Navigating health service systems can seem daunting, to say the least. Making phone calls, getting doctor appointments and referrals, attending intake appointments, and preparing oneself for treatment can be both mentally and physically draining. When children and adolescents develop eating disorders, their parents become the main navigators in this scenario, making decisions and arrangements for their under-18-year-olds. But what happens when these adolescents reach the age of 18, and still require and/or desire treatment?
A recent Canadian qualitative study by Gina Dimitropoulos and colleagues (2013) explored the transition between pediatric and adult treatment for eating disorders to identify ways to facilitate smooth and effective transitions. To explore the tensions surrounding transitions, the authors conducted focus groups with service providers from both pediatric and adult treatment programs, as well as interviews with community practitioners.
This study used grounded theory (more in-depth discussion here), a qualitative approach that aims to develop a theory to explain a particular phenomenon based on an analysis of rich descriptions (Strauss & Corbin, 1998). As Strauss & Corbin articulate, this methodology aims to represent participants’ voices as accurately …
I have been fascinated and perplexed by reports of the seemingly invigorating and anxiety reducing effects of bingeing and purging (purging by self-induced vomiting). Personally, I cringe at the idea of self-induced vomiting and have always wanted to avoid vomiting at all costs, including during food poisoning. The insight from recent blog entries and the subsequent comments has made an impact on me. I see that the motivation to engage in bingeing/purging (b/p-ing) behavior can be intense and can provide an effective way increase positive affect and reduce stress. The ameliorating effects of b/p-ing remind me of drug addiction, with b/p-ing behavior as the “drug.” This made me wonder, what happens in the brain to impart such “addiction-like” reinforcement?
I know there are reports of opiate and endorphin release following purging, but to me, this seemed like an effect meant to counter the intense aversion (and discomfort?) of the act of purging itself. Correct me if I’m wrong, but it seems like the feeling of being “empty” should be reinforcing as well. As someone who used to restrict quite a bit, I certainly found that feeling …
The idea of including dance and movement in interventions for eating disorders may seem somewhat controversial; generally, exercise and physical activity are discouraged for individuals recovering from eating disorders. Including dance in therapeutic interventions might raise a few eyebrows given the links between appearance-oriented athletic endeavors such as ballet and gymnastics and the development of eating disorders.
However, some therapists and scholars interested in alternative therapies for eating disorders have suggested that certain forms of movement therapy may help individuals with eating disorders connect to their bodies in a different, more positive way.
In 2011, two such scholars from Portugal, Padrão & Coimbra, published a 6-month pilot intervention for individuals hospitalized for anorexia nervosa (AN) based around body movement.
Data consisted of observations of free movement and conversations that came up during and after the sessions. Their sample size consisted of only 7 young women hospitalized for anorexia.
I’ll admit that despite years of dance training and a keen interest in the potential of dance therapy in mental health treatment, I was skeptical of this study from the start. …
The 2013 International Conference on Eating Disorders (ICED) ended on May 4th. I thought I’d reflect on the experience (short version: it was awesome and I’m so glad I went!). Please note, the following is in no way comprehensive, representative, or scientific.
There were a lot of overlapping events at the conference, which meant that I could only attend a fraction of the events. I highlighted in yellow the workshops/panels/presentations I attended. There are more details about the panels, talks, and presentations on the ICED 2013 website (particularly here and here).
In his keynote speech, Dr. David Barlow wondered whether we are “missing the forest for the trees” as he highlighted some of the changes in the upcoming DSM-V (more disorders, more categories, more, as he said, ‘splitting’). Many disorders in the DSM-IV have the same underlying characteristics: high trait anxiety, neuroticism, negative affect, and emotional avoidance. Those of us with eating disorders tend to have difficulties recognizing and experiencing emotions—not just negative emotions, but all kinds of emotions.
I thought of the lyrics from Silverchair’s “Ana’s Song”:…
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:
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 …
Dear Science of Eating Disorders readers, please welcome Andrea, our newest contributor! Below is her introduction and first post.
Hello SEDs readers, my name is Andrea and I’m excited to be contributing to the blog. I have an undergraduate degree in sociology and I am currently a Masters student studying family relations and human development. My research is looking at the experiences of young women in recovery from eating disorders, and uses qualitative methods including narrative interviews and digital stories to explore stories of eating disorders and recovery. I am particularly interested in stories that fall outside of the “norm,” as I feel that we sometimes hear a limited, scripted story of what it means to be someone who has had and recovered from an eating disorder.
I myself am recovered from ED-NOS, and I am happy to be making meaning from my experiences by exploring eating disorders in an academic way. I hope to be able to add my voice to the conversation–I’ll be looking mainly at the qualitative literature on eating disorders, their treatment, and recovery. You can …
When it comes to eating disorder treatment, few (if any) approaches are as divisive as Family-Based Treatment, also known as the Maudsley Method (I’ll use the terms interchangeably) . When I first heard about Maudsley, sometime during my mid-teens, I thought it was scaaary. But, as I’ve learned more about it, I began to realize it is not as scary as I originally thought.
As a side-note: I know many people reading this post know more about Maudsley than I ever will, so your feedback will be very much appreciated, especially if I get something wrong. I should also mention that I never did FBT or any kind-of family treatment/therapy as part of my ED recovery. (I have done family therapy, but it was unrelated to my ED; it was a component of a family member’s treatment for an unrelated mental health issue.)
In this post, I want to briefly explain what the Maudsley Method entails and put it into context. I also want to discuss some of the key research studies testing the efficacy of FBT and some limitations of the treatment.…
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 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 …