This past week was Eating Disorder Awareness Week in Canada, which is really like any other week in my world. A week of reminding people that eating disorders don’t only impact young, white, thin, cis, hetero girls, and that when treatment doesn’t work, people aren’t failing – treatment is failing them. A week of calling for systemic changes to support a world where more people’s bodies are made welcome. A week of reminding people that all the research into biochemistry and genetics in the world will not convince people that they need to make space to hear people’s suffering, regardless of its origin (necessary caveat – I’m not saying it shouldn’t be done, I’m just saying we need to mobilize research knowledge or it just remains research knowledge and the status quo marches on).
Given that there’s actually a specific ‘reason’ to get on my soap box, I’m emerging … Continue reading →
Lately, I’ve been hearing a lot of noise in the social media sphere about whether or not those who have recovered from eating disorders should be treating eating disorders. Some have come out on the side of saying definitely not, listing reasons like the potential for bias, countertransference (the therapist making assumptions about clients’ emotions/experiences) or triggering. Others suggest that therapists who have “been there” can empathize with patients in a way that those who have not struggled with food cannot approximate.
Tetyana blogged about the lifetime prevalence of eating disorder professionals in recovery in 2013; she wrote about a 2002 study that revealed that around 33% of women and 2% of men treating eating disorders had a history of an eating disorder themselves. I have also written on the subject before (here); I focused on a 2013 study looking at experiences that recovered clinicians held in … Continue reading →
As usually happens, when I spill my brain out onto Twitter I end up having some minor (or, let’s face it, major) discussions and disagreements with other Twitterites. It’s both a wonderful and a stressful experience, in part because one of the hazards of the medium is its rapid-fire and protracted style. Inevitably, discussions lose their nuance and some of what I am advocating for gets lost in the ether.
The latest discussion centered around recovery and how it is portrayed in the literature. I’ve been working on a meta-analysis of recovery studies, and commented that I was tired of the way that researchers tend to write about recovery as “becoming whole” or finding oneself. Because I am a critical researcher and a generally squeaky wheel, and based on some research I’ve done, I question whether this framing is helpful for all of those who have recovered/are in recovery/want to … Continue reading →
To me, the idea of “treatment resistance” in eating disorders sparks some ill feelings. While many have suggested that treatment resistance is common among those with eating disorders, others have noted how receiving the label of “treatment resistant” can make it more difficult to receive needed support or impact how one is perceived in treatment settings and how one’s behaviours are interpreted (e.g., Gremillion, 2003).
Of course, this is a tricky ground to tread, primarily because sometimes people do resist treatment. Regardless, I think it is important to think about what lies behind the resistance to treatment. Is it the type of treatment? The people doing the treating? The compelling nature of the behaviours (e.g., restricting, binging and purging) at least in the short term?
In any case, to say that treatment resistance occupies a contested place in the eating disorder literature would likely be an understatement. Perhaps for this … Continue reading →
I feel like a broken record when I say that we continue to lack an evidence base for most “alternative” forms of support for eating disorders. As I’ve noted in prior posts, just because something is not evidence based does not mean it does not work for anyone; often, an evidence base is established when researchers can secure enough funding to run a randomized-controlled trial (RCT) that would act as evidence.
Even when an RCT has been run, it is hard to say that one form of treatment is best for all. People with eating disorders, like people in general, respond to different things, based on personal preference, history, culture, age, gender, and so many other factors. It feels a bit simplistic to write that, but I sometimes think we need a reminder of that fact!
Ultimately, and unsatisfyingly, it can be hard to predict what will work best … Continue reading →
Is ED recovery easier when your body is “normative or stereotypically desirable”? The anon asking the question implied that recovery could be more difficult because “an obese person … will never stop hearing hearing extremely triggering stuff about their body type.” Anon asked, “Have there been any studies on this?” Andrea tackled this question in her last post (it might be helpful to read it first if you haven’t yet); in this post, I will expand on my original answer.
Assuming anon meant, “Have there been anything studies assessing whether recovery is harder for individuals who do not fit the normative body type (because of fat phobia/fat shaming/diet culture)?” Then, my answer is: Not really, or at least I couldn’t find anything evaluating this question directly.
I was only able to find a few studies commenting on the history of overweight or obesity as a predictor of recovery/treatment … Continue reading →
It can be somewhat controversial to suggest that untreated recovery from eating disorders is possible. Certainly, people have varied opinions about whether someone can enact the difficult behavioral and attitudinal changes necessary to recover without the help of (at the very least) a therapist and a dietitian. Nonetheless, we still hear stories about individuals who consider themselves recovered without having sought out external sources of professional support.
When I think about untreated (or “spontaneous”) recovery from eating disorders, two studies in particular come to mind. The first study I am thinking about was written by Vandereycken (2012) and explores self-change, providing an overview of community studies of individuals who have not sought treatment for their eating disorders and implications for treatment and recovery. The second, by Woods (2004) is a qualitative study looking at the experiences of 16 women and 2 men who report recovering from … Continue reading →
Another issue in defining and understanding recovery is that patients and clinicians may have different opinions about what recovery looks like and how to get there. Certainly, there is a body of literature from the critical feminist tradition in particular that explores how at times, patients can “follow the rules” of treatment systems to achieve a semblance of “recovery,” from a weight restoration and nutrition stabilization perspective, but feels nothing like a full and happy life (see, for example, Gremillion, 2003; Boughtwood & Halse, 2008).
This potential disconnect is one reason for favoring a holistic recovery as articulated by Bardone-Cone et al. and for attending to patients’ subjective experiences of recovery (see part 2 of this series here), as Malson and others have done (see part 3 of this series here). In 2006, Noordenbos & Seubring conducted a study that further unpacked this potential disconnect through … Continue reading →
Today I have the distinct pleasure of writing about one of my favourite articles about eating disorder recovery by Malson et al. (2011) exploring how inpatients talk about eating disorder recovery. I have personally found this article to be very helpful in understanding some of the difficulties of understanding and achieving recovery in our social context.
As Malson and colleagues explain (and as we’ve established), eating disorder recovery is elusive. Often, poor prognosis is described in relation to individual factors, including:
- Treatment resistance
- Ambivalence about change
- Ambivalence about the possibility of change
Problematically, seeing these as the primary reasons for which patients do not recover can make individuals with eating disorders themselves feel as though they are to blame for their “inability to recover,” which help approximately no one. How do patients internalize these kinds of framings, and what impact does it have on how possible … Continue reading →