Living With Food: The Science Supporting Eating Disorder Treatment

By Dr. Mark Warren

One of the most exciting presentations at this year’s international AED conference was given by Dr. Brian Lask, a scientist from England. His presentation focused on how brain structure may be related to the development of anorexia. This work is exciting for multiple reasons. One reason is that historically, behavioral illnesses have thought to be related to brain neurotransmitters, that is, the chemicals that transmit impulses between nerves in the brain. For illnesses such as depression, bipolar disorder, or schizophrenia, the medications used to treat these illnesses all affect these neurotransmitters, meaning serotonin, dopamine, and norepinephrine. Dr Lask’s work suggests there are structural, rather than chemical abnormalities in clients with anorexia, which may explain how the disorder develops and expresses itself. The work is also important since it rests on understanding the development of brain structures, which are primarily genetically determined, may also be impacted by environmental influences and experiences.

Dr Lask has identified the areas of the brain where various parts of eating disorder symptoms are located. These areas include parts of the cortex involved with body dysmorphia, hunger, sensory perception, eating, the ability to self-measure and evaluate one’s environment and one’s health. Researchers and mental health providers have become aware that these parts of the brain are widely distributed throughout the brain and there can be no single anatomical abnormality that explains all parts of anorexia. Instead, a section of the brain, called the Insula, which is involved with communicating sensations and feelings to higher level cortical functioning is hypothesized to be where the abnormality occurs. His hypothesis is that by losing the central connections of feelings and perceptions to thoughts and behaviors that the multiple diagnostic features of anorexia may arise. This understanding, which still needs significant testing for verification, is a new and hopeful way to look at anorexia. By seeing the illness in terms of anatomical development we can also then see how early intervention and treatment may provide an opportunity for development and growth of this section of the brain so that the illness can be resolved. It also suggests why early intervention in adolescents, whose brains are not fully developed, may have better outcomes than older individuals who may have had structural changes in brain that will require significant re-wiring and re-connection for recovery to occur.

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Contributions by Sarah Emerman