This category contains 54 posts

Unpacking Recovery Part 5: Clinical Recovery Without a Clinic?

It can be somewhat controversial to suggest that untreated recovery from eating disorders is possible. Certainly, people have varied opinions about whether someone can enact the difficult behavioral and attitudinal changes necessary to recover without the help of (at the very least) a therapist and a dietitian. Nonetheless, we still hear stories about individuals who consider themselves recovered without having sought out external sources of professional support.

When I think about untreated (or “spontaneous”) recovery from eating disorders, two studies in particular come to mind. The first study I am thinking about was written by Vandereycken (2012) and explores self-change, providing an overview of community studies of individuals who have not sought treatment for their eating disorders and implications for treatment and recovery. The second, by Woods (2004) is a qualitative study looking at the experiences of 16 women and 2 men who report recovering from AN and BN without having sought treatment. Vandereycken identifies some difficulties associated with trying to study untreated recovery, and Woods’ study highlights some possible mechanisms through which untreated recovery might …

Unpacking Recovery Part 4: Are We All on the Same Page?

Another issue in defining and understanding recovery is that patients and clinicians may have different opinions about what recovery looks like and how to get there. Certainly, there is a body of literature from the critical feminist tradition in particular that explores how at times, patients can “follow the rules” of treatment systems to achieve a semblance of “recovery,” from a weight restoration and nutrition stabilization perspective, but feels nothing like a full and happy life (see, for example, Gremillion, 2003; Boughtwood & Halse, 2008).

This potential disconnect is one reason for favoring a holistic recovery as articulated by Bardone-Cone et al. and for attending to patients’ subjective experiences of recovery (see part 2 of this series here), as Malson and others have done (see part 3 of this series here). In 2006, Noordenbos & Seubring conducted a study that further unpacked this potential disconnect through a deeper examination of how individuals and therapists conceive of recovery. Carrie at ED Bites touched on this article in her recovery series here, but I’m hoping that this …

Unpacking Recovery Part 3: Can Patients Imagine Recovery?

Today I have the distinct pleasure of writing about one of my favourite articles about eating disorder recovery by Malson et al. (2011) exploring how inpatients talk about eating disorder recovery. I have personally found this article to be very helpful in understanding some of the difficulties of understanding and achieving recovery in our social context.

As Malson and colleagues explain (and as we’ve established), eating disorder recovery is elusive. Often, poor prognosis is described in relation to individual factors, including:

  • Treatment resistance
  • Hostility
  • Opposition
  • Ambivalence about change
  • Ambivalence about the possibility of change

Problematically, seeing these as the primary reasons for which patients do not recover can make individuals with eating disorders themselves feel as though they are to blame for their “inability to recover,” which help approximately no one. How do patients internalize these kinds of framings, and what impact does it have on how possible they feel recovery is?

Malson et al. used discourse analysis to explore patients’ perspectives, looking at how these participants felt about themselves currently and imagined their future “in recovery.”


In Defense of Eating Junk Food in Eating Disorder Treatment

Should eating disorder patients be introduced to “junk food” or “hyper-palatable” foods during treatment? A few days ago, I stumbled across a blog post where Dr. Julie O’Toole, Founder and Director of the Kartini Clinic for Disordered Eating, argues against introducing “junk food” during ED treatment. The crux of the argument is that “hyperpalatable foods”—e.g., chips and Cheetos—are not real food and should never be forced or encouraged for anyone, regardless of the presence of an eating disorder:

A lot of ink has been spilled on teaching Americans in general and children in particular to make good food choices. Just because you have anorexia nervosa as a child, and desperately need to gain and maintain adequate weight, does not mean that you will be immune from the health effects of bad eating as you get older. This is true whether or not you get fat later on. You can be thin and unhealthy; you can destroy a lot of things by ingesting a chemical cuisine in the place of real food.

While I don’t disagree that some foods are more …

Unpacking Recovery Part 2: The Multiple Facets of Recovery

One of the most common definitions of eating disorder recovery I have seen comes from a 2010 study by Bardone-Cone et al. Before I begin exploring this study I thought I might direct readers to some more resources on recovery: Carrie Arnold over at ED Bites wrote a few posts about recovery on her blog, and the first in the series can be found here. In this post, Carrie looks at the 3 dimensions of recovery that surface in Bardone-Cone’s article, so I thought I might also explore a study Bardone-Cone et al. published in the same year, which specifically touches on self-concept in eating disorder recovery, for variety’s sake.

Aspects of Eating Disorder Recovery

One of the most appealing things about Bardone-Cone and colleagues’ definition of recovery is that it looks at more than just the physical aspects of recovery. The researchers conceptualize recovery instead as comprised of 3 main areas:

  • Physical
  • Behavioral
  • Psychological

Of these elements, Bardone-Cone et al. argue that the psychological elements of recovery are the most often absent from definitions and understandings …

Unpacking Eating Disorder Recovery Part 1: The Recovery Model

What does eating disorder recovery really look like? When you say the word “recovery,” differences of opinion loom large. The lack of definitional clarity around the concept of recovery came up many times at ICED, and continues to surface in discussions among researchers, clinicians, and individuals with eating disorders themselves. We’ve looked at recovery on the blog before (for example, Gina looked at how patients define recovery here; Tetyana surveyed readers about their perspectives on whether or not they thought of themselves as being in recovery and wrote about it here; I wrote about men’s experiences after recovery here). It’s something of a hot topic in the research literature, too.

My Master’s thesis focused primarily on recovery, with one “take home message” being that there can be a disconnect between what recovery means in treatment settings, in popular understanding, and among individuals who have experienced eating disorders. Of course, my study was qualitative and from a critical feminist standpoint, so it is still unclear how well my findings map onto the larger dynamics of recovery. Still, understanding …

The Dollars and Cents of Eating Disorders

I must admit that I cringe slightly every time I try to think about healthcare from an economics perspective. To me, this comes a little close to putting a dollar value on human beings, which feels uncomfortably post-humanistic to me. Nonetheless, there is no ignoring the ways in which economic concerns factor into policy decisions that drive our human services, including health care.

There are also a number of pragmatic reasons for thinking about the costs associated with illnesses; talking in dollars and cents can make for a convincing argument when seeking funding to do research on a particular illness, for example. The ability to reduce healthcare costs is incredibly compelling in a time of fiscal restraint.

Crow (2014) published a short article about the economic costs of eating disorder treatment. In this article, he highlights some recent studies that have examined factors related to “the economics of eating disorders” and suggests avenues for future research in this area.

I will preface my analysis by noting that healthcare economics are not my area of expertise, and I doubt …

Of Family Dynamics and Eating Disorders: Parents’ Experiences of Skills-Based Training

Parents of children with eating disorders face an extraordinarily difficult challenge; the work that they put into caring for their loved ones cannot be discounted. This can be especially challenging in the face of a social environment that tends toward parent-blaming for disorders. Further, the kinds of behaviors caregivers are obliged to encourage in the individual with an eating disorder (for example, eating calorically-dense foods in order to gain weight) are frowned upon, to say the least, in our “anti-obesity” oriented society.

There is a rich body of literature exploring caregiver well-being, including studies suggesting that increasing the availability of support in various forms from social to practical may help caregivers to navigate a complicated path toward supporting a loved one with an eating disorder. Researchers are asking key questions around what we can do to better support parents and other caregivers.

Along these lines, Goodier et al. (2014) talked to parents who had participated in a skills-based training intervention. They were interested in finding out more about whether this intervention helped to bolster against the potential negative …

Walking a Mile in Your Shoes: Treating Eating Disorders with a Personal History of Eating Problems

A big topic at ICED, and one that seems to continually resurface, is treatment professionals in recovery. One the one hand, many see healthcare professionals with a history of eating disorders as possessing a kind of empathy that may be inaccessible to those who have not “been there.” On the other, some argue that this history complicates the patient-professional relationship in potentially detrimental ways.

You’ll find proponents of both sides of this debate from both professional and patient communities, and there are compelling arguments to be made on both sides of the coin. As an eating disorder researcher with a history of eating disorders, I don’t think you will be surprised that I lean toward the “it’s totally fine” side of the debate.

One thing that stood out to me about the larger discussion on this topic at the conference, however, was how we need to be careful about not stigmatizing those who either do or do not have a history of eating disorders. For some, becoming a professional treating eating disorders might be a great way of making sense …

Hypermetabolism in Anorexia Nervosa

Weight restoration is a crucial component of anorexia nervosa treatment. It is a challenging process for a multitude of reasons. Adding to the complexity and the challenge is the fact that during weight restoration, individuals with anorexia nervosa tend to require increasingly more calories to maintain the same rate of weight gain.

That is, individuals need to continually increase their caloric intake, in steps, sometimes upwards of 100 calories (technically, kilocalories) per kilogram per day, to continue gaining weight. For instance, an individual weighing 45 kg may need to eat 4,500+ calories to continue gaining 1-1.5kg (2.2-3.3lbs) a week. Indeed, studies have found that standard resting energy expenditure (REE) equations tend to overestimate caloric needs at the beginning of refeeding but underestimate them in the later stages (Forman-Hoffmann et al. 2006; Krahn et al., 1993).

After achieving a healthy weight, individuals recovering from anorexia nervosa still typically need to eat more calories to maintain their new healthy weight — more than healthy individuals of the same weight who do not have eating disorder histories — usually at


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