Eating disorder websites: What about camaraderie?

Viewership of pro-eating disorder websites: Association with body image and eating disturbances
http://www3.interscience.wiley.com/cgi-bin/abstract/114293313/ABSTRACT?CRETRY=1&SRETRY=0

Semi-interesting study.  There always seems to be a lot of hype around the “pro-eating disorder” websites and forums.  I think I see the issue less black-and-white than most.  Sure, there are many harmful things about pro-ED sites: “tips” on purging, lying to friends and family, cheating through medical exams, etc…  But how different is this from picking up a copy of “Wasted,” by Marya Hornbacher?  Or “The Best Little Girl in the World” ?  You could pick up stuff even from an eating disorder documentary.  Lots of people with eating disorders have read most of this material, and some will even tell you that they did use it for motivation.

I don’t really know how you decide what is “online eating disordered behavior.”  So, if you track every single calorie you consume with an online calorie tracker, and talk for hours on some diet board about how evil fat is… that’s okay… as long as you don’t discuss the NUMBER of calories that you just recorded.  I bet you there are plenty of people with eating disorders on dieting forums.  I KNOW that there are.

What all of these forums do provide… eating disorder, dieting, etc… is support and a sense of community.  Eating disorders are lonely, isolating, and secretive.  Having a place where you feel like you CAN talk about the eating disorder (because face it, you can’t with most people.  “ugh, I had the worst BP last night after an argument with my parents, and just really need a hug.”  do you really think you could say that to a friend without an eating disorder?) is invaluable.  And often when you’re in the heyday of the ED, your relationships with the people around you are not going very well… and there really are genuine people on forums who care.  Sometimes you really just need to have a friend who can relate and sympathize.

So, in response to this article… I would argue that it’s not the different people who cause the body dissatisfaction and eating disturbance discrepancy, but the purpose of the website.  Any pro-ED sites that people frequent offers community.  How many professional websites do you know that have forums with professionals?  Hmm… NONE (you can’t count something fishy.  it has a handful of moderators, not a reasonable team of professionals).  Hence, you go to a professional website for information, and a pro-ED site for support / relationships / camaraderie / community.

This brings me to bit on social mental health care, which is a difficult and unpopular subject in the traditional sense.  But there really ARE inexpensive, innovative ways to reach people with eating disorders (and other mental health issues).  There SHOULD be forums run by professionals.  (add all the disclaimers you need to cover yourself legally.  it shouldn’t take the place of real treatment, etc etc). With inpatient stays being cut so short these days, people are thrown into treatment where they are surrounded by support and community, and then abruptly taken right back out.  There is a need for a professional online support medium.  If you want to decrease the prevalence of pro-ED sites, then you really need to provide an alternative.

Flawed studies extend far beyond PTSD research

Psychiatric News
Flawed Studies Underscore Need for More Rigorous PTSD Research — Aaron Levin

This article sums up [almost] all psychological / psychiatric research:

• “Significant gaps” in the evidence underlying treatments
• Poorly designed and executed studies that don’t account for important comorbidities
• Useless conclusions, including “treatments may or may not be effective,” and “inadequate evidence”
• Irrelevant research
• Overly conservative standards that are not applicable to looser, clinical standards
• Drug trials funded by pharmaceutical companies

It was exciting to see a written publication on the inadequacy of psychological research.  While I realize that that sounds pretty negative, often I think that I’m the only one who’s frustrated with the current methodology.  Every day I run into an article where I think, “WHY did they study this?”  Do we really need a study that says adult individuals with an anxiety disorder (and no depression, no substance abuse, a BMI between 18 – 23, and male between the ages of 25 and 30 with a college education) get an hour less sleep than non-anxious individuals?  … how is that helpful?  Probably 95% of patients don’t meet that criteria… and even if they do, what are you going to do with those conclusions?  Diagnose  (non-depressed, healthy weight, in their mid-to-late 20s with a college education) males with anxiety, based on their average amount of sleep?

The clinical relevance would be… ?

This article specifically addressed PTSD research, but I really think that the ideas can be applied to all psych diagnoses.  While I understand the importance of reliability, validity, participant and study controls, etc., those studies aren’t producing any stellar “this therapy works for 90% of patients” results.  Maybe one therapy isn’t going to be the solution… but if the goal is to be able to treat someone, you’re going to be looking for a treatment that can address person-to-person variability.