Quantum Units Continuing Education

Despite the number of men with eating disorders continuing to rise, men with eating disorders feel invisible and unable to seek professional help, according to research by the South London and Maudsley NHS Foundation Trust (SLaM).

SLaM Clinical Psychologist Dr Victoria Mountford and her co-researchers at Canterbury Christ Church University, found that men with eating disorders felt alone and worried about the stigma surrounding male eating disorders.

It is now estimated that at least 10 per cent of binge eaters, anorexics and bulimia sufferers are male. Interestingly, rates of eating disorders among men are on the rise, whereas rates among women have remained largely the same over the last 10 years.

The stigma around males and body image means males find it even harder to acknowledge they have an eating disorder and seek help. Males showing signs of eating disorders are less likely to be recognized and diagnosed by professionals including GPs and psychiatrists.

To coincide with London Fashion Week, SLaM has contributed a piece on the rise of eating disorders among men to Nutrition Rocks, a lifestyle and celebrity website that aims to improve nutrition and body image among young people.

This London Fashion Week, media attention has zeroed-in on the so-called ‘size zero debate’. Models and eating disorders, and the unrealistic body image promoted by the fashion industry, is nothing new.

What is different is that the fashion industry’s obsession with body weight is no longer confined to women. Men, and in particular male models, are increasingly aspiring to unrealistic, unobtainable and unhealthy body shapes.

The article cites the research of Dr Mountford and colleagues, who spent a great deal of time talking to men suffering eating and body image problems.

“They told me they felt male eating disorders were an invisible issue and that eating disorders were thought to only affect women. They felt very alone with their eating disorders and worried about how people would react if they found out,” Dr Mountford explained.

“The men we spoke to had found it difficult to admit to themselves and others that their eating behaviors were problematic and that they needed some support. This meant that many of the men waited a considerable amount of time before seeking help.”

Hala El-Shafie, Specialist Dietician and co-founder of Nutrition Rocks, agreed with Dr Mountford’s research.

“The greatest challenge surrounding body image issues and eating disorders in men, is that men historically find it difficult to share and discuss emotional issues they may be facing. Sadly, disordered eating behaviour and distorted body image is becoming increasingly prevalent in males,” Hala said.

“However, without greater awareness of the problem, many men will continue to suffer in silence and shame, and the underlying stresses that often precede disordered eating will continue to go undetected. Greater awareness of how men can access help and support is needed. This is not just a women’s issue.”

Notes
- Dr Victoria Mountford is a clinical psychologist in SLaM’s Eating Disorders Inpatient Service. Internationally renowned for its research and treatment development, the service offers assessment, treatment and management of people with anorexia nervosa, bulimia, binge eating and other eating problems. Care is tailored to individual needs, and outpatient, daycare and inpatient treatment is offered.

- For more information on SLaM’s Eating Disorders Service visit here.

- Nutrition Rocks aims to offer people easy and practical advice on living a healthier lifestyle whilst providing accurate tips in nutrition and well being. Together with celebrity interviews, Nutrition Rocks features real life stories to encourage and inspire alongside no nonsense information around food, nutrition, beauty, fashion and fitness.

Source: South London and Maudsley NHS Foundation Trust (SLaM)
Copyright: Medical News Today
This article was originally published at:
http://www.medicalnewstoday.com/articles/202112.php

The consumption of drugs and alcohol by teenagers is not just about rebellion or emotional troubles. It’s about being one of the cool kids, according to a study by led by researchers at the Université de Montréal.

“Our study highlights a correlation between popularity and consumption,” says Jean-Sébastien Fallu, lead researcher and professor at the Université de Montréal’s School of Psycho-education. “The teenagers we studied were well-accepted, very sensitive to social codes, and understood the compromises that it takes to be popular.”

Link between popularity, friends and consumption

The study, which is to be published during the next year as part of a collective work, was conducted on more than 500 French- speaking students at three separate moments of their lives: at ages 10 to 11, 12 to 13 and 14 to15. It took into consideration the popularity of the child and their friends and tracked their consumption of alcohol, marijuana and hard drugs.

The findings showed an increase in consumption, as the child got older regardless of their popularity level. However, the more popular a child and their friends were, the greater this consumption was. There was a two-fold between increase between ages 10 and 15 for the most popular kids who also had very popular friends. However, this trend did not apply to popular kids whose friends were not as popular.

Maintaining popularity

The results suggest that popular teenagers are more at risk if their friends are also considered popular. “Teenagers don’t consume to belong to the group or to increase their popularity level, they do it to remain well-liked,” says Fallu. “It’s more about keeping their status than increasing it.”

Teenagers who aren’t considered popular are obviously also at risk of other deviant behaviors. However, other studies have shown that they are more inclined to develop violent behaviors than consume alcohol or drugs.

This research was made possible by grants from the Social Science and Humanities Research Council of Canada, the National Health Research and Development Program, and the Fonds Québécois de Recherche sur la Société et la Culture.

Fallu conducted the study with the help of Frank Vitaro, Stéphane Cantin and doctoral student, Frédéric Brière of the Université de Montréal School of Psychoeducation as well as colleagues at the University of Oslo.

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Montreal, via EurekAlert!, a service of AAAS.

Researchers from Utrecht University who studied the effect of negative emotions on pain perception in women with and without fibromyalgia found that anger and sadness amplified pain equally in both groups. Full findings are now online and will publish in the October print issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

Fibromyalgia (FM), a chronic pain condition, has among the largest impact of all rheumatic and chronic pain conditions. In addition to chronic, widespread pain, patients report accompanying symptoms such as fatigue, functional disability, and psychological distress. FM is thought to involve heightened pain sensitivity to a variety of psychophysical and emotional stimuli, with negative emotions believed to be experienced more strongly in FM patients than in the general population.

The Utrecht team theorized that specific negative emotions such as sadness and anger also would increase pain more in women with FM than in healthy women. Their study examined the effects of experimentally-induced anger and sadness on self-reported clinical and experimentally-induced pain in women with and without FM. Participants consisted of 62 women with FM and 59 women without FM. Both groups were asked to recall a neutral situation, followed by recalling both an anger-inducing and a sadness-inducing situation, in counterbalanced order. The effect of these emotions on pain responses (non-induced clinical pain and experimentally-induced sensory threshold, pain threshold, and pain tolerance) was analyzed with a repeated-measures analysis of variance.

Self-reported clinical pain always preceded the experimentally-induced pain assessments and consisted of reporting current pain levels (“now, at this moment”) on a scale ranging from “no pain at all” to “intolerable pain.” Clinical pain reports were analyzed in women with FM only.

Electrical pain induction was used to assess experimentally-induced pain. Participants pressed a button when they felt the current (sensory threshold) and when it became painful (pain threshold) and intolerable (pain tolerance). Four pain assessments were conducted per condition, and very high internal consistencies were obtained.

More pain was indicated by both the clinical pain reports in women with FM and pain threshold and tolerance in both groups in response to anger and sadness induction. Sadness reactivity predicted clinical pain responses. Anger reactivity predicted both clinical and electrically-stimulated pain responses.

Both women with and women without FM manifested increased pain in response to the induction of both anger and sadness, and greater emotional reactivity was associated with a greater pain response. “We found no convincing evidence for a larger pain response to anger or sadness in either study group (women with, or without FM), said study leader Henriët van Middendorp, Ph.D. “In women with FM, sensitivity was roughly the same for anger and sadness.”

Dr. van Middendorp concludes, “Emotional sensitization of pain may be especially detrimental in people who already have high pain levels. Research should test techniques to facilitate better emotion regulation, emotional awareness, experiencing, and processing.”

In a related study, a research team from Radboud University Nijmegen Medical Centre found that tailored cognitive-behavioral therapy (CBT) and exercise training tailored to pain-avoidance or pain-persistence patterns at a relatively early stage after diagnosis is likely to promote beneficial treatment outcomes for high-risk patients with FM.

The Nijmegen team evaluated the effects of this approach in a randomized controlled trial. The study compared a waiting list control condition (WLC) with patients in a treatment condition (TC) to demonstrate improvements in physical and psychological functioning and in the overall impact of FM.

High-risk patients were selected and classified into 2 groups (84 patients were assigned to a pain-avoidance group and 74 patients to the pain-persistence group) and subsequently randomized to either the TC or WLC. Treatment consisted of 16 sessions of CBT and exercise training, tailored to the patient’s specific cognitive behavioral pattern, delivered within 10 weeks. Physical and psychological functioning and impact of FM were assessed at baseline, post-treatment, and 6-month follow-up.

The treatment effects were significant, showing notable positive differences in physical (pain, fatigue, and functional disability) and psychological (negative mood and anxiety) functioning, and impact of FM for the TC in comparison with the WLC. Clinically relevant improvement was found among patients in the TC group.

“Our results demonstrate that offering high-risk FM patients a treatment tailored to their cognitive behavioral patterns at an early stage after the diagnosis is effective in improving both short-and long-term physical and psychological outcomes,” says junior investigator Saskia van Koulil. “Supporting evidence of the effectiveness of our tailored treatment was found with regard to the follow-up assessments and the low dropout rates. The effects were overall maintained at 6 months, suggesting that patients continued to benefit from the treatment.”

This article was originally published on the Behavioral Medicine Report:
http://www.bmedreport.com/archives/17543

For many people, fear drives their prejudice against psychiatric patients.

by Gary Small, M.D.

I was having coffee with a friend, when he confided in me that he had been feeling depressed and was thinking about taking an antidepressant. I was both surprised and relieved – I had always enjoyed his dry, humorous and incisive perception of the world, and believed that his sarcastic brooding was just part of his personality, entertaining though a tad on the negative side. But the symptoms he now described – trouble sleeping through the night, loss of appetite, forgetfulness, and occasional thoughts that he might be better off dead – all sounded like a major depression that could have a good chance of responding to the right medication. Unfortunately, he was a guy who had always been reluctant to take medicines. He swallowed an occasional aspirin when a fever topped 101 degrees, but avoided antibiotics, antihistamines and most other common drugs. It was a huge step for him to consider taking an antidepressant medicine that could affect his mental state. And now, even though he was thinking about antidepressants, he still wasn’t sure. He had just read an article about a study showing that a daily jog or swim could cure the blues. Maybe all he needed was the exercise-induced endorphin rush to lift his mood.

I suspected that exercise might help but wasn’t likely going to be enough to cure the blues in my friend’s case. Some of his reluctance to get conventional psychiatric treatment probably stemmed from a lingering stigma of mental illness. A lot of people are concerned that they will get a psychiatric label, and a new study indicates that they have reason for such concerns. Despite decades of effort to educate the public about the biological basis of mental illness and its response to treatment, the stigma of mental illness has not changed.

Dr. Bernice Pescosolido of Indiana University and her collaborators analyzed surveys given to nearly 2,000 people in 1996 and 2006. The subjects were asked to respond to vignettes describing patients withschizophrenia, major depression, and alcohol dependence. They discovered that 67 percent of the respondents attributed major depression to biological causes, which was an increase from 54 percent a decade earlier. They also thought medical treatment was best for people with mental illness regardless of the diagnosis.

Despite this greater acceptance of mental illness as a medical condition requiring medical treatment, the stigma of the disease lingers. Six out of 10 respondents were not willing to work closely with someone with schizophrenia, and more than seven out of 10 felt the same about people with alcohol dependence. Even if a person believed that the mental disturbance was from a biological cause and they were in favor of treatment, the respondent was more likely to endorse community rejection of the person described in the vignette.

The stigma doesn’t just seem to apply to patients with psychiatric conditions, but also to those who treat them, and I’ve known several doctors over the years who have endorsed such anti-psychiatry views. I remember the anti-psychiatry sentiments when I was in medical school – I would overhear an occasional student or professor take a poke at psychiatry, insinuating that it was an ineffective specialty based more on speculation than science. Scottish psychiatrist R. D. Laing had questioned whether mental illness should be considered an illness at all, since it had no proven physical cause. He argued that the concept of madness stemmed from political and interpersonal influences.

In 1973, Stanford psychologist David Rosenhan published “On Being Sane in Insane Places,” which described how university students pretending to be psychotic gained entrance into psychiatric facilities. Once admitted, these pseudo-patients stopped feigning their madness, yet the hospital staff perceived their normal behavior as symptoms of psychosis. Interestingly, the actual inpatients knew better.

After WWII, psychoanalysis – a form of psychiatric theory and treatment – dominated many medical school psychiatry departments. In Freudian psychoanalysis, patients verbalize their free associations, fantasies anddreams to their analyst, who then interprets the unconscious conflicts that may be causing the patient’s symptoms or problems. When the patient gains insight from the analyst’s interpretations, the symptoms often improve, but it can take years of nearly daily treatment, which is expensive and obviously time consuming.

Psychoanalysis has helped many people with their neuroses and personal problems, but it’s difficult to prove scientifically that it works any better than just talking with a friend who is empathic and supportive, although systematic studies have demonstrated the effectiveness of a similar treatment approach, psychodynamic psychotherapy. Also, psychoanalysis is not for everyone, particularly patients with severe depression or psychosis. With the development of antidepressant and antipsychotic medicines that can improve mental symptoms more rapidly, the medical community seemed to warm up to psychiatry. And, many psychiatrists turned away from pure psychoanalytic approaches and took a more eclectic strategy combining both talk-therapy and medication. This medicalization of psychiatry gave the field more credibility and acceptance by other medical disciplines, although anti-psychiatry sentiments persist.

For many people, fear drives their prejudice against psychiatric patients and their treatment. Sometimes in denial about their own mental struggles, people avoid or attack psychiatry in an attempt to keep mental health practitioners from somehow recognizing their secret psychological issues – as if the psychiatrist had some magical powers to do so.
This latest study suggests that the public now has greater acceptance of the biological basis of psychiatric illness, but most people wouldn’t want to work with a depressed patient or one who suffers from schizophrenia, let alone have such a patient move in next door.

This latest study suggests that the public now has greater acceptance of the biological basis of psychiatric illness, but most people wouldn’t want to work with a depressed patient or one who suffers from schizophrenia, let alone have such a patient move in next door.

One reason for the prejudice and discrimination may be the perception that psychiatric symptoms are permanent. Although we have no cure for a biological predisposition to a mental disorder, many symptoms respond well to treatment. An estimated one in four adults – nearly 60 million people in the United States – suffer from a mental disorder. Psychiatric interventions have been shown to diminish and often eradicate the symptoms of psychosis, depression, and anxiety; yet many people do not have access to care, and often those who could improve with treatment, never seek out a specialist, in part because of fear and their perceived stigma.

Teaching about the biological basis of mental illness has brought about a greater understanding that mental illnesses in many ways are like medical illnesses. But that awareness has not reduced the fear and shame of mental illness. What do you think will alter the stigma and make us more accepting of the psychiatric patient next door?

Visit me at DrGarySmall.com

By Jon Wertheim

It was before the famous tent stint in Australia, the various drug suspensions, the holistic medicine, the Toronto Argonauts and the Redemption. In the summer of 2003, Ricky Williams was passing through New York on a media tour and we ended up talking. Williams said a few words about his football career, but then, candid as ever, he took the conversation on a hairpin turn and began to talk about his battles with mental illness.

You may recall that during his fairly disastrous tenure with the New Orleans Saints, Williams had a habit of answering questions without removing his football helmet. But that wasn’t all. After practice, he would leave the locker room and head to the Burger King drive-thru, only to realize that he would have to interact with someone to place an order. So he would head home to spend the rest of the day in seclusion. The phone would ring and he wouldn’t pick up. “At practice [the next day] my teammates would be like, ‘Hey, what did you do last night?’ ” Williams recalled. “I’m thinking, I went from the living room to the office to the bedroom.”

The team did little to help. Only after tooling around the Internet did Williams self-diagnose himself with social anxiety disorder. He finally massed the courage to confront the Saints’ hidebound coach, Jim Haslett. He explained that he was seeking treatment for a psychological issue. According to Williams, Haslett used profanity to tell him, in so many words, “to stop being a baby and just play football.” (Haslett did not respond to SI’s questions about the incident.)

Around the same time, Williams broke his ankle. The team treated his recovery as a matter of vital importance. Trainers and rehab specialists oversaw his every move and asked for near-daily updates on his condition. Teammates texted him daily. Williams was struck by the contrast. “There’s a physical prejudice in sports,” he says. “When it’s a broken bone, the teams will do everything in their power to make sure it’s OK. When it’s a broken soul, it’s like a weakness.”

I recalled this when the news broke that Denver Broncos wide receiver Kenny McKinley was found dead on Monday afternoon in Arapahoe County of an apparent self-inflicted gunshot wound. While the investigation is ongoing and McKinley hasn’t been officially linked to depression, one has to wonder if he was depressed, especially after he was placed on injured reserve with a knee injury. (According to the National Institute of Mental Health, the risk factors for suicide include depression and other mental disorders or a substance abuse disorder. More than 90 percent of people who commit suicide have these risk factors.)

To the uninitiated, it makes no sense. Aren’t these young, sculpted, famous, rich gladiators antithetical to the whole concept of depression? Aren’t pro athletes supposed to be impervious to all manner of pain? Don’t they collide violently against each other, and need to be talked out of playing with the kinds of injuries that would incapacitate most of us for weeks?

In the macho, less-than-enlightened Republic of Sports, depression and other mental illnesses are often stigmatized as maladies for the weak. “Gutless” was the term Bobby Valentine, then the Mets manager, allegedly used to describe Pete Harnisch after the pitcher suffered a depressive episode. “Run it off,” an NBA coach once told Vin Baker when the player tried to explain his depression. “Don’t let the blues get you down!”

“Head case” remains one of the most damning labels in the front office. Sports psychologists know that if they want acceptance among athletes, they’re better off re-branding themselves as the less-menacing “performance coaches.”

The abiding irony: it’s entirely possible that athletes in pro sports — the ultimate kennel of alpha dogs — might be MORE prone to mental illness than members of society at large. After hereditary influences, the biggest risk factor for depression is stress. Performing in front of thousands of fans, having your work scrutinized and judged regularly, and laboring in a field where success and failure are so clear-cut can exact a huge psychic toll. There’s also the stress of knowing that your career, and thus the window of opportunity to make millions, is narrow. As McKinley’s agent, Andrew Bondrarowicz, told the Denver Post: “These guys, they’re made of steel on the outside. But for a lot of them, the challenge of being at your best and living up to all the expectations is a difficult situation. Some people are better equipped and have the support system.”

Other factors include:

• Head injuries. Studies show that someone who has endured multiple concussions is up to four times more likely to suffer depression. Athletes, of course, are at a far greater risk than the general population to suffer cranial injuries, which can alter brain chemistry. Andre Waters, the Eagles’ fearsome defensive back, committed suicide in 2006 at age 43; an autopsy revealed that his brain tissue had degenerated to that befitting a man in his 80s.

Another Philadelphia football player, Owen Thomas, a reserve for Penn, committed suicide in April and was honored posthumously just last weekend. According to researchers, he, too, showed early signs of chronic traumatic encephalopathy.

• Childhood trauma. Researchers know that exposure to trauma at a young age can lead to an increased likelihood of depression and mental illness later in life. (Studies have also shown that growing up in a single-parent household can increase the risk.) Think about how many “athlete narratives” contain almost unimaginably bleak childhood episodes.

Apart from medication and therapy, mental health can be improved by social stability and a solid home life. For all the perks of playing sports for a living, social stability does not rank high on the list. From the road games to the constant possibility of a trade to an all-consuming regular season to the dissonance that accompanies coming into vast sums of wealth overnight, sports are hardly conducive to social stability.

The wheels of progress tend to turn slowly in sports. But they do rotate. As mental health has become better understood and accepted in the mainstream — where the National Institute of Mental Health suggests that a quarter of American adults suffer from a diagnosable mental disorder in a given year — so too are psychological issues beginning to lose some of their stigma in sports. In recent years a welter of athletes in a variety of sports (Jennifer Capriati, Joey Votto, Stephane Richer) have unashamedly admitted to battling mental illness. It was the inimitable Ron Artest who, during his memorable monologue after the NBA Finals, expressed profuse thanks to his psychiatrist.

In this excellent recent article, my colleague Pablo Torre notes that Royals pitcher Zack Greinke is even hailed as the “Jackie Robinson” of mental illness. Greinke missed most of an entire season to address and treat social anxiety disorder and clinical depression. Crediting therapy and anti-depressants, he returned to win the Cy Young Award. “Whether he likes it or not, [Greinke] is the guy who really paved the way for the modern player to come out about these issues,” Mike Sweeney, a former teammate, told SI.

Scan the injured reserve or disabled list and, likely for the first time, explanations of “social anxiety” and “stress-related” are among the listed causes. To Ricky Williams’ point, athletes now can have a credible reason for missing games even if the malady doesn’t appear on an X-Ray or MRI.

In some cases, teams and leagues and even college programs have gone proactive, educating athletes and making psychiatrists, psychologists and mental health experts readily available. In Torre’s story, source after source suggested that the culture in sports is, finally, shifting. As it should be. Athletes like Kenny McKinley might appear to be made of steel on the outside. Inside? They’re simply as prone to mental illness as the rest of us — likely more so.