Anorexia Nervosa

By: Khushi Sheth

With guidance from Amy Hutchinson

Eating disorders are surrounded by stigma and misinformation about these deadly diseases is rampant. Scientists still don’t fully understand these complex diseases. Currently, they are characterized by several genetic, environmental, psychological, and social factors. Eating disorders are defined by a disturbance in behavioral eating patterns that impair health and/or psychological functions. While there are many different types, one of the most common (and most misunderstood) eating disorders is Anorexia Nervosa.

There are many misconceptions about the types of people that can be diagnosed with Anorexia. The disorder is often only associated with skinny, white women in their teens and twenties. While Anorexia is often associated with these traits, this narrow definition is far from the truth. The disorder is diagnosed after careful analysis of specific behaviors, not based on body size, age, or gender. Individuals with this disorder restrict their eating, are reluctant to gain weight, closely tie their self-confidence to their body image, and fail to see how their habits negatively affect their health.

While Anorexia Nervosa is most commonly associated with modern Western culture, researchers can trace the disorder back to 12th century Ancient Greece. Multiple religions promote practices such as fasting in an attempt to cleanse the body of impurities. Fasting also demonstrated eternal faithfulness and spirituality. Anorexia has a deep rooted correlation to the idea of perfection and control, and it is believed that some of these early religious fasters were some of the first documented cases of Anorexia.

Even with its long history, Anorexia is mostly misunderstood. It is one of the most fatal mental illnesses. Anorexia is so dangerous because the malnutrition that often results from the disorder's psychological characteristics can lead to anemia (iron deficiency), heart problems, fertility issues, loss of muscle or bone density, nutrient deficiencies, and gastrointestinal issues. Some of the physical effects of Anorexia may not be reversible even if the disorder is under control and eating stabilizes. This can include lower bone density, which cannot be regained and requires sufficient nutrition to be built; leading to brittle and easily broken bones. People with Anorexia have a disorder just like any other mental illness, and it causes an extreme level of anxiety and discomfort around food, eating, exercise, and body image.

Besides the physical effects, the psychological effects of Anorexia include depression, anxiety, personality disorders, substance abuse, and suicidal thoughts and actions. Although there is no specific cure for Anorexia, there are multiple treatment pathways meant to stabilize patients, improve quality of life, and mitigate long-term health effects. One prominent form of treatment is Cognitive Behavioral Therapy. This form of psychotherapy focuses on how an individual's thoughts, patterns, and beliefs ultimately impact their feelings and behaviors. The goal of treatment is to help the individual shift their perceptions about food, exercise, and body image into something that can be faced head on. This form of therapy is also used to treat anxiety, depression, Post Traumatic Stress Disorder, and Obsessive Compulsive Disorder. For Anorexia, the focus is on identifying and challenging the beliefs, thoughts, and feelings about food in order to break food “rules” and stabilize eating.

But what if that method fails to succeed? Behavioral therapy is generally considered the most effective treatment for Anorexia but even after remediation, some people still do not recover and fall back into old patterns. Only 50% of those with Anorexia fully recover, while 20% of patients remain chronically ill. A group of neuropsychological researchers conducted a study as to why some individuals have such treatment resistant disorders. The experiment consisted of a group of recently hospitalized women with Anorexia and began by having them rate 76 food items based on taste and perceived “healthiness.” The researchers then offered each participant the choice between eating one of three food items. One option was an item that was statistically equal in tastiness and healthiness (according to the previous survey), another was a low taste high “healthiness” carrot, and the third was the high taste low “healthiness” chocolate cake. The researchers scanned the subjects’ brains with an fMRI to measure the frequency of brain activity when participants were deciding which option to eat.

This brain-imaging data offered some very interesting results. Individuals who don’t have an eating disorder typically evaluate specific criteria like hunger, food preferences, etc. when deciding which foods to eat. The brain-imaging data reflected this in healthy subjects. However, the subjects with Anorexia showed increased activity in the dorsal striatum, a part of the brain used in decision making, reward systems, and habit forming that healthy controls didn’t. Individuals without the disorder normally look at specific criteria after making a decision; however, those with Anorexia Nervosa correlate certain foods with an immediate decision. From these results, researchers were able to conclude that Anorexia is rooted in the decision-making process. But this still didn’t solve the puzzle as to why patients returned to their disorder patterns after receiving treatment. Researchers later came to the conclusion that the reason patients, after leaving treatment, ended up returning to their old state was because they were surrounded by their old environment. They also concluded that this familiar environment triggered a behavior in the parts of the brain that control decision making associated with that familiar environment, unbeknownst to the individual. This trend in decision-making in the subjects with Anorexia is what led researchers to come up with a potential solution for permanent treatment.

Researchers concluded that in order for recovery to occur, gradual changes in routines must happen so that patients can begin to break disordered neural pathways. The goal of this strategy is to ultimately replace the old restrictive habits with a healthier routine. Although it takes a tremendous amount of time and dedication to let go of restrictive behavior and break disordered pathways, recovery and wellness is possible.

Educational Content

Q: What are some common misconceptions regarding anorexia?

A: Many people are under the assumption that anorexia only affects extremely “thin people.” This is actually far from fact. Some individuals diagnosed with anorexia might look “healthy” to the common eye. Anorexia is a psychiatric disorder, and the mental aspect is the most important part. There is also a misconception that men do not develop Anorexia, and while Anorexia affects more women than men, many men struggle with eating disorders. It also can develop at any age, not just in adolescence.

Q: Why were only women used in the group if men also get anorexia?

A: The researchers intentionally excluded that group to prevent any sex or gender factors from possibly impacting the results.

Citations