When we think of eating disorders, we rarely picture a man working out obsessively, starving himself to look lean or wanting to emulate celebrities on magazine covers.

For years, eating disorders have been viewed as a “white woman’s disease.” And estimates of male eating disorders told a similar story: while the majority of women suffered from eating disorders, only about 10 percent of men did.

Recent research, however, paints a different, bigger picture: more men are suffering from eating disorders than previously thought. Out of 3,000 people with anorexia and bulimia, 25 percent were men (and 40 percent had binge eating disorder), according to a Harvard study.

What distinguishes men with eating disorders from their female counterparts?

• Symptoms: The diagnostic criteria for anorexia, for instance, focus on women, which is evident in its hallmark symptoms of amenorrhea (the absence of menstruation) and fear of fatness. Though some men do exhibit a fear of fat, others typically want to be muscular (particularly their chest and arms), obsess over attaining a low body fat percentage and focus their efforts on excelling at a sport (which prompts some to abuse steroids and exercise excessively).

Instead of engaging in traditional compensatory behaviors like vomiting or abusing laxatives, men instead are more likely to exercise compulsively (as cited in Weltzin, Weisensel, Franczyk, Burnett, Klitz & Bean, 2005).

• Images and ideals: For decades, women have been inundated with unrealistic, thin images in magazines, movies, ads and other media outlets. And now, men are also feeling the pressure for physical perfection, surrounded by unattainable images of muscular physiques, six-pack abs, bulging biceps and lean bodies.

But, in contrast to women, where the images are one size fits all (thin is always in), men have a variety of images to emulate, psychiatrist Arnold Andersen, M.D., told The Wall Street Journal:

“Some want to be wiry like Mick Jagger; some want to be lean like David Beckham, and some want to be really buff and bulked, like Arnold Schwarzenegger.”

Interestingly, reports that wiry images are contributing to eating disorders have …

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One of the significant problems people with bipolar disorder grapple with is weight gain. Many online commentators have suggested that this is due largely to the impact of certain types of medications commonly being prescribed for bipolar disorder (a class of medications called atypical antipsychotics).

However, recently published research suggests that the whole picture is a bit more complicated than laying blame on the medications alone.

First, it helps to start off by understanding America’s overall weight problem. Nearly two-thirds of all Americans are overweight (over 70% of all men and over 61% of all women), and one-third of us are considered obese (National Health and Nutrition Examination Survey). America is fat, there’s simply no easy or other way to say it. So if you’re packing a few extra pounds, you’re in the norm for America today.

Susan Simmons-Alling and Sandra Talley (2008) examined the research into the factors surrounding weight gain and bipolar disorder. They note that 35% of people with bipolar disorder are obese, the highest percentage of any psychiatric illness. They also reviewed previous research which suggested factors that may be contributing to this problem: gender, geographical location, co-existing binge-eating disorder (up to 18%), co-existing bulimia nervosa (up to 10%), higher numbers of depressive episodes, treatment with medications that cause weight gain, high carbohydrate consumption, and physical inactivity.

But research results to-date have been decidedly mixed about whether bipolar disorder (and its treatment) causes significant weight gain, or whether weight is more of a general population issue that can be magnified by the presence of bipolar disorder (and its treatment). The researchers note one study that found that 68% of people seeking treatment for bipolar disorder presented as overweight or obese (a …

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I was browsing some of my regular news sites and came across an article in CNN.com’s Living section about phobias. (It was actually a syndicated article from a New York Times company, go figure.)

In the piece, which actually gets to some good suggestions at the end, it promulgates a common misrepresentation of what a phobia is:

A “specific” phobia, or an “excessive and unreasonable fear of a specific object, place or situation,” afflicts about 19 million people in the U.S., according to the Anxiety Disorders Association of America.

Okay, that’s fine. That’s the shorthand version of what a phobia is. But the real diagnosis includes meeting all 6 criteria, including this very important one (often overlooked in the mainstream media):

The diagnosis is appropriate only if the avoidance, fear, or anxious anticipation of encountering the phobic stimulus interferes significantly with the person’s daily routine, occupational functioning, or social life, or if the person is markedly distressed about having the phobia.

What if the diagnostic criteria had left out that the “person is markedly distressed about having the phobia?” I’d bet the incidence of phobias would be far less. Being afraid of fear is, I’d argue, a normal, natural human reaction. It multiplies our fearful thoughts and feelings, and can happen to anyone — not just someone with a phobia.

Without that catch-all phrase at the end of this criteria, you’re left with a fear of something that would have to cause you significant interference in your daily routine, work, or social life. For most people with a phobia, the phobia simply doesn’t impact their daily lives that much.

The reason you don’t see drug makers lining up to research and market a dozen new medications to treat phobias is that …

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Psychiatrist Danny Carlat and mental health blogger Philip at Furious Seasons reported on the news that the world-renowned psychiatry researcher Charles Nemeroff has resigned from his position as chair of the psychiatry department at Emory University, after Sen. Grassley’s continuing investigation into pharmaceutical funding payments, proper reporting, and ethics questioned why the researcher failed to report $1.2 million (yes, that’s million) in pharmaceutical payments since 2000.

In simultaneously published news accounts, both David Armstrong of the Wall Street Journal and Gardiner Harris of the New York Times have detailed the extent of Dr. Nemeroff’s cynical pattern of subterfuge regarding his involvement with the pharmaceutical industry.

I’m glad that Sen. Grassley’s office is continuing to police this industry when the FDA and universities ranging from prestigious Harvard University on down to Emory University (among many others) have failed to do so. Their reluctance to actually conduct the simple audits that Sen. Grassley is conducting is disturbing and symptomatic of the fundamental problem with the research funding model as it exists today in psychiatric pharmacological research.

I hope Sen. Grassley takes his investigation from individual cases into formulating new regulations or policies to ensure universities and government agencies do not suffer from future lax oversight. Because as soon as the spotlight is turned off, I imagine it’s only a matter of time before researchers start cutting corners again.

And as Dr. Carlat pointed out, if this kind of funding deception can happen with one of the country’s most-respected psychiatric researchers, imagine the kind of things lesser well-known researchers have also likely been getting away with for years.

The Carlat Psychiatry Blog: Curtains for Nemeroff

Furious Seasons: Nemeroff Resigns

Worth a laugh: Emory University’s statement about the resignation (treating the matter as …

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Imagine this scenario. Your seven-year old son is riding his bike, and takes a nasty fall. He has a gash on his knee that looks pretty bad, but you get out your first-aid kit, clean the wound, put a little iodine on it, and cover it with a sterile gauze pad.

Two days later, your son complains that his knee hurts a lot and that he “feels crummy.” He didn’t sleep well the night before, and his face seems a little flushed. You remove the gauze pad and notice that his knee is red and swollen, and there is a foul-looking, greenish liquid oozing out of the wound. You get that sinking, “Uh-oh!” feeling, and decide you had better have your family doctor take a look at the knee.

As you are about to drive off, your friendly neighbor buttonholes you and asks where you are going. You explain the whole situation to him. He looks at you like you are from Mars, and says, “Are you nuts? You want this kid to grow up to be a wimp? He is supposed to be in pain! Pain is a normal part of life! We all have to learn how to live with pain. Redness and swelling are normal, after you bang up your knee! Let the kid heal up naturally! The doctor is just going to put him on some damn antibiotic, and you know the kind of side effects those drugs have. Those doctors, you know, they just make money on all those prescriptions!”

Would you feel that your well-intentioned neighbor was giving you good advice? I very much doubt it. Well, it’s the kind of advice some well-meaning but misinformed individuals give, when …

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Since the 1990s, legislators in Congress have been pursuing the end of discrimination for people with mental illness by health insurance companies and employers. Even after they passed historic legislation (at the time) in 1996 to end this discrimination, health insurance companies found ways to subvert the intent of the bill and still discriminate against the people they covered if they had a mental health issue.

On Friday, the U.S. House of Representatives approved the $700 billion bailout bill (263 to 171), which included the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This Act (which we reported on earlier), a compromise that’s been years in the making, mandates that all employers with more than 50 employees offer mental health coverage that’s comparable to their physical health benefits. With Senate approval on Wednesday, the bill becomes law upon President Bush’s signature.

This means that for 110 million Americans, their health insurance will now be required to offer benefits and coverage of their mental health concerns at a level equal to that of physical concerns. Insurance companies will no longer be legally allowed to limit outpatient visits for psychotherapy (unless they do so already for other doctor’s visits).

We applaud Congress and the tireless work of Sen. Pete Domenici, the late Sen. Paul Wellstone, Sen. Edward Kennedy, Sen. Mike Enzi, among dozens of others, who never gave up hope of getting this historic piece of legislation passed.

We are relieved that finally, one more discriminatory and stigmatizing practice by the “free market” has been extinguished. It gives us hope that more government bodies and private corporations will follow and recognize that mental illness is just as real and has just as significant impact …

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Country music artist Wade Bowen will host his 11th annual “Wade Bowen Classic” concert and celebrity golf tournament on November 2 and 3 in Waco, TX. This year’s event benefits Postpartum Support International.

An all-star concert kicks off the two-day event at the Heart of Texas Fairground GE Building in Waco at 7pm on November 2nd. The concert will feature Wade Bowen, as well as Cross Canadian Ragweed and Stoney LaRue. More “surprise” guests will be announced in the coming weeks. The golf tournament the next day will be a two-man scramble and will take place at the beautiful Cottonwood Creek Golf Course in Waco.

“I’m so proud of how this event has grown and how everyone has come together to raise so much money,” said Bowen. “This year we are partnering with PSI, which hits really close to home for me because my wife battled postpartum depression after the birth of our first child, and I know how severely it can affect families. Believe me when I tell you that it is a cause that needs more awareness.”

Bowen recently released his new album “If We Ever Make It Home” featuring the song “Turn on the Lights,” which he wrote about his family’s personal experience with postpartum depression.

Tickets for both components of the weekend are available and start at $15. Over the past two years, the Bowen Classic has raised nearly $60,000. For questions regarding sponsorship or group ticket rates, please contact “Big Hearted Babes.”

According to research published in the Personality and Social Psychology Bulletin in August, the answer is “Yes,” sexual cues can directly influence a person’s relationship-oriented behaviors.

The researchers conducted a number of experiments to try and determine whether an association exists between erotic stimuli (sexually explicit words and pictures) and attributes that might increase a person’s tendency to want to be in a close relationship with another person.

Participants were divided into four groups — two were shown sexual photos, and two were shown neutral photos. Within each set of groups, one group was shown the photos for 30 ms (subliminal) and the other was shown it for 500 ms (supraliminal). The sexual photos shown were erotic but not pornographic pictures (an attractive naked, reclining man shown from the groin up for the female participants; an attractive, naked, kneeling woman photographed from behind for the male participants). The neutral photos were abstract pictures.

The effects of “sexual priming” on the tendencies to initiate and maintain a close relationship were measured using a variety of psychological and self-report tests.

The researchers’ findings? Subliminal exposure to these sexual stimuli increased participants’:

• Willingness to self-disclose
• Accessibility of intimacy-related thoughts
• Willingness to sacrifice for one’s partner
• Preference for using positive conflict-resolution strategies

This study’s findings seem to indicate that exposure to sexual or erotic stimuli can create a psychological environment conducive to relationship-oriented behaviors. There were no gender differences observed in the study related to sexual priming, and only the subliminal, not the supraliminal, stimuli had an effect on sexual priming. (The researchers believe this is because “subliminal exposure bypasses conscious beliefs and attitudes about sexuality and socially appropriate reactions to sexual stimuli.”)

These studies were conducted on university students, …

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Jane Pauley was at a fundraiser locally earlier this week, talking about her battle with bipolar disorder. “Pauley, 57, is best known for her 13-year work on NBC’s The Today Show and 11 years on the network’s news magazine, Dateline NBC.” A local newspaper, The Patriot Ledger, had the coverage of her comments:

“My goal in talking about mental illness is to help people with mental illness see themselves differently,” she said. “And more importantly, to help everyone else see us in new and powerful ways.

“Because this stigma thing is more than mean and ignorant, it inhibits people from facing a medical issue that’s treatable. It keeps parents from getting kids timely treatment, and that can be dangerous.” […]

“Bipolar is an isolating disease, and that can be dangerous,” she said.

“Some people say the high-energy creative phase is almost worth the devil that lurks behind it,” Pauley said of her manic state followed by a “deepening depression.”

“At best, I enjoyed a few weeks of high-octane creativity and confidence, but after that, it was just an idling engine on overdrive. The intensity of thought was exhausting. Living with me had to be very hard.”

“I had my first bipolar episode at 50, not 30, which is typical, or 14, which is becoming more common,” she said.

She added, “I had a 30-year career behind me. Everyone I cared most about already knew. I had little to lose.”

I appreciate her point of view as someone who grappled with late-onset bipolar disorder, but repeating the mantra of childhood bipolar disorder as though it’s a new epidemic that must be properly recognized and treated was a bit unfortunate to read. Childhood bipolar disorder (if it even exists) is an …

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Psychodynamic psychotherapy is often the overlooked stepchild in modern psychotherapeutic circles. While still regularly taught and practiced, it’s a therapeutic style that’s largely fallen out of favor in the U.S. with the rise of shorter-term therapies, such as cognitive behavioral therapy (CBT), which typically have a stronger research base.

New research published yesterday in JAMA (the Journal of the American Medical Association) suggests that, in a large-scale meta-analysis of 23 previously published studies on the efficacy of psychodynamic therapy, it can be a very effective therapeutic technique, especially in complex cases (such as those involving a personality disorder).

What is psychodynamic psychotherapy and what are its defining characteristics? As the accompanying JAMA editorial notes, psychodynamic therapy is:

“A therapy that involves careful attention to the therapist-patient interaction, with carefully timed interpretation of transference and resistance embedded in a sophisticated appreciation of the therapist’s contribution to the two-person field.” Identification and interpretation of transference and resistance are distinctive features of psychoanalytic psychotherapies that are commonly misunderstood.

Transference is defined as, “those perceptions of, and responses to, a person in the here and now that more appropriately reflect past feelings about, or responses to, important people earlier in one’s life, especially parents and siblings.” Transference occurs regularly in everyday life outside a psychotherapy setting. A strong reaction to a person or situation in which the intensity of the emotion is more than what would be attributable to the current situation may be a clue to the presence of transference.

Resistance is the “patient’s attempt to protect herself or himself by avoiding the anticipated emotional discomfort that accompanies the emergence of conflictual; dangerous; or painful experiences, feelings, thoughts, memories, needs, and desires.

Of course, as regular readers of World of Psychology know, …

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When a new TV seasons starts up and one of the hit shows is about sex addiction, suddenly everyone is focused on sexual addiction. “Look, a new disorder!” “Look, David Duchovny actually has it!” Like most other compulsive behavioral conditions, sexual addiction is not recognized as a “real” disorder by the psychiatric diagnostic book, the Diagnostic and Statistical Manual of Mental Disorders (the DSM).

However, unlike most other behavioral compulsions, sexual addiction does have a fairly rich and long research history (over 550 citations appear in PsycINFO on sexual addiction). The concept of sexual addiction, according to Levin and Troiden (1988), first came from a member of a Boston-area Alcoholics Anonymous chapter, who recognized his sexual behaviors as something he called “sex and love addiction.” He then adopted the 12 steps to this problem, which then began to spread and was eventually picked up by psychology clinicians and researchers. The first professional conceptualization and description of sexual addiction in the research literature appeared in 1983 (by Carnes, an ex-prison psychologist, who claimed he actually discovered the problem in the 1970s but didn’t write about it until years later). Debate swirled back and forth about the legitimacy of these labels when they first appeared on the scene.

Sexual addiction, like other behavioral compulsions outside of gambling, has never made it into the DSM, however (contrary to what is claimed in the Wall Street Journal article, which inaccurately states it was in the DSM-III [don’t newspapers fact-check any more?]). In fact, the DSM-IV, the most current revision of this book, makes absolutely no mention of the concept of sexual compulsions or addiction, not even under categories for further study. Given that the DSM-IV was …

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Ever wonder why your 8 year old can’t seem to learn from his mistakes when you tell him over and over again how he’s done something wrong?

It may be because their brains simply don’t react to negative feedback as teens’ and adults’ brains do. So says recent research published in the Journal of Neuroscience.

Eight-year-old children have a radically different learning strategy from twelve-year-olds and adults. Eight-year-olds learn primarily from positive feedback (’Well done!’), whereas negative feedback (’Got it wrong this time’) scarcely causes any alarm bells to ring. Twelve-year-olds are better able to process negative feedback, and use it to learn from their mistakes. Adults do the same, but more efficiently.

The researcher can’t say whether this is simply a function of the brain’s development itself, or a child’s experience and learning over the years (e.g., an 8 year old has significant less experience and knowledge than a 13 year old).

However, it’s valuable knowledge to understand that an 8- or 10-year-old brain might not be in the same place as an older child. And that negative feedback isn’t going to really start kicking in or working well in a child of that age until they hit age 12 or so. And of course, a study like this isn’t widely generalizable — your child may start responding to negative feedback at 10 or 9, and someone else’s child may not respond until 15 or 16.

Read the full article: Learning From Mistakes Only Works After Age 12, Study Suggests