Sunday Smorgasbord

Your weekly assortment of unusual nibbles from around the web and various research journals. This week's selections were unusually eclectic, so I hope you enjoy!


I've blogged before about the TED Talks, and this fall, there is going to be a second TEDMED, a four-day series of TED talks on all aspects of health and well-being. I've never listened to a TED talk and not been at least marginally intrigued, so I'm especially keen to listen to these talks. The 2009 speakers are currently up, although the 2010 speakers haven't been announced yet. One of my life fantasies is being asked to do a TED Talk and you, my dear readers, would be the first to know if I ever got asked (hint, hint...Universe...are you listening?).

Strep today, anxiety tomorrow?

It sounds almost sci-fi in its wackiness- a common bacteria can trigger a serious mental illness. Yet over the years, evidence has been growing that a particular subset of pediatric Obsessive-Compulsive Disorder (OCD) patients may have had their illness triggered by an infection with Streptococcus. Known as PANDAS (pediatric autoimmune neuropsychiatric disorders associated with strep), the diagnosis is still rather controversial, although one PANDAS researcher estimates that approximately 25% of all pediatric OCD and Tourette's syndrome patients may in fact have PANDAS. Scientific American Mind does a good job of introducing the subject:

In the 1980s Susan Swedo, a pediatrician at the National Institute of Mental Health, came across several cases of children who seemed to have developed tics and behaviors resembling OCD, such as excessive hand washing, overnight. Swedo noticed that the children in all the cases had recently recovered from strep throat. The traditional strep symptoms were gone, but when she did laboratory tests, Swedo found the children’s blood still contained high levels of strep antibodies. Perhaps most compelling, the symptoms seemed to abate after renewed treatment with antibiotics. Swedo became convinced that the symptoms were the result of an overactive immune response to strep bacteria.

These strep bacteria have long been known to trigger auto-immune conditions, such as rheumatic fever. Evolution and natural selection have given the bacterial antigens similar shapes to human antigens to confuse the immune system (the body is supposed to destroy any of its antibodies that react to "self" antigens). But this doesn't always work 100%, and the same antibodies that help the body fight off strep infection can then attack the body itself. In rheumatic fever, the body's immune system attacks the heart. In PANDAS, the immune system is thought to attack the basal ganglia, which leads to the abrupt development of OCD symptoms and tics.

Cognitive Behavioral Therapy is still the treatment of choice for OCD, but people with suspected PANDAS also show a reduction of symptoms with a low dose of penicillin. A recent study in mice appeared to replicate the strep antibody response seen in human that is thought to cause PANDAS, which may lead to a better understanding of what causes PANDAS and how to best treat it.

Interestingly, PANDAS has also been tentatively (very tentatively, I might add) associated with anorexia, especially in younger children. There have been very few research papers published on the subject (a PubMed search of "PANDAS anorexia" only turned up three), and it's been known to make some clinicians and researchers twitch a little bit. To be sure, the evidence isn't great, but I also think we would be doing everyone a disservice by not looking into it.

Startle as an objective measure of distress related to teasing and body image

Though not exactly rocket science (people who were teased about their appearance had a more negative reaction to pictures of themselves morphed to look heavier), this study, published ahead of print in the International Journal of Eating Disorders, did have some interesting results.

From the abstract:

All participants, regardless of teasing history, self-reported that the photo morphed to look heaviest was more unpleasant than the neutral photo. When assessed by the affect modulated startle paradigm, a significant teasing history by photo interaction was found between the neutral and morphed to look heaviest photos and the neutral and morphed to look smallest photo. Those with a teasing history had greater startle response to the morphed images in comparison to the neutral images than did those without a teasing history. College-aged women with weight-related teasing histories may have negative emotional reactions to personally relevant body image cues, as measured by the startle reflex, even when they subjectively report no distress. Objective measures, such as the startle reflex should be considered when assessing emotional reactions to body image cues.

Assessing startle reflex could be an interesting and innovative way to try and measure people's body image on a visual, rather than verbal, level. I'd be curious to see what my results were, since I, too, have a history of being teased about my weight.

The surprising reason why being overweight isn't healthy

CNN had a fantastic article earlier this week about the real reason fat may be so (seemingly) unhealthy. It's not ZOMG TEH FATZ! but rather discrimination against people who are fat. Thus says CNN:

A recent Yale study suggested that weight bias can start when a woman is as little as 13 pounds over her highest healthy weight. "Our culture has enormous negativity toward overweight people, and doctors aren't immune," says Harvard Medical School professor Dr. Jerome Groopman, M.D., author of "How Doctors Think." "If doctors have negative feelings toward patients, they're more dismissive, they're less patient, and it can cloud their judgment, making them prone to diagnostic errors."

The story describes a larger women who went to the doctor's office with an asthma flare-up. Instead of discussing her breathing, she got a lecture on her weight. Because we all know how easy it is to exercise when you can't freaking breathe. Hypoxic is the new black, right?

Seelaus's nurse made a classic diagnostic error, according to Groopman. "It's called attribution, because your thinking is colored by a stereotype and you attribute the entire clinical picture to that stereo­type. Because obesity can cause so many health problems, it's very easy to blame a variety of complaints, from knee pain to breathing troubles, on a patient's weight. That's why doctors -- and patients -- need to constantly ask, 'What else could this be?' "

There aren't statistics on how many diagnostic errors are due to weight, but the data for the general population is disturbing enough. "Doctors make mistakes in diagnosing 10 to 15 percent of all patients, and in half of those cases it causes real harm," Groopman says. Based on anecdotal evidence -- patients who've told her that their doctors are often too quick to blame symptoms on weight -- Rebecca Puhl, Ph.D., director of Research and Weight Stigma Initiatives at the Rudd Center for Food Policy and Obesity at Yale University, suspects that being heavy could further increase the odds of being misdiagnosed.

Of course, the article did have some smashingly ignorant quotes, such as "Whether they know it or not, doctors' attitudes may actually encourage unhealthy behavior. Feeling dissed about their weight can make some women turn to food for comfort. "Stigma is a form of stress, and many obese women cope by eating or refusing to diet," Puhl says. "So weight bias could actually fuel obesity." "

Except for the teensy little fact that DIETS DON'T WORK. Also, since when is discrimination against fat people surprising? It's been around for quite some time, and anyone who is even a few pounds heavier than what our culture deems acceptable knows damn well the differences in how people get treated.

Still, it brought attention to the issue, which is the first step. Just do NOT, for any reason, read the comments. They will make you crazy.

Thus concludes this week's smorgasbord. Join me next week for some new findings!

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Jane said...

Your smorgasboard is always so fun to read!

Katie said...

I've always been intrigued by the link between strep and OCD. I've had OCD and a tic disorder since I was very young, and have always wondered if that could have happened to me. I didn't go through anything traumatic until I was 18 and no one else in my family has full blown OCD or any tics. It's an interesting read anyway :)

It was sad to read about the woman whose asthma was misdiagnosed - I might have never been overweight but I know how that feels, I've had many physical problems attributed to my mental health history before. It's the same thing really, people take one look at you (or your medical history, as the case may be) and make their minds up before you open your mouth. I guess it's human nature to make snap judgements, but it's wrong to take opinion as fact and unprofessional to let that bleed into treatment of patients.

Thanks Carrie!

Amy said...

Haha, you want to *give* a TED talk, I just want to *go* to the TED conference. Now where did I put that spare six grand...

Jenna said...

I just came across your blog and I love reading it! I can't wait to continue to follow it!
I would love it if you could check out my blog and follow as well :)

Cathy (UK) said...

Like Katie (above) I've also had OCD and a tic disorder (and in addition, an ASD) from being a very young child - and then I started with anorexia nervosa at age 11 yrs. But even pre-AN I had many difficulties around eating, food choices, food rituals, emetophobia etc. As a baby I also had continual respiratory tract infections that could not be treated with penicillin due to an allergy.

For all of the above reasons the PANDAS data interest me.

Having said that, we have a family history of anxiety disorders and ASDs, so my 'issues' may be largely inherent.

I will decline to comment on the body image study because I have something of an aversion to body image research...

I feel very sorry for people whose physical health problems are automatically attributed to their weight - be their weight be too high or too low. I had illnesses while anorexic which were initially attributed to my anorexia nervosa, but later found to be totally independent of it...

Carrie Arnold said...


I don't know if you can get this book in the UK, but it was mentioned in the CNN story called "How Doctors Think" by Jerome Groopman. It was fascinating, and I think you might like it.


You raise a very good point, that illness misattribution due to weight can go in both directions. Then there's the opposite of that, where illnesses are secondary to the eating disorder but some doctors don't think that the two conditions are related. Sigh.

Mallory said...

I love the DIETS DONT WORK! it is so so true i hope all peoplecome to realize that simple fact one day. an overweight body is just as malnourshed as an underweight one.

Jenna said...

I just came across your blog the other day and I really enjoy reading it!!
I would love it if you could check out my blog and follow as well :)

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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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