Science of Eating Disorders

making sense of the latest findings in eating disorder research

Psychology

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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

…

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 …

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 …

Rigid Food Rules in Eating Disorders: Is Perfectionism to Blame?

By Tetyana ⋅ February 25, 2013 ⋅ 12 comments

I remember cutting baby carrots into 6 pieces. Rushing home to eat because I wasn’t “allowed” to eat after 7 pm. Eating the exact portion size–no more, no less. (Oh the rules. I don’t miss them.) Rigid food rules are very common among eating disorder sufferers. These rules can be about anything: the foods you are allowed to eat, how you are allowed to eat them, the time you are allowed to eat them, and so on.

But where do they come from? Why do some individuals have more rules and more ritualistic behaviours than others?

It is a complex question, but a recent study suggests that perfectionism might play a role. Specifically, the authors explored the idea that perfectionism mediates adherence to food rules in disordered eating behaviours. In order words, food rules might be a way in which perfectionism “expresses itself” in eating disorders.

Why perfectionism?

Previous studies have shown that self-imposed food rules may lead to even more preoccupation with food, “setting the stage for more rigid adherence to these rules” and “increasing the …

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) …

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 …

Will The Real Vegetarian Please Stand Up? – Part 1

By Tetyana ⋅ December 11, 2012 ⋅ 10 comments

When my younger sister first told me she wanted to become a vegetarian, I was worried. My biggest fear was that she would, like I did, develop an eating disorder. In high-school, I didn’t eat meat for roughly 14 months, and though I can’t be sure now of what my reasons were at the time, in retrospect, I do think in large part it was just a convenient way to avoid yet another food group. It was a legitimate reason to restrict my intake.

But is there any evidence that this behaviour (becoming vegetarian as a convenient way to restrict intake) is common among individuals with eating disorders? What is the relationship between dietary restraint, eating disorder symptoms, and vegetarianism? Is vegetarianism a risk factor for developing an eating disorder or do eating disorders lead many to adopt a vegetarian diet as a socially acceptable excuse to avoid eating specific foods? And, is there a difference between vegetarians that do not engage in dietary restraint and do not display eating disorder symptomatology, and those that do?

Thus far it appears that the research in this …

3 Personality Subtypes in Eating Disorder Patients: Which One Fits You?

By Tetyana ⋅ December 2, 2012 ⋅ 6 comments

Scientists love classifying and categorizing things they study. But it can be a double-edged sword. Classification can lead to new insights about etiology or new treatment methods. But classification can also hamper our understanding. For example, researchers like to classify and study anorexia nervosa and bulimia nervosa as if they are two wholly separate disorders, but clinicians know that most patients fluctuate between diagnoses, and as a result often fall into the eating disorder not otherwise specified (EDNOS) category.

Nonetheless, if we keep in mind that the way in which we classify things can be very artificial and may not necessarily reflect some fundamental truths about the subject matter, we can focus on extracting the insights gained from the classifications.

In the case of eating disorders, classifying patients into subtypes may be useful for developing successful treatment approaches suited for particular patient subgroups.

Previous research on this topic has identified three personality subtypes that seem to “cut across eating disorder diagnoses” (Westen & Harnden-Fischer, 2001):

Heather Thompson-Brenner and Drew Westen wanted to build upon the initial findings and find out …

Self-Denial, Secrecy and Deliberate Lying in Eating Disorders

By Tetyana ⋅ November 23, 2012 ⋅ One comment

I don’t know how many times I’ve said, “I’ve already eaten, thanks,” “No thanks, I’m going be eating later,” or “I’d love to, but I’ve got a stomach ache,” when I actually hadn’t eaten, wasn’t going to eat later, and didn’t have a stomach ache. Why did I do that? Did I realize I had, or was developing, an eating disorder? How long did it take for that realization to click? And once it did, did I stop lying to avoid eating with others or did I do it more?

A lot of questions spring up when you start thinking about secrecy, denial, and lying as it related to eating disorders. And answering these questions by having to remember what you thought when you first began to show signs of your eating disorder is hard. It is hard for many reasons, but one reason is that the we feel about events in the past is inevitably coloured by our experiences since then. That’s important to consider when thinking about the data in the study I’m about to discuss.

A little …

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

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