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 →

Poverty and Eating Disorders in Hong Kong

Eating disorders are typically seen as an illness of the middle class, with most patients coming from that socioeconomic group. However, the invisibility of poorer patients within eating disorder research in part reflects the barriers to treatment that they face, including both cost and lower levels of awareness. This paper, written by a Hong Kong social work professor, Joyce Ma, focuses less on the process of eating disorder recovery, highlighting instead the context of treatment. She discusses how family dynamics and socioeconomic status come into play in her encounters with 7 Hong Kong teenagers from low-income families.

While her sample size is very small, it reveals a more diverse — and less body image-focused –disease pathway than most American studies, with Ma breaking down the precipitating factors as follows (patient numbers in brackets):

  • Constipation (1)
  • Desire to be thin (3, 7)
  • Relationship issues (6)
  • Parental conflicts (5)
  • Poverty (2,
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 →

Pride Before a Fall: The Intertwining of Pride and Shame in Eating Disorders

Is there a link between eating disorders and shame? What about pride? Can understanding these emotions help us to understand how eating disorders develop, and how they are maintained? In reviewing literature for my specialization paper, I stumbled upon a qualitative study by Skarderud (2007) about the role of shame in eating disorders. I found the article quite interesting, so I fired up the “where was this cited” tool on my university library database and uncovered a wealth of studies looking at shame, pride, and eating disorders.

For the purposes of this post, I’ll comment on Skarderud’s study, also bringing in a longitudinal study by Troop & Redshaw (2012) that looks at general and bodily shame.

Shame and Pride

Skarderud, who uses a phenomenological approach in his study (meaning that he is trying to unearth the particularities of shame for those who experience it) sees shame … Continue reading →

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 3

The articles I’ve looked at so far in this series (Becker, in part 1, and Keel and Klump in part 2) give us some insight into the idea that the link between “Western” societies and eating disorders is more complex than a simple matter of media exposure. But, having read these studies, I was still left a bit wanting in terms of unpacking that black box of “culture” that gets tossed around in scholarly and popular literature. What, exactly, are we talking about when we talk culture in eating disorders?

Rebecca Lester, who is quite a prolific social anthropologist and who has written about eating disorder treatment systems in the USA and Mexico, makes the argument that “culture” is too often used as an umbrella term for semi-related but not-entirely-synonymous factors. This makes me wonder: is it possible that in latching on to the media side of Becker’s … Continue reading →

Disordered Eating and Athletic Performance: Where’s the Line?

If a person severely restricts his diet and exercises for hours each day, he has an eating disorder. If another does exactly the same but it is because she wants to make the lightweight rowing team (which has an upper weight limit), she’s a committed athlete. When the two overlap, and an athlete presents with eating disorder symptoms, how do we distinguish between the demands of the sport and the illness?

I’ve been interested in the distinctions we make between disordered and non-disordered eating and exercise behaviours for a while now. Recently, when I was browsing through articles, I came across a literature review by Werner et al. (2013) (open access) of studies examining weight-control and disordered eating behaviours in young athletes.

The authors start by noting the sheer lack of research that has actually been done in this area. This is worrying: typical onset of eating disorders is during … Continue reading →

You Sure You Want to Eat That? Perceived Consequences of Eating & Its Relation to Recovery

I recently had a total Aha! moment (or a why-didn’t-I-ever-think-of-it moment) when I had chanced upon a recently published article titled “Eating Expectancies in Relation to Eating Disorder Recovery” by Fitzsimmons-Craft and colleagues. The title caught my attention because I had never come across any research tying eating expectancies to eating disorders, though I was familiar with the concept from the health psychology and obesity literature. Eating, as a behaviour and as a mechanism, is incredibly complex, with many factors contributing to why and how we eat; eating expectancies are one such factor.

Expectancy theory, first proposed by Tolman (1932), suggests that expectancies, or assumptions about the consequences of various behaviours, develop as a result of one’s learning history (Smith et al., 2007). Such expectancies are thought to influence subsequent behavioural choices, with one acting to either increase the likelihood of reward … Continue reading →

Is Eating Disorder Prevention Possible?

How did I ever find things to write about before social media? Recently, someone on Tumblr asked whether eating disorder prevention and awareness efforts do more harm than good. In other words, can attempting to prevent eating disorders actually contribute to their development? Good question, I thought. I’ve often wondered about this myself, especially in light of some emerging studies suggesting that “healthy eating” campaigns may actually contribute to unhealthy (restrictive) behaviours around food in school children. So off I went to scour the literature. I came up with a number of hits, but surprisingly few from the past few years. With this recent silence in mind, I will look specifically at a meta-analysis by Stice, Shaw & Marti published in 2007 that highlights some of the characteristics of effective prevention programs and comment on some of the potential pitfalls of prevention.


As a bit of a primer prevention … Continue reading →

Calorie Restriction, Anorexia Nervosa, and Memory Gaps

This post has been translated into Russian by Polina here.

I have often heard anorexia nervosa sufferers complain of “memory gaps,” particularly during the times they were really sick. As if they weren’t really there.  It can be scary and unnerving, to say the least. A few months ago, a Tumblr user asked me about this:

Hi Tetyana, I’m not sure if this is merely based on my own subjective experience of if there is any grounding at all, but I was wondering if there could perhaps be a link between EDs and a sort of memory loss. It’s hard to describe but I definitely seem to have huge “gaps” in my memory of during that time, as if I selectively block things out. I have limited inaccurate knowledge with regards to memory on a molecular/neurological basis so I do not know if there’s anything there. Perhaps with calorie

Continue reading →

What's The Point of Bingeing and Purging? And Why Can't You Just Stop?

I defended my MSc on Tuesday and I’m not going to lie: I was pretty symptomatic with bulimia in the days prior to my defence. As I explained to my boyfriend: the anxiety-reducing effects of purging are so powerful, and the compulsion to binge and purge (when I’m stressed/anxious/”not okay”) is so strong that it is much easier to do it, get it over with, and continue working (in a much calmer state).

I’ve mentioned before, for me, purging is very anxiety-reducing and in some ways, almost a positive experience. It is so tightly coupled with bingeing that it is hard to separate the two, but the anxiety-reducing effects are strongest when I binge and purge, non-existent when I binge, and weak when I purge a normal meal (which is exceptionally rare/almost never.)

It turns out, of course, that I’m not alone.

Negative emotional states and stressors have long been … Continue reading →