Content analysis of male participation in pro-eating disorder web sites.

The pro-anorexia community has emerged as a powerful cultural movement that takes an at least partially positive attitude toward anorexia nervosa and other eating disorders. A systematic review of the literature on pro-ana forums focused specifically on females with eating disorders. However, epidemiological data suggest that as much as 25% of the eating disorders population is male. In our review of pro-anorexia web sites, we found a substantial number of participants were male. We conducted a qualitative content analysis of male participation in pro-ana forums in an effort to learn more about male participation in these forums. In this article, we present the results of this analysis, highlighting themes of social support, community appreciation, and ambivalence, as well as themes that appear to be particular to the male experience of eating disorders, such as alienation and teasing.

"How His Hair is Growing Thin!": On the Emotional Significance of Male Pattern Hair Loss.

Hair is a powerful symbol of individual and group identity: physical and therefore personal yet public rather than private. Despite the fact that male pattern hair loss causes men considerable emotional distress, its unconscious emotional significance is almost entirely unrepresented in the psychoanalytic literature, with a few notable exceptions. After a review of the sociological literature on male pattern hair loss and the relatively sparse psychoanalytic literature on hair and hair loss, four interlocking perspectives on hair loss in men are elaborated: (1) hair as the locus of maternal desire, (2) hair as evoking the helplessness of early infancy, (3) hair loss as a symbol of aging and death, and (4) hair loss as evoking paternal identifications and experiences with the paternal function. These ideas are illustrated with reference to T. S. Eliot's "The Love Song of J. Alfred Prufrock" and with a clinical case.

Deception in Anorexia Nervosa: An Aspect of The No-Entry System of Defense.

As Williams (1997) describes, patients with anorexia nervosa have been on the receiving end of intrusive maternal projections and consequently develop a no-entry system of defense. This paper explores how deception may function as an aspect of this system in two ways. First, deception may serve as a self-preservative effort to evade emotional contact with the maternal object, which is experienced as overflowing with projections, and to attenuate accompanying persecutory anxiety. Second, rumination-painful thoughts, feelings, and sensations-about the deception being discovered by the object leverages the mind's hypnoid capacities to construct an omnipotently generated container for the self that further protects the patient from emotional contact with the maternal object's projections. These ideas are illustrated with a clinical case of a patient with anorexia nervosa who engaged in frequent deception.

Immunity 12 years after alemtuzumab in RA: CD5⁺ B-cell depletion, thymus-dependent T-cell reconstitution and normal vaccine responses.

OBJECTIVES: Lymphocyte depleting therapies have been used to treat refractory autoimmune disease, including RA, but treatment may be associated with long-term lymphopenia. It is unclear whether delayed reconstitution preferentially affects lymphocyte subsets, how this modulates immune challenges and whether thymic function influences the outcome. These questions are now addressed in a detailed analysis of RA patients 12 years after alemtuzumab (anti-CD52) treatment. METHODS: Blood was obtained from 20 RA patients 12 years after alemtuzumab treatment. Lymphocyte subsets were enumerated by flow cytometry. T-cell receptor excision circles (TRECs)/ml were determined to quantify thymic function, and serological responses to neoantigens and recall antigens were assessed. RESULTS: RA patients remained lymphopenic 12 years after their first dose of alemtuzumab. CD5(+) B cells, which may be associated with autoantibody production, were significantly reduced in alemtuzumab-treated patients compared with age-matched disease controls. In addition, naïve and memory CD4(+) T-cell subsets were present in altered proportions in patients who had received alemtuzumab, with increased effector memory CD4(+) T cells, and decreased naïve and central memory CD4(+) T cells. TRECs were detectable in alemtuzumab-treated patients and correlated with CD4(+) lymphocyte counts. Vaccine responses to neoantigens and recall antigens fell within the normal range for an ageing population. CONCLUSIONS: Alemtuzumab therapy resulted in long-term alterations in lymphocyte subsets. The significance of these changes remains uncertain but patients respond normally to antigenic challenges. Thymic function remains an important determinant of T-cell reconstitution even several years after lymphocytotoxic therapy.

An overview of anorexia nervosa in males.

This article presents an integrative overview of existing research on anorexia nervosa (AN) in adolescent males. AN is commonly thought of as a female disorder. Even though as much as 25% of the clinical population is male, research on AN in males is limited. Additionally, most conceptualizations of male AN emphasize a single etiological factor and, therefore, produce treatments that fail to address it as a global phenomenon. In contrast, an integrative understanding that incorporates research on the familial, biological, cultural, and psychodynamic elements involved in male AN encourages treatment that comprehensively addresses the disorder.

The Paternal Function in Anorexia Nervosa.

The role of the father, both flesh-and-blood and symbolic, is explored in a subset of families of patients with anorexia nervosa. In these families the mother's narcissistic investment in her child makes separation-individuation difficult. A factor potentially influencing whether the child goes on to develop anorexia nervosa is the strength of the paternal function, which optimally helps the child learn how to appropriately deploy his aggression in the service of separation-individuation and as a means of developing "the experience of agency": the phenomenological experience of oneself as having an intentional impact. The role of the paternal function in developing the experience of agency is illuminated by the metaphor of rough-and-tumble play, which encapsulates the kind of experience with early objects that facilitates or forecloses the child's capacity for experiencing agency. In the families of these patients, the father is frequently described as passive or absent and the paternal function as compromised, which arguably leads the anorexic-to-be to relegate his experience of agency to his body, which he subjugates through omnipotent control.

Finding Freedom: Exploring the Relationship Between Agency, Motility, and Aggression.

After an overview of the opposed concepts of freedom and psychic determinism, and of the compatibilist reconciliation between the two that is most appropriate for psychoanalysis, the importance of agency as a psychoanalytic idea is considered. In particular, two ways in which the term agency may be used are examined: agency as fact and agency as experience. The former refers to the degree of relative freedom an individual possesses from "inner" constraints, whereas the latter refers to the experience of oneself as having an active impact on the self, other people, and/or the world. Importantly, these two senses are not coextensive. With this distinction in place, it is argued that agency as experience is rooted in the infant's earliest experiences of motility. As an extension of Winnicott's reflections (1950) on the relation between motility and aggression, it is argued that inasmuch as it involves the overcoming of opposition, aggression is integral to the developmental unfolding of the experience of agency. Further developmental conditions needed for a full experience of agency are noted. Ultimately, it is suggested, agency is central to the psychoanalytic project itself.

Go big or go home: A thematic content analysis of pro-muscularity websites.

Existing content analyses of pro-eating disorder web content have focused on thinness-oriented eating disorder pathology. With the increasing prevalence of muscularity-oriented body image concerns, we conducted a systematic content analysis of 421 active pro-muscularity websites including static content websites, blogs, and online forums. Emergent coding methods were utilized (Cohen's kappa range=.78-.88), and eight distinct thematic categories were identified: rigid dietary practices (26.2%), rigid exercise rules (18.4%), the broader benefits of muscularity (16.1%), the encouragement of the drive for size (15.9%), the labeling of non-ideal body (11.4%), marginalizing other areas of life (6.1%), muscle enhancing substances (3.3%), and minimizing medical risk (2.6%). Pro-muscularity websites provide explicit material surrounding potentially non-healthful muscularity-oriented eating and exercise practices. Clinician awareness of the potentially non-healthful behaviors involved in the pursuit of muscularity may enhance the detection and treatment of male eating disorders, in particular.

Morbidity and mortality in rheumatoid arthritis patients with prolonged therapy-induced lymphopenia: twelve-year outcomes.

OBJECTIVE: To assess immunologically relevant outcomes in a cohort of rheumatoid arthritis (RA) patients with prolonged therapy-induced lymphopenia. METHODS: Morbidity (infection or malignancy) and mortality were assessed in 53 RA patients who were treated with the lymphocytotoxic monoclonal antibody alemtuzumab between 1991 and 1994. Data were obtained by interview, medical record review, and Office for National Statistics mortality monitoring. Lymphocyte subsets were enumerated by flow cytometry. A retrospective, matched-cohort study of mortality was performed with 102 control subjects selected from the European League Against Rheumatism database of patients with rheumatic disorders. RESULTS: Lymphopenia persisted in the patients: median CD3+CD4+, CD3+CD8+, CD19+, and CD56+ lymphocyte counts measured at a median followup of 11.8 years from the first administration of alemtuzumab were 0.50 x 10(9)/liter, 0.26 x 10(9)/liter, 0.11 x 10(9)/liter, and 0.09 x 10(9)/liter, respectively. Twenty-seven of 51 cases and 46 of 101 controls with available data had died, yielding a mortality rate ratio of 1.20 (95% confidence interval 0.72-1.98). Causes of death were similar to those that would be expected in a hospital-based RA cohort. No opportunistic infections were noted, and only 3 infections were documented following 36 elective orthopedic procedures. CONCLUSION: Despite continued lymphopenia 11.8 years after therapy, our patient cohort did not exhibit excess mortality or unusual infection-related morbidity, and surgery was well tolerated. These data should be reassuring for clinicians and patients who are considering lymphocytotoxic or other immunomodulatory therapy for RA.

Is parathyroid carcinoma indeed a lethal disease?

BACKGROUND: Parathyroid carcinoma is a rare malignancy with a wide range of aggressiveness. There is no current staging system. Our primary aim was to review the presentation, diagnosis, surgical treatment, and outcomes of patients, with the goal of assessing the incidence of death related to parathyroid carcinoma. METHODS: The authors present a retrospective chart review on patients with parathyroid carcinoma from 1975 to 2004, identified by the tumor registry of a single tertiary-care center. Diagnoses were confirmed histologically, clinical and radiographical data were recorded, and statistical analyses were performed. RESULTS: Twenty-three cases were identified. The mean patient age was 54 years. The female:male ratio was 1.5:1. Follow-up ranged from 1 month to 23 years (median, 134 months). Mean preoperative calcium was 12.9 mg/dL. Median parathyroid hormone was 290 pg/mL. Two patients (9%) had an asymptomatic presentation, and five (22%) presented with a palpable neck mass. Only nine (39%) underwent initial comprehensive en-bloc resection. Median survival was 22 years. Five- and 10-year survival was 85.9% and 69.4%, respectively. Five- and 10-year survival with en-bloc resection was 90% and 67.5%, respectively. Local resection resulted in survival rates of 82.5% and 70.7%. Three of ten deaths were attributed to parathyroid carcinoma. In recurrent disease, computed tomography and scintigraphy had localization rates of 53% and 67%, respectively, with a concordance of 22%. CONCLUSIONS: Long-term survival is possible with parathyroid carcinoma. Death associated with parathyroid carcinoma was uncommon. A staging may be warranted despite the rarity of this disease.