I don't usually do a smorgasbord on Saturday; however, this week had a number of interesting little tidbits that were worth mentioning, so I'm putting together two different smorgasbords for all of you. There's the Saturday "Early Edition," and I will have something for you tomorrow as well.

And, onto the smorgasbord!

Recovery-based care in specialist mental health services

Eating disorders have much talk related to recovery, similar to addictive and other disorders. This recovery approach to mental health care has been expanding to encompass mental health issues in general, rather than just EDs and chemical dependency. The organization Rethink has defined the recovery approach as:

Recovery can be defined as a personal process of tackling the adverse impact of experiencing mental health problems, despite their continuing or long-term presence. Used in this sense, recovery does not mean "cure".

Recovery is about people seeing themselves as capable of recovery rather than as passive recipients of professional interventions. The personal accounts of recovery suggest that much personal recovery happens without (or in some cases in spite of) professional help.

Recovery involves personal development and change, including acceptance there are problems to face, a sense of involvement and control over one's life, the cultivation of hope and using the support from others, including collaborating in solution-focused work with informal carers and professional workers.

A new study explored the meaning of 'recovery' with different groups of patients and found many similarities and some subtle differences in people with different mental health issues (including EDs):

The relevance of themes identified in mainstream recovery literature was confirmed; however, the interpretation and relative weight of these themes appeared to be affected by factors that were specific to the diagnosis and treatment context. 'Clinical' recovery themes were also seen as important, as were aspects of care that reflect core human values, such as kindness.

Eating disorder symptoms improved by antireflux surgery: a case report with a six-year follow up

Although this study is only a case report (i.e., an explanation of how a single patient was medically treated) and therefore isn't as reliable as a larger, randomized study, it still struck me as interesting and promising. Gastrointestinal issues are overwhelmingly common in eating disorders. GERD (Gastroesophageal Reflux Disease) is very common in EDs, and many of the symptoms of GERD and other GI complaints by people with eating disorders have a significant degree of overlap. Besides reflux, delayed gastric emptying (gastroparesis) is one of the other major complaints.

These GI issues can make recovery much more difficult, or even inhibit it altogether, so the use of anti-reflux surgery may be an additional option for people who have exhausted other forms of treatment and have significant GI issues due to the eating disorder.

Emotion recognition and alexithymia in females with non-clinical disordered eating

Previous research has found links between eating disorders and difficulty recognizing emotion and difficulty identifying and expressing emotion (alexithymia). This study looked at emotion recognition and expression in people with disordered eating who did not meet the DSM criteria for an eating disorder to see whether or not these difficulties with emotions were associated only with clinical eating disorders, and "establish if other psychopathological and personality factors contributed to, or accounted for, these deficits."

The researchers split the disordered eaters into two groups based on scores on the Eating Disorder Inventory, a simple high/low split. They were assessed both on their ability to recognize emotion on a videotaped discussion and on several self-report measures. The researchers found that

"Relative to the low EDI group, high EDI participants exhibited a general deficit in recognition of emotion, which was related to their scores on the alexithymia measure and the bulimia subscale of the EDI. They also exhibited a specific deficit in the recognition of anger, which was related to their scores on the body dissatisfaction subscale of the EDI. CONCLUSIONS: In line with clinical eating disorders, non-clinical disordered eating is associated with emotion recognition deficits. However, the nature of these deficits appears to be dependent upon the type of eating psychopathology and the degree of co-morbid alexithymia."

It would be interesting to see a long-term study to evaluate whether alexithymia was related to the degree to which people with disordered eating progressed into full-blown eating disorders. It also strikes me as an interesting point for secondary prevention efforts to prevent disordered eating from becoming an eating disorder. How eating disorders and alexithymia are related I can't say, although it does appear that emotion recognition improves with recovery.

Ghrelin may explain why some people eat even when full

I've blogged about ghrelin many times here at ED Bites, but a (very) brief introduction can be made by referring to ghrelin as the Hunger Hormone. High levels of ghrelin mean you're hungry; low levels mean you're not. Or so the system is thought to work. Researchers published a new report in Biological Psychiatry shows that our brains can prompt us to eat even when we're not hungry. From a press release:

“What we show is that there may be situations where we are driven to seek out and eat very rewarding foods, even if we’re full, for no other reason than our brain tells us to,” said Dr. Jeffrey Zigman...Scientists previously have linked increased levels of ghrelin to intensifying the rewarding or pleasurable feelings one gets from cocaine or alcohol. Dr. Zigman said his team speculated that ghrelin might also increase specific rewarding aspects of eating.

{snip}

For this study, the researchers conducted two standard behavioral tests. In the first, they evaluated whether mice that were fully sated preferred a room where they had previously found high-fat food over one that had only offered regular bland chow. They found that when mice in this situation were administered ghrelin, they strongly preferred the room that had been paired with the high-fat diet. Mice without ghrelin showed no preference.

“We think the ghrelin prompted the mice to pursue the high-fat chow because they remembered how much they enjoyed it,” Dr. Perello said. “It didn’t matter that the room was now empty; they still associated it with something pleasurable.”

The researchers also found that blocking the action of ghrelin, which is normally secreted into the bloodstream upon fasting or caloric restriction, prevented the mice from spending as much time in the room they associated with the high-fat food.

For the second test, the team observed how long mice would continue to poke their noses into a hole in order to receive a pellet of high-fat food. “The animals that didn’t receive ghrelin gave up much sooner than the ones that did receive ghrelin,” Dr. Zigman said.

The fact that people eat when they're not hungry is hardly news; what I find interesting is the identification of ghrelin as a key player. Traditionally, dopamine is thought to be the Pleasure Chemical, so the introduction of another hormone may help us better figure out the relationship between hunger and satiety.

Stay tuned for an extra smorgasbord tomorrow!