Treatment Notes

More on Adult Anorexia Nervosa

I have written a few pieces before about adult anorexia and recently did an interview with More magazine (for women over age 40) on the subject that I think should be appearing soon. It is such an important topic and older women certainly struggle with anorexia in silence. 

But breaking some of that silence this week is an article to which I'd like to draw your attention:" Adult anorexia: the forgotten tragedy of lives lost to illness", which ran in the Sydney Morning Herald.

Here's a quote: ''People who fall into this particular category are not in treatment because they are too scared to seek help - because getting better means putting on weight." And you can read the full article at the link below.

Mentioned in the article are two of my esteemed colleagues, June Alexander and Christine Morgan, chief executive of the highly esteemed Butterfly Foundation. Check out their great website here: http://www.thebutterflyfoundation.org.au/

And here is the link to the full article heralding from Australia.

For more about adult anorexia nervosa as well as both the hope and the challenges of treating this illness, feel free to check out my book, "100 Questions and Answers about Anorexia Nervosa".

What Worked for You?

There has been an interesting discussion taking place among my colleagues recently about what to say to those with eating disorders who do not see the need for treatment or who do not think their eating disorder is severe enough to raise concerns. It is a long-standing issue with eating disorders, as there are far more who never seek treatment than those that do. Some studies indicate that as few of 9% of people with bulimia in community sample ever seek treatment for their illness!

So, I thought I would open the question to you...

If you have been in treatment for an eating disorder but originally resisted getting help, what worked for you? What was it that helped to convince you that getting some help would really help?

Feel free to post a comment, even anonymously, or if you prefer, e-mail me back-channel at mail@drshepp.com and I would be happy to summarize your response for you and post it to this Blog, again anonymous responses are welcome too!

Best wishes,

Sari Shepphird

Proposed Changes to Eating Disorders Diagnoses

The American Psychiatric Association has released a draft of their proposed changes to the Diagnostic and Statistical Manual of Mental Disorders, the standard used in the United States for diagnosing mental illness, including eating disorders.

The proposed changes for the forthcoming version (DSM-V) include the recognition of Binge Eating Disorder as a unique diagnosis. In the current edition (DSM-IV-TR), Binge Eating Disorder is included as a Criteria Set for Further Study in the Appendix of the manual and is not given its own diagnosis, but is rather included under the broader catch-all category of "Eating Disorder: Not otherwise specified"

Proposed changes to the diagnostic criteria for Anorexia Nervosa include the omission of the criteria of amenorrhea and the omission of the word "refusal" with regard to maintaining a normal weight, as the term can be potentially pejorative.

Proposed changes to the diagnostic criteria for Bulimia Nervosa include reducing the required minimum frequency of binge episodes from at least twice per week to a minimum of once per week.

The diagnostic category of Eating Disorder, not otherwise specified would still be included in the updated version of the DSM, with updated descriptions.

In addition, it has been proposed that the diagnostic category "Eating Disorders" be changed to "Eating  and Feeding Disorders" so that Feeding Disorders such as Pica and Rumination Disorder and the more commonly known eating disorders be included in the same diagnostic category (see Treatment Notes dated 02-04-10 for a discussion of Feeding Disorders).

For a more complete discussion of the proposed changes to the DSM with regard to eating disorders, visit this link: http://www.dsm5.org/ProposedRevisions/Pages/EatingDisorders.aspx

Visitors to the site may register and leave their comment regarding the proposed changes to diagnostic criteria.

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.

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