Asking the Impossible? Eating Disorder Recovery in Context

This past week was Eating Disorder Awareness Week in Canada, which is really like any other week in my world. A week of reminding people that eating disorders don’t only impact young, white, thin, cis, hetero girls, and that when treatment doesn’t work, people aren’t failing – treatment is failing them. A week of calling for systemic changes to support a world where more people’s bodies are made welcome. A week of reminding people that all the research into biochemistry and genetics in the world will not convince people that they need to make space to hear people’s suffering, regardless of its origin (necessary caveat – I’m not saying it shouldn’t be done, I’m just saying we need to mobilize research knowledge or it just remains research knowledge and the status quo marches on).

Given that there’s actually a specific ‘reason’ to get on my soap box, I’m emerging … Continue reading →

Who’s Failing Whom? Treatment Retention for Eating Disorders

I find the idea of treatment retention for eating disorders to be quite interesting. Mostly, I find it intriguing to dissect the way that authors write about treatment retention – that is, how they tend to look at factors within people that make them more or less able to complete treatment, rather than things about the treatment that serve or don’t serve people’s needs. I’ve been reading a lot more about adolescent eating disorder treatment these days, given that I’m doing a practicum at an adolescent treatment centre that does things a bit differently. Resultantly, I’ve become more interested than ever in how we can better meet people’s different treatment needs and provide a more comprehensive treatment continuum.

The stark reality of treatment is that people don’t always finish it. That statement sounds fairly banal, but it’s a loaded one. Too often, I see this framed as people failing Continue reading →

Psychoeducation for Eating Disorders: Motivational or Distressing?

It’s no secret that I am not a fan of primarily psychoeducational interventions for people with eating disorders (EDs). It irks me that the overall theory in implementing this kind of intervention seems to be: if they only knew what they were doing to their bodies, people with EDs would take better care of themselves. Of course I take issue with this idea – if knowing that EDs were harmful to one’s health was enough to make the changes needed to not have an ED anymore, far fewer people would be struggling.

In case you don’t know what I’m talking about, a psychoeducational program is one that focuses on educating people about a mental illness, including what qualifies as pathology, what the behaviours look like, what the harms are, and what possible interventions exist. To be fair, there are not that many examples of purely psychoeducational interventions for … Continue reading →

What’s Working? Comparing Partial Hospitalization and Residential Treatment for Eating Disorders

I can’t help but think I often write more about the issues surrounding the general lack of treatment options for eating disorders that I sometimes neglect to comment on what is available. A part of this is that I would refer to myself as somewhat of a treatment modality atheist – I have the luxury of being someone who does eating disorder research but is not involved in directly treating those with eating disorders, and so I don’t need to specialize in one type of treatment. My bottom line tends to be that no one-size-fits-all, and that the type of treatment that works for someone will depend on so many factors (like their gender, ethnicity, socioeconomic status, body size, ability, even their politics to a certain extent) that I wouldn’t want to proclaim one type of treatment as king.

In spite of this treatment modality atheism (or perhaps because of … Continue reading →

Where’s the Change? Service User Views on Eating Disorder Services

I write a lot about systems-level change for eating disorders, and about how the services that we have available for eating disorders are severely lacking. What I tend to struggle with – though it’s something I’m working on – is how to actually MAKE the changes I’m advocating for. I always fear the tendency to get caught up in saying “this is how things should be,” when I know that eating disorders are so complex and multifaceted and that one size does not fit all when it comes to support. I also fear my experience and my story becoming “the” story about eating disorders and recovery; just because something worked for me does not mean it will work for others.

Surprisingly, despite a general discontent in the ED field with the service continuum, there are few studies that explore what kinds of changes might be made to eating disorder services … Continue reading →

Let’s Talk about Systems Level Change for Eating Disorders

This past Wednesday, January 27th, was Bell Let’s Talk day in Canada. In case you’re unfamiliar with the campaign, Bell Canada (a telecom company) donates 5 cents to mental health awareness initiatives for every social media post or text with the hashtag #BellLetsTalk. In general, the campaign has been lauded for its contribution to decreasing shame and stigma around mental illness, which is awesome. There are a number of critics, though, who point out that:

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Exploring Family Based Treatment for Eating Disorders in China

Not much is known about eating disorders in China, especially compared to its East Asian counterparts of Hong Kong and Japan. It would appear that researcher-practitioners in China are not publishing much data about eating disorders in the country; in fact, the author of the study I’ll be looking at in this post, Joyce Ma, practices primarily in Hong Kong. In this study, Ma explores China-specific patterns of ED presentation and how they relate to the social context. As she notes, treatment models have been slow to develop from the mother-blaming paradigm proposed by Chen (1990), which recommended that eating disorder patients be isolated from their parents. No other study appears to have been done (at least that she cites) using evidence-based modalities.

In her study, she reports on the results of treatment with 10 families in a Shenzhen clinic, with patients of a relatively wide age range – … Continue reading →

We’re In This Together: Collaborative Care for Eating Disorders

This week I had the pleasure of attending a workshop with Janet Treasure on collaborative care in eating disorders. Treasure focused her workshop on supporting caregivers of people with eating disorders, offering practical skills for carers and clinicians alike to improve interactions with those with eating disorders. Though I am neither a carer nor a clinicians, I got a lot out of the workshop, and it reminded me of a few of Treasure’s articles I’ve read over the years, and how much I appreciate her strong focus on working collaboratively with patients and families to facilitate recovery.

I especially appreciated how she aims to integrate those with lived experience (of either having an eating disorder or caring for someone with an eating disorder) in research and treatment design. Some of her journal articles, including this article on the potential for harm in existing treatment models, even include former patients as … Continue reading →

Not Horsing Around: Using Equine Therapy For Eating Disorders

It’s possible that some of you are already rolling your eyes: I know my audience. In the calls for evidence-based treatment, alternative therapies are often sidelined, deemed less important or less effective. While I certainly see that side of the argument, and would advocate for a continued search for treatment efficacy, I’m not ready to abandon the search for alternative approaches. Especially when used in concert with other treatments, I find alternative therapies very intriguing, partially for what they tell us about the complexity of treating eating disorders.

In a recent study, Lac, Marble & Boie (2013) explored the use of equine-assisted psychotherapy (EAP) for eating disorders. Keep in mind that as is the case with many alternative therapies, the article is based on a case study, rather than a large-scale clinical trial. To me, the point of these types of articles is to get … Continue reading →

Culture and Eating Disorders: Treatment Outcomes in Singapore and Hong Kong

In this last post about eating disorders in Singapore, I’ll write about the one Singapore-based retrospective outcome study in relation to a similar retrospective study conducted in Hong Kong.

In the Singapore study, researchers reviewed the charts of 94 patients diagnosed with anorexia nervosa from 1992 to 2004 at the National University Hospital, looking back from the time of the study. They didn’t contact any of the subjects for follow-up. 49 were first seen as inpatients, 34 as outpatients, and 11 were seen as outpatients but later admitted. The hospital doesn’t have a specialized ED service, so the authors relied on dietetic notes that unfortunately don’t provide a full picture of the patients’ eating disordered behaviors and cognitions.

The authors wrote about patient ‘improvement’ (not recovery!) as making a weight gain of at least 0.5 kg, or about 1 pound. 83% of their patients attended follow up appointments, which lasted … Continue reading →