--Adolescent program parent
By Dr. Mark Warren
I had the opportunity this year at the International Conference on Eating Disorders to spend a day with Dr. Bryan Lask and Dr. Ian Frampton, the developers of the insula dysfunction hypothesis as the biological root of anorexia. Thanks to the work of Drs Lask, Frampton and others, we have a better idea of what it may mean to say that anorexia is a biologically based illness. Essentially, they believe that a section of the brain called the insula, which runs through the center of the brain, does not develop in the expected way in clients with anorexia. The insula is responsible for more connections within the brain than any other area. Our brains have billions of connections and in order for the brain to work properly it has to both send and receive messages to itself as well as the spinal cord and the sensory nerves in the body. One of the oddities of eating disorders is that various symptoms of anorexia seem to be located in different areas of the brain. Executive functioning in the frontal lobes, issues surrounding reward and pleasures in the nucleus accumbens, body size and shape in the parietal lobe, as well as other functions throughout the brain all seem to be affected in anorexia. The research by Drs Lask and Frampton identifies at least 8 to 10 areas of the brain that show dysfunction in anorexia. With eating disorders there seem to be multiple areas of the brain showing abnormalities and it appears that connectivity is the issue, rather than the areas themselves. Research is demonstrating that the area that connects them, the insula, is where the dysfunction actually lies. The hard news is that to recover from the eating disorder means that either the insula regains function or new areas of the brain will have to take over the function that the insula would have had. The good news is twofold. Due to neuroplasticity, which is the ability of the brain to change itself, some people may be able to gain a new insula function. One of the reasons early and aggressive treatment is so effective is likely due to an easier promotion of brain development where the illness has been present for a shorter amount of time while the brain is still developing. What is even more hopeful is that we now believe that neuroplasticity is possible throughout the life and for anyone with an eating disorder, especially anorexia, the treatment may allow a change in insula function. This, then, is the other piece of good news-that brain connectivity developing as part of healthy brain functioning is not only possible but likely. All of this still a hypothesis, but there are researchers now actively working on developing and improving various parts of this hypothesis. This work is key to our understanding of anorexia and the most effective treatment.
For more on the research by Drs Lask and Frampton check out Eating Disorders and the Brain
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Contributions by Sarah Emerman
A recent article by Atul Gawande, the medical writer for The New Yorker Magazine, discussed which hospitals have the best results with post-surgical complications. Most people assume that hospitals with the best results are hospitals that have the least post-surgical complications. What research has shown, however, is that almost all hospitals have roughly the same rate of post-surgical complications and that the hospitals that have the most success at saving patients lives or preventing lasting damage from post-surgical complications are those that can rescue patients before complications become life threatening. “Failure to rescue” thus becomes the primary reason for hospitals having high complications and death rates after surgeries. The ability to rescue, that is to recognize problems early on, understand that problems are of great significance and respond with appropriate measures, becomes the single most important thing a hospital can do to help their patients. This perspective applies to the eating disorder world as well. Our treatments are not anywhere near 100% effective, there is always a risk of relapse early on, and treatment that had been working may stop being effective. Treatment that works best is treatment that includes the ability to self evaluate progress, change course rapidly, and alter strategies, level of care, and interventions when necessary. After patients have moved out of the acute phase of their illness, long term monitoring, long term therapy, and appropriate interventions are likely the most important things we can do to maintain our clients well-being and long term health. Our ultimate goal is the best treatment with the best follow up and the ability to rapidly respond if trouble occurs.
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By Sarah Emerman
Please check out this blog post by Jenni Schaefer on what it means to look and feel truly beautiful. A big thanks to Jenni for her inspiring words!
Body Image: I Love How I look - In a World that Doesn't
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