Treatment
This category contains 45 posts

Good Clinicians, Helpful Comments, & Unpopular Opinions: SEDs Readers’ Responses – Part II

A few weeks ago, I asked SEDs readers a bunch of questions about their experiences with an eating disorder. Then, pretending to be a qualitative researcher, I went through the answers to see if I could find trends. I blogged about people’s responses to the first half of the question here; this post will be about the second half of the questions. (Here’s a ED survey results – Parts I and II to the pdf with all of the raw data).

Please note that this analysis was not rigorous, so in grouping and identifying themes (or how many times a theme/word was mentioned), I will use words like “approximately.”

[The breakdown for the last half of the respondents is:

6. What are characteristics of good eating disorder clinicians?

By far the two most comment themes, mentioned ~13 times each were “understanding” and variations of “willing to challenge,” “confront,” and have a “no bullshit” attitude. Other qualities mentioned were patience, good listening skills, nonjudgemental, empathetic and compassionate, not dismissive, patronizing or condescending, and firm but flexible.

Two individuals mentioned the …

I Asked, “Are You In Recovery? Why or Why Not?” Here’s What You Answered (And More): Exploring SEDs Readers’ Experiences

Are you in recovery right now? Why or why not?” That’s one of the questions I’ve been asking on the SEDs Tumblr every once in a while. It is interesting for me to find out about the people who read the blog/Tumblr. But more importantly, it gives me an opportunity to show diversity of experiences (and feelings).

Last week I decided to formalize this a little bit and to open the floor to non-Tumblr users; I made a survey with over a dozen questions. I received a lot of responses  and I wanted to share them in the hopes that some of you will, perhaps, find them reassuring. I won’t get to cover all the questions I asked, so this will be part I of, well, I don’t know how many posts.

Please note that this survey is not scientific, not comprehensive, and not necessarily representative of the general population of ED sufferers. Here’s a PDF of all the “raw” data for the questions covered in this post: ED survey results – Part I. Some of the …

Matters of Appearance: Eating Disorder Patients’ Interpretations of Therapists’ Bodies

Therapeutic alliance is often highlighted in studies looking at treatment effectiveness, both in and beyond the realm of eating disorder therapy. Evidently, there are a number of factors that can impact how well we get along with our therapists, ranging from disagreements with the course of treatment or type of therapy to a simple, unnamable dislike for the person. But what about their appearance? What kind of impact could a therapist’s body size have on the therapy relationship?

Rance, Clarke & Moller (2014) sought out to investigate this issue, looking specifically at how clients evaluate therapists’ body size and speculate on their relationship with food, with an eye to determine what impact this might have on the therapeutic process.

I was immediately drawn to this study when I was browsing the latest literature; I wondered why this hadn’t been studied before. In some ways it seems obvious; we’re bound to compare ourselves with others, social beings that we are. So when looking at the therapeutic alliance, it would be illogical to assume that physical appearance could be left …

Setting a Target Weight: An Arbitrary Exercise?

Achieving a healthy weight is a major goal of anorexia nervosa treatment. Indeed, a healthy weight is often seen as a prerequisite for psychological recovery. The fact that weight restoration is a crucial component of recovery is uncontroversial, the problem arises when it comes to determining what constitutes a healthy weight. How are ideal, optimal, or goal weights set? And who gets to decide?

Despite its recognized importance, there’s surprisingly little consensus on how target weight should be determined. Moreover, as Peter Roots and colleagues found out, when it comes to inpatient treatment centres in the UK and Europe, there is little consistency too.

In a study published in 2006, Roots et al. examined how treatment centres determine, monitor, and use target weight in the treatment of adolescents with anorexia nervosa. They also wanted to know the centres’ expected rate of weight gain, how often patients were weighed, who was involved in setting the target weight, and how target weights were used in the “therapeutic process and discharge planning.” They sent out questionnaires to 28 specialist inpatient ED services (17 …

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 …

Examining Mandometer(r) Founders’ 10 “Reasons” Why Eating Disorders Are Not Mental Disorders – Part II

This is the last post in my mini-series on the Mandometer® Treatment. (Links to earlier posts here: Part I, Part II, and Part III). In this post I’m going to continue examining Bergh et al.’s reasons for why eating disorders are not mental disorders (#6-10). In my last post I omitted something important: I didn’t define mental disorders, but to avoid repeating myself, please see my comment on the topic here.

Bergh et al.’s reason #6 why EDs are not mental disorders:

Reason #6. Gender differences argue against an underlying mental health disorder. Women constitute more than 90% of eating disorder patients (Hoek & van Hoeken, 2003), but teenage males are more likely to have OCD than teenage females (Fireman, Koran, Leventhal, & Jacobson, 2001), and there are no differences in the prevalence of anxiety and anxiety-related disorders in male and female teens (Beesdo, Knappe, & Pine, 2009).

The ratio of women to men receiving treatment is NOT representative of the ratio of women to men struggling with an eating disorder. I think this is fairly …

Examining Mandometer(r) Founders’ 10 “Reasons” Why Eating Disorders Are Not Mental Disorders

This is Part III of my mini-series on the Mandometer® treatment. In my first post, I wrote about the history and rationale of the Mandometer® treatment. In my second post, I evaluated a recent study published by the creators of Mandometer® (Bergh et al., 2013); I wanted to see whether their data supported their claims (spoiler alert: it didn’t). In this post, I’m going to focus on the first five of Bergh et al.’s ten reasons why eating disorders are not mental disorders (or something like it, anyway).

If it seems like I have a personal vendetta against Cecilia Bergh & Co/Mandometer®, rest assured that I most certainly do not. I just don’t like bad science, misleading claims, and snake oil. As I mentioned in my first and second posts, I actually like many of the components of the Mandometer® treatment. (For example, I agree that weigh restoration (when applicable) and normalization of eating are crucial, primary components of ED treatment.) I just thought I’d take the opportunity to illustrate how critical we have to be when evaluating …

The Finest Quality Snake Oil: Mandometer(r) Treatment for Eating Disorders – Part II

This is Part II of my mini-series on the Mandometer(r) treatment for eating disorders (link to Part I). In Part I, I provided some background on the Mandometer(r) treatment; in this post, I want to take an in-depth look at the recent Mandometer treatment study. My main goal is to see whether their data live up to their claims. Warning: This post may contain high levels of snark.  

Their main claims? This is from the abstract:

The estimated rate of remission for this therapy was 75% after a median of 12.5 months of treatment. A competing event such as the termination of insurance coverage, or failure of the treatment, interfered with outcomes in 16% of the patients, and the other patients remained in treatment. Of those who went in remission, the estimated rate of relapse was 10% over 5 years of follow-up and there was no mortality.

Sounds pretty good, right? (Note the use of the word “estimated.“)

The Patients

From 1993 to 2011, Bergh et al. followed 1,428 consecutively admitted patients to the six …

The Finest Quality Snake Oil: Mandometer(r) Treatment for Eating Disorders – Part I

PROTIP: When selling your snake oil treatment, try NOT to make wildly outrageous efficacy claims. But if you can’t resist that temptation, try to limit your hard-to-believe, eye-roll-inducing claims to your treatment — there’s no need to go further.

In this post, I’m going to give a brief history of the Mandometer® treatment and its apparent rationale. In the next one or two posts, I will do an analysis of the most recently study by the group that claims to show remission rates of 75% and relapse rates of only 10%. Sounds great, right? Well… we’ll see.

We suggest that the reason self-starving patients do not fit the DSM-IV criteria of anorexia nervosa is because there is in fact no psychopathological basis of the disorder … The DSM-IV offers no definition [of psychopathology], but it is reasonable to assume that a psychopathological basis of anorexia nervosa would be reflected in a behavioural or cognitive marker. There is, however, no need to refer to self-starvation and enhanced physical activity as a reflection of an underlying psychopathology.

We suggest therefore that

Complex Motherhood: The Perspectives of Mothers with Eating Disorders

Studying, as I do, in a department of family relations, I have become interested in family relationships and parenting. Accordingly, I have begun to take note of interesting studies that link family dynamics and parenting with eating disorders, including studies that look at the sibling relationship (as I wrote about here), family-based treatment, and motherhood/fatherhood in the context of eating disorders.

The literature appears to have shifted, lately, from a focus on “eating-disorder generating” families toward an acknowledgement of the complex family dynamics that can play into the development and treatment of eating disorders. A move away from mother- or family-blaming discourses is essential, I would argue, to gaining a better understanding of the lived experience of eating disorders for individuals and families alike.

Accordingly, I was pleased to stumble across an article by Tuval-Mashiach et al. (2013) that used a qualitative approach to explore the experiences of mothers with eating disorders. The authors suggest that their study helps to fill a gap in the literature surrounding how mothers experience the intersections between their motherhood roles, their …

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