Wednesday, 29 February 2012

A letter from Charlotte to Dr Christian


Dr Christian read my blog this morning, and only cared that I spelt his name wrong. He needs to read this too...from Charlotte

Dear Dr Jessen

I am writing to raise my concerns about Supersize vs Superskinny. 

I don’t know if you are aware of the major changes to the DSM V for Eating Disorders and I am concerned that some participants in the programme may be suffering from a brain disorder and require expert medical attention.   As most Eating Disorders are on the Anxiety Disorders spectrum as well, I am not sure that the format of your show necessarily takes this into account.  I would hate for you to look back at your show, once the new DSM V is published and find that you have treated an undiagnosed Eating Disorder patient in the wrong way.

The first category I would like to draw your attention to is Avoidant/Restrictive Food Intake Disorder: 

Avoidant/Restrictive Food Intake Disorder 
A. Eating or feeding disturbance (including but not limited to apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; or concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one or more of the following:
1.   Significant weight loss (or failure to gain weight or faltering growth in children);
2.   Significant nutritional deficiency;
3.   Dependence on enteral feeding;
4.   Marked interference with psychosocial functioning.
B. There is no evidence that lack of available food or an associated culturally sanctioned practice is sufficient to account alone for the disorder.
C. The eating disturbance does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa, and there is no evidence of a disturbance in the way of which one's body weight or shape is experienced.
D. If the eating disturbance occurs in the context of a medical condition or another mental disorder, it is sufficiently severe to warrant independent clinical attention
The new DSM V is also including Binge Eating Disorder for the first time:

Binge Eating Disorder  
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
2. a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
B. The binge-eating episodes are associated with three (or more) of the following:
1. eating much more rapidly than normal
2. eating until feeling uncomfortably full
3. eating large amounts of food when not feeling physically hungry
4. eating alone because of feeling embarrassed by how much one is eating
5. feeling disgusted with oneself, depressed, or very guilty afterwards
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for three months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.
I think that perhaps it would be wise for you to consider carefully whether the participants in your programme may be suffering from an undiagnosed Eating Disorder.  There are many specialised Eating Disorder professionals who would be able to help you and, if you would like to discuss this further, or you would like me to put you in contact with some Professors of Eating Disorders, I would be delighted to help.
Yours sincerely
Charlotte Bevan

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