December 9, 2012

what we've known since the 1940s about eating disorders but still don't accept

A few things need to be said the day someone is diagnosed with an eating disorder:

This is not your fault.
You can fully recover.
Read about the Minnesota Semi-Starvation Study

But the problem with the Minnesota study has always been that you had to read an entire book, or a chapter to a book you didn't necessarily have, or a long dense chapter from a book from 1997 that is available online but is a copy of a long quote hosted on an iffy site.

So this morning I am thanking Dr. Emily Troscianko for her piece in Psychology Today that explains exactly and specifically what I think parents need to know in a moving and direct way. In the imaginary care package that I wish I could deliver to every family on the first day of diagnosis, this article is on top.

This study isn't all we need to know, but it is one piece we cannot do without.

8 comments:

  1. When I read the MSS while desperately trying to find help for my ill daughter lightbulbs went off in my head. It made so much sense and made it that much easier to help me refeed my daughter and now help support her so that she doesn't fall back down the rabbit hole.
    I have spoken at seminars for families in the beginning stages of treatment and I always mention this study as a must for parents to read.

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  2. In 2003-2004, researchers interviewed the men who had participated in the Minnesota starvation study more than fifty years earlier. The results of the interviews were published in the Journal of Nutrition in an article entitled "They Starved So That Others Be Better Fed," http://jn.nutrition.org/content/135/6/1347.full The interviews confirmed several facts that are relevant to anorexia nervosa, including the extreme psychological changes the men experienced when subjected to semi-starvation, the psychological and physical difficulties experienced during refeeding, the long time (several months) required to restore psychological health after weight was restored, and the fact that all the men ultimately made a complete medical and psychological recovery from semi-starvation and went on to live rich and rewarding lives.
    CB-US

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  3. Alleluia ... Amen!
    Hugs,
    M.B.

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  4. Well, now I feel like I should go and read both volumes of the MSS to get the real story!

    Emily Troscianko says that the men in the MN Starvation Study all developed EDs. Is this true? Yes, they were depressed, asexual, preoccupied with food and developed many symptoms of AN--is this the same as anorexia or are they the symptoms of starvation/malnutrition? They would have eaten if they'd been able to (recognizing that they were not prisoners and stayed of their own free will).

    They were suffering, no doubt, and their bodies and brains were messed up for a long time after the starvation ended. But is this the same as the delusional thinking that makes someone with AN literally fear food? None of the men had to be 'required' to eat once the restrictions were lifted. You don't see the struggle to eat or the avoidance of eating--or the fear of weight gain or any of the many other hallmarks of ED recovery.

    I also have a HUGE problem with Emily's insistence on a BMI of 19. I would have a hard time recommending this article to parents who are new to eating disorders.

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  5. I agree very much with Colleen. The Minnesota Starvation Experiment (which nowadays would never pass ethical review) is a fascinating study that demonstrates how people with 'normal' psychology respond to semi-starvation - both physiologically and psychologically.

    But none of the men struggled to start to eat at the end of the study. In fact, the biggest problem with eating was binge-eating, which is a normal physiological response to prolonged energy deprivation in individuals who do not have restricting AN.

    This study may explain the psychological responses to disordered eating and some cases of BED or bulimia nervosa, but in no way does it explain restricting AN.

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  6. OK, it's a blog post and not a sourced article, so I probably shouldn't overblow the significance, but let me ask you all: show me an article in a mainstream publication that draws the connection between semi-starvation and the PSYCHOLOGICAL symptoms of eating disorders and JUST that?

    No, the Minnesota guys did not have anorexia - and that line is a problem*. Theirs was a malnourishment imposed from outside and from which they fully recovered (mostly - there is some question about that).

    My point, and one that is the important one for everyone dealing with eating disorders to know, is that low nourishment is the direct cause of most of the psychological symptoms of anorexia and other eating disorders. That is why you don't get those symptoms without inadequate nourishment in the recent past and why especially when caught early the symptoms go away when well-nourished - even for those with the most florid illness.

    It should not be surprising that a patient experiences social disconnect, obsessive thinking about food, compulsive behaviors, and most of the other symptoms of anorexia when they are or have recently been undernourished. Therapy doesn't help, nor does insight, nor does getting close but not TO full nourishment and holding it for months.

    I may be cheering too much for this piece as I am starved for ANY references to give people on this that are "bite-sized" and credible. I've fought for years to get such a piece in scholarly journals or the popular press. JUST this topic, and with a direct connection to these specific psychologocal effects.

    The difference between these men and their experience and of a teen with an eating disorder is that young people often have predisposing traits that send them down the malnourishment path and make it even harder to challenge it as they recover. But the symptoms themselves are the same for strapping adult men as teenage kids: a fact that simply IS NOT getting to the public and is refuted still by MOST of those likely to treat our kids.

    * PS, the 19 BMI number is objectionable but she's not making it up. That's what the experts use. It is a whole 'nother fight we need to have.

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  7. While it is true the men in the Minnesota starvation experiment did not develop anorexia nervosa, I agree with Laura that the experiment is useful in showing that semi-starvation itself typically has profound effects on psychological well-being. As you all know, the men who were selected for the study were selected because they were the ones who were judged to be the most psychologically healthy before the experiment began. This helped to eliminate the idea of pre-experiment psychopathology. Also, these men were generally ones who loved intellectual ideas and scholarly pursuits. They were housed in a dormitory at the University of Minnesota during the experiment. This helps to show that it was not the social environment that likely caused their psycholgical distress rather than the state of semi-starvation. They were living in what, for them, was an ideal social environment. They still experienced these terrible psychological symptoms.

    While none of the men appeared to develop anorexia nervosa, the interviews with them later confirmed that for many the stage of refeeding resulted in more severe anxiety and depression than the stage of semi-starvation. This is an important insight, in my opinion, into anorexia nervosa because people with AN often report that with refeeding they actually feel MORE depressed and anxious than when they were starved. This may explain the resistance to refeeding, the perception that loved ones and treatment providers are trying to harm them, and the high rates of dropout from treatment.
    I think it is also significant that the subjects in the Minnesota experiment were all men, not females. Had the experiment been conducted on females, there may well have been some who developed AN, due to the biological sex differences that seem to play a role in etiology. Also, it seems clear that relatively rare genetic preconditions must exist in order for someone to develop anorexia nervosa. Experimenting on a small number of subjects, as was the case in Minnesota, would likely not capture people who have the necessary genotype to go on to develop anorexia nervosa as a product of semi-starvation.
    CB-US

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  8. I see what you like in this article, Laura.

    "...low nourishment is the direct cause of most of the psychological symptoms of anorexia and other eating disorders..."

    Amen to that!

    Naomi Wolf made the same exact point at the NEDA conference in Brooklyn in 2010. She said something like (and I could get my notes), "Crazy didn't lead to dieting. Dieting led to crazy." Meaning that when she lost weight in high school, she experienced all the psychological symptoms we associate with anorexia AFTER the weight loss, not before. They were symptoms, not causes.

    Too bad she went on to spoil it though with all her talk of the media and feminine ideals... She was *this close* to getting it right!

    Still, sigh. Too many fallacies in Emily's post for me to recommend.

    CB-US: I find the same thing really fascinating: the idea that once refeeding started, things got worse instead of better. They had a buddy system for the starvation phase to help support each other. They had to abandon it during refeeding because these men--pacifists all--were in danger of killing each other!

    Parents should know this!

    The other thing I take home from this study is that 'normal' people overeat after a period of starvation and gain (on average) 10% over their original weight. I really think that makes lowballing a target weight doubly dangerous--and why even weight restoration is not enough for some.

    I do love the MSS...so much still to learn...

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