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There is a "hidden benefit" to an eating disorder, and it is not the weight lost or gained, it is the cause/effect of the problem that helps victims seek out more healthy and sustainable solutions in the long-term.

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Eating disorder recovery. The “benefit” of an eating disorder, by Mary Anne Cohen. Although there are many reasons for developing an eating disorder and many treatment strategies to heal, little attention has been paid to the “benefit” of holding onto it.

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Eating disorders give the person many psychological deficiencies; however, many people learn, with the correct amount of help, self-awareness and new prosperity within their mental space.

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Please excuse me while I nerd out all over your computer screen. I recently turned a corner on my appreciation of the value of quantitative social science, having taken a structural equation modelling class last winter, and today I'm going to share a little of that with you. While I'm still a qualitative researcher through and through, this course taught me that there is great value in understanding how scales are constructed and what that means about how we can interpret results from survey-takers.

What, you might ask, does any of this have to do with eating disorders? Plenty. A while back, Shiran wrote a post about the issues with the Eating Disorders Examination Questionnaire. Her post didn't focus on the scale psychometrics - that is, how well the scale measures what it is supposed to measure and how consistent it is - but still reveals how questionnaires used to ... Continue reading →

I find the idea of treatment retention for eating disorders to be quite interesting. Mostly, I find it intriguing to dissect the way that authors write about treatment retention - that is, how they tend to look at factors within people that make them more or less able to complete treatment, rather than things about the treatment that serve or don't serve people's needs. I've been reading a lot more about adolescent eating disorder treatment these days, given that I'm doing a practicum at an adolescent treatment centre that does things a bit differently. Resultantly, I've become more interested than ever in how we can better meet people's different treatment needs and provide a more comprehensive treatment continuum.

The stark reality of treatment is that people don't always finish it. That statement sounds fairly banal, but it's a loaded one. Too often, I see this framed as people failing ... Continue reading →

All Eating Disorders, All Posts, Anorexia Nervosa, Treatment & Recovery

Identifying risk factors for eating disorder symptoms may help us develop more evidence-based prevention mentions. Personally not convinced that prevention is really possible with the types of individual-focused programs we have today, I would argue that identifying risk factors may at least help us determine which individuals should be screened in subsequent years. If they do develop eating disorders, they will hopefully be more likely to receive early intervention and treatment.

To identify predictors of eating disorder symptoms, Elizabeth Evans and colleagues (2016) conducted a longitudinal study that measured various putative risk factors at ages 7, 9, and 12 in a group of boys and girls. The authors also wanted to identify correlates of eating disorder symptoms at 12 years of age. They measured eating attitudes and dietary restraint, BMI, body dissatisfaction, and depressive symptoms.
THE STUDY

516 participants; 262 girls and 254 boys

all individuals were residents of Gateshead, located

... Continue reading →

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Please excuse me while I nerd out all over your computer screen. I recently turned a corner on my appreciation of the value of quantitative social science, having taken a structural equation modelling class last winter, and today I'm going to share a little of that with you.

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According to the National Institute of Mental Health, the estimated death rate for anorexia nervosa was around 1 in 10.

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By Thomas Insel on

What is the most fatal mental disorder? The answer, which may surprise you, is anorexia nervosa. It has an estimated mortality rate of around 10 percent. What is the cause of this high rate of mortality? The answer is complicated. While many young women and men with this disorder die from starvation and metabolic collapse, others die of suicide, which is much more common in women with anorexia than most other mental disorders.

The last week of February is National Eating Disorders Awareness Week. Eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. We often hear about the epidemic of obesity and the health consequences of over-eating, but the perils of anorexia and bulimia are less recognized. Here are some little known facts about eating disorders, all gleaned from NIMH-funded research.

First, the demographics of eating disorders may be changing. The National Co-Morbidity Study-Replication, an NIMH-funded population-based epidemiologic study from a decade ago, struggled with estimating the prevalence of eating disorders because the researchers found that many respondents were reluctant to admit to these syndromes during a structured interview. Nevertheless, the study reported that these disorders are more common in women. The lifetime rate for anorexia nervosa among women was estimated at 0.9 percent compared to 0.3 percent among men. The lifetime rate among women for bulimia nervosa was 0.5 percent compared to 0.1 percent among men. And the lifetime rate among women for binge eating disorder was 3.5 compared to 2 percent among men. Almost certainly, these numbers are under-estimates. We have seen hospitalization rates for eating disorders continue to rise, increasing 18 percent between 1999 and 2006. In addition, contrary to the traditional stereotype that eating disorders mostly affect white upper middle class females, the ethnic makeup of those contending with eating disorders may be changing. On a recent trip to China, when I asked mental health officials about their number one concern, in both Beijing and Shanghai, I heard about anorexia nervosa.

Second, the treatments for eating disorders are changing. Traditionally, anorexia in adolescents has been viewed as a "family systems" problem requiring a "parentectomy" - exclusion of the parents or caregivers from the teen's treatment plan. But research at the Maudsley Hospital in London, which was replicated in the United States by Le Grange and Lock, has shown that outcomes appear much better if parents are empowered and included, rather than excluded, from the treatment. In fact, a carefully controlled trial evaluating the effectiveness of a family-based treatment approach found 50 percent of participants continued to experience full remission one year after the end of therapy. Whether this same approach will work for older patients is not clear, but research is currently underway that incorporates families in the treatment of adults with anorexia. The proof of principle is important: family involvement can be critical for recovery.

While it is encouraging to have new and effective treatments, we continue to hear from families with a teenager who has received insurance coverage for intensive care for a metabolic crisis, but could not get coverage for the underlying eating disorder. There may be no other area of mental health care with such an obvious injustice. Imagine a teenager with leukemia receiving antibiotics for an infection but not receiving treatment for the cancer. While the dynamic duo of mental health parity and health reform may lead to a solution, coverage of treatment for eating disorders will ultimately differ by state. That is all the more reason to remember - at least one week of the year - that eating disorders are serious, sometimes fatal, disorders.

References

i Arcelus J, et al. Mortality rates in patients with anorexia nervosa and other eating disorders. Archives of General Psychiatry, 68(7):724-731.
iiHudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 2007; 61:348-58.
iiiZhao, Y., and Encinosa, W. Hospitalizations for Eating Disorders from 1999 to 2006. HCUP Statistical Brief #70. April 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb70.pdf
ivLock J and Le Grange D. Family-based treatment of eating disorders. International Journal of Eating Disorders. 2005;37 Suppl:S64-7.
v Lock J et al. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry. 2010 Oct. 67(10):1025-1032.

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By Thomas Insel on What is the most fatal mental disorder? The answer, which may surprise you, is anorexia nervosa. It has an estimated mortality rate of around 10 percent. What is the cause of this high rate of mortality? The answer is complicated.