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 →

Whose Weight Are You Watching? Schools, Surveillance, and Eating Disorder Prevention

Health class in school is an experience few of us would like to repeat, I’m sure. Though it’s been a good many years since I was subjected to the joys of health education, I continue to think about the types of lessons I had, particularly about eating disorders, and how lacking these were. I can only imagine that things have gotten progressively worse with the focus on the “obesity epidemic” that is so pervasive today.

In one of my favourite articles ever, Pinhas et al. (2013) outline some issues with healthy curricula related to “healthy eating” in schools in the wake of obesity rhetoric. These include:

  • The simplistic “energy in, energy out” message can be highly problematic for some children, who may take this to mean they need to engage in restrictive behaviours
  • Without addressing weight stigmatization in schools, messages about health hold little purchase, and tend to
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:

Continue reading →

Finding What You’re Looking For? Exploring the Eating Disorder Examination Questionnaire

If you’ve ever been assessed for an eating disorder in a clinical setting, there is a good chance you’ve completed the Eating Disorder Examination Questionnaire (EDE-Q). The EDE–Q is a self-report questionnaire widely used in ED assessment and research. Clinicians and researchers calculate several different scores from patient or participant responses to the questionnaire:

  • A score on the global scale, which provides a measure of the severity of ED psychopathology
  • 4 sub-scales: eating restraint, eating concern, weight concern and shape concern

There are a number of cut-off scores that can be used to distinguish between clinically significant and non-significant cases. In this post, I will look at a few papers critiquing the use of the EDE-Q in clinical and research settings.

BACKGROUND

The EDE-Q was originally developed as an assessment tool for bulimia nervosa and binge eating and contains few, if any, questions that specifically assess anorexia nervosa symptomology. … 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 →

Sensing the Body: Bodily Experience in Anorexia Nervosa

I’ve been reading a lot of literature on bodies and eating disorders lately as I gear up to write the theoretical paper that becomes the basis of my PhD qualifying exam. Perhaps unsurprisingly, I’ve become a little preoccupied with teasing out my understanding of the relationship between body image and eating disorders in an era in which even saying those words in the same sentence sparks visceral reactions among listeners.

This post is not about whether body image causes eating disorders or not (sorry to disappoint). It is, however, about one of the best articles I’ve stumbled across thus far that seeks to shed some light on the ways in which those with eating disorders (specifically anorexia nervosa, in this case) might experience bodily sensations, which in my view is much more interesting than quibbling about whether body image is the primary causal factor for eating disorders.

In the article, … Continue reading →

Is The Doctor In? Eating Disorders Training Amongst Medical Professionals — Part 3

The thing about critiquing systemic issues like lacking training environments for medical professionals (and others) is that we have to be cautious to not place undue blame on those who are stuck immobilized between the desire to a) train or b) get training in eating disorders. If the solution to the egregious lack of training was simple, I feel sure that someone would have done it already! What I am gesturing at, here, is that the reasons behind lacking training opportunities are deeply rooted in socio-political, historical, and economic trends and policies. Those providing training and those seeking training do not exist in some glorious black hole devoid of austerity (frugalness, restrainedness) and neoliberalism.

In this post I’ll focus on a few studies that help to illuminate why these gaps in training might exist, including dominant sentiments (in the general public, in government, in training environments themselves) toward eating disorders. … Continue reading →

Not So Fast: Is There a Connection Between Religious Fasting and Eating Disorders?

I’ve always wondered about how being encouraged to fast for religious reasons might impact those who are vulnerable to eating disorders and those who already have eating disorders. I can’t imagine it would be easy to be around others who were fasting in the name of religion while struggling with an eating disorder. Equally, I can certainly see the dangers of participating in fasting for those who are predisposed to eating disorders.

Despite not being religious myself, however, I understand that fasting is important to some people who subscribe to religions that encourage the practice. So, how might we balance the potential dangers of fasting with the freedom of religious observance? And, what is the impact of religious fasting on individuals with eating disorders, or those developing eating disorders?

In this post, I’ll highlight some of the main findings from 2 studies about religious fasting and eating disorders: one quantitative … Continue reading →

Beyond Thinness: Men, Muscularity and Eating Disorders

Eating disorder research tends to focus on girls and women. Which makes sense: eating disorders disproportionately affect women. However, it isn’t just the research on eating disorders that focuses on women: it’s the entire history of eating disorders as a diagnosis. The first descriptions of anorexia nervosa by William Gull and bulimia nervosa by Gerald Russell were both based primarily on observations of female patients (although Russell did include two men). Therefore, it’s possible that our basic construction of eating disorders is based on a specifically female experience.

One example of this is the focus on weight loss as a cardinal component of eating disorders (barring binge eating disorder). This is often attributed to the pursuit of a “thin ideal” created by our culture; however, this thin ideal doesn’t necessarily apply to men. Whilst women encounter pressure to be thin, evidence suggests that men encounter pressure to be more muscular—a … Continue reading →

Resistance is (not so) Futile? Exploring Treatment Resistance in Eating Disorders

To me, the idea of “treatment resistance” in eating disorders sparks some ill feelings. While many have suggested that treatment resistance is common among those with eating disorders, others have noted how receiving the label of “treatment resistant” can make it more difficult to receive needed support or impact how one is perceived in treatment settings and how one’s behaviours are interpreted (e.g., Gremillion, 2003).

Of course, this is a tricky ground to tread, primarily because sometimes people do resist treatment. Regardless, I think it is important to think about what lies behind the resistance to treatment. Is it the type of treatment? The people doing the treating? The compelling nature of the behaviours (e.g., restricting, binging and purging) at least in the short term?

In any case, to say that treatment resistance occupies a contested place in the eating disorder literature would likely be an understatement. Perhaps for this … Continue reading →