Managing anxiety in eating disorders with knitting.

OBJECTIVE: Recovery from anorexia nervosa (AN) is often confounded by intrusive, anxious preoccupations with control of eating, weight and shape. These are distressing and represent a potential barrier to psychological change. Theoretical and empirical evidence suggests that performing a concurrent visuospatial task reduces the emotional intensity of distressing images. We assessed whether the visuospatial task of knitting influences the anxious preoccupation experienced by inpatients with AN. METHOD: Prospective interventional cohort. SUBJECTS: Thirty-eight women with AN admitted to a specialized eating disorder unit. INTERVENTION: All subjects were given knitting lessons and free access to supplies. MEASURE: Subjects were asked to report the qualitative effects of knitting on their psychological state using a self-report questionnaire. RESULTS: Patients reported a subjective reduction in anxious preoccupation when knitting. In particular, 28/38 (74%) reported it lessened the intensity of their fears and thoughts and cleared their minds of eating disorder preoccupations, 28/38 (74%) reported it had a calming and therapeutic effect and 20/38 (53%) reported it provided satisfaction, pride and a sense of accomplishment. DISCUSSION: This preliminary data suggests that knitting may benefit inpatients with eating disorders by reducing their anxious preoccupations about eating, weight and shape control. The specificity of this effect is yet to be determined. This preliminary outcome requires further controlled study in AN subjects. From a clinical perspective, knitting is inexpensive, easily learned, can continue during social interaction, and can provide a sense of accomplishment. The theoretical and empirical rationale for this observation, and implications for deriving alternative strategies to augment treatment in AN, are discussed.

Are plasma homocysteine and methionine elevated when binging and purging behavior complicates anorexia nervosa? Evidence against the transdiagnostic theory of eating disorders.

OBJECTIVE: To determine whether plasma total homocysteine (tHcy) and plasma methionine levels are different in anorexia nervosa restricting type (AN-R) compared to anorexia nervosa binge eating/purging type (AN-BP). METHODS: Cross-sectional design. SUBJECTS: Subjects were recruited from the outpatient program of the Eating Disorders Program at St. Paul's Hospital, Vancouver, Canada. All subjects had a current Diagnostic and Statistical Manual of mental Disorders - Fourth Edition (DSM-IV) AN-R, or AN-BP diagnosis. Controls were recruited from staff and trainees of Child and Family Research Institute, and Children's and Women's Hospital, University of British Columbia. RESULTS: Samples were obtained from AN-R (N=30), AN-BP (N=32) and control women (N=73) and men (N=33). The 5- 95th% confidence intervals from the control women were taken as the normal range. The plasma tHcy and methionine for the control group had a 5-95th percentile range of 5.66-10.57 and 15.3-40.2 microM, respectively. Plasma tHcy was elevated in women with AN-BP (9.24+/-0.85 microM, N=32) but not with AN-R (7.90+/-0.38 microM, N=30). Plasma methionine was decreased in women with AN-BP (22.2+/-1.43 microM, N=32) compared to the control group of women (25.1+/-0.89 microM). The plasma methionine/tHcy ratio was elevated in the women with AN-BP (0.50+/-0.09) but not in those with AN-R (0.34+/-0.03). CONCLUSION: Elevated plasma tHcy and decreased plasma methionine are consistent with impaired homocysteine remethylation. Altered methyl transfer capacity or methyl deficiency could impair monoamine neurotransmitter metabolism potentially impacting cognitive and psychological function.We hypothesize that the treatment of AN-BP should consider the need for nutritional support of methyl metabolism.

Anorexia nervosa: a survival analysis.

BACKGROUND: There are numerous reports of the standardized mortality ratio (SMR) of anorexia nervosa (AN). However, the life expectancy of AN, has not been reported. OBJECTIVE: To estimate the average life expectancy of patients who are diagnosed with AN at various ages. METHODS: A survival analysis was performed using decision analysis software and mortality data for British Columbia, Canada from Statscan and the SMR for AN previously reported for British Columbia, Canada. RESULTS: The life expectancy of patients who are diagnosed with AN is displayed in Table 1 and Figure 2. For example, statistically, a woman who has had AN since 15 years of age is likely to live 25 years less than predicted for the normal population. DISCUSSION: Survival curves should be used to illustrate the loss of life in AN, to motivate patients and families, and to assist in legal arguments and requests for funding.