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 →

Eating Disorder Awareness Week: Useful, Useless, or Worse?

National Eating Disorder Awareness Week came and went (in the US, anyway). Posters were shared, liked, and tweeted. Pretty (but often misguided) infographics made the rounds on the internet. Local ED groups visited schools and college campuses to educate students about eating disorders. To, you know, increase awareness. 

The thing is, awareness is not always a good thing. For one, as Carrie over at ED Bites mentioned, there’s a whole lot of misinformation masquerading as fact. And two, awareness campaigns, even when the information in them is correct, may have unintended consequences, like, for example, increasing stigma or self-stigma.

Moreover, not all approaches to increasing awareness or decreasing stigma are equally effective, and the effectiveness of a particular approach may differ depending on the population studied.

So, what about the effectiveness of EDAW? In 2012, Kathleen Tillman and colleagues published a study looking at … Continue reading →

Models of Anorexia Nervosa: A Few Insights from Our Animal Cousins

In 1967, Routtenberg and Kuznesof reported a very peculiar phenomenon in rats:

They discovered that when rats were on a restricted feeding schedule (1 hour per day in their experiment) and had free access to a running wheel, their food intake was significantly lower than in control rats, which were on the same feeding schedule but without access to a running wheel. This discrepancy between increased running activity and decreased food intake caused substantial body weight loss, and if rats were not removed from the experimental setup timely, they would eventually die of starvation. This model, later named the activity-based anorexia (ABA) model, is one of the most widely used animal models for the study of anorexia nervosa (AN). (Source)

Of course, rats are not humans. Nonetheless, animal models of anorexia nervosa can inform us of some of the underlying neuropsychological and physiological influences and consequences of Continue reading →

Clinical Utility of Weight Suppression in Bulimia Nervosa Treatment – Part II

In this post I will continue my discussion on weight suppression in bulimia nervosa (click here to read Part I). Just in case you happen to be reading the posts out of sequence, I will summarize the main points of that entry:

  1. Weight suppression is the difference between one’s current body weight and highest adult body weight.
  2. It has been found that individuals with BN are on average well below their highest historical weights (i.e. they are weight suppressed).
  3. Many studies have consistently found positive associations between WS and the onset and maintenance of BN symptoms.


Because most individuals with BN have undergone significant weight loss, this makes them susceptible to weight regain — much like obese individuals usually regain the weight they have lost. Indeed, evidence suggests that weight suppression predicts weight gain in individuals with … Continue reading →

Your Body’s Response to Chewing & Spitting: The Role of Ghrelin and Obestatin

Shelly’s follow-up post on chewing and spitting, an often overlooked symptom in eating disorders. In her first post, Shelly discussed the prevalence of chewing and spitting among eating disorder patients. In this post, Shelly discusses some of the physiological effects of chewing and spitting. Enjoy! – Tetyana

Your body responds to food long before it reaches your stomach. The taste, smell, even the mere sight of food all act to trigger a physiological response, “priming” the gut by stimulating various enzymes required for proper digestion and absorption of nutrients. This is called the “cephalic response”, and it is mediated by a part of the nervous system that’s generally not under conscious control (the autonomic nervous system). Keep in mind, the actual consumption of food is NOT necessary to trigger this reflex.

As you may have already guessed, the act of chewing and spitting … Continue reading →

Characteristics of Women with Midlife-Onset Eating Disorders

Since the late 1990’s, Remuda Ranch Program for Eating Disorders has experienced a 400% increase in patients 40 years of age and older, according to the authors of this paper. However, we don’t really know what the similarities and differences are between women who develop eating disorders in adolescence and those who develop their eating disorders in midlife (40-65 years of age).

It has been theorized that EDs in midlife may be triggered by midlife transitions, such as loss of parents, siblings, or children; divorce; traumatic illness; and empty nest syndrome (Harris & Cumella, 2006; Maine & Kelly, 2005; Shellenbarger, 2004). […] Two quantitative studies found a high correlation between the fear of aging and disordered eating in older populations (Gupta, 1995; Lewis & Cachelin, 2001).

In this paper, Edward Cumella and Zina Kally present a summary of 50 women who first developed eating disorders at the age of 40 … Continue reading →

The “Double Life” of Bulimia Nervosa: Patients’ Perspectives

My psychiatrist once compared my life to Dexter. He said I was living a double life. It was the summer before my final year in undergrad and I was working in a neuroscience lab. Yet things were so bad that at one point I was very close to quitting and doing Day Program treatment. (I didn’t, and things ended up getting better, thankfully.)

This post is going to be more personal than most. One, I can relate well to the topic. Two, I feel that I can give voice to it under my real name. (As opposed to just discuss it abstractly, or anonymously. There’s nothing wrong with being anonymous, but I feel that, for many reasons I am in a position where I don’t feel I have to be anonymous anymore.)

I think this is important because there are a lot of myths that surround eating disorders and … Continue reading →

Anorexia Nervosa: Can We Blame The Season Of Birth?

You might have heard that individuals born between the months of June – August (or sometimes March – August) have a higher chance of developing anorexia nervosa. But is it true? A lot of studies have been done to investigate the question of whether a season of birth (or a month) correlates with a higher risk of anorexia or bulimia nervosa. The results are inconsistent, weak, and fraught with methodological problems.

But first, how could seasons (or the average temperature during birth, or conception) have an effect on the etiology of eating disorders? What’s the hypothesis?

There seem to be two main ideas (summarized in Winje et al., 2012):

  1. alterations in neuropsychological function as a result of sunlight exposure during gestation or postpartum, maternal infections during pregnancy, or nutritional changes (seasonal variation in nutrients, vitamins)
  2. alterations in fertility/reproductive patterns of the parents due to cultural influences, disordered eating in
Continue reading →

What Makes a Good Nurse? Perspectives of Anorexia Nervosa Patients

Nurses can play an important role in facilitating recovery from anorexia nervosa, particularly in an inpatient or residential treatment setting. But what makes a good nurse from the patient’s perspective? More specifically, what qualities do adolescents with anorexia nervosa consider important and helpful during recovery?

The answer may seem obvious: understanding, empathetic, supportive, non-judgemental, and the like. But those are sort of general characteristics that apply to good friends, family members, partners, doctors, other healthcare professionals, and even teachers.

Joyce von Ommen and colleagues wanted to dig a little deeper than that. They wanted to find out what components of nursing care helped patients restore normal eating and exercise patterns.

In order to find out, they collected interviews from 12 female adolescent patients (mean age of 15, range from 13-17), who were discharged from a specialized eating disorder treatment centre within three months of the interview. The patients were diagnosed … Continue reading →

The Instability of Eating Disorder Diagnoses

Eating disorders are rarely static. Symptoms fluctuate, waxing and waning as circumstances change. Often, these fluctuations lead to diagnostic crossover–between subtypes of one disorder or to a different eating disorder altogether. The heterogeneity of symptom severity and frequency led to the establishment of the “eating disorder not otherwise specified” diagnosis in the Diagnostic and Statistical Manual. Essentially, it is everything that doesn’t quite fit into the “anorexia nervosa” or “bulimia nervosa” categories. (For example, I would guess that it is a common diagnosis for patients who fail to meet the “amenorrhea” criterion for the AN diagnosis.)

ED-NOS is a category for everything that doesn’t conform to some rather arbitrary criteria required for bulimia nervosa and anorexia nervosa, meaning: it is the diagnosis for a lot of people. Okay, that’s not very scientific, I know, but I wouldn’t trust these numbers anyway–usually people who fall into this category don’t … Continue reading →