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 →

The Art of Therapy: Using of Arts-Based Therapies in Eating Disorder Treatment

Arts-based therapies are often used to supplement more “traditional” eating disorder treatment protocols in various different settings, ranging from individual therapy to inpatient units. However, as Frisch, Franko & Herzog (2006) note, no published research provides empirical support for the use of arts-based therapies for eating disorder treatment.

You might be wondering: if there is no empirical support, why are clinicians still using these therapeutic practices? You might also be wondering why I’ve chosen to dissect an article from 2006.

I’ll address the first question in this post (teaser: it’s really hard to say!). As for my delving back into the depths of academia, there is surprisingly little literature that touches on arts-based therapy, despite its continued use. This article provides an overview of why this might be, and where we can go from here.

WHAT IS ARTS-BASED THERAPY?

Arts therapy is an umbrella term used to refer … Continue reading →

Should Insurance Companies Cover Residential Treatment for Eating Disorders?

Should insurance companies cover residential treatment for eating disorders?  The price tag is high, about $1,000/day on average, but evidence of treatment effectiveness  is astonishingly low. Practically nil, as I’ve recently discovered. Despite spending my free time punching away different keywords into the PubMed search bar, I came up with very little. And you know what I think? I think treatment centers should be embarrassed. And I think, wow, maybe insurance companies have a point? (A scary thought! I don’t actually think they do, though – but then, I just can’t wrap my head around for-profit healthcare, having lived all my life with socialized healthcare, and loving it.)

Carrie over at ED-Bites recently blogged about the fact that there a dearth of evidence-based treatment for eating disorders. It is a complicated issue, I know, but I do think that any organization or center that offers treatment (especially … Continue reading →

Who Gets Treatment? Your Ethnicity Matters

In 2010, I wrote a literature review on eating disorders in women of color in North America. I expected to find only a few articles on this subject – every lecture in my undergrad psychology classes, every piece of information targeted to the public, every discussion I had, it seemed, either omitted the existence of EDs in non-stereotypical (white, female, heterosexual, adolescent, upper/middle-class) populations altogether – or glossed over it with a footnote on “acculturation” that reductively attributed the disorder to a misguided desire to fit into the dominant culture, much as other women might aspire to look like the images of female bodies in mass media. (Acculturative stress is actually far more complex than this, and furthermore is not necessarily the sole or even the primary cause of EDs for all people of color.)

[Some people] think that I hate being Asian and want to look

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When Clinicians Do More Harm Than Good (Attitudes Toward Patients with Eating Disorders)

I was going to blog more about mortality rates in eating disorder patients, but recent ED-related deaths have left a bitter taste in my mouth (huge understatement). So, I’ve decided instead to write about a paper requested by the founder of The Joy Project on clinician reactions to patients with eating disorders by Thomspon-Brenner and colleagues that came out this year.

If you have an eating disorder or are close to someone with an eating disorder, you’ve likely heard many stories about dismissive or down-right negative and harmful attitudes that clinicians often have toward patients with EDs.

I’ve experienced it myself: I had to find another doctor to refer me to an outpatient clinic, because the first one didn’t – he didn’t think I needed help (probably because I was very aware that things were not heading in the right direction even before I was at a low weight). Needless … Continue reading →

A Case Against Eating Disorder Not Otherwise Specified (EDNOS)

This study is a follow up on the previous study (last entry) which examined the problems with the EDNOS classification, the frequency of transitions between eating disorders and how the DSM should be changed to reflect the clinical reality of eating disorders (and what is the clinical reality?)

In this study, Eddy and colleagues followed 246 women who were initially diagnosed with either AN or BN, for an average of 9 years. The main goal was to study the growing disparity between (1) the consensus that eating disorders are not stable overtime and how (2) the current diagnostic criteria which do not adequately address this, by following the clinical presentation of EDs overtime and providing suggestions for the upcoming DSM-V.

EDNOS is an often ignored category in research–in main part because it is difficult to study such a heterogeneous group. Nonetheless, Eddy et al. summarize some interesting findings … 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 →