I have in the past blogged a bit about eating disorders. Now I would like to climb on a soap box because I have had yet another mishandled client with an eating disorder. I don't know if others would refer to me as an expert in the field of eating disorder treatment, but I do feel pretty conversant on the subject, and try to keep up with research (lets hear it for Pubmed). I am also aware that there sems to be some disagreement about the correct ways to treat these conditions. Few of us would disagree that the all too common E.R. intervention is unhelpful: "What is your problem? Are you so vain, so in love with your reflection that you would purposely do this to your family?" (actual quote from an E.R. physician).
There are some people doing great research and publishing very helpful articles and books on outcome-based comparative studies. Craig Johnson, Chris Fairburn, Jim Mitchell etc are making valuable contributions in the areas of cognitive behavioral and dialectical behavioral therapy with eating disorders. Similarly, scientific refeeding regimens are now statndardized and most treatment centers apply this knowledge. But there are two notable omissions that I think show the very provincial stick in the mud culture of too many in academia as well as on the ground. First, there is ample proof that the genesis of eating disorders is from distinct genetic markers, or as Craig Johnson says: genetics is the gun, society is the trigger. And yet I still see centers advertising as an "addiction and eating disorders treatment center" (Fairburn has debunked that). When questioned they say to me they all have individualized treatment plans, but how would one surmise the treatment would proceed if it was advertised as a such, or as a childhood trauma and eating disorders treatment center? Second, other centers advertise in such ways as to imply that their focus is anxiety, personality disorders, ODD, spirituality etc. Now, co-morbidity statistics with depression and anxiety spectum disorders are well published, but the percentages vary so wildly as to leave uncertainty.
As I said in that previous blog, the professional community is notoriously slow in accepting new knowledge, as shown in the infamous "limeys": British sailors who knew that eating limes prevented scurvy 60 years before the medical establishment accepted that. So preconcieved notions, prejudice and demagoguery seem to be hurting the advance of treatment.
Now for the two pieces of credible research that are being ignored. First, the eating disorders treatment program at the prestigious Karolinska Institute in Stockholm, Sweden has for two decades produced a 96% recovery rate with eating disorders following the premise that these disorders are neuroendocrine in nature. Their treatment is a 6 month regimen of supported refeeding with little else but housing and socio-educational classes. The vast majority of comorbid symptoms disappear as the regular eating patterns and renourishment progresses. They use a unique technological tool they coin a Mandometer which is essentially a Blackberry that works as a neurofeedback device to advise and support healthy eating (see their web site). They have published some compelling research, have a huge 'n', and the best success rate anywhere. Yet I only get disdain when I talk to experts in the U.S. Their complaints are that the Mandometer is patented and must be purchased to be utilized. While some would condemn being so prorietary, it seems little different from the pharmaceutical companies, and these same detractors seldom refuse to use newer, proven psychotropic medications just because the drug company is making a mint off of it.
The second oversight involves the now well accepted data that eating disorders are genetic in nature. From an evolutionary psychology perspective, it is questioned why such disorders would be existant, seeing the high morbidity and mortality rates. One researcher/theorist who has tackled this with a rigorous eye for validity has postulated that this is an artifact from primitive days when periods of feast and famine were common occurrances. In those cultures, starvation was a common cause of mortality. When most people are starving, they have little energy, and just give up and die. But studies of aboriginal cultures have shown a curious thing: a subset, of mostly young women, get more energetic, more driven and in oral traditions led the tribe to food. This has been termed "adapted to flee famine". This is not the place to review all the detatils of how this was derived, but I can tell you that when this theory is told to a new patient with an eating disorder, their shame and denial diminish and compliance soars. So this narrative could offer an important window of opportunity to help those in need who are essentially hormonally impaired. And yet it is little known though relatively well published. Those of you interested can Google Dr. Shan Guisinger or "Adapted To Flee Famine Hypothesis".
Are we being lazy; are we being provincial? Or am I missing something?
Steve Bryson is a counselor in private practice in Whitefish, Montana and a registered nurse. He works with adolescents and adults, couples and families and has a special interest in eating disorders.