Science of Eating Disorders
Eating Disorders in the Elderly
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 …
Extreme Medical Negligence: Failure to Feed Patients with Anorexia Nervosa
They are crazy stories, really. It is hard to believe they are true.
A 28-year-old woman with anorexia nervosa complained about weakness and nausea following the insertion of a feeding tube. Her gastroenterologist sent her to the emergency room (ER). The woman was in the emergency room for two days without receiving any food. She was discharged home after she was told her lab tests and X-rays came back normal. Unfortunately, her X-rays weren’t normal. Her gastroenterologist determined she had a bowel obstruction and sent her back to the hospital. She lost a substantial amount of weight in those 3 days.
The second story is even worse.
A 26-year-old woman with a feeding tube was discharged prematurely from a residential facility. She began to feel dizzy and weak, and was admitted to a hospital. She did not receive any food for the 6 days she was there, despite extremely low blood sugar levels (half of what is defined as the threshold for low blood sugar). For reasons that are not clear, an order for tube feeding was cancelled and two days after …
Are All Anorexia Nervosa Patients Just Afraid of Being Fat? – Part 2
If you’ve been reading this blog for a while (or literature on this topic) you know the answer is no. I’ve blogged about this before, but I think it is a topic that needs a lot more coverage because the myths that all anorexia nervosa patients are just afraid of being fat, that they lose weight just to be thin, and that thin models are to blame for AN are still very common.
As you’ll see, I am not claiming that this isn’t true for some patients. Instead, what I am claiming is that it is not true for all patients.
And a big personal goal of mine with this blog is to broad the conversation about eating disorders. Let’s get away from stereotypes and painting all anorexia nervosa or bulimia nervosa patients in the same light. Let’s instead have meaningful discussions about research on eating disorders, about our experiences, and let’s develop a more comprehensive understanding of eating disorders that’s enriched by the research and the science, and our personal experiences as patients, friends, family members, partners, …
Does Too Much Exposure to Thin Models Cause Eating Disorders? Anorexia, Bulimia in Blind Women
As many of you already know, Vogue has recently banned models that are “too-thin” (and “too young”). It is a big step in the right direction, no, a huge step, and one deserving an applause, that’s according to an article on allvoices.com. Cue a drop in the prevalence of eating disorders, right? The logic in most articles, whether implicit or explicit, seems to be: no more skinny models = no more girls aspiring to be like skinny models = no more eating disorders.
Sounds more like a PR move to me, but OK. I do have some questions and thoughts:
What does “appear[ing] to have an eating disorder” mean? Bulimics, by definition, are of normal weight or overweight. Conversely, being thin doesn’t mean having an eating disorder.
BMI above or below a certain number is not a marker of “good health”. BMI demarcations are not scientifically derived and were never meant to be applied on an individual basis.
Finally, this perpetuates the idea that looking at skinny models for too long leads to an eating disorder. It …
Gender Nonconformity, Transsexuality and Eating Disorders
Too many people still mistakenly believe that eating disorders are for the Mary-Kates, Nicole Richies and Lara-Flynn Boyles, or vain adolescent and teenage girls aspiring to be just like them. Actually, as I’ve blogged earlier, even male veterans in late middle age are not immune to struggling with anorexia and bulimia nervosa. All in all, males make up ~ 5-10% of all eating disorder sufferers.
But what about those that dread having to check off “male/man” or “female/woman” on a data form? The individuals who feel their gender identity is not the same as their birth sex. Perhaps they were born in a female body, with two XX chromosomes, but they feel and prefer to think of themselves as males, or the reverse? There’s some research (albeit limited, due to the rarity of both gender dysphoria and eating disorders) that suggests these individuals face an increased risk of developing eating disorders.
The most relevant and recent study on the intersection of gender identity and eating disorders that I found was published by Vocks et al. in 2009. The goal …
Double Whammy: EDs are Mental Disorders with Physical Consequences
Today, I spent the morning and early afternoon in the ER.
Here’s the run down of what happened: I woke up feeling slightly nauseated, but okay enough to do my usual long walk before going to the lab. However, things went downhill during lab meeting. I was presenting today, and right before it was my time, I felt really nauseated to the point of wanting to get up to go throw up in the bathroom. I didn’t, instead I just closed my eyes for a bit, then went ahead with my presentation. It was fine at first. But, somewhere near the end, I started feeling dizzy and light-headed, very rapidly. My supervisor and others were asking me questions, but I couldn’t focus on answering them. I couldn’t think. Then, I could barely hear. Everything was dizzy, and I felt really faint. I almost fainted, but didn’t (I was sitting). This was all happening very fast. I was also sweating a lot, soaked in sweat, really, and sharp abdominal pain did not help. Anyway, with the help of others, who said …
- The Genetics of Thin-Ideal Internalization
- Transitioning from Adolescent to Adult Eating Disorder Treatment Programs: What Are The Challenges?
- Bingeing and Purging: Keeping the “Positives” and Eliminating The Negatives?
- Dancing Your Way to Recovery from Anorexia Nervosa
- International Conference on Eating Disorders (ICED) 2013: Personal Reflections
- Pills for Bites: The Alarming Link between Drug Abuse and Eating Disorders
- Factors Associated with Recovery from Anorexia Nervosa
- Patient Perspectives on Anorexia, Treatment, and Therapeutic Alliance
- Family-Based Treatment for Adolescents with Anorexia Nervosa: Hype or Hope?
- Nonpurging Bulimia Nervosa: Where Does It Fit?
- Should Insurance Companies Cover Residential Treatment for Eating Disorders?
- Does Too Much Exposure to Thin Models Cause Eating Disorders? Anorexia, Bulimia in Blind Women
- Are All Anorexics Just Afraid Of Being Fat and Can We Blame The Western Media?
- What’s Wrong with How We Talk About Eating Disorders in the Media and in ED Communities – Part 2
- When Clinicians Do More Harm Than Good (Attitudes Toward Patients with Eating Disorders)
- Family-Based Treatment for Adolescents with Anorexia Nervosa: Hype or Hope?
- The “Double Life” of Bulimia Nervosa: Patients’ Perspectives
- International Conference on Eating Disorders (ICED) 2013: Personal Reflections
- How Can We Treat Chronic and Severe Anorexia Nervosa? (On the Need for New Approaches)
- What’s Wrong with How We Talk About Eating Disorders in the Media and in ED Communities – Part 1
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Tetyana
I haven't heard of the book -- thank you for
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Bryan You both raise some interesting points. If you hav
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HK I can only hope we get some answers KO. Every doct
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Tetyana
"My understanding, from Becker and Stice’s
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Cathy (UK) I haven't read the original paper, but what I
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ES I'm not sure that it's just an 'ano
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Liz Agreed! It sounds like they are missing out on a L
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Andrea Hi Liz, Sorry if I was unclear in the post; in th
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Charlotte I can't articulate how much I can relate to e
Science of Eating Disorders by Tetyana Pekar is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
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Avoiding Refeeding Syndrome in Anorexia Nervosa
Refeeding syndrome (RS) is a rare but potentially fatal condition that can occur during refeeding of severely malnourished individuals (such as anorexia nervosa patients). After prolonged starvation, the body begins to use fat and protein to produce energy because there are not enough carbohydrates. Upon refeeding, there’s a surge of insulin (because of the ingested carbohydrates) and a sudden shift from fat to carbohydrate metabolism. This sudden shift can lead to a whole set of problems that characterize the refeeding syndrome.
For example, one of the key features of RS is hypophosphotemia: abnormally low levels of phosphate in the blood. This occurs primarily because the insulin surge during food ingestion leads to a cellular uptake of phosphate. Phosphate is a very important molecule and its dysregulation affects almost every system in the body and can lead to ”rhabdomyolysis, leucocyte dysfunction, respiratory failure, cardiac failure, hypotension, arrhythmias, seizures, coma, and sudden death.”
I’m not, however, going to go into too much detail on RS as there are pretty good sources available here, here, and here. Instead, I want …