Beyond the Muscular Ideal: Talking About Eating Disorders and Masculinity

There’s a growing acknowledgment that women/feminine-presenting people are not the only people who get eating disorders. Increasingly, headlines proclaim that “men get eating disorders too!” and note that the stereotype that eating disorders are a “girl thing” is tired and problematic. This is great – anything that breaks down the well-entrenched notion that only young, rich, skinny, white, cis- and hetero girls are the only ones to get eating disorders is a welcome move in my opinion.

However, are we just reinscribing gender norms and the focus on body image and body ideals in the way we talk about eating disorders in boys and men? I just finished reading an article by Wright, Halse & Levy (2015) asking just this question. The article provides a compelling argument for re-visioning how we talk about eating disorders amongst boys and men.

Discourses

Wright, Halse & Levy explore discourses around eating disorders … Continue reading →

Many Types of Expertise: Recovered Therapists Reflecting on Recovery

Lately, I’ve been hearing a lot of noise in the social media sphere about whether or not those who have recovered from eating disorders should be treating eating disorders. Some have come out on the side of saying definitely not, listing reasons like the potential for bias, countertransference (the therapist making assumptions about clients’ emotions/experiences) or triggering. Others suggest that therapists who have “been there” can empathize with patients in a way that those who have not struggled with food cannot approximate.

Tetyana blogged about the lifetime prevalence of eating disorder professionals in recovery in 2013; she wrote about a 2002 study that revealed that around 33% of women and 2% of men treating eating disorders had a history of an eating disorder themselves. I have also written on the subject before (here); I focused on a 2013 study looking at experiences that recovered clinicians held in … 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 →

The Stigma is Real: Self-Blame and Explanations for Eating Disorders

Stigma is a real thing. There you go, the most profound statement I’ve ever written. In all seriousness though, there’s a big stigma problem around eating disorders, and not all of it is imposed from the outside. Many people with eating disorders also self-stigmatize, feeling responsible for their disorder (Holliday, Wall, Treasure & Weinman, 2005 wrote more about this). Other stigma is externally imposed; for instance, the widely held (and erroneous) belief that eating disorders are only something vain young girls get or that they are a choice.

Stigma around eating disorders sometimes differs betweens diagnoses, and especially between eating disorders and other mental illnesses – for instance, Roehrig and McLean (2010) found that eating disorders (both anorexia nervosa and bulimia nervosa) were more stigmatized than depression, and that eating disorder stigma uniquely (and horribly) included a certain degree of envy. The stigma associated with AN is … Continue reading →

Incidence of Eating Disorders on the … Decrease?

Reports that eating disorder (ED) rates are rapidly increasing seem nearly ubiquitous, but are rates actually increasing? Are EDs at an “epidemic” level? I came across a recently published study suggesting that this may not be the case; indeed, ED rates might actually be decreasing, at least in the Netherlands.

In the study, Smink and colleagues (2015) followed a group of general practitioners (GPs), servicing roughly 1% of the total population, asking them to record all the newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) between 1985-1989, 1995-1999, and 2005-2009. They were interested in whether incidence rates changed or remained stable over time.

Incidence refers to the number of new cases of a disease or disorder in a population over a certain time period; it is not the same as prevalence, which refers to the total number of individuals suffering from the condition at a given point in time … Continue reading →

Plenty of Reasons to Sit Still: The Problem(s) with Fitspiration

I can’t quite believe that I have yet to write a post here about fitspiration, given the ire that it provokes in me. And there you have it, right off the bat, my bias: I find fitspiration to be incredibly problematic – this will be controversial, but I often wonder if it could be more dangerous than thinspiration, in its subtleness. Fitspiration posts closely resemble what we are asked to do with our bodies every single day: eat “clean,” work out in a gym, put mind over matter, be productive, and succeed. Unlike thinspiration, these messages target a wide demographic of people with and without eating disorders; they carry neoliberal undertones (ok, probably overtones).

I’m not the only one interested in unpacking the issues with fitspiration. Indeed, I’m far from the first to call out these problematic messages (I especially like this article!). Researchers, too, have become interested … Continue reading →

We’re In This Together: Collaborative Care for Eating Disorders

This week I had the pleasure of attending a workshop with Janet Treasure on collaborative care in eating disorders. Treasure focused her workshop on supporting caregivers of people with eating disorders, offering practical skills for carers and clinicians alike to improve interactions with those with eating disorders. Though I am neither a carer nor a clinicians, I got a lot out of the workshop, and it reminded me of a few of Treasure’s articles I’ve read over the years, and how much I appreciate her strong focus on working collaboratively with patients and families to facilitate recovery.

I especially appreciated how she aims to integrate those with lived experience (of either having an eating disorder or caring for someone with an eating disorder) in research and treatment design. Some of her journal articles, including this article on the potential for harm in existing treatment models, even include former patients as … Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 1

Some previous posts on this blog have explored whether eating disorders might (or might not) be considered culture-bound, or in other words specific to or presenting specifically in certain cultures. If you consider eating disorders to be “culture bound,” they would present primarily in Western cultures, with non-Western cultures ‘receiving’ eating disorder pathology through Westernization. In this post, I explore eating disorders in the Singaporean context to continue to unpack the relationship between culture and eating disorders. Singapore is an interesting place in which to look at eating disorders (not just because I live there) because it complicates the idea of “culture-boundedness.”

Studies have been conducted in Asia; primarily in Hong Kong and to a lesser extent Japan. Most notably, Lee (1991) found non-fat-phobic presentations in Hong Kong supported by Ngai, Lee & Lee (2000) (see this post for more on the Ngai study). Singapore is … 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 →

Is the Doctor in? Eating Disorders Training Amongst Medical Professionals — Part 1

Something that has often shocked and, frankly, appalled, me is how little training exists for those at the front line of eating disorder service delivery. I’m talking about people like family doctors, teachers, coaches, and others who might act as key gatekeepers for eating disorder services; those who don’t make eating disorders the focus of their practice but who likely encounter people with eating disorders as a part of their work life.

When I hear horrible stories about doctors shrugging off symptoms of eating disorders because the person presenting to the office does not “look like they have an eating disorder,” I want to cry. When I talk to teacher friends about the lack of built-in training around eating disorders (sometimes they have sought out opportunities to enhance their mental health awareness, but these don’t tend to be built in), I wish I had more to offer them. When I … Continue reading →