Blog of the UNC Center of Excellence for Eating Disorders.Blog seek to provide outstanding education and training in eating disorders detection and care to medical students and other health profession trainees at UNC.
The National Eating Disorders Association encourages awareness, conversation, and involvement in eating disorders activism and outreach. Every spring, the National Eating Disorders Awareness Week (#NEDAwareness) is an opportunity to focus a national discussion on the importance of identifying, treating, and preventing eating disorders and to provide resources for these often stigmatized and underdiagnosed conditions. The NEDAwareness Week 2018 (February 26th – March 4th) theme was “Let’s Get Real” with the goal of expanding the conversation about eating disorders to highlight stories that are not always heard. For example, stereotypes about how eating disorders present (i.e., in thin, white, female bodies) often prevent individuals from seeking the treatment they need. Many individuals who do not fit this profile may not be screened for eating disorder symptoms and/or may not reach out for help if they need it. This year’s NEDAwareness Week theme reminds us that stigma and erroneous stereotypes prevent people from seeking help, and NEDA encourages us to bust myths to help get people screened and into treatment.
NEDAwareness Week 2018 encouraged individuals to get involved and stay involved—after all, eating disorder awareness and advocacy are essential and relevant year-round. If you want to join these efforts, here are a few ways to get started:
Take the NEDAwareness Quiz. This quiz is designed to assess your thoughts and feelings about food, body image, exercise, and social media. It also allows you to learn about what perspectives others have on these same issues and will hopefully generate meaningful discussion about the influence these factors have on our daily lives.
Get Screened: Last year, NEDA launched their free and confidential online screening for eating disorders and this screening tool has been lauded as an important resource for those who might be questioning whether they are dealing with disordered eating thoughts or behaviors. Participants are connected with a volunteer at the end of the quiz who can help funnel identified individuals toward crucial treatment.
Get Connected: NEDA has Facebook, Instagram, YouTube, and Twitter accounts that you can follow to join the conversation. You can share the Faces of Recovery video and stories which help remind everyone that although eating disorders do not discriminate based on age, race, weight, or socioeconomic status, recovery is possible with appropriate treatment and the consistent support of loved ones.
Although NEDAwareness Week may technically be over, let’s have 2018 be NEDAwareness Year! “Let’s get real” and challenge common myths and stereotypes about eating disorders, have real conversations about how food, body image, and exercise affect our lives, and increase awareness of how eating disorders can affect anyone regardless of gender, age, or race and ethnicity. With your help, NEDAwareness 2018 has the potential to be an inclusive movement with the power to make a significant, positive change in the lives of those affected by eating disorders.
Eating disorders affect people of all genders and sexual orientations. However, people with certain identities experience higher rates of disordered eating than others.1 It is important that we talk about these differences, so we can better understand and support individuals at high risk of developing an eating disorder.
Research on the lesbian, gay, bisexual, and transgender (LGBT) population shows that this group is at heightened risk of disordered eating.1,2 LGB and transgender individuals (people whose gender identity does not match their sex assigned at birth) face similar stressors, such as stigma, that increase eating disorder risk.3,4 Other factors are unique to each group. For example, transgender individuals who experience gender dysphoria may engage in eating disorder behaviors, such as fasting or excessive exercise, in attempts to alter their body shape or size to achieve a desired physique.5
Most people in eating disorder research samples are cisgender (a person whose gender identity matches their sex assigned at birth), and even among LGBT studies, the number of transgender individuals included is often small.4 In fact, most studies still only allow binary responses for sex/gender questions, in which you can click “Male” or “Female.” Occasionally, respondents are given the option of clicking “Other” or “Prefer not to answer.” It is critical that transgender people are identified and represented in research so that we can understand how to best prevent and treat eating disorders in this vulnerable population.
Through a survey of 923 Canadian transgender youth, Watson and colleagues compared 14 – 18 year olds and 19 – 25 year olds across five disordered eating behaviors: binge eating, fasting, diet pill use, laxative use, and vomiting.4 The researchers also explored factors that may increase or decrease risk of disordered eating.
Main takeaways from the study:
Binge eating and fasting were highly prevalent, with 35 to 45% of individuals reporting each behavior.
Roughly half of the 14 – 18 year olds reported disordered eating in the last year: 42% reported binge eating, 48% fasted, 7% used diet pills, 5% used laxatives, and 18% vomited. Among the 19 – 25 year olds, almost a third reported disordered eating, with 29% reporting binge eating, 27% reporting fasting, 4% using diet pills, 3% using laxatives, and 5% vomiting.
Transgender youth frequently experience violence and harassment, which is often linked to gender-based stigma.6,7 Watson and colleagues call this “enacted stigma.” Youth who experienced more enacted stigma were at higher risk of binge eating, fasting, and vomiting.
Those with greater social connectedness and support were less likely to binge eat, fast, or vomit. For the 19 – 25 year olds, social support was negatively associated with vomiting. In 14 – 18 year olds, family connectedness, and to a lesser extent school connectedness and perception of friends as caring, were associated with lower risk of disordered eating.
Those with the lowest number of protective factors and the most enacted stigma experiences had the highest risk of disordered eating.
Transgender adolescents and young adults are at heightened risk for disordered eating.1,3,4 In a large population-based sample of U.S. college students, 15.82% of transgender students reported having a diagnosed eating disorder in the past year, compared to .55 to 3.52% of cisgender students.1 Clearly eating disorders are a serious concern for the transgender community, and it is important for parents, teachers, and clinicians to be aware of this. Those of us close to transgender people need to be familiar with the signs and symptoms of eating disorders. Families and schools should strive to create an environment that helps transgender youth feel connected to others and provides protection from enacted stigma. By offering our support and fighting back against stigma, we may help protect transgender youth from developing disordered eating and other mental health problems.
Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144-149.
Watson, R. J., Adjei, J., Saewyc, E., Homma, Y., & Goodenow, C. (2017). Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. International Journal of Eating Disorders, 50(1), 22-31.
Testa, R. J., Rider, G. N., Haug, N. A., & Balsam, K. F. (2017). Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychology, 36(10), 927.
Watson, R. J., Veale, J. F., & Saewyc, E. M. (2017). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50(5), 515-522.
Murray, S. B., Boon, E., & Touyz, S. W. (2013). Diverging eating psychopathology in transgendered eating disorder patients: A report of two cases. Eating Disorders, 21(1), 70-74.
Kwon, P. (2013). Resilience in lesbian, gay, and bisexual individuals. Personality and Social Psychology Review, 17(4), 371-383.
Saewyc, E., Konishi, C., Poon, C., & Smith, A. (2011). 2. Is it Safer to be Gay in High School Today? Trends in Sexual Orientation Identity and Harassment in Canada. Journal of Adolescent Health, 48(2), S8-S9.
In Lighter than My Shadow, author Katie Green shares her personal experience in living with an eating disorder, starting from the time that she was a young girl. This novel is unique in that it is not comprised of chapter after chapter of words on a page, telling the story of her experiences; instead, she tells us about her experience with eating disorders in the form of a graphic novel.
More than 500 pages are filled with illustrations, simply but artfully sketched, depicting Green’s journey through adolescence into adulthood. The words that accompany these sketches narrate her life, thoughts, and conversations as she navigates the development of and treatment for her eating disorder.
These sketches deliver the very powerful and raw portrayals of Katie’s experience. For instance, her destructive, disordered thoughts surrounding food, her body, and her peers are depicted by dark and messy scribbles above her head. They start out small, but as the thoughts get darker, messier, and more destructive, so do the scribblings—sometimes growing so large that they take over the whole page until they swallow Green whole. In watching this progression, the reader is confronted with what so many people with mental health issues face: pervasive negative thoughts that can feel as though they have entirely engulfed one’s life.
The introduction page of the book holds a short letter from the author to the person holding her novel. There Green expresses her intent to, “be honest about how hard recovery is, and how long it takes, at the same time proving that it is possible.” She encourages readers who are also suffering from an eating disorder or other mental illness and acknowledges the challenges of seeking treatment by saying that “getting better is so inherently personal, and everyone must choose it for themselves”. This book is her promise that “it can and does get better”. If you or someone you know is dealing with an eating disorder, this book can be a powerful insight into the realities of the illness and a reminder that no one is alone in illness, no matter how isolating it may feel.
According to theories of emotion regulation in eating disorders, unpleasant emotions, like sadness, anger, and anxiety, can precipitate eating disorder symptoms. Eating disorder symptoms, in turn, can distract from or even temporarily alleviate unpleasant emotions. Coping with unpleasant emotions by binge eating, purging, restricting, or compulsively exercising, may make these symptoms become more entrenched.
Researchers have used scientific strategies to study emotion regulation within the context of eating disorders. Many questions have been investigated: Do people with an eating disorder feel negative emotions more intensely than those without an eating disorder? Do their coping methods differ from people without an eating disorder? Can teaching skills to cope with strong emotions reduce eating disorder symptoms? Here, we look at the research findings on emotion regulation in the past year and present a snapshot of up-to-the-minute research.
Recent Research Findings on Emotion Regulation
The data suggest that people with eating disorders report greater difficulties with emotion regulation than people without eating disorders, and tend to engage in less healthy emotion regulation strategies, such as worry, rumination, and self-punishment, than cognitive reappraisal (i.e., re-interpretation of the situation) or acceptance of uninvited emotion1,2,3,4. People with anorexia nervosa (AN) and bulimia nervosa (BN) were found to have a bias where they rated neutral facial expressions as expressing more anger than controls did and were less likely than controls to express positive emotion in their own facial expressions5,6.
People with eating disorders engage in eating disorder behaviors to regulate their moods. In one study, individuals with BN carried digital devices and were asked periodically during the day, over 2 weeks, to record their emotion and binge-eating, purging, or combined binge-purge episodes. Acute increases in unpleasant emotions preceded eating disorder behaviors, and after these behaviors odes mood was boosted, although there was also greater instability in unpleasant emotions7. Likewise, for individuals with AN, guilt peaked before restrictive eating periods and decreased afterward8.
According to emotion regulation theory, enabling individuals to better regulate their moods and emotional reactions to stressors could reduce eating disorder symptoms. In one study, improvement in one’s ability to regulate emotions during psychotherapy for BN was linked to greater improvement in eating disorder-related cognitive symptoms and binge eating frequency, but not purging frequency9. Other studies found that improvements in emotion regulation during treatment were correlated with treatment gains10,3. Sloan and colleagues tested the idea that emotion regulation difficulties underlie a range of mental health problems11. Results supported emotion regulation as a “transdiagnostic” construct. They suggested that when targeted for improvement in treatment, emotion regulation may help with a range of symptoms associated with anxiety, depression, eating disorders, and substance use.
People with acute eating disorders may have an internal world where positive emotions (e.g., joy) seem harder to tap, while negative emotions (e.g., distress, anxiety, disappointment, sadness) are closer to the surface and more frequently experienced. Their strategies for dealing with these emotions may be ineffective and may be compounded by problems with social communication, such as misreading others’ emotional states (in a negatively biased way). Enhancing the ability to manage emotions is incorporated into several psychotherapies (e.g., cognitive-behavior therapy) and is one way in which disordered eating behaviors can be addressed therapeutically. A deeper understanding of the role of emotion regulation in eating disorders and how best to enhance emotion regulation strategies are important topics in both basic research and in treatment development and refinement.
Crino, N., Touyz, S. & Rieger, E. (2017) How eating disordered and non-eating disordered women differ in their use (and effectiveness) of cognitive self-regulation strategies for managing negative experiences. Eat Weight Disord. 1-8.
Kenny T.E., Singleton C., & Carter J.C. (2017) Testing predictions of the emotion regulation model of binge eating disorder. Int J Eat Disord. 50, 1297-1305.
Mallorquí-Bagué, N., Vintró-Alcaraz, C., Sánchez, I., Riesco, N., Agüera, Z., et al.(2018) Emotion Regulation as a Transdiagnostic Feature Among Eating Disorders: Cross-sectional and Longitudinal Approach. Eat. Disorders Rev., 26: 53–61.
Westwood, H., Kerr-Gaffney, J., Stahl, D., & Tchanturia, K. (20**) Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 99, 66-81.
Dapelo, M. M., Surguladze, S., Morris, R., & Tchanturia, K.(2017) Emotion recognition in face and body motion in bulimia nervosa. Eat. Disorders Rev., 25, 595–600.
Leppanen, J., Dapelo, M.M., Davies, H., Lang, K., et al. (2017) Computerised analysis of facial emotion expression in eating disorders. PLOS ONE 12(6): e0178972.
Berner, L., ***et? (20**) Temporal associations between affective instability and dysregulated eating behavior in bulimia nervosa. Journal of Psychiatric Research, 92, 183-190.
Haynos, A. F., Berg, K. C., Cao, L., Crosby, R. D., et al. (2017). Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa. Journal of Abnormal Psychology, 126(5), 495-505.
Peterson, C.B., Berg, K.C., Crosby, R.D., Lavender, J.M., et al. (2017). The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self-directed behavior, and self-discrepancy within the mediation model. Int J Eat Disord. 50, 636-647.
MacDonald, D.E., Trottier, K., Olmsted, M.P. (2017) Rapid improvements in emotion regulation predict intensive treatment outcome for patients with bulimia nervosa and purging disorder. Int J Eat Disord.50, 1152-1161.
Sloan, E., Hall, K., Moulding, R., Bryce, S., et al. (2017) Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review. 57, 141-163.
Drs. Jessica Baker and Melissa Munn-Chernoff, faculty members at CEED, recently launched a new research study, Carolina CARES (College Assessment for Research and Education in Science), aimed at understanding mental health in college students. This study will have a particular focus on eating disorders and substance use.
The purpose of Carolina CARES is to examine mental health in college students and what factors contribute to how well students do during their college years. Starting college is a major milestone associated with a lot of big life transitions. For many students, this is an exciting time, filled with new opportunities. However, the college years are harder for some students. For some individuals, this period can be a high-risk time for the development of problems associated with emotional and mental health.
Carolina CARES invites all first-year UNC students to participate (UNC students who are at least 18-years old). Participation entails completing an online survey about personality, mood, anxiety, eating behaviors, substance use, and life experiences. From this information, we want to understand what factors contribute to emotional and mental health outcomes for UNC students. First-year students who participate, and who consent to be re-contacted, may be asked to complete additional surveys so that we may also understand how emotional and mental health changes over the course of college.
Additionally, research is an important part of all universities, and at UNC in particular, Carolina CARES is an opportunity for UNC students to get involved in the research process. Carolina CARES has four main themes/aims: research, training, education, and community.
Research: identify risk factors for emotional and mental health challenges during the transition to college
Training: provide UNC students with research volunteer and research internship opportunities, such as completing an independent research project with Carolina CARES
Education: disseminating research findings from Carolina CARES to the UNC community
Community: use information obtained from Carolina CARES to improve the quality of life for UNC students
Carolina CARES just launched Fall 2017 (you may have received our email!), so we are in the beginning stages of the research study. Therefore, we are currently focused on building our research and training aims. As we grow, we will be able to begin building on education and community.
If you have been contacted to participate, please note that as with any research study, participation is completely voluntary. You do not have to complete the survey if you do not want to. All information collected in the survey will be kept confidential and anonymous. We also will not share any individual student’s information with parents, the university, or any other university affiliates.
If you have questions about Carolina CARES, you can contact a member of the research team at firstname.lastname@example.org.
As e-cigarette use has skyrocketed, the popularity of “vaping” has become visible in day-to-day life. For some, vaping is an alternative to traditional cigarette use, but most people use both traditional and electronic cigarettes1. Since the popularity of vaping is relatively new, we don’t know much about e-cigarette use among people with eating disorders.
In a recent research study, Morean and L’Insalata assessed differences among adult e-cigarette users based on eating disorders history2. Participants with a current eating disorder diagnosis were almost four times more likely to vape daily than participants without an eating disorder history. Those with eating disorders were also more likely to use liquid nicotine in their e-cigarettes (91.6% vs. 85.7%) and used a higher nicotine concentration on average (9.50 mg vs. 7.86 mg). These findings fit with previous research findings that people with eating disorders may be at greater risk of smoking cigarettes and of developing nicotine dependence3. This suggests that among individuals with eating disorders, the prevalence of e-cigarette use may mirror that of traditional cigarette use.
People with eating disorders often report smoking to lose weight and may use nicotine to suppress appetite and cravings4. As expected, individuals with eating disorders in the Morean and L’Insalata study reported controlling weight as a motivation for vaping at a much higher rate the non-eating disorder group (32.0% vs. 10.4%). People with eating disorders were also more likely to report other motives for vaping, including the sweet flavors available for e-cigarettes, ability to hide from others, and undetectable use indoors2.
This was the first study to show a link between vaping and eating disorders. It’s important that clinicians who work with patients with eating disorders assess for e-cigarette use. Ability to hide vaping from others and undetectable use indoors were more commonly reported as motivators for vaping by people with eating disorders. This indicates that without clinicians asking directly, patients may not disclose their use of e-cigarettes. Friends and family members of people with eating disorders should be aware that vaping may be driven by desire for weight control and appetite suppression. Individuals may use vaping in a similar way to other compensatory behaviors, such as taking diet pills, purging, or exercising excessively.
McMillen, R. C., Gottlieb, M. A., Shaefer, R. M. W., Winickoff, J. P., & Klein, J. D. (2014). Trends in electronic cigarette use among US adults: Use is increasing in both smokers and nonsmokers. Nicotine & Tobacco Research, 17(10), 1195–1202.
Morean, M. E., & L’Insalata, A. (2017). Electronic cigarette use among individuals with a self‐reported eating disorder diagnosis. International Journal of Eating Disorders, [e-pub before print].
Anzengruber, D., Klump, K. L., Thornton, L., Brandt, H., Crawford, S., Fichter, M. M., … Mitchell, J. (2006). Smoking in eating disorders. Eating Behaviors, 7(4), 291–299.
White, M. A. (2012). Smoking for weight control and its associations with eating disorder symptomatology. Comprehensive Psychiatry, 53(4), 403-407.
The Order of the Chocolate Fish was established in 2003 to recognize individuals who go beyond the call of duty in service of the Center of Excellence for Eating Disorders (CEED). We recognize people from within CEED as well as people outside the center who demonstrate extraordinary dedication to our mission.
This holiday season I am especially pleased to bestow this honor on Rachel Guerra. In many ways, Rachel represents the heart and the soul of CEED. If you were to ask me, ‘What does Rachel do?”, the only honest answer I could give would be, “Everything!”
Rachel has worked as a Research Assistant and Project Coordinator playing a vital role in just about every project that we have undertaken over the past several years. Here is what some of her colleagues say about her:
Dr. Christine Peat: “Rachel is a fantastic research assistant in every sense of the word. She is consistently dedicated and professional regardless of the task. She is thorough in her work and always willing to lend a hand. I have personally benefited from having Rachel as a part of our research team – she reminds me of things I sometimes forget, she anticipates needs that I might have (which is invaluable), and she is incredibly dependable. I don’t know what CEED would do without her and I’m so thankful she’s been a part of our team!”
Dr. Laura Thornton: “Rachel is one of those people who can step in to any role, learn the task quickly, and find a better way of doing things. She is amazingly efficient and does everything with a smile and a kind word. You can count on her to get things done – always. Everyone should have a Rachel. Everyone needs a Rachel – you just might not know it yet.
Dr. Stephanie Zerwas: “Rachel is like sunshine. You take it for granted sometimes that the sun will rise and you forget how much she gives life and light to everyone. She is warm, kind, and an amazing caring person. We are so lucky that she always gets the job done and often makes it look so easy in the process.”
Dr. Camden Matherne: “Rachel goes above and beyond in every domain. She recognizes needs for organization and problem-solves independently, then voluntarily completes tasks (even the mundane ones!) without being asked to do so. She is also a lovely person to work with, and her sense of humor and kindness go a long way in making the work environment more pleasant.”
One of Rachel’s latest roles is to be the outreach coordinator for the Psychiatric Genomics Consortium. Her first task in this position was to wrangle busy geneticists at an international meeting to get then to do brief interviews on camera about the value of psychiatric genetics. This is not a uniformly camera seeking lot, but Rachel managed to get even the most reluctant researchers to share their enthusiasm for psychiatric genetics.
In addition to all of these wonderful qualities, what I value most about Rachel is her resourcefulness and focused determination to figure out how to do things and to do them right. It has been an honor to watch her grow as a professional, and everyone at CEED will enthusiastically support her throughout the rest of her career. Rachel is a true all-rounder and the heart and soul of CEED!
Please join me in congratulating Rachel Guerra on being inducted into the Order of the Chocolate Fish.
In spirit of the holiday season, I wanted to take a moment to thank all of our undergraduate and postgraduate students who volunteer their time and energy to ensure that our research studies are successful. Since CEED was founded in 2003, we have had over 80 volunteers, many of whom have gone on to graduate or medical school. Currently, we have 7 volunteers, and I’d like to tell you a little bit about them.
Emma is a senior at UNC and has been with us since January 2017. She is a Psychology major and plans to take a year off school before applying to graduate school to obtain a Master’s degree in Social Work. Currently, Emma works on two projects – BEGIN (Binge Eating Genetics INitiative) and Carolina CARES (College Assessment of Research and Education in Science), where she is primarily responsible for data management and analysis. Emma also works closely with Dr. Laura Thornton on projects related to the large, epidemiological studies at Karolinska Institutet in Sweden. In addition to volunteering at CEED, Emma works on another research study at the Center for Developmental Sciences examining infant sleep and the mother-baby bond. As if that is not enough, she is even working on her own independent project with the Carolina CARES data!
Andy has also been with us since January 2017. He is a sophomore at UNC, double majoring in Biology and Psychology. Andy assists with BEGIN, where he packages and checks research materials, and with Dr. Stephanie Thomas, helping with bench lab work related to microbiome research. After graduation, Andy plans to attend medical school to become an internal medicine physician.
Ruchi joined CEED in May 2017. She is currently a junior at UNC, majoring in Psychology and Neuroscience. Ruchi works on UCAN (Uniting Couples in the treatment of Anorexia Nervosa) and Carolina CARES, assisting with data entry and survey management in Qualtrics. She also works with Dr. Jessica Baker on BAN (Biomarkers of Anorexia Nervosa) and ecological momentary assessment, or EMA, studies. Upon graduation, she will apply to medical school.
Emily is a senior at North Carolina State University, majoring in Psychology. Since beginning with us in May 2017, she has assisted with UCAN and Carolina CARES. She also works closely with Dr. Jessica Baker on the BAN study and an ecological momentary assessment study. Her primary responsibilities include data entry, survey management in Qualtrics, and conducting literature searches. After graduation, Emily plans to apply to graduate school and become a clinical psychologist.
Kate Scheyer El-Sharkawy
Kate comes to us from Dr. Anna Bardone-Cone’s eating disorders lab in UNC’s Department of Psychology and Neuroscience, where she still works. After completing an undergraduate degree in art history, Kate worked in New York City in the fashion industry. However, she realized that she wanted to pursue additional education and research experiences in psychology, with a specific interest in eating disorders. Kate currently works on BEGIN, where her responsibilities include helping to revise and implement standardized participant contact protocol, and assists Dr. Cynthia Bulik on tasks related to research on the treatment of eating disorders. Kate is applying to graduate school, where she plans to further develop her research skills and build expertise as a clinical psychologist.
Rachel graduated from UNC in May 2017 with a B.A. in Psychology and has been working at CEED since September 2017. Currently, she works on various projects, including BEGIN, where she assists with data management, participant tracking and communication, and mailing out study kits, as well as Carolina CARES, where her primary role is data management and analysis. She also assists Dr. Melissa Munn-Chernoff on a grant examining genetic and environmental risk for eating disorders and substance use. In addition to volunteering at CEED, Rachel works at Veritas Collaborative. She is currently applying to graduate school to pursue a PhD in clinical psychology, where she plans to study eating disorders among racial and ethnic minorities.
As a junior at UNC, Tatiana originally joined us as a Gil Intern through the Department of Psychology and Neuroscience in September 2017. We are pleased that she will be continuing as a volunteer next semester! Tatiana has been involved with Carolina CARES, assisting with various data management projects, and conducting her own research project regarding the differences in ED symptomatology between ADHD-medication users and non-users. In addition, she will be assisting with BEGIN and BAN. Prior to graduation, Tatiana plans to take a gap year to gain clinical and research experience regarding the neurobiological causes of eating disorders and psychiatric comorbidities, and the different modalities to prevention and treatment. In the long-term, Tatiana plans to pursue a Ph.D. in clinical psychology, with the hopes of becoming a neuropsychologist and researcher at a university.
Thank you again for your service – we could not do what we do without you!
One of the Nine Truths of Eating Disorders is that eating disorders affect people from all walks of life. This includes people who live in rural areas and may find it challenging to access specialized eating disorder treatment providers. They may find that their only option is to temporarily relocate for treatment, but this is often cost-prohibitive and a huge endeavor that requires total upheaval of their lives. Also, an individual’s family and community can be crucial components of eating disorder recovery. Anderson, Byrne, Crosby & Le Grange1 addressed this dilemma with a study that proposes a way of bringing family-based therapy (FBT) to those who are geographically out of reach.2
FBT is an evidence-based treatment for adolescents with anorexia nervosa (AN). During the course of treatment, patients in FBT attend therapy sessions alongside their family members, who learn and have opportunities to practice ways to support the patient. In their study, Anderson et al.1 employed a HIPAA-compliant videoconferencing tool to deliver 20 sessions of FBT over the course of six months. The participants who received this treatment were ten adolescents who had been diagnosed with AN or atypical AN and lived in areas without access to face-to-face FBT.
Anderson et al.1 were interested in both the feasibility of this treatment mode and its acceptability to patients. The researchers reached their target numbers for participation, indicating sufficient interest in this form of treatment delivery. Furthermore, this study had an unusually high retention rate; none of the participants withdrew from the study during treatment. Levels of acceptability to patients and their families were also high.
Even though it was a small trial, the researchers wanted to determine preliminarily if treatment outcomes seemed promising. In order to do so, they assessed participants for weight gain and eating disorder symptoms using the Eating Disorders Examination (EDE). As a group, participants experienced significant weight gain during treatment and six months afterward. Likewise, scores on the EDE were significantly lower than baseline at the end of treatment, and significantly lower again at the six-month follow-up, reflecting an overall reduction in symptoms.
This study’s small sample size limits the generalizability of the findings and encourages replication with larger sample sizes. However, it is a promising addition to a growing body of knowledge about incorporating technology into treatment and could have meaningful implications for individuals without access to face-to-face treatment for eating disorders.
1Anderson, K.E., Byrne, C.E., Crosby, R.D. & Le Grange, D. (2017). Utilizing Telehealth to deliver family-based treatment for adolescent anorexia nervosa. International Journal of Eating Disorders, 50, 1235-1238. doi: https://doi.org/10.1002/eat.22759
In the genre of memoirs about food and eating, Professor Roxane Gay’s recent release “Hunger: a Memoir of (my) Body,” provides a much needed perspective. Gay explains in detail the experience of living in a large body as a Black, queer woman in America. She discusses her plans to gain weight in an effort to hide from the world after an experience of sexual abuse as a child, followed by a heart wrenching account of living in what she sometimes terms an “unruly” body. Gay often highlights the shame associated with living in her body, and speaks to the complex relationship that she has with body acceptance and weight management. As Gay discusses her history with dieting, I was reminded of a recent piece, “Losing It in the Anti-Dieting Age,” in the New York Times by author Taffy Brodesser-Akner. Both Gay and Brodesser-Akner express the frustration of countless weight management attempts throughout their lives, ultimately championing movements of radical body acceptance and Health at Every Size (HAES®), but hedging somewhat on these approaches with a desire to care for their body in a way that will also support longevity and quality of life. In many ways, their struggles reflect ongoing discussions on the utility (and often experienced futility) of weight loss efforts, along with how messages designed to promote health, even from well-meaning family members and friends, may also carry the potential of increasing weight stigma and risk for unhealthy weight control behaviors.
Most notably, Gay offers some experienced wisdom related to what has NOT worked to promote healthy body image and behaviors, namely shame. Gay intricately describes situations in airports, doctors’ offices, clothing stores, grocery stores, and other public spaces where she has felt shame. In all such instances, she describes how this shame was harmful as she attempted to pursue a positive relationship with food, exercise, and her body. She discusses going to doctors as rarely as possible because “doctors only see and diagnose my body,” highlighting the humiliation when a doctor’s office is ill-equipped for her body. Gay rails against the central importance of one’s body shape in determining self-worth and the shame that often arises from failing to have a specific body type, particularly for women.
Another voice that Gay offers in this book is the experience of developing an eating disorder as an adult. Gay describes that it still “feels strange to use that word [bulimia] with regard to myself” and that “when you’re fat, no one will pay attention to disordered eating … you hide in plain sight” and “I was really so old to be dealing with what we think of as an adolescent problem .. I was embarrassed.” With frank expressions and reflections on her eating disorder, Gay identifies pervasive cultural stereotypes about eating disorders, highlighting how these outdated stereotypes are often misguided. For further discussion about research related to who is at risk for eating disorders– see the Academy for Eating Disorders 9 truths about eating disorders.
In summary, Gay’s memoir is an important book that offers an expression of her personal experience of body image and eating from an incredibly vulnerable position. Although her voice as a woman of a certain color, age, and size highlights the importance of the representation of her experience, it is ultimately Gay’s vulnerability that makes this book a necessary read.
[Important note, mature themes in the book are often depicted in detail, and all material is not suitable for younger readers.]