Science of Eating Disorders

making sense of the latest findings in eating disorder research

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International Conference on Eating Disorders (ICED) 2013: Personal Reflections

By Tetyana ⋅ May 6, 2013 ⋅ 26 comments

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”:…

Avoiding Refeeding Syndrome in Anorexia Nervosa

By Tetyana ⋅ March 12, 2013 ⋅ 20 comments

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 …

What’s Wrong with How We Talk About Eating Disorders in the Media and in ED Communities – Part 2

By Tetyana ⋅ January 18, 2013 ⋅ 31 comments

This is a follow-up to my last post on what I think can be improved in how we talk about eating disorders in the media and in ED communities. If you haven’t read my last post, I strongly recommend doing so before reading this one. My focus in this post will be on what individuals with a history of EDs and ED organizations can do to improve how eating disorders are perceived by the general public.

(Sidenote on my last post: I feel I didn’t emphasize enough that I used Emma Woolf’s quote as an example and a starting point. I’m confident I’ve made the same blunders that I am now speaking about. It is okay. I think the important thing is to think about our future actions, as opposed to dwelling on the past. My goal isn’t to single anyone out. Woolf is not the first, the last, or the only person to have said things of that nature–her quote was just on my mind since I saw it just a few days ago on tumblr.)

First, for those …

What’s Wrong with How We Talk About Eating Disorders in the Media and in ED Communities – Part 1

By Tetyana ⋅ January 17, 2013 ⋅ 24 comments

I’m going to do something different today. I’m going to talk about some of the problems I see in how eating disorders are discussed by some media organizations, ED awareness groups, and ED advocates.

This isn’t meant to be an exhaustive list of everything that’s wrong (and there will be a follow-up). It is my personal opinion and I strongly encourage readers to leave comments if you disagree with me or feel that I’m missing something important.

I saw this quote on tumblr two days ago:

This quote is amazing for all the wrong reasons. It is so wrong, so harmful, and embodies so much of what’s wrong with mainstream ED discourse. It was written by Emma Woolf. I traced the quote back to this document put out by the UK organization ED awareness organization b-eat.

Let me be clear: I do not care who said this quote, or what was meant by it, or what context it was said in. The quote was floating around the internet, and most would read the quote out-of-context. This has nothing to do …

Extreme Medical Negligence: Failure to Feed Patients with Anorexia Nervosa

By Tetyana ⋅ December 30, 2012 ⋅ 12 comments

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 …

Eating Disorders Among Lesbian and Bisexual Women

By Tetyana ⋅ October 25, 2012 ⋅ 4 comments

The hardest part of science blogging is picking an article to blog about. In times when I’m indecisive–when I spend hours sifting through the literature, inevitably creating several draft posts before deciding each article isn’t interesting enough–I turn to the list of topics that have been suggested by readers. The last suggestion I received was “eating disorders in the lesbian community.” It is a great suggestion, but I thought my search wouldn’t turn up much. But, to my surprise, it did turn up some studies.

But please, don’t expect too much: it is not a well-studied area, and most of the data comes from self-reported questionnaires, which are not particularly reliable:

First, there’s selection bias: the 50% or so of people who return the surveys could be different in significant ways from the 50% that don’t. For example, in a survey about mental health, perhaps individuals that have had personal experiences with mental health issues are more likely to respond. This skews the data in a such a way that it might appear that a specific subgroup that’s being studied

…

Can Eating Disorders Be Contagious?

By Tetyana ⋅ August 22, 2012 ⋅ 11 comments

Treating a patient with an eating disorder can often feel like walking on eggshells; it is easy to say or do the wrong thing. I’ve covered this topic in my previous posts. In my first post, I wrote about negative attitudes that health care providers often have with regard to eating disorder patients and in my second post, I covered some ways in which caring clinicians that do work with ED patients may – usually inadvertently - negatively impact treatment, often by impairing the physician-patient/caregiver relationship.

But let’s forget about clinicians for a second, what if the treatment environment itself is damaging? Could treatment itself do more harm than good?

That’s the question that Walter Vandereycken explored in this commentary article. (This interesting paper was brought to my attention by a reader – you know who you are, so thanks!)

And just to be really clear Vandereycken doesn’t mean contagious in the infectious-disease kind of way. Coming into contact with someone who has an eating disorder is not going to put you in danger of getting an eating disorder yourself.…

Are All Anorexics Just Afraid Of Being Fat and Can We Blame The Western Media?

By Tetyana ⋅ July 17, 2012 ⋅ 34 comments

A really fun aspect of blogging is seeing what search terms lead people to my blog; a frustrating side-effect is not being able to interact with those people directly. This entry is, in part, an attempt to answer a common question that leads individuals to my blog. Common question or search queries are variants of the following (these are actual search terms that led to this blog, I corrected spelling mistakes): “do models cause eating disorders in women?”, “pictures of skinny models linked to eating disorders”, “do the images of models in magazines cause eating disorders?”, “eating disorders relating to thin models”, “psychiatrists thought on how skinny models are causing eating disorders”, “thin models are to blame for eating disorder.”

Well, you get the point.

I briefly started tackling the notions that the ”thin ideal” promoted by Western media is to blame for the prevalence of eating disorders and a related idea that all anorexics are afraid of becoming fat, in a previous post where I examined case studies of eating disorders in (mostly congenitally) blind women.

These assumptions, along with …

When Clinicians Do More Harm Than Good – Part 2 (Risks Associated with Treatment)

By Tetyana ⋅ July 12, 2012 ⋅ 6 comments

My previous post on the effectiveness of residential treatment centers (RTCs) generated a lot of discussion. A point that was raised several times, on the blog, on Facebook and other forums was the fact that there are risks in choosing an RTC for treatment.

Laura Collins did a great job of articulating some of the risks in her comment:

There risks are not specific to RTCs. They hold true for inpatient treatment, partial hospitalization and to a lesser extent, outpatient treatment. I thought it would be nice to explore in more depth some of the risks associated with treatment. If you are receiving treatment or are the caregiver of someone who is, hopefully this will help you in recognizing what to avoid and when to seek alternative treatment options.

Inadvertent effects that are associated with the treatment itself, whether it is due to medication or actions of the physician/healthcare provider, are called iatrogenic.

Also, if you are wondering about Part 1, you can check it out here: When Clinicians Do More Harm Than Good (Attitudes Toward Patients with Eating Disorders). …

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

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