Treatment Notes

Feeding Disorders

Are feeding disorders the same thing as eating disorders?

Psychological Treatments of Binge Eating Disorder

The January, 2010 issue of Archives of General Psychiatry includes a study that may be of interest, entitled "Psychological Treatments of Binge Eating Disorder."

The abstract is reprinted here, and the article can be acessed on the journal's website with a subscription.

Is BMI a Trustworthy Tool?

There continues to be much dialog about the usefulness and merit of the Body Mass Index (BMI) as a tool for screening and diagnosis of eating disorders. For example, there is current discussion underway about routinely monitoring BMI among patients diagnosed with a psychiatric illness. 

Today, my colleague and friend, Margarita Tartakovsky, MS, offers a very informative guest blog piece about BMI for our learning. Margarita is a writer/blogger for Psych Central and authors very helpful articles about body image and eating disorder issues. Thanks to Margarita for sharing her guest post with us today.

Athletes and Anorexia Nervosa: An Elite Athlete's Story

On the heels of my last post, which featured guest Blogger Patrick Bergstrom sharing about his experience as a male athlete with anorexia nervosa, we have another athlete's story for us today.

Lynn Bjorklund, an elite, record-setting distance runner who writes of her journey in my book, 100 Questions and Answers about Anorexia Nervosa, joined me on a radio broadcast a few weeks ago. The Dr. Casey Show on AM830 in Los Angeles is a sport psychology program and Dr. Casey dedicated the morning hour in November to the topic of eating disorders in athletes.

You can listen to the entire broadcast with Dr. Casey, Dr. Sari Shepphird and Lynn Bjorklund here... (just give the file a few moments to download...)

Dr Casey Show 11_15_2009_ AM830 KLAA

After the broadcast concluded, Lynn and I had a conversation about what she wished she would have shared had the nervousness of her first radio appearance not been a distraction to her. With gratitude to Lynn, she shares her "afterthoughts" with you here, and I am sure you will agree that they are an eloquent, powerful, and helpful account of her journey. 

Male Eating Disorders, Part 5: the "Iron Man" Who Chose to Live

Rounding out our brief look at male eating disorders (at least for now), I am pleased to share a guest Post today, written by Patrick Bergstrom. Patrick shares a must-read Post that is eye-opening, educating, and inspiring. 

Thanks to Patrick for his efforts to dispel the myths of "female only" eating disorders, for his work with althetes and EDs, and for his continued support of eating disorders recovery.

Male Eating Disorders, Part 4: Media Influence

I am sure that few of you escaped the recent headlines about Kate Moss and her stated motto, "Nothing tastes as good as skinny feels", an oft-repeated slogan by those in the Pro-Ana and Pro-Mia movements (see Treatment Notes dated May 14, 2008).

Experts and non-experts alike have long debated the media's influence on eating disorders. Recent research has highlighted the affect that media can have on body image and disordered eating behaviors.

However, the focus on the effect of media on male body image and eating disorders is far less prevalent.

Males and Eating Disorders Part 3: Gender stereotyping?

Are eating disorders "just a female problem?"

Studies say "no", and eating disorder professionals know that to be true, but many factors nevertheless leave many cases of eating disorders undiagnosed in many males.

Factor One: Diagnostic Criteria

While eating disorder professionals believe that anorexia is under-diagnosed in both genders, certain diagnostic considerations may make this of particular concern for males. For example, the DSM-IV-TR diagnostic criteria for anorexia includes amenorrhea, which is, of course, a strictly female concern (the
ICD-10does include a male gender counterpart criterion of abnormal gonadotropin functioning).

As simple as it sounds, this may be one reason why healthcare professionals are less accustomed to
suspecting anorexia in their male patients. Regardless, the danger is that some doctors may overlook, ignore, or misdiagnose male patients with this disorder.

Factor Two: Socialization

Leigh Cohn, author of Making Weight: Men's conflicts with food, weight, shape, and appearance, along with other noted specialists, suggest that some men with disordered eating behaviors may be unaware that they have an eating disorder, viewing symptoms such as excessive exercise and body shape concerns as just “a guy thing.” When does "working out hard" become a problem of disordered eating for men? is the standard different for men than for women?

Studies do highlight some differences in males versus female eating disorder symptoms. For example,  research shows that men are more likely to engage in excessive exercise and less likely to engage in self-induced vomiting, use laxatives, or take diet pills to achieve desired weight loss.

Factor Three: Gender stereotyping

As much as we might like to think otherwise, gender stereotyping (e.g., regarding anorexia nervosa as a “female” condition) may be the root of what invariably is the underdiagnosis of eating disorders in males and which also causes some males to refrain from seeking treatment. And unfortunately, when men and boys do seek treatment, they find that there are far fewer residential treatment programs available to men than to women.

Some co-ed programs do offer specially designed treatment “tracks” that address uniquely male concerns, but there is a need for many more such programs. Consequently, males with eating disorders often report feeling isolated in treatment support groups composed of predominantly female patients.

Nevertheless, the course of treatment for males is similar to treatment for female patients and generally has the same rates of efficacy. We have been making strides in recent years toward improving
the diagnosis and treatment of males with eating disorders, and this is indeed promising.

Source: Shepphird (2010). 100 Questions and Answers about Anorexia Nervosa. Sudbury, MA: Jones & Bartlett Publishers.

If you have a question or topic you would like to see addressed in this Blog, go to

http://www.drshepp.com, or e-mail mail@drshepp.com, or send your question via Twitter to www.twitter.com/drshepp

Male Eating Disorders Part II: Male Subgroups and Eating Disorder Risk

Just as is true of females with eating disorders, there appear to be certain subgroups who are at higher risk for developing eating disorders.

For example, athletes whose weight is a factor in their performance are an especially vulnerable group.

Wrestlers, jockeys, runners, male gymnasts, and male dancers have a higher reported rate of eating disordered behavior than in the general population, due in part to beliefs and practices that see weight loss is a necessary requirement for peak athletic performance in their sports.

In addition, higher rates of eating disorders have also been reported in homosexual and bisexual males, with incidence reports as high as 20%. Other studies, however, have found no relationship between homosexuality and eating disorders, so the association remains in question.

Researchers also caution that there is nothing about homosexuality itself that increases the likelihood of developing an eating disorder. Instead, higher prevalence rates may be attributed to stereotypes
of physical attractiveness within the gay community and to increased help-seeking behaviors among gay males.

Another male subgroup that appears to be at greater risk is professional males where their appearance is influential, namely actors and male models.

Male subgroups with eating disorders face the same risk factors for developing EDs, including genetic, biological, social, cultural, psychological factors described in other Treatment Notes postings. Unhealthy diet behaviors and a history of weight issues place both females and males at greater risk.

Stay tuned for more posts in this series...

Source: Shepphird (2010). 100 Questions and Answers about Anorexia Nervosa. Sudbury, MA: Jones & Bartlett Publishers.

Male Eating Disorders - Do Boys and Men Get Eating Disorders?

It is still surprising to me the degree to which eating disorders are considered solely a female issue.

Processed Foods and Depression

This morning the BBC News released on article providing additional coverage of the British Journal of Psychiatry study: "Depression link to processed food."  Very interesting findings, with important implications for clinical interventions, especially for patients with co-occuring mood disorders...