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alwaysvigilantCAN

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Reply with quote  #1 
Not sure if this is posted anywhere on FEAST site, but I thought it was a great video, especially on explaining the wiring of the brain for body image and set shifting.
There are a couple of graphic pics that might be upsetting to some in his presentation.


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MarcellaUK

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Reply with quote  #2 
I love this - thank you Alwaysvigilant for posting it here.
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Reply with quote  #3 
wow excellent - I'm sharing this
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Son diagnosed @ 12.5 yrs old with Severe RAN 2/11. Co-morbids - anxiety, Active restriction for 3 months. He stopped eating completely 2x. He needed immediate, aggressive treatment from a provider who specialized in eating disorders, adolescents and males. We got that at Kartini Clinic. WR since 5/11. 2017 getting ready to graduate slipping lost 8lbs. Fighting our way back.
nettemom

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Reply with quote  #4 
Thanks for sharing! We know that this is a brain-based illness but to actually SEE it is powerful!
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Christopher

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Reply with quote  #5 
There is much to like in Chris Thornton's video. However, in a couple of areas I think he may have stretched the research a little too far.
First, he claims that people with anorexia nervosa are "not wired to see the big picture," are "hard-wired not to be able to take a step back," and find it
"difficult to take on new information."  He claims "they can't set-shift."

With regard to set-shifting, it is true that researchers have noted a tendency of anorexia nervosa sufferers to perform relatively poorly on tests designed to test set-shifting ability. Several of these studies were conducted at the Institute of Psychiatry in London and were published in 2002, 2004, 2005, 2007, and 2012.
http://www.ncbi.nlm.nih.gov/pubmed/12588060 
http://www.ncbi.nlm.nih.gov/pubmed/15380406 
http://www.ncbi.nlm.nih.gov/pubmed/16330590 
http://www.ncbi.nlm.nih.gov/pubmed/17261218 
http://www.ncbi.nlm.nih.gov/pubmed/22253689 

These studies generally involved adults who suffer from anorexia nervosa, not children or adolescents.

In more recent years, researchers tested adolescent sufferers. In at least three studies, they found no significant differences between adoelscents who suffer from anorexia nervosa and adolescents who do not have AN with respect to set-shifting abilities.
http://www.ncbi.nlm.nih.gov/pubmed/22644538 
http://www.ncbi.nlm.nih.gov/pubmed/22492553 
http://www.ncbi.nlm.nih.gov/pubmed/22692985 

These findings show that 1) not all people with AN have difficulty set-shifting, and 2) among adolescent sufferers, as distinguished from adult chronic sufferers, poor set-shfiting might not be an endophenotype for anorexia nervosa after all. Rather, it may be that when people develop AN during childhood or adolescence, they don't have set-shifting problems, but after many years of semi-starvation that problem arises.

In another recent study, published two months ago, researchers found that impairments in set-shifting seemed to be correlated more with anorexia nervosa/ unipolar depression than with anorexia nervosa alone. In other words, it may be the depression, not the AN, that explains the set-shifting difficulties.  In the words of these researchers, "Impairments of set-shifting ability in AN patients may hve been overrated and may partly be due to comorbid depressive disorders in investigated patients."  http://www.ncbi.nlm.nih.gov/pubmed/22748187 

The second area in which Chris Thornton may have gotten out ahead of the research is in making the claim that metacognitive and mindfulness based treatments have been shown to be successful in treating eating anorexia nervosa. To the best of my knowledge, these treatment models have been subjected to scientific study for the treatment of bulimia and binge eating disorder. However, for anorexia nervosa, I'm not aware of research showing that those approaches have been shown to be effective, particularly for adolescent patients. Rather, in the case of AN, I don't think anyone has shown that any treatment model is superior to the approach in which the parents step in to restore the patient to normal weight and help her to return to normal patterns of eating.    


        
  
perdido

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Reply with quote  #6 
Wow! What a wonderful video showing what the big picture is! Thank you!
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Reply with quote  #7 
The part I liked best was the indication that self-viewing and fear food viewing stimulate the amygdala in AN patients, and that fearful images can appear bigger, thus providing at least part of an explanation why AN sufferers perceive their body as larger than others see them, and why they see even modest food helpings as overwhelming. Not sure how grounded it is, but it is appealing in that it takes away blame. I shared this part with our daughters and at least D17 seemed to get some relief from this.
Colleen

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Reply with quote  #8 
Thanks, Christopher.  I appreciate that as my d doesn't have any problem seeing the Big Picture.  I kind of resent these blanket statements about cognition which may be symptomatic rather than causal.  Don't get me started about pre-morbid anxiety!!  It's not universal, folks!

I also wondered about the effectiveness of mindfulness in treating AN.  Who is doing that?  Is there a program that specifically uses it and have they published results?

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MarcellaUK

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Reply with quote  #9 
This team are using DBT including mindfulness in AN http://www.devonpartnership.nhs.uk/fileadmin/user_upload/publications/Unit_info/Haldon/Haldon_Flyer_DPT.pdf
I have problems with their assertion that those with AN ALWAYS have problems with over-control and yes, agree that if and when they do it is more than likely that this has been caused by the starvation rather than being a cause OF the illness. I can't find the published data on the treatment's effectiveness either although Professor Thomas Lynch was said to be working on it.

However, as the mother of someone with significant pre-morbid problems who did not respond well to FBT (you can take that as meaning my daughter didn't respond well to FBT or that I didn't, both are true) I do welcome considered, sensitive attempts to use what little the science tells us at the moment to try to develop additional methods of help for those who continue to struggle.

I agree, blanket statements about PEOPLE with eating disorders are wrong. You can't say that all people with eating disorders have difficulty with set-shifting any more than you can say that all are female, or white, or middle-class. Only some of what Thornton is saying applies to my child. Maybe none of it does to yours. What I like about mindfulness is the acceptance of difference but then again that could be because we were quite difficult as a family to accept in "normal" therapy.

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Reply with quote  #10 
I watched this video a few days ago and one statistic has stuck with me..

Can anyone verify that there is higher rate of suicide in people diagnioses with eating disorders than in poeple diagnosied with depression - I think he said that in the video. If that is indeed true then it is an absolute outrage that more is not known about the effective treatment for eating disorders

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Son diagnosed @ 12.5 yrs old with Severe RAN 2/11. Co-morbids - anxiety, Active restriction for 3 months. He stopped eating completely 2x. He needed immediate, aggressive treatment from a provider who specialized in eating disorders, adolescents and males. We got that at Kartini Clinic. WR since 5/11. 2017 getting ready to graduate slipping lost 8lbs. Fighting our way back.
IrishUp

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Reply with quote  #11 
ttp; These are hard numbers to get at, for similar reasons; a lot of ppl who commit suicide have *undiagnosed* or misdiagnosed or under/untreated mental health conditions. Also, most historical methodology is hard to interpret well; there is a LOT of over-representation of hospitalized people, under-documentation of MH causes of death, and poor extrapolation methods. All of the numbers below are derived from the best documented data within the last 10yrs. I had to convert some of the presented stats to ratios, and all maths mistakes are mine.

These general ballpark figures are for people with the indicated diagnoses.

For comparisons sake, the overall populational risk of suicide: 0.1 in 100

With depression, never been in a psychiatric treatment facility: 2 in 100. Most people with depression fall here.
With depression and hospitalization history: 4 in 100.
With bi-polar affective disorder:  4 - 6 in 100 (~30-50% of ppl with BPAD will attempt suicide).
With AN /EDNOS: 3 - 6 in 100.

Obviously, these are NOT mutually exclusive groups.

An additional source of outrage is that the mean ages of ED group is way *younger* than the others. These are children and young adults incurring this kind of risk.



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Reply with quote  #12 
Thanks for the chris Thornton video. I found it interesting and reassuring in most respects. However, I do not agree that mindfulness therapies are appropriate until after a patient is fully weight restored /weight stable and their starved brains returned to some sort of normality. My daughter would not have had the ability to 'step back' until she was re-fed.
trusttheprocessUSA

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Reply with quote  #13 
IrishUp - I watched the video again a listened to the stat re: suicide. Three minutes into the video he states "more patients with a diagnosis of anorexia will kill themselves than patients with a diagnosis of depression". I am stunned.

Also to be clear I am not sure how to interpret this data:

Does it mean that:

AN patients are most likely diagnosed with depression also and that patient has a higher risk of suicide?
or
Is AN diagnosed more frequently than depression - I cant imagine that
or
Of all the people who are diagnosed with AN (and co-morbids) or all of the people diagnoses with depression the person with An is at a higher risk of suicide?

If the last scenario is accurate then this is chilling data -- coupled with the fact that you pointed out the AN group is much younger.
 
When I do a brief general web search on suicide rates and causes I find data that supports depression - nothing is mentioned regarding eating disorders. Do you have a webpage that you can suggest that discuss the correlation between suicide rates and eating disorders - I would like something to pass along.

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Son diagnosed @ 12.5 yrs old with Severe RAN 2/11. Co-morbids - anxiety, Active restriction for 3 months. He stopped eating completely 2x. He needed immediate, aggressive treatment from a provider who specialized in eating disorders, adolescents and males. We got that at Kartini Clinic. WR since 5/11. 2017 getting ready to graduate slipping lost 8lbs. Fighting our way back.
IrishUp

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Reply with quote  #14 
TTP, yes, it can be confusing to parse this stuff out.

It sounds like to me what he is saying translates to "If you take 100 people with AN and 100 people with Depression, more of the AN people will wind up committing suicide." IOW, it translates to the numbers in my upthread post. All other things being equal, death from suicide is ~2x more likely if you have AN than if you have depression. Yes, it is VERY frightening.

To flesh out an answer to your post, we need to use "lifetime prevelances". Lifetime prevalence is a measure epidemiologists use to describe "How many people will be diagnosed with $Disease_X at least once between their birth and death?".  The lifetime prevalence of AN (as defined now by the DSM4) is ~1% of the population. This means that you can expect that of every 100 people observed for their entire life, 1 of them will have AN. The lifetime prevalence of Depression (as defined now by the DSM4) is somewhere around 15%. Lifetime prevalence of all the Bi-Polar disorders is ~4%. I'm throwing BP in because this is a VERY high risk population, and is acknowledged as such. Yet you can see AN carries a comparable risk.

Of these diagnoses, only depression appears to be highly variable across countries and ethnicities. Suicide rates are HIGHLY variable across countries and ethnicities
(source: http://www.who.int/mental_health/prevention/suicide_rates/en/). 
BP and AN are stable across populations, so this makes straight up comparisons hard. I'll be using US data (UK and AU figures are pretty comparable).

So if you looked at 100,000 people (a standard population size to use), you would expect 1,000 people with AN, 4,000 with BP, and 15,000 with depression diagnoses. Of those 1000 AN people, somewhere between 30-60 will have died by suicide. Call it 45. Another 200 will be BP - 5% of all those with the diagnosis. The depression group will have 300 people - far more than the other two numerically, because the diagnosis is more common, but the RISK of suicide is far lower than for the other two diagnoses.




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Reply with quote  #15 
Thank you  - that makes sense to me scary sense. This seems to be a place where pediatricians and suicide prevention organizations could use a huge dose of reality regarding eating disorders.  How can I help educate the professionals in my area, any ideas?
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Son diagnosed @ 12.5 yrs old with Severe RAN 2/11. Co-morbids - anxiety, Active restriction for 3 months. He stopped eating completely 2x. He needed immediate, aggressive treatment from a provider who specialized in eating disorders, adolescents and males. We got that at Kartini Clinic. WR since 5/11. 2017 getting ready to graduate slipping lost 8lbs. Fighting our way back.
IrishUp

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Reply with quote  #16 
Well, struggling to educate first line clinicians has sort of been A Thing. There are definitely good materials now and in development. One would be the AED handout (and MB Krohl may have more of the shiny printouts). These were designed to be given to pediatricians and PCPs.

http://feast-ed.org/Portals/0/Documents/Library/AED%20Report%202011%20Eating%20Disorders.pdf

This editorial by Dr. Kaye is pretty short, and gets to the point:

http://ajp.psychiatryonline.org/data/Journals/AJP/3908/09aj1309.PDF

As for suicide prevention groups, I have less familiarity with them. Well, really none. My impression is that they predominantly run crises hotlines and community outreach type programs. I think you've identified a source of possible allies! :: goes to ponder ::

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Reply with quote  #17 

Colleen,

You asked who is doing "mindfulness" treatment for adolescents who suffer from anorexia nervosa, and whether results have been published.
An article that might give you answers appeared recently in the Winter 2013 issue of Renfrew Perspectives. It's entitled
"Acceptance-based Separated Family Treatment for Adolescent Anorexia Nervosa."
http://renfrewcenter.com/sites/default/files/Perspectives%202013%20-%20FINAL%20Issue.pdf  

I think it's fair to say that mindfulness-based treatments for adolescents who suffer from anorexia nervosa are purely experimental at this time. You'll see in the list of references, in the Renfrew article, a few papers that claim to provide data.  Each is, however, an unpublished manuscript. There are no peer reviewed, rigorous, randomized clinical trials.

In my opinion, mindfulness-based treatment for adolescent AN is based on faulty premises. One is that, as claimed in the article,
adolescents with AN are psychologically inflexible, rigid, and have difficulty "switching gears." The best available data, as I mentioned above on this thread, however, shows that while adults with AN tend to have cognitive rigidity, adolescents who suffer from anorexia do not experience cognitive rigidity or inability to set-shift to any greater extent than adolescents
who do not suffer from AN. (See research paper published by Fitzpatrick, Lock, et al in 2012, "Set-Shifting Among Adolescents with Anorexia Nervosa,"
International Journal of Eating Disorders 45:7  909-912   Consequently, by targeting supposed cognitive rigidity, it would appear that mindfulness-based treatments are aimed at a problem -- cognitive rigidity -- that doesn't really exist. The difficulty with anorexia nervosa in adolescents is not a faulty style of thinking, it is semi-starvation and eating patterns that maintain a state of semi-starvation. All the "mindfulness" in the world will not solve these problems. Only food will.

In addition to targeting hypothesized cognitive rigidity in AN patients, ACT family treatment (a form of "mindfulness" treatment) also claims that parents of anorexia nervosa patients tend to be pathological. Their theory is that parents have an
"avoidant coping style."  They argue that parents accomodate AN behaviors in order to avoid conflict and reduce their own anxiety. The "mindfulness"  treatment, therefore, attempts to reduce parental anxiety and teach parents how to "model healthy coping."  This approach is purely theoretical. First of all, nobody has accurately measured the levels of anxiety actually experienced by parents of AN patients, demonstrated that parental anxiety impairs treatment, or proven that eating disorder professionals are particularly knowledgable or skilled to help parents in this regard. In fact, reducing parental anxiety may be counterproductive.  Manualized FBT aims to increase, not decrease, parental anxiety in order to prompt parents into decisive action. Most parents I know find that they perform difficult tasks, such as refeeding a child with anorexia, with greater proficiency when they are anxious, not relaxed. Research on athletes, and others who need to perform challenging tasks under difficult circumstances, supports the FBT approach. Anxiety has gotten a bad name, but actually it serves a useful purpose in helping people become energized.

For these, and other, reason, I am personally very skeptical of mindfulness-based approaches to the treatment of anorexia nervosa in adolescent patients. However, I have an open mind (no joke intended) and am willing to look at the data when and if it becomes available.  

MarcellaUK

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Reply with quote  #18 
Quote:
Manualized FBT aims to increase, not decrease, parental anxiety in order to prompt parents into decisive action. Most parents I know find that they perform difficult tasks, such as re-feeding a child with anorexia, with greater proficiency when they are anxious, not relaxed. Research on athletes, and others who need to perform challenging tasks under difficult circumstances, supports the FBT approach. Anxiety has gotten a bad name, but actually it serves a useful purpose in helping people become energized.


That's what I always thought was the case, having had our anxiety as parents (which was unfortunately, and counter productively, already extremely high owing to our family experience of death in AN and of suicide, not in this case at the same time) boosted through the roof by our initial FBT.

Actually I was interested to read in the second edition of their textbook that Lock and LeGrange specifically don't advocate an increase in anxiety in all cases, they say that "the aim is to calibrate parental anxiety (heighten when low and contain when high) so that the parents can take appropriate action, while at the same time reducing parental guilt." (The highlighting is mine).

I see nothing in this or any of the rest of the manual which would contradict the use of ACT or DBT type techniques alongside the difficult but absolutely necessary task of re-feeding the patient. Yes, much of this work comes out of stuff which is pretty parent-blaming, but then so did FBT.

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Christopher

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Reply with quote  #19 
 I see a huge amount of content in "Acceptance-based Separated Family Treatment" that is incompatible with FBT, starting with the fact that
ASFT involves 16 of 20 sessions in which the therapist sees the adolescent and the parents separately. In FBT, on the other hand, the
therapist sees them together. The ASFT model will provide an opportunity for triangulation and misunderstandings.

It is ironic to me that the Renfrew article is co-authored by James Herbert, whose website identifies him as someone "known internationally
for his writings on quackery and pseudoscience in mental health."

I have no problem if people want to use ASFT, but they should know it is not evidence-based and is premised on some shaky assumptions.
The problem is not only the parent-blaming aspect; it is mainly the naivete. Have any of the authors of the ASFT approach ever actually
been in charge of refeeding an anorexic teenager for several months and successfully returning her to health? If not, then who are they to be
offering parents unsolicited, non-evidence based advice? It would be like a surgeon telling parents how to conduct a complex operation that the
surgeon herself has never performed.
MarcellaUK

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Reply with quote  #20 
Hmmm, I haven't studied the ASFT work and don't know the authors so don't know what their experience is.

On the other hand I'm darn sure that my FBT therapists have never re-fed and cared for their own distressed and angry child, at home, 24/7 without respite. The younger ones of them have never even HAD children. I'm not sure whether Lock and LeGrange have children of their own, and if they have, whether any of them have been desperately sick and cared for at home either, and it's none of my business to ask. Either way it wouldn't make their work any less valid.

It's true that most of these techniques have not been studied enough. There isn't enough money about for research, especially as drug companies aren't interested so don't add to the funding. Eating disorders, AN in particular, are also, fortunately, relatively rare conditions, so there aren't many subjects to enrol in trials. This makes research frustratingly slow and evidence, as Irishup has explained so coherently above, difficult to interpret even when it does exist. To me that doesn't mean we should reject things that DO work for certain populations. Rather we need to look at them carefully and adapt them so that they work for more, just as the FBT therapists do when they adapt their work, for example to include separated FBT when they think it is appropriate http://glossary.feast-ed.org/5-psychology-and-therapies/separated-family-therapy-sft

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Reply with quote  #21 
On the issue of the mortality rate through suicide... I copied an excerpt of the speech that  

DR. MARK CHAVEZ, NIMH, gave at the 10% is unacceptable congressional briefing in November 2012.

“What the research shows – mortality statistics for eating disorders.”

 

So, what I am going to do is to talk about the mortality data associated with eating disorders. When

we talk about mortality data, the way that this is generated is with standard mortality ratios, and so

what you do is you take a very specific patient population, say anorexia nervosa, and you pick a time

frame representing the data that is going to be analyzed, and what you do is take the patient

population and then you also take the standard population that is going to be analyzed as a

comparison. And that standard population gets matched on demographic variables, age, sex, those

type, and they are put into the same time frame and we compare that ratio to each other: how many

expected deaths would you see in a standard population to how many do you actually see in an

eating disorder population.

 

That’s how mortality is calculated from a medical perspective, and any time that number, that ratio, is

greater than one, that means that in the study population, for example anorexia nervosa, there is

excess death in the population relative to the general population. Again, keeping all the demographic

variables and comparing with a population that has never had or currently does not have an eating

disorder diagnosis, the mortality ratio for anorexia nervosa (and this is based on very good, very

large populations from studies in Europe and in America - a very well done, very rigid study), the

standard mortality ratio for anorexia nervosa is 5.7. So, there is a 5.7 % greater chance of dying if

you have, or have had, a diagnosis of anorexia nervosa relative to the general population.

That is not a trivial number. The data for bulimia nervosa is 1.93, and the data for binge eating

disorder is 1.52. There are a lot of “eating disorder not otherwise specified” categories, but the data

is not good for that. I am not comfortable talking about that because there are some numbers…that I

think…and there are some problems that make it very hard for me to feel confident.

One thing I was happy to see is that these [campaign] buttons say “10%.” I didn’t try to find numbers,

I tried to find what I thought were the best studies and get from those the numbers. But these

numbers, when you look at them, just these three categories; it really does equal about 10% (or 9.7

or 9.6) and that’s actually very nice, to see that there is a clear correspondence between the two.

The last point that I wanted to make is that (and when I saw these numbers for the first time, they

shocked me), looking again at the general population, but this time instead of looking at general

mortality, we are going to look at suicide. So, with standard mortality and mortality due to suicide, we

do the same thing. We take a study population with anorexia nervosa and a general population and

match them up by age, sex, as close as possible. Again, you look at the ratio; and any time the

number is greater than one, there is excess death due to suicide in that study population. So, the

standard [suicide] mortality ratio for anorexia nervosa is 31. So, your chance of dying from

suicide, if you have been diagnosed with anorexia nervosa, currently have anorexia nervosa,

or have had that diagnosis, is 31 times greater, relative to the general population. Again,

that’s… and they say these are not serious disorders? It really seems absurd.

When you look at [suicide in] bulimia nervosa (and again I have data that I have confidence in

talking about for bulimia nervosa - the other categories, I am not so sure), the ratio is 7.5.

Again, these are very, very, high numbers.

If you want any information on where these numbers
come from, contact me, and I will send you those references.


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Our 20 year old daughter has been working out her recovery from Restrictive Anorexia Nervosa and compulsive exercise for the last 10 years. She was DX at 9, re fed at home with support from local FBT and ATDT forum, and weight restored at 11.
Colleen

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Reply with quote  #22 
Quote:
the mortality ratio for anorexia nervosa (and this is based on very good, very

large populations from studies in Europe and in America - a very well done, very rigid study), the

standard mortality ratio for anorexia nervosa is 5.7. So, there is a 5.7 % greater chance of dying if

you have, or have had, a diagnosis of anorexia nervosa relative to the general population.



I think this is supposed to be 5.7 times greater, not percent.  So it would be 570% greater chance of dying with AN.  Or is my math thinking off today?

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"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
Christopher

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Reply with quote  #23 
FBT has been tested in clinical trials, so we can examine the outcome data. The personal lives of Lock and LeGrange are completely irrelevant; they have subjected FBT to objective, systematic, randomized controlled clinical trials, so we as parents can evaluate the resulting evidence.  By contrast, ASFT has not been systematically studied in trials. The underlying assumptions, however,
have been studied empirically and have been shown to be incorrect.
This is a pretty good clue about effectiveness. One of the authors of the Renfrew artice, James Herbert, has written an article
entitled Science and Pseudoscience in the Development of Eye Movement Desensitization and Reprocessing: Implications for Clinical Psychology. In it, he
argues that EMDR provides an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapeutic techniques. I would arge the same rationale applies to ASFT.

When it comes to ASFT, show me the data.

In my earlier days, when I was beginning advocacy work on eating disorders, I was all in favor of increasing funding for eating disorder research. Now, I'm not so sure. Most of the research being churned out is low quality, pseudoscientific, and misleading. I'd like to see more randomized controlled clincial trials, which are the gold standard in scientific research, but most eating disorder researchers have neither the talent nor the motivation for it. The result is substandard research that is doing more harm than good. The article in the Renfrew journal is an example.
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Reply with quote  #24 
I would like to see more RCTs too, Christopher.

In defense of researchers, I think there are some real heroes out there.  I don't think the lack of research is altogether because there are lazy researchers.  AN patients are notoriously difficult to track.  Adults tend to leave research studies.  Why do you think L&L focused on adolescents?  It's not because the therapy only works until you turn 18.  It's because parents have the ability to require their children to participate--but that disappears with age of majority.

As much as I want to see the science progress, I can't even convince my own d to participate in one of UCSD's studies. 

I see this difficulty with research as much more a function of the illness, not the researchers.

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Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
Christopher

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Reply with quote  #25 
Colleen,
How often has an eating disorder researcher actually received funding for a study, but been unable to find subjects?
I'm aware of only one time. It's rare.

Given the high cost of treatment, families would love the opportunity to participate
in clinical trials, which are normally free of charge. The problem is that not very many are being offered because funding agencies have become
quite skeptical of eating disorder research, for good reasons, because of how a lot of it has historically been conducted.

There are, though, some trials available, many of which are listed on http://www.clinicaltrials.gov 
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This forum is sponsored by F.E.A.S.T., an organization of parents serving parents and caregivers of patients of all ages with anorexia, bulimia, and other eating disorders. Information and advice given on this forum does not necessarily represent the policy or opinion of F.E.A.S.T. or its volunteers and is meant to support, not replace, professional consultation.

F.E.A.S.T. is registered as a nonprofit organization under section 501(c)(3) of the United States Internal Revenue Code.

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