Outcomes of Bulimia Nervosa – A Quarter Century of Research…

… where are we?

Objective: The present review addresses the outcome of bulimia nervosa, effect variables, and prognostic factors. Method: A total of 79 study series covering 5,653 patients suffering from bulimia nervosa were analyzed with regard to recovery, improvement, chronicity, crossover to another eating disorder, mortality, and comorbid psychiatric disorders at outcome. Forty-nine studies dealt with prognosis only. Final analyses on prognostic factors were based on 4,639 patients. Results: Joint analyses of data were hampered by a lack of standardized outcome criteria. There were large variations in the outcome parameters across studies. Based on 27 studies with three outcome criteria (recovery, improvement, chronicity), close to 45% of the patients on average showed full recovery of bulimia nervosa, whereas 27% on average improved considerably and nearly 23% on average had a chronic protracted course. Crossover to another eating disorder at the follow-up evaluation in 23 studies amounted to a mean of 22.5%. The crude mortality rate was 0.32%, and other psychiatric disorders at outcome were very common. Among various variables of effect, duration of follow-up had the largest effect size. The data suggest a curvilinear course, with highest recovery rates between 4 and 9 years of follow-up evaluation and reverse peaks for both improvement and chronicity, including rates of crossover to another eating disorder, before 4 years and after 10 years of follow-up evaluation. For most prognostic factors, there was only conflicting evidence. Conclusions: One-quarter of a century of specific research in bulimia nervosa shows that the disorder still has an unsatisfactory outcome in many patients. More refined interventions may contribute to more favorable outcomes in the future.

http://ajp.psychiatryonline.org/cgi/content/short/appi.ajp.2009.09040582v1?rss=1

Fat Talk Free Week — Luvin’ It

Outside of the word ‘Ma’am’ there is another word — the ‘F-A-T’ word that I despise quite vehemently… it’s been refreshing to be rid of at least one of those words this week!

: Happy Deepavali! :

 

Tu jagmagaaye teraa deep jagamagaaye
Saare jahaan ki khushiya tere bhee ghar ko aaye
Ganga aur Yamuna sa nirmal ho tera man
Ambar our dhara sa swachh ho tera tan
Is nagar me teri jyoti chamchamaaaye
Tu jagmagaaye teraa deep jagamagaaye

Achchhe karmo se jag me naam hogaa tera
Teri aahat se buraiya lengi nahi basera
Tere marane ke baad bhee log tera naam gaaye
Tu jagmagaaye teraa deep jagamagaaye

Mit jaaye andhera jo teri dagar me aaye
Aaye kabhi na gam jo deti chintaaye
Naam amar ho tera ek taaraa timtimaaye
Tu jagmagaaye teraa deep jagamagaaye

Door karna chhuachoot mandir masjid ka jhagara
Koi mare na bhookha koi rahe na kangala
Aane waalaa kal tera naam gungunaaye
Tu jagmagaaye teraa deep jagamagaaye
    -Shambhu Nath

*Wishing You a Very Happy Diwali!*

: Sursis d’été…

 

Men say the world is full of fear and hate,

 And all life’s ripening harvest-fields await

 The restless sickle of relentless fate.

 

But I, sweet Soul, rejoice that I was born,

When from the climbing terraces of corn

I watch the golden orioles of Thy morn.

 

What care I for the world’s desire and pride,

Who know the silver wings that gleam and glide,

The homing pigeons of Thine eventide?

 

What care I for the world’s loud weariness,

Who dream in twilight granaries

Thou dost bless

With delicate sheaves of mellow silences?

 

Say, shall I heed dull presages of doom,

Or dread the rumoured loneliness and gloom,

The mute and mythic terror of the tomb?

 

For my glad heart is drunk and drenched with Thee,

O inmost wind of living ecstasy!

O intimate essence of eternity!

-Sarojini Naidu
 

~~ Summer is in full-swing and we are finally escaping for a long overdue respite. Destined long nights, mythical and ancient sites… meditating on cliffs, dusting off the lens and capturing images that provoke and provide aesthetic sustenance. Lingering and contemplative hikes up temple steps that have been etched by devotees feet countless times before– who are we but humble and gracious guests- not the arrogant and time-constrained forceful tourist.

Foraging in sacred forests with gamelons playing in the distance, and dancing deities battling the age-old epic between black&white-good&evil ending with the balance of Life, once again, restored. Then taking what was digested of the day to a lamp lit night to write, write, write. Littering my splattered journal with poetic meanderings that have waited, sometimes it seems far too long, for a time such as this.

Life has certainly been blessed and full of positive changes lately! Our daughter has courageously turned the tables on Anorexia within the past couple of months, and is enjoying a summer filled without “fear“, vibrant, healthy and triumphant in this very moment– we are so extremely proud of her!

Thank you so very much to all of you who are a constant source of human wisdom, compassion and many who have also lent a comforting shoulder to lean on. Along with the ever gracious comrades who work with me tirelessly towards creating our monthly “healing&creative space”– which will return once again late this fall; I really don’t have enough words to do justice in this meager post to give adequate appreciation.

I am deeply grateful for the small patch of ground we continually attempt to uncover to help support those with eating disorders and their families, partners and loved ones. I hope to continue to dig a deeper and wider-reaching network that will eventually have an even greater substantial and purposeful base of resources, along with caring, intelligent and genuine individuals to be of greater service for those who continue to suffer. Patience, time and perserverance– many of us know all too well the meaning of those words, but they truly do remain at the forefront of what long-term recovery entails well after weight-nutritional restoration has been established.

As always, many additional thanks to those who continue to be of support, who listen, read the blog and email, and have allowed me this welcoming space to share our family’s Journey to Recovery– much deep love.

 Wishing everyone a relaxing, peaceful and enjoyable summer! See all of you when the leaves begin to crinkle and the crispness of fall begins to fill the air.~~

BDNF… say what?

An interesting study… 

This study shows that serum brain-derived neurotophic factor (BDNF) is significantly lower in women with anorexia nervosa (AN) compared with women without an eating disorder and women recovered from AN. While recovery from AN is difficult to define, BDNF may emerge as a useful biomarker of AN and of recovery from AN.

Finding biomarkers for AN and recovery from AN can help improve diagnostic accuracy and help better identify individuals who have recovered from AN. BDNF polymorphisms have not only previously been associated with AN {1}, but the BDNF-specific receptor neurotrophic tyrosine kinase receptor type 2 has also been associated with temperament characteristics and low BMI in individuals with eating disorders {2}. The current study evaluated serum BDNF levels in women with AN (n=29), women without an eating disorder (n=28) and women recovered from AN for 1 or more years (n=18). In addition, set-shifting ability was also evaluated in all 3 groups using the Wisconsin Card Sorting Task (WCST). Age was similar among all three groups, and women with AN and recovered women did not differ in lowest lifetime BMI. Women with AN had lower serum BDNF than controls and recovered women. Overall, there was a positive association between BDNF and BMI. BDNF was inversely correlated with the eating concerns, shape concerns, weight concerns, and global scale on the Eating Disorder Examination Questionnaire and on the depression and anxiety sections of the Hospital Anxiety and Depression Scale. Women with AN made more mistakes on the WCST than control women, but BDNF level was not associated with performance on the WCST. Set-shifting was not impaired in individuals recovered from AN. The current study excluded healthy control women with a BMI below 19 or over 26 thereby excluding constitutionally thin and obese women. It is plausible that BDNF is related more to BMI or the starvation state than to AN per se. However, the relationship between BDNF and BMI is unclear as the results from one study indicate lower levels of BDNF in morbidly obese individuals compared with obese individuals {3}. Including constitutionally lean and obese women in future studies may help clarify the relationship among BDNF, BMI, and AN. BDNF may be a useful biomarker in the underweight AN state and in indexing recovery from AN. However, it is important to first ensure that BDNF is in fact associated with AN and not strictly BMI or other indices of starvation.

References: {1} Ribases et al. Mol Psychiatry 2003, 8:745-51 ]. {2} Ribases et al. Mol Psychiatry 2005, 10:851-60 ]. {3} Bullo et al. Eur J Endocrinol 2007, 157:303-10 ].

: السلام عليكم و رحمة الله و بركاته :

Each star a rung,night comes down the spiralstaircase of the evening.

The breeze passes by so very close

 as if someone just happened to speak of love.

 

In the courtyard,the trees are absorbed

 refugees embroidering maps of return on the sky.

 

 On the roof,the moon – lovingly, generously -is turning the stars into a dust of sheen.

 From every corner, dark-green shadows,in ripples, come towards me.

At any moment they may break over me,

like the waves of pain each time I remember this separation from my lover.

 

 This thought keeps consoling me:

though tyrants may command that lamps be smashed

in rooms where lovers are destined to meet,

they cannot snuff out the moon,

so today,nor tomorrow, no tyranny will succeed,

no poison of torture make me bitter,

if just one evening in prison

can be so strangely sweet,

if just one moment anywhere on this earth.

-Faiz Ahmed Faiz

: Chère fille de joyeux anniversaire ! :

We know you always deal with your illness with such courage,

but we still wanted to send you a few hugs,

along with rays of sunshine, big smiles,

and a whole roomful of good thoughts!

So think of these words as a beautiful sunset all your own

and the sound of the ocean gently washing the shore…

Let our thoughts wrap you up in warmth and peace

and sit at your side.

So as you imagine yourself in the midst of these things,

remember how many people care about you and are

wishing you comfort and Love.

-Mary Miro

 *Lots&Lots of LOVE to You Today and Everyday! — Mom*Dad*Sis*

 

 

: Métamorphose de Mère :

 

When you begin to touch your heart or let your heart be touched, you begin to discover that it’s bottomless, that it doesn’t have any resolution, that this heart is huge, vast, and limitless. You begin to discover how much warmth and gentleness is there, as well as how much space.

-Pema Chodron

* A Very Blessed and Happy Mother’s Day! *

Mai Bienvenu!

 

The world’s favorite season is the spring.

All things seem possible in May.

-Edwin Way Teale

__________________

Is it really May, already?

Life has been good… definitely busy, but equally good!

The frenzy of prepping for gallery openings along with late nights doing my own work at the studio, holding support groups combined with some Yoga&Massage on the side has been quite the balancing act to say the least.

The end of the school year countdown has begun by our daughter, who has been finding recovery balances, challenges, and triumphs, mingled in with the excitement and plans for what she’ll be wearing and planning for graduation along with pre-summer preparations– Life is good!

And daily I try to make time to reflect on how grateful and blessed I am for my family, dear friends and acquaintances on this journey of Life- merci!

: Jour de Terre Heureux! :

In every walk with Nature one receives far more than he seeks.

-John Muir