Levels of negative affect (negative emotional state/mood) and affect variability (fluctuation between negative and positive states)
  2. Frequency of bulimic behaviours
  3. Relationship between emotional states (negative or positive affect) and bulimic behaviours

They used the ecological momentary assessment (EMA) tool to track behaviours and emotional states close to when they occurI’ve blogged about a study using EMA before (‘What’s The Point of Bingeing/Purging? And Why Can’t You Just Stop?’), but briefly,

EMA techniques provide methods by which a research participant can report on symptoms, affect, behaviour and cognitions close in time to experience, and

Is Anorexia Nervosa a Subtype of Body Dysmorphic Disorder?

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?

[BDD] is defined as distressing or impairing preoccupation with an imagined[/perceived] or slight defect in physical appearance. If a slight physical anomaly is present, the preoccupation is

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

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:

The link between drug use and eating disorders is strong:

  • Between 30-50% of bulimia nervosa (BN) patients and 12-18% anorexia nervosa (AN) patients abuse/are dependent on alcohol/ drugs, compared to roughly 9% of the general population. This

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 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 …

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