Big Ideas In Eating Disorders

William Sharp, PhD, directs the Pediatric Feeding Disorders Program at Emory's Marcus Autism Center, where he's also a Professor in the Division of Autism and Neurodevelopment in the Department of Pediatrics. Kathryn Peterson, PhD, BCBA-D, is a professor at Rutgers Robert Wood Johnson Medical School. Professors Sharp and Peterson join us for this second episode in our Big Ideas in Eating Disorders series that features contributing authors to the book that Dr. Ruth Weissman and I co-edited.
 
In Chapter 2 of Weissman and Pike's Big Ideas in Eating Disorders, Sharp and Peterson tackle a diagnostic puzzle hiding in plain sight. Two conditions, Pediatric Feeding Disorder and Avoidant Restrictive Food Intake Disorder, are both used to describe eating disturbances in children, and they overlap so heavily that clinicians are often left guessing which one actually fits.
 
That confusion isn't just academic. Will and Kate trace how the field ended up with two overlapping categories instead of one clear path forward, and make the case that untangling them is essential to improve treatment. Get the diagnosis wrong, they argue, and the treatment doesn't just fail. It can make things worse. 
 
Join us for a behind-the-scenes conversation with Will and Kate as they unpack the chapter, the debates that shaped it, and what it means for the kids caught in the middle.

Phillipa Hay MD, DPhil, is Chair of Mental Health, Translational Health Research Institute, Western Sydney University, Penrith South, New South Wales and the Director of Mental Health Research at Southwestern Sydney Local Health District. Dr. Hay is an academic psychiatrist who is recognised internationally for her expertise in reducing the personal and public health burden of eating disorders and obesity.
Deborah Mitchison, PhD is Associate Professor in Psychology at the Graduate School of Health at the University of Technology Sydney. Professor Mitchison also holds adjunct appointments at Western Sydney University and Macquarie University. 
Drs. Hay and Mitchison’s chapter in Big Ideas In Eating Disorders poses a big and provocative idea: What if we completely reimagined how the field classifies and diagnoses eating disorders? They argue that the current diagnostic frameworks are confusing and limited in practice, and they strongly advocate that the field will be better served by understanding the defining features of an individual’s eating disorder and the unique constellation of symptoms as experienced by the individual. In this podcast, Dr. Hay elaborates on these core ideas and what they would mean in real-world practice.

Professor Phillipa Hay is a psychiatrist and the current Chair of Mental Health at Western Sydney University in Australia, the co editor-in-chief of the Journal of Eating Disorders, and past recipient of the Lifetime Leadership Award from the Australia New Zealand Academy for Eating Disorders. Drawing on her experience from decades of teaching, research, and clinical care in eating disorders, Dr. Hay discusses the limitations of weight-based criteria in eating disorder diagnostic criteria, both in terms of limiting treatment access and in restricting our understanding of recovery.

Today we have the good fortune to hear from Dr. Kelly Klump whose contributions to the field of eating disorders are indeed invaluable. Inspired by one of her early mentors, Professor Gloria Leon, Dr. Klump has embarked on a journey of groundbreaking research that reshapes our understanding of the complex interplay between genetics, hormones, and environmental factors in the development of eating disorders. Dr. Klump’s exploration of gonadal hormones, including estrogen, progesterone, and testosterone, is steadily uncovering the relationship of hormonal fluctuations, particularly during puberty, to the onset and expression of eating disorders. Translating these findings to clinical practice has the potential to inform more effective prevention strategies and personalized interventions for individuals at risk of developing eating disorders.

In this episode, we delve into the insights of Trinity University Psychology Professor Carolyn Becker, whose insatiable curiosity and openness to explore diverse fields have been the driving forces behind her innovative and fruitful career. Recognized for her excellence in teaching and research, Professor Becker's expertise lies in implementing scientifically backed interventions in both clinical and real-world contexts. She has led innovative work focused on body image and athletes and has spearheaded groundbreaking research on eating disorders among individuals facing food insecurity, a demographic often overlooked by conventional eating disorder studies. Her work underscores the imperative to dismantle stereotypes surrounding eating disorders.

Today’s episode takes us on a global journey with Dr. Anne Becker, Maude and Lillian Presley Professor of Global Health and Social Medicine at Harvard Medical School. Although Anne never became the meteorologist she imagined in her youth, as a psychiatrist and anthropologist, she traveled far from home to launch pioneering work in Fiji focused on how culture contributes to shaping the meaning of body image and risk for eating disorders. In this episode, Anne shares how she got to Fiji, the surprising conversations, and the evolving meaning of weight in Fijian communities at different points in time. Anne shares the serendipitous circumstances that enabled her to map the impact of the arrival of American television on triggering eating disorder symptoms and rising body shape and weight concerns. Dr. Becker’s keen intellect and her delight in discovery is riveting and contagious as she shares her pioneering work, which is foundational for anyone who wants to understand culture and eating disorders.
Becker, A.E. Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity during Rapid Social Change. Cult Med Psychiatry 28, 533–559 (2004). https://doi.org/10.1007/s11013-004-10...
Becker, A.E. Body, Self, and Society: The View from Fiji, 1995.

I am delighted to be joined today by Rachel Rattenni as part of our special series focused on the proposed diagnosis “terminal anorexia nervosa.” Rachel has a graduate degree in bioethics from Columbia University and is currently pursuing a master’s in public health at Johns Hopkins University Bloomberg School of Public Health. She also serves as Rachel serves as the Program Assistant for Big Ideas In Eating Disorders. Her formal studies and work, in combination with her own lived experience with an eating disorder, inform her thoughtful and insightful comments on the risk of losing hope associated with the proposed diagnosis and the need to create more space for patients to have voice and agency in shaping their treatment goals, i.e., from the beginning and long before they meet the proposed criteria for “terminal anorexia nervosa.”

The current episode is the third of our six-part series focused on the proposed diagnosis of “terminal anorexia nervosa.” My guest is Rosiel Elwyn (they/them/she), a PhD candidate at the Thompson Institute, Australia, who is studying the neurobiology of anorexia nervosa with a focus on the role of trauma and its effects on the glutamatergic system, the gut microbiome, and interoceptive function. Rosiel has lived with anorexia nervosa since childhood and currently works as a lived experience researcher and mental health consultant on a number of projects and advisory groups in eating disorders, suicide prevention, psychosis, trauma, and trauma-informed care, with a particular interest in co-design in these areas. With heart and mind, Rosiel shares with us hard earned insights on the proposed diagnosis of “terminal anorexia nervosa” and demonstrates brilliantly the unique and essential contributions that people with lived experience bring to field of eating disorders.
Elwyn, R. A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope. J Eat Disord 11, 2 (2023).
Treem, J., Yager, J., Guadiani, J.L. AMA J Ethics. 2023;25(9):E703-709.

We are thrilled to be joined today by Dr. Paul Appelbaum for the last of episode in our special series focused on the proposed diagnosis of “terminal anorexia nervosa.” Dr. Appelbaum is the Elizabeth K Dollard Professor of Psychiatry, Medicine, and Law at Columbia University and Past President of the American Psychiatric Association, the American Academy of Psychiatry and the Law, and the Massachusetts Psychiatric Society. A member of the Institute of Medicine of the National Academy of Sciences, Dr. Applebaum has received numerous awards for his extraordinary contribution to forensic psychiatry, psychiatric aspects of jurisprudence, clinical trial ethics, capacity assessments, and medical aid in dying. Dr. Appelbaum brings a depth of experience and particular expertise to our discussion of “terminal anorexia nervosa” and the use medical aid in dying in psychiatry more broadly.

Join the podcast is Dr. Angela Guarda, the Stephen and Jean Robinson Professor of Eating Disorders in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine and Director of their Eating Disorders Program since 1997. This is the second episode in a six-part series that revolves around Guadiani, Bogetz, and Yager's suggested diagnosis of "Terminal Anorexia Nervosa." In our conversation, Dr. Guarda reflects on her decades of clinical and research expertise and provides a thoughtful and impassioned response to this complicated and provocative proposal. I have reflected many times on our conversation since its recording. Consummate educator, Dr. Guarda has much to teach us.
Guarda AS, Hanson A, Mehler P, Westmoreland P. Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined. J Eat Disord. 2022 Jun 7;10(1):79.
Gaudiani, J.L., Bogetz, A. & Yager, J. Terminal anorexia nervosa: three cases and proposed clinical characteristics. J Eat Disord 10, 23 (2022).