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  • The Biology of EDs

    BrainXsecUp until about 15 years ago, the understanding of eating disorders was almost solely based on trying to understand the psychosocial history of the individual. However, over the past two decades, the advent of neuroimaging and the advancement in scientific research has lead to several observations about the biological aspects of eating disorders.

    An eating disorder is first and foremost a medical and psychiatric condition. Over the past several years, scientists have studies neurobiology and well as the body’s physiological biology when an eating disorder is present. Compared to individuals who do not have an eating disorder, research as shown numerous differences in the brains of people who suffer with an eating disorder. Changes in blood flow patterns, neuro-hormone regulation, neuro-chemistry and brain cell loss all result in changes in brain functioning. As the brain changes, so does the individual’s emotional and behavioral patterns.

    Patients often feel “to blame” for many of the eating disorder behaviors that are, in fact, driven by biological processes. To worsen the situation, perhaps well-meaning friends and family try to encourage the patient to “just try harder,” “just eat,” “just stop doing that,” or “have more willpower.” In turn, patient’s feel they are “weak”, “not strong enough,” or not capable of  finding recovery leading to an even lower sense of self-esteem.

    Eating disorder clinicians need to understand the biological facets so they can help educate patients and families. Clinicians further need to integrate this knowledge into treatment plans and during therapy sessions. A physician well-versed in eating disorder biology should also play an important role in the treatment team. All this being said, it is not always an easy task to find treatment providers with such knowledge, especially if they’re not specialist.

    However, with an understanding of the biological aspects of an eating disorder, treatment can be more effective and certainly more safe.  At times, medical interventions are possible for some of the complications caused by changes to the body and brain’s functioning. Currently, researchers are looking into more types of treatments that are biologically based to accelerate the process of recovery. And during this period, research has contributed to a more integrative bio-psycho-social approach to the understanding of eating disorders which has helped in the treatment planning process with clinicians who remain current with published literature.

    A small sampling of the research published in some of the most respected medical/scientific journals has included:

    • Multiple studies have found replicated evidence for heritability and the genetic contributions to the onset of eating disorders. Bulik CM, et.al., J Psychiatry Neurosci. 2005
    • Neuroimaging if the brain has shown significant changes in the brains anatomy such as a reduction in total “grey and white matter” volume which is not only present during an active eating disorder but also may continue after recovery. Joos A, et.al., Eur Eat Disord Rev. 2011; Katzman DK., et.al J Pediatr. 1996
    • Volume reductions is the brain’s limbic system (or emotional center) such as the hippocampus have also been discovered. Coonan F, et.al., Psychiatry Res. 2006
    • Researchers have concluded that regional brain blood flow patterns that become altered during an eating disorder tend to normalize with recovery. Frank  GK, et.al., Int J Eat Disord. 2007
    • Functional magnetic resonance imaging (fMRI) has demonstrated that body image therapy has in decreasing activity in brain regions responsible for intense body image processing. Vocks S, et.al., Psychiatry Res. 2010
    • There are studies that show there is an increase in blood flow to certain brain regions that is similar to patients with psychotic disorders which may help explain the severe body image distortion common with eating disorders. Gordon Cm, et.al., J Pediatr. 2001
    • Research has shown the hormonal changes found with eating disorders that are associated with thyroid dysfunction, gynecological complications, and sleep rhythm disturbances.
    • Støving RK, et.al., Int J Eat Disord. 2001; resch M, et.al., J Obstet Gynaecol. 2004  Leu-Semenescu S, et.al., Sleep.2010
    • Nerurorimaging has demonstrated that men have a significantly different way of processing negative stimuli about body image compared to women who may be responsible for gender differences in susceptibility to eating disorders and treatment response. Shirao N, et.al., Br J Psychiatry. 2005
    • Addiction researchers have found that there are similar reductions in certain reward system dopamine (the “feel good” neurotransmitter) receptors in obese overeaters as there is in drug-addicts. Wang GJ, et.al., J Addict Dis. 2004
    • Levels of a very important neuroprotective protein, Brain Derived Neurotrophic Factor (BDNF), are substantially reduced with eating disorders and can effect the severity of the ED by modulating the associated psychopathology. Other studies have shown BDNF gene alterations that may contribute to the susceptibility for the onset of an ED. Mercader JM, et.al., J Neural Transm. 2010; Hashimoto K, et.al., Prog Neuropsychopharmacol Biol Psychiatry. 2005
    • Biological research explains how treatments such as massage therapy work by decreasing blood stress hormones, such as cortisol, while simultaneously increasing neurotransmitters responsible for decreasing stress and improving mood such as serotonin and dopamine. Field T, et.al., Int J Neurosci. 2005

    Again, this is only a sampling of the research discovered about eating disorders. If you wish to better understand the biology of eating disorders you may read Understanding the Biology of Eating Disorders by Dr. Jeffrey DeSarbo’s as well as his book, Demystifying the Biology of Eating Disorders (Expected publishing date 2017).