So wrong and so right, one after the other

Interesting. Dr. Snyderman gets it pretty much completely wrong one minute:

And then right the next:

The autism piece juxtaposition is all the more ironic because the use of the word environment includes prenatal environment and infection. There is no longer any mention of parenting or experiences. Are the parents good or bad? Competent or incompetent? Themselves showing traits of autism? No. We don't do that any more. Is this because a child's autism is unaffected by parenting or possible abuse - no, it is because we don't need to question that these things damage children and especially harm children with autism or other disorders.

But with eating disorders we blame the patient. For wanting to be thin, for feeling pressured, for experiencing too much stress. The eating disorder piece treats adult women's eating disorders as happening because of their failed responses to incidents in their life. There is one referernce to the brain, but it isn't used to mean that something is wrong with the brain but rather that the thoughts are ingrained.

Eating disorders are treatable but we need to start with smarter assumptions. The autism community fought long and hard to START at a different place so they can begin to get to a better place. We need that, too.


  1. "when you are beautiful young blonde... have a very suburban also tell yourself you have to hit a certain bar"

    Someone read the Golden Cage one to many times. Maybe, she should read the book, Lying in Weight.

  2. I caught her statement about her scale. I just wrote a post to review what I think is a helpful book to understand the effects of restricting.....

  3. The autism report is very interesting, however, the ED report is dreadful... typical run-of-the mill discussion of feminist theory, culturally-related body dissatisfaction (note the headline "80% of women are dissatisfied with their bodies" - yet no mention that 80% of women do NOT have EDs!). The only really valid point made in the ED report was that the majority of women who present with EDs in their 30s and 40s are, in effect, relapsed cases.

    I personally think that one factor that confuses the issue is lumping AN and BN into a single category of EDs. Yes, AN and BN are both EDs, and sometimes they co-occur or follow on one from another, but the brain mechanisms responsible for restricting AN are quite different to those that drive binge-purge behaviours. Research evidence suggests that the real prevalence of AN is similar in the 21st Century to that of the 1970s and 1980s (i.e. <1% of the population), whereas the prevalence of BN has increased, in line with an increased prevalence of dieting behaviour.

    I firmly believe that (restricting) AN is as neurodevelopmental as is autism. After all, autism and AN can co-occur in families and in individuals. That is not to say that all people with AN have autism; they don't. But some studies estimate that approx. 1 in 5 people with AN have a co-morbid autistic spectrum condition.

    Watching these two reports consecutively made me think that if I had had earlier intervention for the sensory sensitivities, OCD, 'extreme shyness' with lack of eye contact and other autistic features I showed as a small child, perhaps I would not have developed AN as an 11-12 year old...

  4. Cathy, what you describe is EXACTLY what I hope we will move toward! Jen gets at this in her post as well: that we need to use what we know about the brain, individualize it to the person, and intervene early to prevent these issues by building strengths and skills!

  5. Laura, I agree 100%. But the problem with EDs is that they are often seen in the context of Fairburn's Transdiagnostic Model - which holds shape and weight concerns at the core of the illness. In other words, ED behaviours are 'practiced' with the objective of modifying shape and weight.

    I actually think that the latter may be true in terms of the genesis of many cases of BN; however, restricting AN is very different. I actually believe that restricting AN is neurodevelopmental, with the anxiety being inherent, and any weight/shape concerns coming from within the person as opposed to our culture.

    Of course, lifestyle stressors don't help, and can exacerbate already existing anxiety, but I would hazard a guess that many people who develop restricting AN would develop it (or another anxiety disorder, or major depression) irrespective of their environment.

  6. Cathy, I too believe that BN and AN are two different biologically based brain disorders. I also think restricting AN is neurodevelopmental and there may be connection with autism spectrum disorders. I am hoping that Dr. Kaye's continuing work will get to the bottom of AN and in the meantime that there's more recognition of the need re AN to renourish first.

  7. as long as dr kaye et al don't ignore the bingeing disorders altogether. I'm still no expert on fairburn beimg stuck on chapter 8 and leaving it for a bit to read june alexander's autobiography which brings up a whole host of other issues, but personally i'm okish with the transdiagnostib bit, it's the concentration on 'feeling fat' and the assertion that the behaviours are 'practiced' because of this rather than driven by other compulsions that i'm finding unhelpful whether those behaviours are restricting or bingeing or what fairburn calls compensatory but i would categorise as self-harm

  8. i haven't actually been able to watch the clips and am guessing i should avoid the ed one. One thing that strikes me about the subjects though is that neither of them is looked for and treated early and asserively enough within our system in the uk

  9. Thanks Laura!
    I really found Nancy S. to be a Debby Downer. Kari was very hopeful and believed in full recovery while Nancy kept trying to squash that thought. I hate when doctors do that.

    It was also apparent that there was little to no talk of genetic predisposition to illness. Eating disorders are more than a blonde suburban woman's disease. They featured a brunette also, after all.

    I wish I could tell Nancy "I'm sorry if you don't like your job and make yourself wear clothes you don't like. Feel free to start slowly setting a new example for society and women anytime you feel ready. Don't think I want you to pretend to be prim and proper. I want someone who is authentic."

    Me thinks the person with the most healthy body image might have been the featured patient, Kari.

  10. I just wish that there could be discussion of EDs, and in particular, AN, WITHOUT making reference to 'body image'.

    In the 21st Century it would seem that EDs, including AN, are synonymous with body dissatisfaction or body dysmorphia. So there is talk of "AN and other body image disorders" - with the axiomatic assumption that AN is a 'body image disorder'.

    I just don't think that AN in itself actually is a disorder of body image, even though it can be accompanied by body dysmorphia. AN is more like OCD, or other forms of restricted repetitive behaviours. The person gets stuck in a pattern of thinking and behaviours around restrictive eating. If it does come from the environment, is more likely to be triggered by rules learnt in school around 'healthy eating' than thin models/celebrities in magazines.

  11. note to self - try to avoid posting from the mobile phone - the typos are awful!

  12. I see one big problem with the idea that AN and BN are separate illnesses: they may be in theory, but in practice many sufferers "jump the fence" from one to another. I know people who have gone from AN to BN, AN to BED, EDNOS to BN or AN, BN to AN - any permutation you can think of. I started out with a more "bulimic" personality and more bulimic symptoms, and gradually became more typically AN FIRST in personality, then in behaviours. How odd is that? Until a model can explain all the weird bits of eating disorders as well as the very typical cases, it's not one I can get behind. I do believe that they are largely biological but not that they are separate illnesses as such.

  13. I guess in terms of the 'separateness' of AN and BN, I go by the research evidence that links b/p behaviours to activation of the brain's reward centre, dopaminergic activity etc., while restricting behaviours relate more to a fear of eating and perhaps a lack of appetite (which I certainly experienced). In my comment above, I wasn't referring to personality as such. And, of course, restricting and bingeing produce very different fluctuations in the levels of blood glucose, insulin, ghrelin, fatty acids etc. which will feedback on the brain.

    I know that some people 'jump the fence', or have cyclical restricting and b/p behaviours, but if these are separate mechanisms, there's no reason why they cannot occur at the same time or separately.

    The main issue I have with the transdiagnostic model is that it places weight and shape concerns at the heart of the ED.

  14. The main issue I have with the transdiagnostic model is that it places weight and shape concerns at the heart of the ED - me too.

    The main issue I have with Kaye et al is that, quite reasonably because they've got to start at the beginning, they aren't also looking at bingeing disorders - I know I just have to give them time but I'm impatient!

  15. Wow -- I just wanted to say that this is a fantastic discussion! :) and makes me realize how behind I am in all my blog reading!

  16. Cathy, I was referring to personality traits because of your earlier comment - obviously there is a well established tie between AN and ASC traits which some (but not all) sufferers exhibit from childhood. But there are also ties between ASC and BN/BED, and some people with anorexia are perfectly happy children with no sign of mental health problem until their eating disorder appears. It's far too complicated for either the transdiagnostic model OR the idea that they are totally separate illnesses to explain.

  17. Katie, perhaps everyone with an ED should be treated as an individual with an individualised programme of treatment? That's what the autism world is moving towards - where there's a saying that 'when you've seen one autistic person you've seen one autistic person' (only).

    Even if one narrows the ASD category to HFA or Asperger's syndrome the same thing applies: everyone with that named condition is an individual and experiences the condition uniquely. I think that is true with EDs. Some of the outward symptoms are similar, but beneath the illness is a unique individual.

  18. I do think everyone with an ED should be treated as an individual, although treatment should also be evidence based (I'm sure it's possible to do both!). For example, my treatment entailed full nutrition, full weight restoration, complete cessation of behaviours, help learning new ways to cope with anxiety, and working on co-morbid issues once I was healthy.

    But this won't stop people wanting to know what causes eating disorders, making false over-generalisations about people with eating disorders, or squishing us all into boxes which don't really fit. Not that there's anything wrong with intellectual curiosity, but the problem with theories and labels is that they tend to move professionals away from treating patients like individuals...

  19. Dr. Nancy Snyderman is at it again!

    When talking about eating disorders and pregnancy:

    "I think this is an Upper East Side, white-girl problem." She continued, "It's irritating to me: we want perfect babies, we want perfect bodies, we want perfect lives — I just find the whole thing vulgar."

    I think the eating disorder community should send the message that this kind of journalism is unacceptable!

    I am so upset that she would call people with this disorder vulgar on tv.


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