AED conference travelogue - healthy conflict

Really, Laura? Really? It takes a full month for you to clear your desk and get on to writing up your experiences at the AED conference in Miami? Please.

Well, I say back to me, wondering why I bother arguing with you: better late than never.

So, I spent five days in Miami at the ICED conference put on by the Academy for Eating Disorders. They run a great conference - packed with content, draws from a range of disciplines and countries, and a real Who's Who of thinkers in the ED world. At my first ICED in 2007 I remember sitting in a corner of the lobby typing "this is like being at the Oscars!" as I recognized the people going by... Every year I know more people by sight, so I can accost them in the hallways with questions - and this year to press flyers for the F.E.A.S.T. conference into their hands.

I enjoy travel, not least because it means I get to choose food I don't have to cook and stay in a room I don't have to clean.... plus noone is asking me where their favorite t-shirt is or making me supervise homework. So when the airport security screener looked up at me a bit startled and said "Wow. A smile!" I said, "Hey, I'm out of the house!" After which I bet the TSA shadowed me all the way for being a BIT too cheery.

Arrived in Miami and unpacked and plugged in the dozens of appliances one must carry: cell charger, computer charger, Kindle charger (oops, forgot that), portable wireless charger... why don't they have more plugs in hotel rooms? Met up with Carrie Arnold and we sallied forth to scout the premises. Found Julie O'Toole and Steve Nemirow along the way... who were with, sigh, one of my longtime idols: Kenneth Nunn. I managed not to fall all over myself immediately but before the evening was over did effuse a bit about how grateful I was and remain so for his support back in 2002 when he kindly fielded emails from this strange American mother trying to help her very ill daughter. Made in person acquaintance with Rod McClymont, too. Ken and Rod were great to know throughout the week, for many good conversations on science and policy.

Mojitos. Shrimp dinner with a lovely cast of folks and a Forrest Gump quiz.

For those who don't make a hobby of these types of conferences, here's how it works. The conference centers around a large area set up with dozens of exhibitor tables - mostly treatment clinics - and this is the area where coffee and snacks are found. The tables are usually well-appointed, with large pleasant graphics and lots of giveaways (stress balls, mints, pens, sticky-pads...), and well-caffeinated staff. I go from table to table learning about the programs and asking annoying questions like "do you use evidence-based methods?" "how exactly do you involve families?" "who is in charge of feeding and monitoring when the patient goes home?" I do not take any swag, on principle. Though I am sorely tempted by the little brains they give out at UCSD's table.

The conference schedule for AED is PACKED. Breakfast starts at 7:30 (it is not really breakfast, though - just pastries and a little fruit. Pet peeve of mine. I had to go out of the conference to stand in Starbuck's endless line to get an egg salad sandwich so I didn't suffer a hypoglycemic event. It's an EATING DISORDER conference. Not serving real, sit-down food is like serving little bottles of hard liquor at an AA event. Just saying.), and first public address is at 8:30. There are keynote addresses, speeches, awards, and plenaries all in the big room with everyone in attendance, and then breakout workshops with as many as 11 choices, until 5:30pm.

Then a reception, and Poster presentations in a room off the exhibitor's hall.

This goes on for three days. Your brain goes soft and pale and you start to giggle strangely by the third day, and then you notice that some people have a suspicious tan instead and realize you really should have taken a break. Then the last night there's a big loud party and you see your brainy idols doing a conga line and whatever sentience you had left gets you on the lift back to your room.. and you pack to go home, trailing your chargers behind you.

Ah, but the content. This conference had the best content I've seen. Granted, I cherry pick. And it is hard to choose. Do I go to the session on real world FBT  by Loeb, le Grange, Jones and Zucker? The Who's Who of the Brain by Lask and Nunn (turned out to be the most talked about among my friends since then)? The Internet communities by Ringwood and van Furth.... Well, all of those would have been good choices, but I felt most intrigued by "Does Family Environment Matter in the Etiology of Eating Disorders? An Integrative Paradigm." by Strober. And I was not disappointed. It was intriguing. And, to noone's surprise including Strober, I asked this question - paraphrasing myself here - "What are the iatrogenic perils of talking about otherwise benign parenting behaviors as "influencing" the development of such a dangerous and mind-altering brain disorder?" Strober agreed that this was a risk. Clearly a risk that I worry about more than he does. Now that it is fashionable to pat parents on the head and say "you didn't CAUSE" this but go on and say things about their parenting, we're seeing more of this. There is an epidemic of this kind of language around parents and I'm going on record to say that it is still blaming the family to say "influences," and "unwittingly pushes," "contributes to." We're talking about a family facing a life-threatening illness that requires enormous parental courage and focus to turn around - a time to focus on the big picture. Anything we say about parenting and family issues during that time better be very important. That's a seed that germinates way too well in a loving family, and out of control in less well-functioning ones. I suggest looking at it more like an allergy: if a family gets a dog not knowing that one of the kids has a horrible allergy to it - the allergy is the problem. Not the choice of the dog, or even the dog itself. Do they need to find another home for Fido? Maybe. Allergy shots? Maybe. Lecturing families on the decision to get a dog is beside the point.

Somewhere in the melee, I got to meet a baby that I've admired from afar - and had lovely Thai food - thank you Sarah!

Odd phenomenon: two of my favorite ED people were at the conference but over three days I never actually SAW two of them. I was even texting with Roxie, and yet, never in the same room. I'm not even sure I believe Mark WAS there, but he says he was.

I won't belabor all the sessions I attended, but there were so many good presentations. There were a few that required more coffee and a little peek at the Blackberry, but they are long days. There were a few presentations that caused mark-throughs in my notebook as I scrawled out my disapproval and dismay. But, mostly good and more importantly : fresh perspectives and science. A few highlights to share.

The Keynote by Timothy Walsh was, even for the non-geeky, worth the early start. "The Diagnosis of Eating Disorders: The Good, The Bad, and the DSM-V" was witty and topical. Aside from hearing the inside story of the process and the reasons for changes to be introduced in V, there was also remarkable humility. Yes, the decisions are being made based on verifiable science, but there isn't much to go on and he acknowledges that. He didn't try to puff it up or make excuses, he explained the genuine complexity of staying within known data AND being useful, as well as the legacy of past DSM efforts. Next time I get frustrated with how "wrong" it all is, I will remember that they are struggling, too - even with the larger DSM authorities - and often can't just do what they want or think would work or even what they believe: they have to work within the structure and published work. You may be startled to hear that he said "We just made this up" when describing the first efforts to manualize diagnosis. He acknowledges that "the DSM really isn't that good." He also said, and I understand "This isn't for amateurs" and "This stuff isn't over." It is good to know that there IS a struggle, not some group of Oldie Boldies plotting to win their points, or be influenced by industry. I know there's politics, too, and money influence, but I applaud AED and the DSM committees and Walsh for taking it out of the back room and sharing it.

The Plenary sessions are often quite feisty and very much so this year. Plenaries entail a panel of presentations on a theme, and then a moderator or discussant to bring it together.

The most talked about plenary presentation was a surprise: Poulsen's "RCT of Psychoanalytic Psychotherapy and CBT for Bulimia Nervosa." It is remarkable enough to have an RCT with psychoanalysis in EDs. But for the researcher, who makes it clear that analysis is his field of interest, to report that his results were not as expected and in fact showed CBT to be clearly superior in this trial - was both brave and newsworthy. It was quite a moment.

There was a public set-to (one of three I observed that week), when a CBT lion, Fairburn, was sharply questioned by Eisler, and even more sharply responded. For those who follow these things, it was a rare view into professional relationships and controversies.

Another open conflagration: after a rare ED world appearance of the founders of Mandometer presented their approach they were questioned openly by Kaye on the question of financial self-interest - to which Soderstrom said "is that a problem?"

Box lunches. Just say bleah.

Um, a word on binge eating and obesity. AED's Keynote said it in the first hour of the conference: the DSM will not define "obesity" as an eating disorder - just Binge Eating Disorder (which may lead to obesity as a symptom, but is also present in "average" weight patients, and many obese people do not have binge eating disorder or any eating disorder). So why were so many presentations about obesity? Why were we subjected to - one during our "box" lunch - two presentations that detailed how to successfully diet? Why did I keep hearing the phrase "healthy weight?"

The Plenary session that knocked me over was "Is Food Rewarding - clinical insights from brain imaging." It started slow: lots of data on reward processing, addiction, food motivation. Ho hum. But then Kenneth Nunn woke everyone up: he analyzed and questioned each of the presentations, saying how great the presentations were but the conclusions were wrong. Then offering alternate explanations - jaws dropped. Conference organizers paled. Then he looked into the audience and called out leading researchers and declared them on the wrong track, too. He did this with warmth and humor, and offered a new frame to it all: saying that AN and BN were best characterized as a problem with fear circuitry, and overeating as addiction. This is a distinction that not many people are making out there - between fear and addiction - but I bet we're all a lot more conversant on it now!

Surreal: was in a hallway with a group that included Bryan Lask, and a woman walked up and offered to do a magic trick. He played her Charming Assistant. That doesn't happen every day.

My own favorite science moment of the week: using weight suppression as a diagnostic and prognostic and treatment tool - presented by Michael Lowe. "The field is focused on food more than weight. Are these eating disorders, or weight disorders? He talked about a very simple measure: highest past weight compared to present weight. He sees diet induced changes as the issue. Level of weight suppression, he believes, predicts bulimic behaviors. We talked afterward and I got more details and predict this will be a really rich line of thinking in the field - or should be. My personal holy grail is finding out how to get away from normative measures of health to individualized ones. Right now, I feel as if people despair of using weight at all as a measure because it 'doesn't work.' I wonder if we add in the variable of weight suppression, we might move forward.

So, although the theme of the conference was "The complexity of eating disorder: many perspectives, one shared goal" I would re-name it: "The healthy conflict of the eating disorders field: many perspectives, usefully engaged."

Now, a month late, I can tell you why I packed a tiara. I had the great honor of being invited to a party to celebrate the Royal Wedding. My friends, Susan and Gary, had a group up to their apartment to enjoy treats and bunting. We all went home with silly hats and big smiles, and waving like the queen at one another as we parted...

p.s. you may recall that there was a bit of an ugly business over a stray email going public during the event. I contacted the emailer when I got home, and we had a long phone call soon after. It was a good call. I learned things. I hope I represented myself well. healthy conflict.


  1. Is there any place where a layperson could go to access information about the RCT relating to CBT and psychoanalysis for BN?

  2. Exactly!!!
    Loved the p.s.! I'm so proud of you. Something else to catch up on when we get to talk!

  3. M.B. - we'll talk. And watch for tomorrow's post "one year later" which deserved a post of its own.

  4. The psychoanalysis presentation was:

    A Randomized Controlled Trial of Psychoanalytic Psychotherapy and Cognitive Behavioral Therapy for Bulimia Nervosa, by Stig Poulsen, Phd.

  5. Great report and worth the wait. Very jealous.

  6. Agree with Charlotte, great report, jealous, wish I was there. Your insight is always appreciated. I am so glad to here so much exchange and dialogue is happening in this field. Thanks Laura !


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