Sunday Smorgasbord

It's that time of week again- your Sunday Smorgasbord! As there has been actual research published this week, I am going to focus more on research-y ED stuff.

Nutrition knowledge in young women with eating disorders in Australia and Singapore

The results of this study were pretty self-explanatory, so I'll let the abstract do the talking.

Women with EDs had greater knowledge than controls, but the magnitude of the difference was small. Greater acculturation to Western culture was associated with greater knowledge. CONCLUSIONS: The difference in nutrition knowledge between women with and without EDs is unlikely to be of clinical importance. The findings may reflect today's ubiquitous availability of nutrition information.

In ED treatment, nutrition education is considered an important part of treatment. And the dietician that I saw for years was one of the most helpful people on my team. I adore this woman and keep in contact with her even though I'm no longer formally her patient. So I'll be the first to admit that a dietician can be an important part of a treatment team. But my RD didn't so much provide nutrition education (such as here is what 2 oz. of meat looks like, this is a glass of milk, here are how many calories/fat grams/etc you need) as much as she first designed a meal plan to help me gain back to a healthy weight and worked with me on the best ways to split up meals and snacks, and then she helped me work through my fear of food. This study confirms that it's not that people with EDs are less knowledgeable about food--my mom told me I could write the book on nutrition, but I just need to read the darn thing!--but that their fears get in the way of eating properly. And an RD can be helpful in working with specific food-related fears.

One-third of psychiatric inpatients who self-harm also have eating disorders

This study was from the French journal Encephale, and so I once again will have to restrict myself to the abstract. However, the results are interesting. The psychiatrists did a survey of 30 psychiatric inpatients who were hospitalized and had self-harming behaviors, although they didn't mention whether self-harm was the reason they were admitted. Among these 30 inpatients (admittedly, a very small sample), they found that 33% had an eating disorder, and among these 50% had the restrictive subtype of anorexia.

Needless to say, self-harm and EDs seem to co-exist rather strongly, although it still remains unclear why there is an overlap in symptoms, and how related these two illnesses are.

Symptoms of psychosis in anorexia and bulimia nervosa

Many of the symptoms of an eating disorder can seem to be almost psychotic in nature. I for once was convinced the entire universe was conspiring to make me fat, and right when I was first diagnosed I refused to take any medication because I thought it was some grand scheme cooked up by my treatment team to get me fat. There were others: at one point, I thought water would make me gain weight, or that I could see my stomach getting larger before my eyes. Clearly, these were not based on reality, and starvation psychosis has been reported over the years in both prisoners of war and in obese patients put on starvation diets. From a study, titled "Follow-Up of Patients Starved for Obesity":

"[Patient No. 15] developed a paranoid psychosis during starvation, left the hospital against advice and since discharge his only communication has been an indignant, accusatory letter to the chief metabolic investigator."

(Can't say I blame Patient No. 15!)

I couldn't find much data on the overlap between schizophrenia and EDs, but it appears that most psychosis seen in people with acute eating disorders is due to malnutrition rather than a separate illness. From the study's abstract:

Compared with controls, the patients with anorexia nervosa were more likely to endorse the item "Never feeling close to another person"; the patients with bulimia nervosa were more likely to endorse the item "Feeling others are to blame for your troubles". Both groups of patients were more likely than controls to endorse the item "Idea that something is wrong with your mind". The students who were identified by the EAT and the BITE as being "at risk" for eating disorders were more likely to assign their body a causative role in their problems. Symptoms of psychosis can be observed in patients with eating disorders, but these could be better explained within the psychopathology of the disorders rather than by assuming a link with schizophrenia.

Prevalence and Factors Related to Substance Use among Adolescents with Eating Disorders

This study wasn't particularly fascinating or earth-shattering, but it did make the recommendation that all people with eating disorders should be formally screened for substance abuse problems.

And thus ends your smorgasbord for this week. I'll be back next week with more delightful little morsels for you to sample!

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Telstaar said...

With the first study, I was one of the participants in that. They had the ability to split up the analysis into those who treated ed patients and those who did not (and those who treated ed clients who themselves had an ed etc)... I wonder if they didn't get enough crazy people like myself who both had an ed and has (previously) treated people with ed's undertaking the survey? I would've loved to have seen those results because I think a lot of damage can come from the non-RD professionals taking on the RD role. I know I was forced into that role a number of times as a clinician but had done my training under an RD (who ironically is currently whom I see for my own ed)... Anyway... I hope they had enough power in their study to do that analysis because I am interested in the results hehe.

All of that aside, I agree that often its not about the knowledge of the RD per se, but rather the RD providing a sort of safety net and a space to talk about the dreaded issues of food and weight, to provide someone who will help see reason when really all the sufferer wants to do is argue that x calories is perfectly sufficient for human life, when it completely isn't.

I'm gonna shut up now!! :D

Cathy (UK) said...

Great post as usual Carrie...

Here are some comments:

1. Nutrition Knowledge

I became an 'expert' on this - as do many people with EDs. However, when I was referred 4 years ago to the psychiatrist who has really helped me A LOT with recovery, I specifically stated to him that I didn't want to talk about food, diet, weight or body image. After 28 yrs of anorexia nervosa (AN) I knew that any focus on these issues were just symptoms of my generally obsessive, perfectistic, anxious (and starved) mind. Obviously I needed to gain weight - because I was 45 pounds underweight, and I knew that some of my food obsessions were linked to starvation, but I wanted to focus on other underlying causes which had created difficulties throughout my life - i.e. pre-AN. These included abuse and bullying (by people outside of my family). I subsequently learned I have an ASD, which contributed significantly to the development and maintenance of my ED.

2. Self-harm

Interesting that 50% of patients had the restricting type of AN, as I did... Many studies have shown that self harm is more common in bulimia and b/p AN. I did self harm through cutting for a few months as an 11-yr old, pre-AN, but this has not been a longstanding problem. Compulsive exercise 'worked' better in relieving tension and over-whelming thoughts/feelings.

3. Psychosis

I think it's pretty much a result of starvation. I also became convinced that my parents and doctors were turning against me when I was a teen with very low weight AN. I didn't recognise that I was sick, and even when I did recognise it, I was too scared to let go of my anorexic behaviours.

4. Substance abuse

This is not something I have struggled with. I don't smoke, I rarely drink alcohol and I am aversed even to taking a simple painkiller.

Katie said...

Wow, this is an interesting set of studies!

I would be really interested to learn the outcome of research into not ED sufferer's knowledge of nutrition, but their beliefs about it. I know many people with EDs who can reel off information on healthy eating, but the same person might be just as convinced that they personally only need a fraction of the average intake to gain weight. I am in my mid 20s and supposedly intelligent, but I was adament at the worst of my illness that an extra 16kcal corn thin would make me gain 5lbs overnight! I was shocked by how many calories it took for me to gain consistently too. I think dieticians can be really helpful in reassuring patients and re-educating them, because there is a lot of conflicting information out there, and what is healthy for the average person might be harmful for an anorexic.

I have had problems with both self harm and psychosis. Self harming induced the same sort of feeling that restriction did - kind of a numb trance-like state. I haven't done it for two years, but it has the same addictive quality to it as well. As for the psychosis, that has only been present during times when I was under extreme emotional stress, but as far as I can remember I wasn't underweight any of those times. Psychosis can also be an atypical symptom of depression and it occurs frequently and trasiently in PTSD. People with eating disorders often have comorbid conditions such as these, so I wonder if the researchers distinguished whether the psychosis was due to malnourishment or another illness? If people with eating disorders are deemed psychotic due to their body image issues, people with depression could be argued to be psychotic for their common conviction that they are worthless, or people with OCD for believing that something terrible will happen if they don't *insert ritual here*. If the label of psychosis can be applied to people with eating disorders, you could make a case for psychosis in all mental illnesses. I don't know how helpful that is really, although maybe it would stop the general public believing that eating disorders are willful choices.

Mike Hunt said...

I really think they are putting the cart before the horse. The clinical and diagnostic void that exits is helping to perpetuate a ton of misinformation and junk science.

I have two friend who are REBT therapists and I was asking them about how they deal with things like PMS and PMDD and both of them said, "women are all over the place." The point being, organicity is part of the equation. Women are 3 times more likely than me to be diagnosed with depression and 4 times more likely to be diagnosed with anxiety or a panic disorder. I don't think we are looking at the big picture.

Back in the late 80's there was this wack job feminist and therapist Janet Greeson PhD (Piled higher and Deeper) who wrote a book titled It's Not What You're Eating It's What's Eating You. In it she blamed men for why women get fat. What she didn't or didn't tell her readers is that there are more fat men than women. Even today women buy and prepare food so it would be more logical to conclude that women are making everyone fat. I blame women! How's that for binary thinking? We are using the same myopic approach to this thing called ED. We have thrown out the scientific method and replaced it with conjecture and theory. Why not look at it form a neuro-scientific perspective and compare some brain scans?

Did you know that they shrinks have cooked up a new disorder called Orthorexia Nervosa? It's true. I must have it because I am quite vigilant about not putting slop in my body. In fact I am so sick with Orthorexia that I think most of the "food" sold in super markets is unfit for human consumption. I make a point to eat fresh fruits and vegetable often and I avoid processed food most of the time. HELP ME! I have and ED. QUICK GET ME SOME MSG and some Aspertame!

There is a myth that fat women suffer from something called "low self esteem" (the concept of self esteem is a myth but that is a whole other topic) when the data suggest that fat women have higher "self esteem" (it's really ego-centrism) than lean women.

My theory is simple. Food is a reward and the yummier the food is the greater the reward. Rewards are usually given from one person to another. Treats generally are rare. Rewards are given for something extraordinary. You don't reward your kids for cleaning their room but you may reward them for making the honor roll. Fat people are constantly reward themselves with their favorite kibble for no good reason. Eventually they live to eat. Would it then follow that a person who feels unworthy would not want to eat to live?

The survivors of the holocaust could not eat after they were rescued. They were like zombies. With them it was not psychological. It was organic. In the case of some anas I think it starts as OCD and then organicity takes over due to malnutrition. There is probably triggers like hyper vigilance and inhibition which also may have some organic genesis. I think REBT would be a helpful adjunct to nutritional therapy.

Fatlings are happy go lucky and disinhibited for the most part. I base this on the fact that fat women are far more promiscuous than lean ones. You don't believe me. Do an unfilterd Google image search with terms like Fat, Obese,
Plump, BBW, SSBBW Fat Woman. Then do a search using the terms: Lean, Skinny, Fit Woman, Waifish.

Then go to google Italia. Italy is known for its great food yet it is the leanest country in Europe. If you use Italian words in Google Image you will not find any fat porno. A big part of the food related stuff is cultural. We are a food centric culture that is fueled by our decadent consumerism. We truly are ugly Americans.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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