I recently attended the International Society of Critical Health Psychology’s 8th Biennial Conference in Bradford, England. At the conference, I had the pleasure of attending many talks that challenged the way we approach health psychology. Luckily for me, there were several sessions that touched on issues of disordered eating and body image.
One such talk, a panel presentation with Hannah Frith, Sarah Riley, Martine Robson and Peter Branney, challenged attendees to re-think the way we approach body image. When I returned home, I immediately downloaded an article by Kate Gleeson and Hannah Frith (2006) that discusses this same idea and essentially begs the question: Is the concept of “body image,” as it is currently articulated, actually useful?
This might come off as a controversial question; after all, body image is central to many studies (and treatment programs) related to eating disorders. We’re told repeatedly that by improving our body image, we can achieve peace with food, with ourselves, with exercise, and with others. Good body image is upheld as the panacea of recovery and …
I have been studying the neurobehavioral aspects of food and drug reinforcement for the past 5 years (read more about it on my profile page). This involves using rats to mimic basic human behaviors surrounding food and drug intake. I then manipulate various neurotransmitter systems by using drugs and observe the effects this manipulation has on the behaviors I am interested in.
What’s important to this type of research is that we constantly challenge and evaluate the validity of using these animal models to study complex human diseases and disorders. Validity can be divided into several categories, but I’m going to focus on two in particular and relate them to an animal model of binge food intake. These two types of validity are predictive validity and construct validity:
Predictive validity and construct validity are important for preclinical studies (that’s before humans get involved) because they aid in determining what we can reasonably infer…
I often hesitate to make broad, sweeping claims about the nature, cause, and experience of eating disorders and disordered eating. However, if there is one thing I feel absolutely certain saying about these disorders, it is that they are incredibly complex and multifaceted with no “one-size fits all” solution. So, I was quite excited when I came across a recent article by Michael Strober and Craig Johnson (2012) that explores the complexity of eating disorders and their treatment. Both authors have significant clinical experience treating eating disorders.
This article uses cases studies, literature, and the authors’ collective clinical experience to respond to some of the key controversies surrounding anorexia and its treatment. Among the major controversies that have come to light of late, they focus on two:
The authors’ exploration of these topics supports an overall argument: focusing on singular explanations and solutions for anorexia, particularly through the vehement defense of any particular approach, obscures the complexity of the disorder, as well …
They are crazy stories, really. It is hard to believe they are true.
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:
It comes as no surprise that the earlier eating disordered individuals receive treatment, the higher the likelihood that they will make a full recovery. In other words, the duration of the illness is inversely proportional with the likelihood of full recovery.
The problem is that a lot of eating disorders are not caught early. That a lot of people don’t have access to the treatment they need. Insurance will not cover it, their doctors don’t think it is a problem or won’t treat it, or there is simply no space. And even if there is space, and insurance will cover it, dropout rates are incredibly high and treatment success is meager. The end result? Sometimes it is a success story – a full or partial recovery. But other times, the stories make headlines across the world, and not for good reason.
So then, what can we do about the individuals who don’t recover within the first one or two years of getting sick?
Again, it comes as no surprise that this question has not been explored in …
Eating disorders don’t discriminate against gender, age, sexual orientation or race. Veteran men in their 50′s can struggle with eating disorders, as can trans men and women of all ages and backgrounds, and so can congenitally blind (and deaf) individuals.
Besides the barriers that many of these patients face in simply getting diagnosed with an eating disorder, yes, even if they’ve passed that hurdle, many face an even bigger problem: getting appropriate treatment.
Naturally, no one treatment method will work for everyone, especially when the patient population is so diverse. What works for a 13-year-old female may not work for a man in his 40′s or 50′s. Unfortunately, treatment options (at least those that have some empirical evidence) are limited. As I’ve recently blogged, new treatments are being developed and utilized in treating adults and/or patients with with long-standing eating disorders - sub-populations that have largely been ignored for a long-time.
Following this trend of broadening the types of interventions available to treat eating disorder patients is UCAN: Uniting Couples in the treatment of Anorexia Nervosa.…
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.…
Treating anorexia nervosa is hard. Treating chronic and severe anorexia nervosa is a lot harder. Although the situation seems to be improving, there are really no evidence-based treatments for anorexia nervosa – particularly for those who have been sick for a long time.
The treatments that many often claim are evidence-based are often only applicable to a select subgroup of ED patients, and even then, the evidence is usually weak. (I’m referring to Maudsley/FBT (family-based therapy) for adolescents with <3 yrs duration of AN and CBT for bulimia nervosa.) But what about those with long-standing anorexia nervosa? In a recent review, Phillipa Hay and colleagues set out to conduct a systematic review of randomized controlled trials of treatment for chronic AN.
Randomized controlled trials or RCTs are at the heart of evidence-based medicine:
Hay et al searched the literature to identify RCTs where, among other criteria, the mean duration of illness was at least three years. They found eleven studies, but they could only confirm that a majority had a mean duration of over 3 years in just four of …
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 …