Trapped in eating disorders

You all will hold your own ideas about the causes of your eating problem and some of these are readily apparent such as the culture we live in. However many people with an eating disorder tell us that they have become confused because insidiously they have become trapped within the eating disorder unable to find a way out.

We have been trying to look into this situation to try to understand what might be going on. One clue is that we know if people do not have effective treatment that can both restore and maintain a normal nutrient balance within the first three years of the onset then it is more difficult to break free. So it appears as if some secondary process develops that causes people to get stuck occurs during that first 3 year time frame. We are interested to know if this involves changes within the biological matrix of a person, in particular within the brain where it all gets controlled with both conscious and unconscious processes.

At the Maudsley and Kings College London funded by the Research into Eating Disorders charity (led by Nina Jackson) we have been undertaking a series of studies to examine in more detail these central processes. The first technique that we use involves examining what happens to brain blood flow in different regions whilst watching images. The second method of study involves observation of the brain in action with more complex issues such strategies used in playing games etc.

What we have found so far is that the activation of the brain to images of food differs in people with eating disorders. Parts of the front of the brain that are involved in decision making and emotional regulation become activated rather than the areas in the lateral part of the front of the brain normally activated by food. Even after recovery these same brain areas remain abnormally activated by food and we are wondering if this might explain the mechanism of the trap described above.

The people who contributed to this scanning study had, on average, had the illness for over 3 years. Thus most of them may have developed some of the secondary features that can keep the illness stuck and so it is possible that this continued activation of the front of the brain above the eyes is part of the biological matrix that forms part of the trap. What was also interesting was that in this recovered group there were additional areas of the brain activated in response to the food images. It is possible that these new areas of activation develop as part of the recovery process. These new pathways may put a break on the over activity in the eating disorder food-cue areas and thus are able to compensate for the persistent abnormal reaction to food.

These studies provide tangible proof of how the reaction to food and weight becomes abnormally wired up in people with eating disorders. It is possible that this is because the reaction to food becomes entangled with other brain processes such as emotional regulation, the synthesis of drives and motivation and planning. These findings help dispel some of the myths that people have about eating disorders such as that they are caused by wilful stubbornness on the part of the sufferer, that the person with anorexia nervosa is on a hunger strike and trying to do something to other people. Rather the symptoms are a marker of deeper levels of stress and distress and are difficult to overcome if they are allowed to take root over time.

Studying how people tackle games etc has shown us that people with eating disorders have a greater ability to focus and not make mistakes but this is at the expense of the ability to be flexible and quick. Similarly there seems to be an enhanced ability to go for detail at the expense of seeing the bigger picture. Also people with eating disorders appear to be more sensitive to signals of threat. We are interested to know whether these styles remain after recovery.

More importantly we want to find out if we can help people learn during therapy to have an approach to the game of life which uses strengths in all suites rather than a rather skewed approach in which they can only play the dominant hand.

In order to examine all these mechanisms more fully we want to continue with this research by looking at people both in the early (less than 3 years) and later ( over 3 years) phase of their illness as well as those that have recovered. If you would like to know more details of what we are doing or would like to help please get in touch with j.treasure@iop.kcl.ac.uk. We are interested in any feedback or ideas you might want to give us.