Date Posted onto Website: September 19, 2016
Dr. Carrie McAdams is an Assistant Professor of Psychiatry at UT Southwestern Medical Center. Dr. McAdams has been fascinated by the relationship between the mind and the brain for over 20 years. Her current research examines the connections between biological and psychological aspects of eating disorders using functional neuroimaging. She has focused on understanding the neurodevelopmental changes related to identity formation and social cognition. These constructs are closely related to long-term psychotherapeutic interventions in eating disorders.
Section 1Neuroscience of Eating Disorders
Section 2Circuitry Involved in Eating Disorders
Section 3Eating Disorders: Patient Interventions
Section 4Coolest Things in Neuroscience
Section 5Eating Disorders Case: Initial Consultation
Section 6Eating Disorders Case: Follow Up Consultation
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I think this is a terrific presentation because it helped me think about a script I could use to talk with patients on our eating disorder inpatient unit, which I sometimes cross cover on weekends.
What I wonder as I work on my grand rounds presentation for the Gastrointestinal specialists next month is whether or not there is a coherent way to similarly explain Avoidant/Restrictive Food Intake Disorder (ARFID). I’m a consulting psychiatrist for the general hospital and our eating disorder treaters have been viewing some of the outpatient consultations from the GI dept as mistakes because most of them have GI disease leading to disordered eating. In general, they don’t think targeted eating disorder treatment would be effective in this population.
On the other hand, one of my colleagues gave a grand rounds in our dept about a patient with ARFID, which seemed to show that inpatient eating disorder treatment was helpful.
Is there a double standard? In other words, does a starved brain work any differently in someone with DSM defined eating disorder such as AN compared to someone with ARFID, at least acutely? Do they respond to psychotherapeutic interventions differently?
Dr. McAdams’ presentation made me wonder about that.
Great question, and I’m glad you found the videos useful. I think your question brings to light the stigma of mental illness labels and how that actually interferes with treatment of eating disorders. There is no reason to think a starved brain that occurred because of a medical illness (infectious disease, cancer, gastroparesis, extended NPO status in hospitals) would be any different from a starved brain that initiated on a more “psychological” basis (dieting or depression). In all cases (ARFID/sometimes in celiac/severe allergies), I have seen rigidity of eating behaviors, difficulty in learning and trying new foods, and repetition of learned behaviors (rumination, purging, consuming only liquids). The idea that eating disorder treatment should only be effective for psychologically-initiated eating disordered behavior is inappropriate. Providing meals in a structured, supportive environment with medical monitoring can be extremely useful for patients for whom the eating disorder did not begin with an identifiable psychological stressor or behavioral decision. We often have a couple of these patients in eating disorder programs, and anecdotally, they appear to do well.
This is an article that reviews the other direction – gastrointestinal complications that occur during the course of anorexia nervosa. Essentially, the GI track is also a “Use it or lose it” organ, and if one is not using it, or using it wrong (purging), the effects of those behaviors also create physiological changes in the GI system. So the medical problems of eating disorders, even in typical eating disorder patients, are often not in their head, but real experiences in their stomach and gut. Validation and treatment for specific complications is important.