New research on anorexia as brain disease

17th December 2007

New research on anorexia as brain disease

posted in Eating Disorders, New Research |

A study published this month in The American Journal of Psychiatry sheds new light on the anorexia-by-super-thin-models controversy.

A team of psychiatrists, led by Walter Kaye, of the University of Pittsburgh, conducted the study, which suggests that the brains of anorexia sufferers behave differently to those of the rest of the population and that certain people are born with a susceptibility to develop the condition.

“What this points to is that anorexics have something different going on in their brains, which marks them out as having either different structures in the brain or different pathways for processing thought that stay with them for life,” said Kaye. “We may be able, with a lot of hard work, to get them back to eating, but deep down in their brain there appear to be biological differences that don’t go away.”

For the specifics on the study, read more at The Times. (The Times article credits Kaye as a researcher at the University of Pittsburgh, but according to the University of California San Diego website, he’s the new psychiatrist and program director of its Eating Disorders Program).

My quick take on the study’s findings:

I think the study marks a positive direction in looking at anorexia as a pathological condition, one whose roots are organic rather than as the result of neurosis. However, I wonder if the study’s grasp exceeds its reach.

The study is limited in scope, based on the responses of 13 former anorectics with that of 13 non-sufferers. Thirteen women can hardly be considered indicative of the eating disordered population as a whole.

While I agree that many with anorexia are genetically predisposed to develop characteristics of the disease, I don’t believe they are necessarily genetically predisposed to develop anorexia, or any other eating disorder. Rather, I think there exists a genetic propensity to developing characteristics that might very well manifest itself in an eating disorder - or any other number of addictions.

The study also doesn’t include the age of onset for the former anorectics in the study nor does the study attempt to explain why the most common age of onset for anorexia is adolescence. If anorexia were entirely a brain-centered disease, why wouldn’t such characteristics also be exhibited throughout childhood? Why is adolescence then a common starting point for many an anorectic?

The study also doesn’t account for why lowered rates of anorexia are found in eastern European and African countries, and much higher in industrialized, western cultures like the U.K. and the United States. If anorexia is entirely a genetic brain disease, it stands to reason that the genetic variance of the disease would then be more evenly distributed.

I do believe anorexia, like other eating disorders, often has much to owe to biological conditions already present. But nor can I ignore the fact that humans are also products of their social environments. Super-thin models, for instance, may not cause one to develop an eating disorder, but the prevalence and saturation of unrealistically thin women bombarding culture does have a powerful, if immeasurable, impact on many in society to then choose food and weight as a loci of obsession.

The characteristics Kaye describes of the anorexic mind are quite similar to other addiction-based behaviors. Therefore, there has to be some environmental influence leading one to choose food as a means of vice and not, say, sports or drugs or any number of thing people can and do become addicted to. Eating disorder-like characteristics may be genetically predestined, but our social environment is the petri dish in which a disorder simmers to life.

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1 On December 17th, 2007, Devi

said:

If anorexia were entirely a brain-centered disease, why wouldn’t such characteristics also be exhibited throughout childhood? Why is adolescence then a common starting point for many an anorectic

Perhaps it’s a bit like Obsessive Compulsive Disorder in the ages it manifests. Though there are younger children with OCD, one of the peak age ranges for developing it it seems to be just before adolescence.

posted on December 17th, 2007 at 11:20 am

2 On December 17th, 2007, Kelly

What I am curious about is how they determined who were the “normal” volunteers. What made them “normal” and who determined the guidelines for finding the characteristics/volunteers? I agree with you in that there are most likely biological conditions already present and have to wonder how the “anorexic” volunteers match up to those who have battled addictions such as drugs and other substances.

Thanks for writing about this article as I saw it earlier and was having difficulty in composing my reaction to it.

posted on December 17th, 2007 at 12:08 pm

3 On December 17th, 2007, Len

“Super-thin models, for instance, may not cause one to develop an eating disorder, but the prevalence and saturation of unrealistically thin women bombarding culture does have a powerful, if immeasurable, impact on many in society to then choose food and weight as a loci of obsession.”

This sentence stood out, for me.
I’ve been diagnosed with a number of eating disorders throughout the years (first bulimia, then EDNOS, then anorexia, then EDNOS again because of changing symptoms). I was also a self-injurer for a number of years, and have participated in a wide range of other self-destructive behaviors. Since I began to work with an amazing therapist several months ago, I’ve come to the realization that my eating disorders and patterns of self-injury were not, and are not, unrelated. They were/are simply symptoms of an underlying psychological state or tendency that just so happened/s to manifest itself in these particular ways. I feel that this may be the case with a lot of other people with eating disorders - the disorder itself isn’t the problem, but the underlying psychiatric condition happens to manifest itself in this particular way because it’s an easy thing to fixate on, an easy target.

Thoughts?

posted on December 17th, 2007 at 12:19 pm

4 On December 17th, 2007, Tari

I also think that the brain goes through a slew of changes during adolescence (hormonal fun!) that could trigger pre-existing traits, especially with the emotional stresses and other baggage that so often accompany puberty.

So many human traits are hard-wired, though, I find it pretty easy to believe that anorexia (or just about any other disorder, eating-related or otherwise) is at least partially genetic.

posted on December 17th, 2007 at 12:46 pm

5 On December 17th, 2007, vesta44

Not that I know anything about anything much, but if these things manifest in adolescence, could it be exacerbated by the hormonal changes these children are experiencing? Or maybe the hormonal changes contribute to it in some cases? Along with all the bombardment of thin models/actresses and obesity epidemic hysteria? It seems to me that there are probably a host of contributing factors and that not all of them affect all children, but any combination of them may be enough to trigger anorexia or addiction or any other eating disorder in children already predisposed to these things.

posted on December 17th, 2007 at 12:49 pm

6 On December 17th, 2007, Kris

Anorexia may be like schizophrenia, which is entirely brain-centered and often has few to no symptoms until adolescence and young adulthood. (And schizophrenia, despite being a genetically transmitted brain disease, is not evenly distributed around the world or even within countries. For whatever reason, living in an urban area is associated with a higher risk of being diagnosed with schizophrenia.)

The changes in the brain that the study noted might also manifest themselves differently in different populations. We don’t know yet, the study was way too small to really tell.

posted on December 17th, 2007 at 2:15 pm

7 On December 17th, 2007, Rachel

Kris: Interesting observations re: schizophrenia. I really wish the anorexia study were more exhaustive and conclusive so as to answer these lingering types of questions.

Len writes: “They were/are simply symptoms of an underlying psychological state or tendency that just so happened/s to manifest itself in these particular ways.”

I think this is true for a number of eating disordered women. While I do think eating disorders are, to some degree, highly organic in nature, I think eating disorders comprise a coping mechanism for many people. One of the stereotypes I so often hear is that the eating disordered person is on a course of slow suicide. An eating disorder isn’t a form of suicide; it’s a form of survival. Obsessions with food and weight are really just a facaded for some deeper issue, regardless if it is a brain disease or some deep-seated psychological issue.

And another thing I’m wary of by chalking anorexia, and other eating disorders, up as a brain disease: If the problem is entirely biological, what incentive is there to try and recover? Those with an eating disorder, particularly anorectics, are notorious for refusing and hindering treatment. If we announce that this is the way you were born and this is the way you were meant to be, I fear many with an ED would use it as an excuse to continue and even strengthen disordered behaviors.

posted on December 17th, 2007 at 2:32 pm

8 On December 17th, 2007, Josie

My theory is that anorexia (and most other EDs) are triggered (but not caused) by restricted eating. Restricted eating usually means dieting, but may be because of illness, depression, etc and that would explain why it’s more common in women, and more common in adolescence (when dieting usually starts) AND why rates of EDs are increasing.
Only those with a biological predisposition go on to develop anorexia though, whilst ‘normal’ people just diet.

posted on December 17th, 2007 at 2:34 pm

9 On December 17th, 2007, sannanina

I agree that it is likely that some people are more vulnerable than others to develop anorexia - just as some people are more vulnerable to develop depression, or other psychiatric disorders. That does not mean that these disorders are only biologically caused (and in turn if they are biologically caused it does not necessarily mean that they are genetically determined). Just as personality is determined by biological and environmental factors, and just as many non psychiatric diseases are caused by a combination of these factors it seems likely to me that the same holds true for psychiatric diseases.

I haven’t read the actual study, but from what I get from the Times article I also have a problem with the conclusion that the differences in brain activation found in the study are proof that biological differences cause anorexia. It could be also the case that the different activation patterns developed after the women became anorexic and that these differences persisted even after recovery. It is also possible that the women were not fully recovered at the time of the study - weight gain alone is hardly an indicator of a full recovery and the Times article does not say which indicators of recovery were used.

Otherwise I pretty much agree with the points that Rachel made, except for this one,
Rather, I think there exists a genetic propensity to developing characteristics that might very well manifest itself in an eating disorder - or any other number of addictions.(emphasis mine)
I don’t think there is clear evidence that anorexia is an addiction. And the personality traits named in the article would rather indicate that it is not. If you are addicted to something the respective substance/behavior should cause you to experience strong reward in the short term - or at least I would expect it to do so. Anorexia (and other eating disorders) seem to have more in common with OCD in my opinion.

10 On December 17th, 2007, sannanina

Oh, and one more quick comment:
I think the study marks a positive direction in looking at anorexia as a pathological condition, one whose roots are organic rather than as the result of neurosis.
Just showing different brain activation patterns does not mean something is not the result of neurosis since neurosis also HAS to go hand in hand with specific brain activation patterns - everything mental/cognitive has to.

posted on December 17th, 2007 at 2:38 pm

11 On December 17th, 2007, Vidya

It may well be a preexisting problem finding a particular culturally mediated expression.
Orthomolecular health practitioners do know that high-dose vitamin/mineral therapy–particularly zinc–can be highly effective in treating/curing anorexia and related disorders, so I don’t doubt it has a strong biological component. Perhaps anorexics just metabolize zinc, etc, differently?

posted on December 17th, 2007 at 2:41 pm

12 On December 17th, 2007, Rachel

My theory is that anorexia (and most other EDs) are triggered (but not caused) by restricted eating.

I agree. Many people automatically think the Pilgrims as the nation’s first settlers. But the nation’s first settlement was actually at Jamestown, Virginia in the early 17th century. The settlement was largely a failure, and many people starved in the first several years. Interestingly enough, reports and diaries left by survivors show that the starving settlers there exhibited symptoms that sound eerily of anorexia today.

There was a study conducted of pacifist volunteers during WWII, the Minnesota Starvation study. It, too, showed the symptoms of malnutrition to also be similar to anorexia.

Both of which might explain why many an eating disorder starts out as an innocent diet. Harriet over at the blog Feed Me! has really opened my eyes to the effects of starvation on the body. She’s a big proponent of family-based therapy, which rests heavily on weight restoration as the initial and primary focus of treatment.

Sannanina: From what I’ve read, I think there are similarities between between many cases of eating disorders and addictive conditions like alcoholism and drug addiction. For more information the biological basis for such, check out this Psychiatric Times article.

To my understanding, OCD and addictions are also very similar in nature - both involve the same brain region - except that the OCD person doesn’t derive the level of satisfaction the addicted person does from the particular activity. So, I think this particular distinction hinges on the relative pleasure an anorectic feels they derive from their behaviors.

posted on December 17th, 2007 at 2:52 pm

13 On December 17th, 2007, charlie.

I self-starved as a teen whenever I was with my father’s family: it was absolutely set off by stressors in my environment as a teenager. I needed a chord of stress to make me stop eating - lack of control, messages about my body as a shameful thing, and deep self-loathing. Once I was in the thick of things, the anorexia was self-sustaining, helping to create a paradoxical feeling of lack of control (hunger, dreaming of food, body hair, weakness) and total control. There was an addiction aspect - things would get bad and then I’d get a hit of adrenaline and be Superwoman.

I haven’t been anorexic in years, but I have found that if a similar trifecta of stresses shows up, I get slightly obsessive about things. Insomnia, list making, trying to understand and therefore make heads or tails of it. Just like I used to planplanplan my next 25 calories and read calorie/nutrition books like the Bible.

It’s still about control: although I’m mainly able to roll with life’s punches now, a big stress (like the terminal illness of a loved one), still fills me with the need to control something, even if just my understanding.

I wouldn’t pathologize that trait in me now - I’m a pretty happy person. However, I do think it’s how my jib is cut, and is therefore what made it possible for me to become anorexic.

I’m female. I would hypothesize the obsessive-fix-and-control trait is pretty common in the world of male brains, and so I hypothesize that the cultural demand for thinness is an extremely important factor in having this trait express as anorexia; as men and boys are more critiqued for weight, (rather than being indulgently called “strapping”), the incidence of men having the problem will go up. (I think that’s happened).

However, chubby boys and men are still on TV. At this point, I’d still say thin is more in for women.

posted on December 17th, 2007 at 2:57 pm

14 On December 17th, 2007, Kim

I don’t claim to have or have had a diagnosed eating disorder, but I’m certainly one of those people who stops eating under the right (usually stressful/disruptive) conditions and who can find it difficult to restart normal eating when that happens. For most of my life it hasn’t been about thinness at all, although I’ve also had problems with body image (an American woman with body image issues, say it isn’t so!).

Having this experience of compulsively not-eating unrelated to dieting or a desire for body change, it makes intuitive sense to me that some underlying disposition might make anorexia easier to come by. I do feel a bit “there but for the grace of god go I”.

posted on December 17th, 2007 at 4:04 pm

15 On December 17th, 2007, Tari

If the problem is entirely biological, what incentive is there to try and recover?

Not to belabor the schizophrenia comparison too much….but that’s part of my family history (at least one in every generation going back four - that we know of), and while I feel pretty confident that this is a genetic tendency, because of the associated fatality/suicide rates and other risks, I wouldn’t say that a biological causation necessarily precludes treatment. Even if, as is typical with schizophrenia, there’s resistance to treatment.

16 On December 17th, 2007, Harriet

“While I agree that many with anorexia are genetically predisposed to develop characteristics of the disease, I don’t believe they are necessarily genetically predisposed to develop anorexia, or any other eating disorder.”

Well, eating disorders run in families, which supports the notion that they are specifically heritable. And their biggest correlation is not with substance abuse or addictions but with anxiety and OCD. What seems likely to me is that there is a spectrum of ailments that are related, and that the same or a related genetic predisposition is responsible for all of them.

I saw the study that linked anorexia to an Ecstasy-like addition. I think it was talking more about the effects of anorexia on the brain, not causation.

Lots of illnesses tend to come on at adolescence. Schizophrenia, as noted above, is one of them. Panic disorder is one of them. Rheumatoid arthritis. ADD (in girls). It seems far more likely to me that hormonal shifts play a triggering role than to ascribe them to psychological issues. In my own life, hormonal shifts have pretty much always been associated with bouts of panic disorder and also with remissions. The disease came on for me at adolescence; went away with pregnancy; came back after childbirth; went away with extended breastfeeding; came back after (an early!) menopause.

In terms of treatment and incentive to recover, I think the incentive is the same no matter what the cause of the illness: Having a full and healthy life.

posted on December 17th, 2007 at 5:30 pm

17 On December 17th, 2007, Sarah

Sannanina: From what I’ve read, I think there are similarities between between many cases of eating disorders and addictive conditions like alcoholism and drug addiction. For more information the biological basis for such, check out this Psychiatric Times article.

Rachel — I agree, and I base that not only on my own experience, but on the astounding number of women I have met in substance abuse recovery who also struggle or are recovered from eating disorders. The overlap is tremendous and although I know it’s only anecdotal — it’s quite amazing. For me — and I’m speaking only for myself — my disordered eating, my alcoholism, my SI — all come from the same place emotionally and it wouldn’t surprise me at all if they come from the same place biologically.

Thank you for highlighting this issue and for providing this forum.

posted on December 17th, 2007 at 5:35 pm

18 On December 17th, 2007, Claire

It irks me that all the British papers are slapping this story with “Scientists Say Models Can’t Be Blamed for Anorexia” headlines. Dr. Kaye’s statement that those who are predisposed “are more likely to go on to develop anorexia regardless of whether they have been exposed to images of super-thin models” was the sound byte from heaven, and unfortunately I think it has overshadowed and oversimplified his findings about the biological roots of anorexia. It seems that no journalist can resist a lede that lets those skinny models off the hook so perfectly. As your post points out, it’s not quite that simple. Of course the media and the fashion industry still hold responsibility, but that fact gets conveniently buried. I will be curious to see how/if this story gets picked up as news item in the U.S.

posted on December 17th, 2007 at 11:35 pm

19 On December 18th, 2007, Laura Collins

Dr. Kaye holds both positions - he’s a busy guy. And this study is only one of many he is involved with, so his conclusions are not just formulated based on this small study.

Biological origin doesn’t mean there is nothing the patient can do about it, nor does it follow that the only interventions are biological.

Diabetes is clearly a biological illness (with cognitive as well as other symptoms), but with behavioral and medical and emotional supports you can live a healthy life. What you can’t do, as a diabetic, is ignore your symptoms, avoid monitoring, play fast and loose with your insulin, eat according to fashion, eat according to what the people around you are doing. Diabetics need to know why they are ill, and how to avoid situations and circumstances (triggers?) that lead to instability and worse illness. Diabetics used to live disabled and die young.

Nothing about it being a biologically based illness means the patient has it any easier, or that the struggle is less important. The wonderful thing is, if people with these deating disorder genes never diet/purge/overexercise - or learn to never do so again - they can be fully recovered for life.

posted on December 18th, 2007 at 10:14 am