Beyond Simple Solutions: The Need for Complex Ideas in Anorexia Nervosa

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:

  1. Genetic/biological causation (Biologically-based mental illness – BBMI)
  2. Family-based treatment (FBT) as the best form of treatment for adolescents

The authors’ exploration of these … Continue reading →

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 Continue reading →

Eating Disorders Among Lesbian and Bisexual Women

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
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Chronicity in Eating Disorders: How Do We Define It and What Do We Do About It?

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 … Continue reading →

Doing It Together: Uniting Couples in the Treatment of Eating Disorders

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 … Continue reading →

Can Eating Disorders Be Contagious?

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 … Continue reading →

How Can We Treat Chronic and Severe Anorexia Nervosa? (On the Need for New Approaches)

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.

Patients with severe and enduring anorexia nervosa have one of the most challenging disorders in mental health care  (Strober, 2010).They have the highest mortality rate of any mental illness with markedly reduced life expectancy (Harbottle et al., 2008). At 20 years the mortality rate is 20%, and given the young age of onset this results in many young adults dying in their 30s, and a further 5–10% every decade thereafter (Steinhausen, 2002)… Patients are often under- or unemployed, on sickness benefits, suffer multiple medical complications… have repeated admissions to general and specialist medical facilities, and are frequent users of primary care services (Birmingham and Treasure, 2010;

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

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:

Among the risks: delaying necessary changes at home, disempowering or alienating relationships at home that are necessary for longterm health, exposure to behaviors and habits that had not been an issue previously, exposure to unhealthy relationships with other clients, an artificial environment that can’t translate to life after RTC, and therapeutic methods or beliefs that are false or don’t apply.

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 … Continue reading →