Case Report
This category contains 11 posts

Impossible Binaries? Eating Disorders Among Trans Individuals

Recently I was doing some research for an upcoming (and very exciting)  endeavour that involves exploring eating disorders among LGBTQ individuals. As one does, I set about scouring the research literature in this area in the hopes of stumbling across some prior articles on which to hang my proverbial research hat.

As I sifted through the databases, however, my searches kept coming up short. After sending out a call to a list-serv enquiring about the state of the field in this area, I received many responses highlighting the gap that surrounds trans individuals in particular. While this is good news for arguing for the value in conducting research in this area, it is discouraging news when it comes to understanding and attending to the experiences of trans people with eating disorders.

All this is to say, it seems as though now is as good a time as any to dip my toes into writing in this area through blogging about it. To focus this discussion, I will explore an article I came across in my search by Murray, Boon, and …

Narrative Therapy and Eating Disorders: Help or Hype?

If you kick around the eating disorder recovery/treatment/research community for a while, you’re bound to come across someone calling their eating disorder “Ed.” In both the popular and scholarly literature around eating disorders, this externalizing and personifying approach has come to be quite popular. At face value, it makes sense to attribute blame for what can be an extremely difficult and painful experience to something other than oneself; it might be easier to “fight for recovery” if you have something to fight against.

But is there any evidence for the helpfulness of externalizing eating disorders? Who is “Ed,” and does “he” (or “she”) hold meaning for most or all sufferers? How might treatment programs make use of this construct in helping to facilitate clients’ recovery?

I will preface this post with a few disclaimers: firstly, I found a lot of solace in personifying my eating disorder early on in treatment and into early recovery. Later, it came to irk me, because I felt that it seemed disingenuous to parse out elements of myself and try to do away with some …

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 …

Dialectical Behavioural Therapy for the “Difficult to Treat” Eating Disorder Patients

If there is anything we’ve learned over the  many years of eating disorder research, it is that eating disorders are extremely complex. Often, this complexity is intensified by comorbidities, including post-traumatic stress disorder, depression, and “personality disorders.” Unfortunately, individuals whose disorders are labeled persistent, chronic, or “difficult to treat” may be even less likely to receive the treatment and support they require, deserve, and desire.

“Standard” approaches to eating disorder treatment, such as cognitive behaviour therapy (CBT), may prove ineffectual for these individuals. In a recent article, Federici & Wisniewski (2013) reflected on the difficulty of treating patients whose eating disorders are accompanied by other mental health issues. They noted that focusing on ED symptoms alone generally fails to achieve treatment goals, as behaviours associated with other disorders often decrease ED treatment effectiveness. This situation may leave both patients and clinicians feeling burnt out and unsatisfied (to say the least).

Resultantly, clinicians are turning to alternative therapeutic options for treating more complex cases, including dialectical behaviour therapy (DBT). Federici & Wisniewski explored preliminary data from pre/post case

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?

One study of 475 community dwelling elderly women aged 60–70 years found that 3.8% met diagnostic criteria for eating disorders. A study of elderly Canadian women reported that symptoms of disordered eating were present in 2.6% of women aged 50–64 years, and in 1.8% of women aged 65 years or older (Gadalla, 2008). In an investigation of eating disorders in elderly outpatient males, a minority (11–19%) who were undernourished were found to have abnormal eating attitudes and body image, including inappropriate self-control around food (60%), unsuitable eating attitudes (26%), and distorted body image (3–52%) (Miller et al., 1991).

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.…

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 …

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.

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

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.

Health of models belonging to both genders has been a growing issue in the past, especially after the death of two models in 2006-2007 from what the doctors blame to their acute eating disorders. This important step by Vogue targets not just skinny models, but also the impact they have on the young minds of girls and boys by presenting an image of perfection that is neither attainable nor healthy.

The 19 editors of Vogue magazines around the world made a pact to project the image of healthy models….. They agreed to “not knowingly work

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” or “female” on a data form? What about individuals who feel their gender identity is not the same as their assigned 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 …

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