[Note: This post has been translated into Croatian, link here.]
Why do some people recover anorexia nervosa relatively quickly while others seem to struggle for years or decades? Does it depend on the person’s desire to get better? Their willpower? How much they are willing to fight? Is it just that some try harder than others? Some might say yes, but most will correctly realize that the picture is much, much more complex.
We can spend hours talking about barriers to treatment, but in this post I want to talk about something slightly different, something perhaps that is perhaps less “obvious.”
Suppose a group of girls–all roughly the same age, same illness duration, same socioeconomic background and race–enter the same treatment facility. What determines why some will do well in treatment and continue to do well after discharge, whereas others will relapse immediately after discharge, and yet others won’t respond to treatment at all? We know that catching eating disorders early is crucial, but what else is important?
There will never be a treatment that will work for …
Serotonin (5-hydroxytryptamine, 5-HT) is a neurotransmitter that is involved in just about everything. It helps ensure proper cell growth, maturation and migration during development. Serotonin is also important in regulating emotions, cognitive functions, appetite, pain, circadian rhythms, and our endocrine system in adulthood. It is hardly a surprise then, that the serotonergic system seems to be important in bulimia nervosa (BN).
I’ve written previously about serotonin in restricting-type anorexia nervosa, so for this post I’m going to be shifting focus and talk about bulimia and binge-purge type anorexia nervosa (AN-BP).
The information in this post isn’t coming from a review paper. Instead, I’m going to be summarizing and explaining information from a chapter in a book titled Behavioural Neurobiology of Eating Disorders. In the chapter on serotonin and bulimia, Howard Steiger and colleagues propose a model for serotonin action in bulimia nervosa which takes into account “diverse hereditary and environmental influences… and helps account for heterogeneous traits seen in the bulimic population“.
Individuals whose eating disorders are characterized by the presence of binge-eating and purging display …
Symptom fluctuation and diagnostic crossover are common in eating disorder patients. A study by Eddy et al. (2008) - who followed patients over an average of 7 years – showed that crossover between subtypes and full-syndrome diagnoses is very common : of those initially diagnosed with anorexia nervosa, almost 73% crossed over to another diagnosis (between symptoms and to bulimia nervosa). More specifically, roughly 50% experienced fluctuation between subtypes (restricting, AN-R, and binge/purge type, AN-BP) and roughly 35% crossed over to bulimia nervosa (a subset experienced both). Of those initially diagnosed with bulimia, roughly 14% crossed over to AN-BP and of those, 3.91% crossed over to AN-R.
This finding (though, well-known to ED specialists and even more well-known to patients) has important implications for treatment. For example, CBT and anti-depressants seem to have positive results in bulimic patients, but not so much in anorexics. What then, about those that crossover from AN-R/AN-BP to BN? Would they, too, benefit from these interventions?
In order to answer those questions, it would be helpful to know who whether we can actually predict who …