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Presented by Jeffrey DeSarbo, Medical Director at ED-180 Eating Disorder Treatment Programs
Eating disorders are complex, multifaceted conditions influenced by various biological, psychological, and sociological risk factors. Even defining an eating disorder can be as complicated as the recovery process; however, we know that the brain plays a crucial role in both the development and progression of eating disorders and the recovery process.
There are many approaches to defining and understanding eating disorders, including:1
The medical-psychiatric component makes it different than other psychiatric issues, such as depression or anxiety.
It’s been hard for professionals to reach a consensus on what defines eating disorder recovery. Many people are proponents of the idea that people always have their eating disorders, much like someone who has stopped drinking will always be an alcoholic. On the other hand, some eating disorder professionals believe that individuals in recovery don’t have an eating disorder anymore.
The DSM-5 definition of recovery only tells part of the story. It focuses on:1
However, this definition ignores the neurobiological restoration component—many neuroscientists believe that only when the brain restores itself to baseline can a person actually experience a subjective experience of feeling recovered from their condition.
Restoration to the baseline of neurobiological processes results in stabilized body and brain function as well as mental function processing. This can be achieved through a combination of treatment modalities, such as:
Every member of the treatment team works together to provide integrated and comprehensive care to bring about long-term change. But ultimately, what’s happening with all of these methods is that the treatment team is working on restoring the brain and central nervous system to baseline.
When determining whether patients are in recovery or not, neurobiological professionals may ask, what percentage of your thoughts do you spend thinking about worrying about food, weight, body image, caloric intake, exercise, body-checking, purging, restricting, and self-worth?
Many patients say about 90-100% of their free thoughts are about these things, which is the true distress behind an eating disorder. They may even exhibit zero behaviors, but that percentage of time is spent worrying. That’s the nature of an eating disorder, making it challenging to live life.
Eating disorders cause physical and functional changes in the brain. Various brain scans, such as CAT scans, PET scans, and fMRI scans, have found:2
Changes in brain functioning typically result in changes in thought and cognitive processing.
When the brain structure and function change, these changes can affect all other systems, such as:
The brain, of course, is tied in with all other systems. Consequently, patients with eating disorders tend to experience many medical complications. And when someone experiences a medical condition associated with an eating disorder, signals are sent back to the brain from that particular system that regulates how the brain functions. Because the brain affects the body systems and the body systems affect the brain, someone with an eating disorder often experiences a feedback loop or cycle that perpetuates the disorder.
When we think about the endocrine system, many people don’t think about adipose tissue or body fat. However, adipose tissue is an organ required for life and healthy functioning. It plays a vital role in endocrine function. It produces and manufactures all these biological peptides that regulate the body’s hormone systems.4
When someone struggles with severe anorexia and their body’s fat content is minimal, they’re likely to experience severe endocrine problems, such as osteoporosis and menstrual disturbances.4
Like many medical and psychiatric conditions, there is a strong genetic component to eating disorders. Researchers estimate the following heritability for each eating disorder:5
People can be predisposed to an eating disorder, and something in the environment can trigger the onset of it—this is known as epigenetics. Things that can trigger the onset of an eating disorder include:
Eating disorders can cause profound changes in the brain. From a neurobiological perspective, full recovery can’t happen until these brain deficiencies and losses have been rectified, and functioning and structure has been restored. This is based on the idea that if someone has an extreme drive to lose weight, even if they gain weight, they need to change that drive, which has changed the brain.
Here are some ways that eating disorders can damage the brain:6,7
Different people experience damage in different areas. But no matter what, an eating disorder causes the brain to function poorly. In the case of bulimia and binge eating disorder, researchers have seen an increase in gray matter in the areas responsible for addictive patterns and reward.3 This shows how eating disorders are not just psychological but also an anatomical issue.
Treatment and recovery can be complicated, and everyone’s journey is different. But no matter who you are, effective eating disorder treatment can help improve neurotransmission and functioning neural network. Important changes made in recovery begin on a molecular and cellular level. When people in recovery report feeling happier and experiencing better control, that is due to vital changes on the molecular level in the central nervous system.
These improvements can be achieved through:
There is a wealth of evidence that psychotherapy causes major changes in the brain in addition to medication. Psychotherapy tends to have a “top-down” approach, working on the outside cortical layer and then going deeper into the limbic system. In contrast, medications have a “bottom-up” approach, working deeper on neurotransmitters in the limbic system first and then flowing to the outer cortex, where we process thoughts and decision-making.
Working together, psychotherapy and medication can restore your brain to optimal functioning, helping you to improve your symptoms, mood, and behaviors.