Bulik

Mobile Therapy: Using Text-Messaging to Treat Bulimia Nervosa

Tetyana 9 Comments

Cognitive-behavioural therapy (CBT) is one of the most commonly used approaches to treat bulimia nervosa, but even CBT (or any treatment) doesn’t work for everyone. Sometimes, even if CBT is helping, a weekly 50 minute therapy session is just not enough. Moreover, like with many other eating disorder treatments, dropout and relapse rates are high.

Although CBT is effective for 40–67% of patients, efforts are required to augment and improve  treatment to better serve individuals who drop out (0–33%), fail to engage (14%), or relapse (33%). The highest risk period for relapse is in the 6 months after treatment, with risk declining at 4-year follow-up. After 10 years, 11% of individuals originally diagnosed with BN continued to meet full diagnostic criteria for BN and 18.5% met criteria for eating disorder not otherwise specified.

What can be done to help the individuals that don’t benefit (or benefit fully) from CBT, or … Continue reading →

Think You Are Not “Sick Enough” Because You Didn’t Lose Your Period? Read This.

Tetyana 1 Comment

Anonymous asked, “I’ve never lost my period. Weight restored I am naturally thin, but even at a BMI of 15 or so I always got my period (although it wasn’t always regularly). This makes me feel like I’m not actually sick because I hear about everyone losing their period.”

eatruncats replied: “To the anon who asked about losing periods: For all the times she worries about not being sick enough because she never lost her period, there are people who lost their periods at BMIs of 18, 19, and 20 who worry about not being sick enough because they never got to a BMI of 15. If you have an eating disorder, you are “sick enough.” Period.“

As it stands now, amenorrhea–or the loss of three consecutive menstrual cycles–is a diagnostic criterion for anorexia nervosa. Individuals who have not lost their periods are diagnosed with eating disorder not … Continue reading →

Doing It Together: Uniting Couples in the Treatment of Eating Disorders

Tetyana

Eating disorders don’t discriminate against gender, age, sexual orientation or race. Veteran men in their 50’s can struggle with eating disorders, as can trans men and women of all ages and backgrounds, and so can congenitally blind (and deaf) individuals.

Besides the barriers that many of these patients face in simply getting diagnosed with an eating disorder, yes, even if they’ve passed that hurdle, many face an even bigger problem: getting appropriate treatment.

Naturally, no one treatment method will work for everyone, especially when the patient population is so diverse. What works for a 13-year-old female may not work for a man in his 40’s or 50’s.  Unfortunately, treatment options (at least those that have some empirical evidence) are limited. As I’ve recently blogged, new treatments are being developed and utilized in treating adults and/or patients with with long-standing eating disorders – sub-populations that have largely been … Continue reading →

Predictors of Diagnostic Crossover and Symptom Fluctuation in Eating Disorders

Tetyana 8 Comments

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 … Continue reading →

Your Time in the Womb Matters: Risk Factors for Anorexia Nervosa

Tetyana 4 Comments

A not-so-recent, but interesting paper by Cynthia Bulik and colleagues outlines an interesting model for perinatal risk factors in the development of anorexia nervosa. The model “focuses on adverse perinatal events and prematurity as risk factors for AN and encompasses the potential role of passive gene-environment correlation in perpetuating AN risk.”

Importantly, this model “provides intriguing data on a potential cycle of risk for at least a subset of individuals with AN.” The word subset is important: this model, if true – and we don’t know yet, undoubtedly applies only to a proportion of individuals that develop anorexia nervosa, so keep that in mind.

(In case you are wondering, because I was, perinatal period  starts at 140 days of gestation and ends 28 days post birth, prenatal period is any time before birth.)

Trying to figure out the risk factors for anorexia, a rare disorder (<1% of the population), is … Continue reading →

The Genetics of Anorexia Nervosa

Tetyana 11 Comments

Is it the culture of thinness, obsession with dieting or just bad mothering? When it comes to determining the causes of anorexia nervosa, the answer appears to be none of the above. Increasingly, the evidence is pointing to genetics playing an important role in predisposing individuals to anorexia nervosa. Among clinicians and researchers, the notion that genetic factors are important in the development of anorexia nervosa seems uncontested. In this short review, Dr. Cynthia Bulik and colleagues summarize some of the findings in the genetics of anorexia nervosa.

Currently (DSM-IV), to be diagnosed with anorexia nervosa, a patient must show:

  • An inability to maintain normal weight (<85% of what is expected)
  • Intense fear of weight gain and/or becoming fat, though underweight
  • Obsession with body weight and shape, giving it undue importance in evaluating self-esteem/self-worth
  • Amenorrhea (missing 3 or more consecutive periods)
  • There are two AN-subtypes: restricting type (AN-R) and
… Continue reading →