August 24, 2011

and people get depression because they're sad

1=1

I wasn't there for this lecture and it may well have been misunderstood by the reporter, but it brings up a common problem with media coverage and those in the ED field: tautology. A tautology is a definition that defines a thing as that thing:

tau·tol·o·gyNoun/tôˈtäləjē/

1. The saying of the same thing twice in different words, generally considered to be a fault of style (e.g., they arrived one after the other in succession).

So, the statement "anorexics often lack a sense of belonging and feel disconnected from society" is no great news item. It implies that these ideas are what drive people to diet and that anorexia is a diet gone to extreme. But this ascetic, righteous, messianic mindset is a well-known symptom of anorexia. Not a cause, not an explanation, not a "reason" to be anorexic. It also usually fades with sustained, normalized nutrition.

Mistaking symptoms for causes leads to treatment that confuses diagnosis with assessment and treatment targets with treatment effects.

Unfortunately, since there is no real eating disorders field - no agreed upon diagnosis, definition, or treatment goals - there is no way to distinguish between innovative ideas and new and creative ways to misunderstand the illness. Just the fact that there could be such widely diverging ideas about the illness says a lot.

It is so important to distinguish symptoms from cause, and assessment with treatment.

8 comments:

  1. YES. Yes yes yes. It would be great to get all ED professionals to understand this - it would save a lot of time and effort when people end up thinking these are issues they need to work on in therapy rather than symptoms of the illness itself. There may well be remnants which need sorting through after weight restoration and behaviour normalisation, but you can't tell what's a personality trait and what's a symptom until someone is physically healthy. For example, I'm obsessive, but I'm not as obsessive as I was when I was anorexic. Then, all my time was taken up by planning meals and counting calories. Now I just rearrange things a bit and like my house to be tidy!

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  2. Megan Warin's interpretation makes me angry. It is HER interpretation, as a social anthropologist. The psychological 'meaning' of AN varies from one person to another. The idea that every person with AN views the illness as a 'lifestyle choice' is misleading. I don't think there's a lot of point focusing on the 'meaning' of crazy thoughts in AN, just as one wouldn't focus on the 'meaning' of hallucinations in psychosis.

    And there is also the question of symptoms versus causes, as you rightly point out Laura (and Katie).... Re-feeding, weight gain and weight maintenance have reversed ALL of the crazy thoughts I had while anorexic in relation to food, weight etc. I no longer have anorexic thoughts or anorexic behaviours. I am still obsessive though, but that obsessionality pre-dated the onset of my AN by many years and is strongly linked to high levels of innate anxiety.

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  3. This article made me so angry. Anorexia is a biological diease. There are no choices, it is not a lifestyle. It is an excrutiating life destroying illness. It is not chosen by the sufferer to 'fit in'. I have rarely meet anorexics who desired to be a part of a group who are good at starving themselves. They had a predisposition to a disease that was triggered out of hibernation by some kind of event. Being an anorexic in recovery, i feel offended when people refer to my suffering and torture as a 'lifestyle choice', and liken me to pro anorexics, which is a crude generalisation. Argh, i am angry!!!

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  4. Hi

    I was there at this talk yesterday. It was presented as part of a regular meeting of the NEDC (National Eating Disorders Collaboration) which is timed to coincide with the ANZAED (Australian & New Zealand Academy for Eating Disorders) annual conference which kicks off tomorrow along with a combined training day of workshops supported by NEDC and ANZAED today.

    The initial part of the presentation was of interesting observations about how some people with anorexia nervosa team together through a shared sense of belonging and can compete with each other to be 'better anorexics'. This pattern was discussed with reference to other types of human group behaviours- social groups.The data was descriptive of what people with established anorexia nervosa DO not about what maybe the mechanisms underlying these behaviours or any discussion regarding if these were a cause of anything rather than just a result of or manifestation of having anorexia nervosa.

    The next part where there was discussion about how this information/ knowledge may contribute to how we help someone with an eating disorder seemed to me (as someone with a lot of experience and knowledge of managing eating disorders but very limited knowledge of the science and methods of anthropology)to involve some marked leaps of logic which were neither clear nor meaningful to me. An experienced colleague sitting beside me had the same response.

    My impression was that there was no attempt to integrate the observations of the group process with other knowledge of eating disorders (including what we have learned in terms of psychology, neurobiology, the neurophysiology of starvation)in looking at how this knowledge may be of benefit in looking at POTENTIAL treatment changes or strategies.

    The talk given immediately preceeding this one was from Dr Ken Nunn (child psychiatrist and neurobiologist) on developments in our understanding the neurobiology of the moods and behaviours commonly observed in anorexia nervosa. For my money, there was a lot more potential useful information in his talk.

    It is unforunate that the talk was reported in this way.

    Rod McClymont
    Paediatrician and Adolescent Physician

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  5. Rod,

    SO grateful to you for the in-person report!

    I am all for us listening to patients and understanding how they are thinking and feeling - and using that knowledge to reach them and connect with them.

    The media is only as good as public education on this issue, and that of course is not the fault or even the responsibility of the researcher. But without that synthesis with the larger picture, and without a clear statement of how this can be used in treatment, and the difference between symptom and cause.... I fear more harm than good comes of it.

    Opportunities to get media coverage are few enough - and valuable. I hate to see any wasted.

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  6. @ Rod McClymont:

    I like Ken Nunn's research :) Was that the work he has done with Bryan Lask on the Insula and development of the Ravello Profile?

    As for the research of Megan Warin. You state "The data was [actually were; data = plural not singular] descriptive of what people with established anorexia nervosa DO not about what maybe the mechanisms underlying these behaviours or any discussion regarding if these were a cause of anything rather than just a result of or manifestation of having anorexia nervosa."

    My response to that statement and to Warin's research is that she collected data that describe what SOME people with established AN do; not what ALL people with the illness do, or think.

    I have never, ever understood why some people with AN compete to be the sickest/thinnest etc. It was never anything I ever thought of doing. Until I started to recover 5 years ago I was reluctant to interact with anyone, including other people with diagnosed AN. I cannot identify whatsoever with Warin's data and I'm not sure that all people with AN would do, either.

    IMO it's pointless focusing on what people think and their self-perception or other-interaction when they are sick with AN - because these things are merely reflective of the illness and they vary from person-to-person. I think that people who are sick with AN should be informed of this and assured that once they gain and maintain an adequate weight that their anorexic thoughts and feelings disappear.

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  7. My (very limited) experience of pro-ana website is that they are mostly populated by kids who want to 'get' anorexia and are not underweight anyway. So how you could make the connection between what these people think and what goes on in the mind of someone actually with anorexia is a pretty big leap IMO.

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  8. @ Cathy (UK)

    I did note that the research reported was about what SOME people with anorexia do -'interesting observations about how some people with anorexia nervosa team together through a shared sense of belonging and can compete with each other to be 'better anorexics''

    The data reported was of a study looking at people with anorexia requiring and receiving inpatient treatment who exhibited this behaviour so yes, it was all of them as that was who was being studied.

    My concern with the extrapolation of the data was that it was compared with similar behaviours in other groups with out commenting on the possible explanations of why including not addressing any distingtion between primary motivation/attributes (what may have been a chartacteristic of a person prior to them developing anorexia), those that develope as a result of having anorexia or those that develope as a result of starvation in someone who has anorexia.

    I agree with Laura that studies approaching anorexia getting information from many sources and using tools from other disciplines such as social anthropology can provide unique insights. These insights can help us formulate new questions about what may or may not be helpful in treatment, prevention and relapse prevention. Such data can also be useful in identifying a subset of people with anorexia who may respond differently to treatment or benefit from a different or additional approach to treatment or support.

    We must be careful to avoid simplistic interpretation of observations or to jump to conclusions about what an observation implies in terms of treatment.

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