Science of Eating Disorders Tumblr
Tetyana here. I run the Science of Eating Disorders blog. This is the SEDs-associated Tumblr. I post about ED research, (mental) health, psychiatry, and medicine. I reblog pretty art and photography, promote critical thinking, and rant about stuff. Previously answered questions are here. Content is not always on topic and may be triggering.


Archive Random FAQ + READ ME Theme
»

amethystpyramid:

That is what she is saying. She is saying binging is not binging as we know it, and just extreme hunger (or reactive eating) from previous starvation. She is invalidating binging as we know it. She continues to write an entire article continuing from that stance. She does not speak about binging as eating ravenously even when not hungry, which is the collectively-agreed upon definition. One will conclude that because she did not speak about the latter and only the former, she thinks there is no such thing as “true” binging.

My understanding is that she’s saying that binge eating following a period of restriction is not the same thing as binge eating without restriction. Gwyneth is arguing, largely on the basis of Stunkard’s research as far as I can tell, that binge eating in the absence of restriction may be a symptom of another problem. That doesn’t invalidate it. I don’t see how that suggests it is not “true” bingeing (whatever that means, what’s true bingeing?). 

And who decided that binge eating even when not hungry is the collectively-agreed upon definition? Who is this collective? It is not the definition that the American Psychiatric Association agrees upon. 

eating, during a discrete period of time (e.g., within any 2 hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances

It says nothing about levels of hunger prior to the episode.

This is Gwyneth’s argument:

One researcher at the forefront of BED and night eating syndrome (NES) is Albert Stunkard. His research indicates that BED not only is rare but also is likely a marker of other psychopathological disorders and not a distinct disorder in and of itself.

Unfortunately both BED and NES are being identified and diagnostically defined through the observation of measurable symptoms and self-reported questionnaire responses, rather than determining what, if any, neuroendocrine genotypes may underpin these unrelated conditions.

Both are defined in the appendices of the DSM-IV but must be classified as ED-NOS for the purpose of diagnosing patients at present.

Stunkard may be on the right track but rather than being markers of psychopathology, both BED and NES may actually be markers for endocrine disorders.

… 

Bingeing in the true clinical sense only occurs for the tiny group suffering what appear to be rare circadian rhythm and endocrine disorders that result in binge eating disorder or night eating syndrome.

I (still) haven’t read Stunkard’s papers, and so it is hard for me to comment on all of this per se — I simply can’t critique it because I haven’t personally evaluated the evidence as I don’t read much about BED/NES at all, but to me, none of this suggests that she says it doesn’t exist — just that it is rarer than we think — and that it may be a symptom of another issue. That’s, as far as I can tell, her argument. I am not commenting on whether or not I agree with it. I haven’t read Stunkard’s papers, for one. I just don’t think this invalidates binge eating.

Interesting, NES does appear to be a circadian disorder (at least in part) (see here).

To me, that doesn’t invalidate binge eating as a thing. Or binge eating in the absence of restriction. Or the psychological distress that any kind of binge eating causes to the sufferer. 

http://tumblr.scienceofeds.org/post/93448835553/for-fucks-sakes-if-you-dont-like-the-advice

amethystpyramid:

You don’t need to say something verbatim for someone to get the general gist of what you’re saying. People are always saying how they never said something word for word when they get accused of it, but you don’t need to because your underlying message is always implied. For example, if you talk about the wrong-doings of a particular race over and over again, people ARE going to say you hate or dislike the race even if it is never explicitally said. And a lot of times, even if they don’t want to admit it, they do.

If whoever wrote that youreatopia article thinks that binge eating “is not binge eating”, and actually just reactive eating from restriction, than obviously she is aware of the definition that is widely-used that is associated with the term “binge eating” and its associated harmful negative side affects, and completely invalidating that, thus making it non-existent.

I don’t know how you go from the argument that binge eating during recovery from anorexia nervosa is reactive and the result of previous restriction to that invalidating binge eating and thus arguing that binge eating is non-existent or that (I’m assuming based on your previous post), binge eating disorder doesn’t exist. I’m sorry, but I am not following the logic there. 

(And I personally don’t think all binge eating during recovery is necessarily reactive/the result of restriction per se. I think it is complicated and while that’s clearly a part of it, and for some people, all of it, I do think there’s more to it than that. I know that for me, when I binged after periods of restriction, it was more complex than just reactive eating, although that was a big part of it, whether I realized it or not then. And hell-fucking-yes it was extremely difficult time period to go through and I felt like shit for eating, for bingeing, for not purging, for weight gain. I felt like utter shit. Reactive or not, it was not fun, psychologically.)

Relevant blog post from the archives:

Hypermetabolism in Anorexia Nervosa

with this accompanying figure:

I find MM really interesting—it’s the highly obsessive cult-like attitudes of the people who follow it that makes me very uncomfortable. I think it ought to be investigated and addressed in more detail. Recovery isn’t a contest to eat the most.

It is interesting because often times the people who follow things become way more “cult-like” than the actual proponents and so then the arguments against it become straw men because of what gets passed around between the followers.

I’ve seen this happen so much w/r/t Maudsley/FBT as well. The things that some parents claim about it, for example, are much more “extreme” than what researchers like Lock and Le Grange (who are proponents of FBT for adolescents) would claim. 

It is interesting to observe. Not surprising, though.

I think it would be very interesting to test MM empirically, but that’s not going to happen any time soon. Le Grange said that the 2010 Archives of General Psychiatry paper testing the efficacy of FBT in adolescents cost a few million ($3 or $5 million, I don’t remember). 

The thing is, people should be critical. Always. But the critiques should be about the science and about the evidence. Not about “I don’t want to eat that much” or “how could anyone eat that much” or “Gwyneth is dumb” or something silly like that, or about the followers. It should be about the evidence presented. And when there’s as little evidence as there w/r/t anything treatment-wise concerning EDs, there’s a lot of room for valid disagreements. In my opinion, anyway. 

http://tumblr.scienceofeds.org/post/93448835553/for-fucks-sakes-if-you-dont-like-the-advice

amethystpyramid:

scienceofeds:

For fuck’s sakes. If you don’t like the advice that someone provides on their own website, don’t follow it. If you are not convinced by the evidence presented, don’t follow it. If you don’t think it will work for you, don’t follow it. Honestly, it is really just that simple.

When I go to the…

No, I won’t “just not follow it if I don’t like it”, because all fucking information has an affect on people’s minds and in case you haven’t noticed it’s obviously harmful if it’s untrue.

Of course as a self-described skeptic (and one who goes to skeptic conferences and talks, and listens to skeptic podcasts), and as a person who writes a blog dedicated to critically appraising literature because so much of how information in the lay media is misrepresented, misinterpreted, or simply untrue, of course I haven’t noticed that false information isn’t harmful. Because I never wrote this, when starting SEDs wasn’t: “My goal is to facilitate knowledge synthesis, translation and dissemination, as well as to encourage readers to think critically about published research (and what media outlets often report). “

Yup. And of course I haven’t noticed how the harmful spread of the Ebola virus that’s helped by lack of information and false beliefs about its spread, its seriousness, and cures. (There are no cures.) 

Or the increasing spread of polio in Pakistan because of misinformation.

And of course, I have never ranted about the damaging effects of the anti-vax bullshit in general (big thanks to Oprah and Jenny Mc-Fucking-Carthy).

Yeah, I don’t really fucking appreciate this site telling people binge eating doesn’t actually exist

Straw man argument. This is not what she is arguing at all. (See here.)

and obesity is perfectly fine,

Straw man argument. As far as I can tell, Gwyneth points out the flaws in the idea that obesity is not a disease (something I agree with). She also points out the flaws in a lot of studies that try to develop a causal relationship. Keep in mind, Gwyneth cites peer-reviewed articles in support of this. This isn’t anything she came up with. This isn’t her research and she’s not alone in her critiques. I don’t know much about obesity research, so it is hard for me to critically evaluate the claims, but I didn’t see anywhere on her site (and I didn’t read EVERYTHING, so maybe I am wrong) that she thinks obesity is perfectly fine. It is just like saying BMI between 20-25 is perfectly fine. Well, it depends!  (See here.)

and completely ignoring the very real effects of BED.

Straw man argument.

Thanks.

Anytime.

And before anyone misunderstands me:

Do I follow MinnieMaud? No. Will I? No. For lots of personal reasons.

Do I agree with everything Gwyneth says? No. In fact, our interaction started when I sent her a very critically and questioning email. We still disagree on lots of things. I disagree on things with Alex (aka cognitivedefusion), too. 

But you know what’s great? Instead of ad hominem attacks (like blog titles that speak of questioning Ms. Owlyn, as opposed to critically evaluating the claims on the website), we talk about the evidence and we discuss what things we disagree on. Often times, the disagreements come from different (but not necessarily wrong) interpretations of the evidence, or on extrapolations of existing evidence. Or explanations of discrepancies in the evidence. 

For fuck’s sakes. If you don’t like the advice that someone provides on their own website, don’t follow it. If you are not convinced by the evidence presented, don’t follow it. If you don’t think it will work for you, don’t follow it. Honestly, it is really just that simple. 

When I go to the store and I don’t want something, I don’t buy it. When I went to doctors/therapists and didn’t like their style, I found new ones. I know, I know, shocking, right.

If you want to actually be productive, spend the time reviewing the primary evidence cited and then provide a critique based on that (because, you know, research findings can often be interpreted in many different ways). That will actually contribute to the discussion, as opposed to a barrage of straw men arguments. 

❝ We analyzed the association between in-hospital mortality and BMI upon admission … . We identified 669 eligible patients with anorexia nervosa (BMI ≤ 16.5) from 229 hospitals … More than 90% of the patients were female and 100 patients were admitted involuntarily. The average body mass index was 13.1, and the in-hospital mortality rate was 0.7% [5 patients]. [The] five patients who died had a BMI under 11. [Two had a BMI

— Body mass index and in-hospital mortality in anorexia nervosa: data from the Japanese Diagnosis Procedure Combination Database