Anorexia in Thirds | 1/3 Die, 1/3 Relapse, 1/3 Recover

This post on anorexia has moved to our top spot, causing me to read much more about the statistics used in the NYT article. I will review all the sources quoted by the NYT. As of this moment, I see no reason to challenge the very sobering statistics on anorexia cited by NYT writer Abby Ellin.

Original article written April 26, 2011:

A NYTimes article on fighting anorexia reminds us that in fighting anorexia, recovery is elusive.

Dr. Suzanne Dooley-Hash believes that she will never fully recover from the anorexia that has plagued her life since she was 15. Believing that she had conquered her anorexia, Dr Dooley-Hash relapsed in 2005, losing one third of her weight in six months.

Dr. Dooley-Hash is not alone in her confusion. Most medical experts agree that a third of people with the disorder will remain chronically ill, a third will die of their disorder, and a third will recover — with one significant caveat. There is surprisingly little agreement as to what “recovery” means for people with anorexia.

There is significant good advice and insights into the reality of defining ‘recovery’ for patients with anorexia.

“I say to patients, ‘This is your Achilles’ heel,’ ” said Dr. Daniel Le Grange, an associate professor of psychiatry at the University of Chicago and director of the eating disorders program at the University of Chicago Medical Center. “If you have another crisis, you’re predisposed to resorting to starvation as your way of managing that issue. It would be foolish of us as clinicians not to prepare our patients that they should be on the lookout for a recurrence.”

The medical history of anorexia sufferers in recovery suggests that they may recover nutritionally and suspend the behaviors of starving, binging and purging, but the ‘self-criticism, self-abuse, perfectionism, judgmentalism and restrictive mind-set persist.’

Crystal Renn at Met gala for Alexander McQueen, May 2, 2011Crystal Renn & Anorexia

The article comes as another former plus-size model, Crystal Renn gives advice about conquering anorexia interview is on tour in cyberspace.

We find Renn’s protestations about people’s focus on her weight disconcerting, writing that — while we support Crystal’s right to be any size she wishes — she is not a spokesperson for successful weight management and conquering anorexia.

I am clear that one doesn’t recover on the short-term from this disease. While I am no doctor or expert, I would think that the weight spins that Crystal Renn is experiencing suggest that she is in flux — what and where to, we don’t know.

Crystal is heavily influenced by Karl Lagerfeld, even waxing poetically that she slept in his childhood bed for her Chanel ad. Karl Lagerfeld absolutely believes not an ounce of fat on a woman’s body and that self-denial and significant self-restraint are critical to maintain this body. Karl practices what he preaches and talks about his diet constantly. (See my writing on Fashion Monasticism)

I totally supported Crystal’s weight loss, because I understand how much better I feel, the energy I have when my weight is down. Watching the dramatic changes that Crystal Renn is experiencing, I feel it’s irresponsible of journalists to continue to make as example of her ‘success’, when medical experts share how complicated anorexia really is.

The reality that one-third of anorexia sufferers relapse is confirmed by Dr. David Herzog, an eating disorders specialist at Harvard Medical School, whose study found that one-third of women treated for anorexia or bulimia relapsed within nine years. Other studies have put the number closer to 40 percent for patients treated in an inpatient facility. 

This article confirms our decision to pull away from treating Crystal Renn as an ‘expert ‘on successful weight management, which she is not. Anorexia affects 10 times as many women as men. Anne

Follow-up: this article is gaining much momentum, and I take any information published at AOC very seriously.  For now, I’m using a comment box below posting additional information as I find it. Then I will write a follow-up piece that surveys what I’ve learned from other sources. I will fact check all the people quoted in the NYT article, because one reader believes some experts were taken out of context by NYT.

I have no opinion one way or the other. My only goal is writing the piece is 1) to have all of us stop writing about Crystal Renn conquering anorexia; and 2) I admit that the statistics posted in the NYT article more than got my attention because I am very concerned about the relationship between fashion designers and women’s self-images.

Update on Tue, April 26, 2011 by Anne

(Actually dated May 3, but I want my commentary to appear first.) Because this article is in our top 5 reads, I am reviewing the responses of other media to the NYTimes article on anorexia.

1) TIME Magazine Defining Recovery in Anorexia — and Addiction.

TIME magazine reviews most of the article but doesn’t quote the statistics. Their piece is a regurgitation but they don’t challenge the article in any way, just emphasize the there’s no real definition of recovery.

Example, if you maintain your weight but jump on the scale twice a day, write down every piece of food that goes in your mouth and constantly talk about food and not getting fat, are you recovered strictly because the scale stays constant and doesn’t drop into a health dangerous zone? Or are you primed for a relapse?  Defining Recovery in Anorexia — and Addiction.

2) Journal of the American Academy of Child & Adolescent Psychiatry Recovery and Relapse in Anorxia and Bulimia Nervosa: A 7.5 Year Follow-up Study (July 1999)

This is one of the studies linked from the NYT article. It distinguishes between anorexia nervosa (AN) and bulimia nervosa (BN) at a median of 90 months follow-up of 246 women.

The full recovery rate of women with BN was significantly higher than that of women with AN, with 74% of those with BN and 33% of those with AN achieving full recovery by a median of 90 months of follow-up. Intake diagnosis of AN was the strongest predictor of worse outcome. No predictors of recovery emerged among bulimic subjects. Eighty-three percent of women with AN and 99% of those with BN achieved partial recovery. Approximately one third of both women with AN and women with BN relapse after full recovery. No predictors of relapse emerged.

3) NewYork-Presbyterian Hospital NewYork-Presbyterian/Westchester to Undertake Groundbreaking Study of Anorexia

Dr. Katherine Halmi is quoted in the NYT article and has extensive commentary on this groundbreaking, four-year study of anorexia. Her hospital, along with five other U.S. and three international research institutions, is studying families in which two or more relatives have suffered from anorexia nervosa.

“We’ve learned a lot about this highly complex disorder and we now know that genes play a substantial role in determining who is vulnerable to developing eating disorders. We also know that early intervention involving the participation of family members during the adolescent years has proven extremely important in successful treatment,” says Dr. Halmi.

She adds: “Environmental factors such as society’s emphasis on being overly thin may serve as a trigger that increases the risk in an individual who is genetically pre-disposed. Although less than half of 1 percent of all women develop this disorder, anorexia nervosa has the highest death rate of any mental illness, which makes the controlled treatment studies we will be conducting extremely important in enhancing our understanding of anorexia nervosa and in developing effective therapeutic treatment plans.”

Dr. Halmi notes that researchers are seeking to improve the chances for recovery.

“Currently, only a quarter of patients with anorexia nervosa fully recover and half have partial improvement but another 25 percent remain chronically ill. There is also a 40 percent rate of relapse. Our hope is that aggressive and sustained research will help us to make significant inroads in better understanding the root causes of the disorder and finding the best treatment programs.”

To be continued …

Update on Wed, April 27, 2011 by Anne

Cyranos DeMet sent me this question and commentary:

A thought for you on the subject of anorexia… to your knowledge has anyone ever done any experimental work involving moving the victims of that plague into a cultural environment where body mass is not considered a negative thing?  Say among the Polynesian peoples?

I’ve often wondered just how telepathic the human critter really is, not so much in terms of intellectual concepts riding the ether, but more in terms of emotional ones.  From life experience there is an easy difference to be seen between those to be called “social creatures” and those like I who could care less what the majority think/feel.  To my observations those who are social creatures seem to synchronize a great many of their attitudes without any visible communication from the group.  The degree of synchronization without any visible means of communicating such complexity does leave open the possibility these individuals share some form of empathetic bond beneath the conscious level.  Such a bond would explain anorexia very neatly:  sensitivity to the emotional is predominantly a female trait, as is emotional security from social acceptance/compliance (the old troop/pack/herd instinct updated).  Could it be those who suffer most to anorexia, those beyond reach, are being telepathically bullied as it were by a sense stream they have no way to defend themselves against, that they are compelled to “feel” our cultures bigotry against body mass on levels they can’t even name? 

Just a thought.

Anne answers:

http://www.anneofcarversville.com/fp/social-group-media-habits-trumps-individuals-in-eating-disor.html

Harvard Medical School’s Anne Becker studies the impact of media on eating disorders in girls in Fiji. Because television is new to Fiji, it’s one of the few locations globally where Becker can conduct her research in a ‘pristine’ cultural state.

Becker previously determined that a rise in eating disorder symptoms among adolescent girls immediately followed the introduction of broadcast television in 1995. A more robust body shape is prized in Fiji’s indiginous culture in sharp contrast to the bodies of women actresses shown on screen.

In her latest research, Anne Becker made the startling determination that peer pressure trumped shutting off the television, in the proliferation of eating disorders among young women. If a girl’s friends were watching TV, and hers shut off, she still absorbed the body perception preferences of her social group.

Higher peer media exposure was linked to a 60 percent increase in eating disorders, independent of a girl’s television viewing habits.

Comments

[Kat]

There is nothing out there saying that a third of those with anorexia will die. NEDA says up to 20% - other sites say 5-20%. I have NEVER seen 33.3%

The article also cut and pasted quotes from at least four people(of the eight) that did not agree with the final product.

there is hope.

http://recoveringinspirings.blogspot.com/2011/04/letter-to-editor.html

[Anne]

Updated: The commenter obviously didn't followup on the experts cited in the NYT story. In my first two investigations, I quote very specific findings that confirm the NYT data. We will continue to verify.

Original response:

I am not the NYTimes who chose to write the statistics in thirds. I've read Kat's post -- and so can you -- and don't find the quotes rendering the NYT article wrong. A person who writes 'I am cured' is accounted for in the 1/3 statistic. I also understand a doctor saying 'I object to not giving people hope.' This was the most startling article on anorexia written to date. I will Google further to read what others have to say about the piece, which didn't allow comments. I fault that practice, but the NYT does it a lot. .

My context for writing about the article is in response to Crystal Renn being a spokesperson on anorexia, when she says she's recovered and just dropped 10 dress sizes again. And she's mad at people for wondering if she's OK, back to being a size 2 when she says she loved herself better as a size 14. Sounds pretty darn complicated psychologically to me.