Inside The Brain of an Eating Disorder
This blog post was contributed to by Anna Kalfayan, a Meredith College dietetic intern and recent graduate of Point Loma Nazarene University. Anna is a San Diego native who spends her weekends baking, surfing, and shopping at the local farmer’s market. Her goal is to become an expert in gut health and open her own private practice one day.
——
Eating disorders as much a biological illness as a psychological one. There are real differences between the brain function of those who suffer from eating disorders and those who do not.
There are several pathways in the brain that regulate eating behavior. When they function as they should, we get positive feedback from eating. It feels good in our bodies and we get a reward response. We subconsciously think “eating feels good and is good for me”. This is part of the survival mechanism of our bodies. Our brains are wired to reward us for doing the things that keep us alive (in this instance, eating food & drinking water). The parts of the brain involved are:
The insula: processes basic sensory information about food.
The nucleus accumbens: processes rewarding stimuli and reinforcing stimuli (i.e., rewards us for eating food & drinking water, which makes us want to do it again).
The dorsal caudate: functions related to learning, memory, reward, motivation, and emotion.
These pathways do not function normally in the brain of someone with an eating disorder. In fact, brain imaging of those with anorexia nervosa shows that there is overactive control and under-active reward with eating. For those with bulimia nervosa and binge eating disorder, there is reduced inhibition around food. This makes it difficult to stop eating and difficult to resist the desire to purge.
Here are some interesting and important takeaways from research on anorexia nervosa (AN) and the brain:
Researchers found in one study that for those with AN, the area of the brain that governs self-control was activated when individuals were exposed to photos of high-calorie foods. This could provide insight into how those with AN shut down their appetites and restrict high-calorie foods.
In another study, researchers found that compared to an individual without AN, those with AN tended to get more answers correct on tests and hardly made any mistakes. This suggests increased memory could help those with AN hold onto and stick to food rules.
For those suffering with AN, food just doesn't really taste good. Many experience anhedonia, or trouble experiencing pleasure. Those with AN do not receive the normal dopamine response (the feel-good hormone released when eating enjoyable food) when exposed to sugar or other highly palatable foods.
In Recovery
Increased anxiety in anticipation of food combined with low reward response and decreased taste when eating all result in the individual avoiding food. These traits also tend to persist into recovery, making recovery from anorexia extremely difficult. Some things that can be helpful to reduce anxiety around eating in recovery are:
Increasing predictability of meals. This can look like a structured meal plan designed by an eating disorder registered dietitian, coping ahead for eating out at restaurants, eating at designated times throughout the day, and other strategies. Predictability allows the individual to mentally prepare for what’s coming next and takes the guess work out of eating.
Eating with supportive persons. These can be trusted friends, family members, members of the treatment team, or anyone who makes the individual feel safe and supported while eating. Having someone provide support when eating is difficult and who can help reinforce meal structure can be very helpful.
Regularly including fear foods into the meal plan. A dietitian trained in working with eating disorders can help the person work through food exposures to ultimately decrease the fear and anxiety around food. Therapists and other members of the treatment team can help reinforce and support this work.
To read more about how the brain works in relation to eating disorders, you can find the articles and research mentioned in this blog post here and here. We also recommend watching this Ted Talk by Dr. Laura Hill, CEO of The Center for Balanced Living, in which she talks about the biology of eating disorders and the brain.
Though it may be a difficult road, recovery from an eating disorder is possible. If you or someone you love is struggling with an eating disorder and would like to work with a registered dietitian, we at SD Nutrition Group can help. You can find our contact info here. We would be happy to talk with you about how we can help support you in recovery.
Sources: