Steinglass, J. E. et al. (2014). The (lack of) effect of alprazolam on eating behavior in anorexia nervosa: A preliminary report. International Journal of Eating Disorders, 47, 901-904.
The authors in this preliminary study wanted to shed light on a topic they described as under-investigated: the relationship between anxiety and caloric restriction for those struggling with a restricting-type eating disorder. Twenty participants previously diagnosed with anorexia nervosa were administered alprazolam (Xanax) or a placebo before being given a test meal. Despite the hypothesis that the medication would lower anxiety and increase food intake, this was not found to be true. Alprazolam was not found to be effective for caloric increase or reduction in anxiety in this preliminary study. The medication did produce a significantly higher experience of sedation for participants. One possible explanation for this lack of effect may be that this medication is more targeted towards fear-based anxieties and less towards rule-based or obsessive-type anxieties.
Victoria Cane: Implications of this study on practice-
Firstly, this study should be interpreted cautiously, as it was preliminary and not a randomly, controlled trial. That being said, I am also someone who recommends using great prudence when taking medication for anxiety and this study supports my reasoning. A medication like Xanax may help someone take down their immediate experience of anxiety, which for some can be helpful so that they can move on to use other skills. For others, this immediate effect keeps them stuck in a loop of negative reinforcement- they experience anxiety- take Xanax- anxiety goes down (thus reinforcing the behavior of taking Xanax by removing the aversive experience of being anxious) but they are not reinforced for using more long-term skills. The most consistently effective treatment for anxiety is exposure- facing into the things that produce the anxiety which ultimately reduces and eventually extinguishes the anxiety. Although somewhat disappointing that those struggling with weight restoration may not find much needed assistance from this medication, my hope that use of other, more skillful responses to anxiety might prove more helpful.
Bardone-Cone, A.M et al. (2010). Perfectionism across stages of recovery from eating disorders . International Journal of Eating Disorders, 43, 139-148.
There is now a solid body of evidence support the role of a perfectionistic style of thinking in fostering, maintaining, and treating an eating disorder. Studies support that this style of thinking remains elevated even after recovery and is likely a continuing risk factor regarding relapse. The authors discuss the complexity of defining "recovery", explaining that there are key differences between those who are considered physiologically recovered and those who are physiologically and cognitively recovered (i.e. no significant fear of weight gain or distorted body image). Elevated levels of perfectionistic thinking is evidence of continuing pathology. The hypothesis in this study is that those who are not cognitively recovered will continue to present with pathological levels of perfectionism, which was founded in the results. One of the main implications of this study is that when eating disorder recovery is defined to include "cognitive" style as a key dimension, perfectionistic thinking is shown to be within normal limits (as opposed to previous beliefs that it remained elevated even when recovered).
Implications of this study on practice-
I found myself somewhat disappointed with what I perceived to be a lack of anything astoundingly new in this study. Eating disorder specialists already know that we need to target a perfectionistic thinking style if we are to target the eating disorder pathology. What I did find interesting is the emphasis on inclusion of "cognitive recovery" in order to be considered recovered. I often find myself talking about "rigidity" with my clients, explaining that when we remain rigid in our thinking style we are much more prone to "breaking". I often use the analogy of a tree that is able to bend and flex in the wind rather than one that stays stiff and cracks. Using this analogy, and consistent with this study, relapse prevention is highly dependent on how one is able to be more flexible in their thinking.
Bruce, K. R. et al. (2011). Effects of acute alcohol intoxication on eating-related urges among women with bulimia nervosa. International Journal of Eating Disorders, 44, 333-339.
Past research has supported a theory that both alcohol consumption and disordered eating share a reward pathway in the brain. Additionally, alcohol has been found to increase appetite and disinhibit restraint. Some researchers have hypothesized that alcohol may also lower tendencies to binge by increasing a sense of satiety and moderating negative emotions that trigger binges. Eight authors constructed a study of 30 White female participants all diagnosed with bulimia or an eating disorder not otherwise specified with binge/purge symptoms. It was found that eating disordered participants reported overall higher consumption of alcohol (outside of the experiment) than control subjects, supporting evidence that those presenting with bulimia have a higher concurrence of issues related to alcohol. For this experiment, participants were administered alcohol in a controlled setting and later given access to food in a cafeteria. The authors found that acute intoxication reduced urges to binge/purge, to restrict, and to exercise excessively. This result appeared connected to alcohol’s effect of lessening attention and awareness (to urges, for example). It was found that alcohol did not have a positive effect on mood and rather increased negative emotions.
Victoria Cane: Implications of this study on practice-
As the authors point out in this study, those suffering from bulimia may have an increased motivation to drink in order to achieve a sense of relief from behavior urges. As a treatment provider, I was somewhat surprised by these results. The results made more sense to me as I considered that alcohol and other substances are often used as a way of self-medicating. As a practitioner of dialectical behavior therapy (DBT), the information gleaned for this study helps me to understand the experiences of clients struggling with binge/purge behaviors more. For them, use of alcohol or other substances may be a way of actually trying to address their eating disordered symptoms. Looking at the behavior from a learning context, if the urges go down, they have been negatively reinforced (something uncomfortable has been taken away) by the alcohol. As someone who depends on teaching my clients new coping skills, however, this is troubling. We know that alcohol and other substances (like benzodiazepines) actually interfere with new learning so then teaching more adaptive coping responses becomes more challenging. We also know that while alcohol can have a short-term effect like reducing attention to an urge, it also has a long-term effect of increasing depression (supported by this study) which can keep the cycle of moods/behaviors going. This study is a good reminder for providers to continually assess for alcohol/substance use and to use current research to help clients understand the implications of alcohol use on their general well-being as well as specific symptoms.