Are eating disorders “brain disorders”?
Sarah has struggled for more years than she can remember with eating disorders. Her long periods of restriction, punctuated by episodes of binging and purging, have resulted in her developing an irregular heartbeat, weak kidneys, and medical bills that only exacerbate the feelings of anxiety that she has fought since she was a child. As her weight has fluctuated, so has her self-worth. She has lost countless relationships, years of education, and her career to this disorder. Now nearing thirty, Sarah is in treatment once again, this time determined to unravel the knotted threads of her disorder. She knows how; she now wants to know why.
The question of why when it comes to eating disorders has fueled hundreds of research studies, books, conference presentations, and late-night arguments between parent and child. And as society begins to recognize that eating disorders are lethal and are are increasingly impacting the most vulnerable among us – children and older adults – we are beginning to have the resources to answer that question.
But we’re not there yet.
On a listserv that I subscribe to, there was recently a lively discussion around the idea of calling an eating disorder a “brain disorder.” While no one was refuting the fact that eating disorders do involve brain functioning – heavily, in fact – there was discussion about the utility of referring to eating disorders in this way.
So what do we mean when we call an eating a brain disorder?
Well, if we’re being technical – and perhaps simplistic – a brain disorder is a disorder that affects and/or involves the brain. Yup, eating disorders do both.
Leading researchers in the field are conducting fascinating studies that reveal just how much brain mechanisms are related to eating disorders. Walter Kaye at the University of San Diego is one such individual. He has headed numerous studies examining how serotonin and dopamine affect eating disorders and exploring how changes in blood flow and oxygen use of the brain during eating. The results of Kaye and numerous others suggest that eating disorders are brain disorders – they irrefutably involve neurobiological functions.
The value of such information is, truly, incredible.
For one, it helps individuals who struggle with these illness and their families loosen the grip of blame that so often accompanies eating disorders. How many times have the victims heard, “Just give it up and stop already,” as if they decided one lazy afternoon to destroy their health and happiness? Recognizing eating disorders as brain disorders also pushes forward the slow process of pressuring legislators and insurance executives to treat them as the serious and life-threatening illnesses they are.
However, some caution, and perhaps rightfully so, that calling eating disorders brain disorders could minimize other important factors that contribute to these disorders, such as family dynamics and cultural influences. They worry that calling them brain disorders puts them in the category of other illnesses that are so often treated by throwing a pill at the problem. They fear that people with eating disorders will feel less empowered and less hopeful if they believe that their disorder represents a brain malfunction.
Thus, as with all language, perhaps we must be mindful of the associations that certain words hold. Because here are the facts:
Eating disorders are brain disorders, but they can also be environment disorders, family disorders, relationship disorders, and culture disorders (all of which admittedly involve the brain as well).
Eating disorders are brain disorders, but that doesn’t mean that they are cured by a pill.
Eating disorders are brain disorders, but they require treatment with a comprehensive team approach.
Eating disorders are brain disorders, but recovery is possible and requires the individual’s (very) hard work.
What do you think of calling an eating disorder a brain disorder?
{Image Credit :: Daniela Hartmann}
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Michele @ Healthy Cultivations
808 days ago
I’m guessing this is a controversial topic eliciting some very opposing opinions. Although eating disorders obviously involve the brain, I don’t like tossing them into the “disease model” of viewing things. I think viewing something as a disease or organic disorder allows a person to continue feeling like a victim — they can say, “Oh, it’s so hard for me because it’s a disease — it’s harder for me than for anyone else because it’s a disease.” This mentality disturbs me.
I think people can be predisposed to things, and I think repeated conduct definitely makes that conduct more difficult to stop. But calling things a brain disorder or disease seems to allow a person to give up responsibility for something they have to work through themselves. It’s about getting to the root cause and building success from there. There is no fast answer.
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Lisa Claudia Briggs, LICSW
808 days ago
hi Ashley-
GREAT topic and it’s been on my mind/brain a lot lately… Daniel Amen’s special on PBS with his newest book about healing your brain to lose weight and all of the other news… it’s definitely big news. Having worked with women for 25 years around body-related issues and eating, I agree that we could put all sorts of labels on the struggle but I do think for sure that there is a big brain-related component here. I’m not a researcher and not a scientist, but given that depression and anxiety and often obsessive and compulsive tendencies haunt women struggling to get their eating into a comfortable place, we KNOW that there is something both chemical and neurological going on.
For one thing- just our beliefs alone are brain-related. The things we think over and over about ourselves are well-worn neural patterns that trigger us and cause us to behave in certain ways. Low levels of serotonin and dopamine, and gaba, the various amino acids and other chemicals, even vitamin D-3 are all now proven to impact mood/cravings/and weight. So there is absolutely a big brain-thing going on here!
What I like about anything that reminds us that there is a physiological component to all of this is that women can stop feeling SO ashamed, so guilty, so filled with negative self-judgment… or at least that is my wish and what I tell my clients. So much of this is physical, and while there is no magic pill there are many things that really good self-care and good “brain hygiene” can help.
I love your writing and thanks for letting me contribute.
Love and Blessings to us all…
Lisa Claudia Briggs, LICSW
Http://www.IntuitiveBody.com
Simple Sacred Solutions To Living Beautifully In Your Body
Alex @ Healing Beauty
808 days ago
This was a very helpful post, Ashley, thank you for sharing it! In my opinion, there is undeniably some benefit to calling eating disorders brain disorders because it helps get rid of the notion that eating disorders are choices, not diseases. However, I think that describing them as brain disorders is more helpful than purely labeling them as brain disorders, because like you said, it might be less empowering for the individual in their recovery. Eating disorders are so complex because they have so many layers and facets, and I think that a brain disorder description is just one of the many components.
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@donewithed
808 days ago
I don’t think you can pin the blame for all eating disorders on the brain. I think it’s an addiction and can have many, many causes. I recovered through EMDR and brain training — so my brain was a large player in my eating disorder. But I wouldn’t say it was the only one.
Dana Udall-Weiner
808 days ago
I definitely understand the conundrum about the term “brain disorder,” and I worry that the medical side of treatment (e.g., psychopharmacology) will take precedent over talk therapy if this term is adopted. That said, it is enormously helpful and freeing to understand the biological basis of eating disorders. So I suppose it’s ultimately a balance of acknowledging the multiple underpinnings of an ED (or any other disorder) so that all parts are treated.
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Squeegeelicious
808 days ago
I myself am not coming at this as someone who has an eating disorder, so I cannot speak for them, but I can speak as someone who has been labeled as having a ‘brain disorder.’ I have been struggling with major depression for several years now, but it was only recently that I’ve had an upturn in my recovery, and I attribute that largely to a change in my thinking on the cause of my disorder. When I was first diagnosed, the brain disorder and chemical imbalance model were very heavily pushed on me. In my recovery, I was left waiting until the medications I was taking made my brain better, and then my life could begin again. The problem is, it didn’t. I kept waiting, and when I didn’t improve, I actually got worse and wound up in the hospital again. Then, about six months ago I started working heavily with a Dialectical Behavioral Therapist. The change wasn’t immediate, as I was doubtful about the usefulness of the therapy considering the chemical imbalance model. It was only when I was able to change my thinking on my depression, and realize that while yes, there were chemical processes in my brain that were not functioning normally, the cause was not just some defect but was at lest in part caused by a series of childhood traumas that I experienced growing up that I never resolved. The chemical brain model dis encouraged me from addressing those issues and the fall out effects in my thought patterns. When I was able to acknowledge that my pain had a cause, I was able to address it and move past it.
To sum up, I think that treating chemical imbalances in people who have them can be part of an effective treatment, but if done to the exclusion of other forms of therapy, it will cause a situation where the patient will blame themselves for not getting better, which in turn might make them worse. Instead, I suggest a more holistic approach that combines medication with therapy that does not judge the patients current ability levels to cope but instead fosters positive thought patterns and behaviors to deal with very real negative societal pressures.
Margarita @ Weightless
807 days ago
Ashley, this is such a well-written, articulate and thoughtful post! I think you did a great job addressing a highly controversial topic. I know that in order to understand something, people usually try to simplify it. But eating disorders are just too complicated. When I talk about causes, I prefer to say that biology and genetics play a prominent role but EDs are a complex combination of causes, which include the environment.
It’s like the saying that genes load the gun but environment pulls the trigger. That might be simplistic, too, but I think it at least speaks to the importance of genes and environment.
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qwerty
807 days ago
I can see where your coming from with this article, genetics have been proven in some cases to have an effect. Certainly for me, I became anorexic and bulimic, only to discover 2 years in (in a family meeting) that my dads mother died of cancer- they think due to the pills she took whilst being bulimic. I was speechless….didn’t stop me throwing up but made me think twice about taking any pills.
I do still though think the bulk of it is down to environmental causes and nurture. Eg the magazines flashed in front of our faces, the porno-style music videos that say “this is what all the guys want/this is what everyone wants to be” and the upbringing one has which can put you at a more vugnrable and needy position where you will do/try/take up anything to fill the void where something is missing…something you forgot to get when growing up or shut out for other reasons.
For that reason, I am in the nurture rather then nature group. I believe nature may add to things but its the same as a dog. It can be bread to be a menace, trained even to kill. Its all in the genes. But given the right upbrining and right guidance it can also grow up to become a loving, obedient and very tame member of the family.
Katie
806 days ago
I can see where the argument comes from, but I think if you are going to call eating disorders “brain disorders”, then you need to call depression, OCD, manic depression, etc. brain disorders, also. These diseases suffer from the stigma of being “only” mental illnesses. Calling them “brain illnesses” or “brain disorders” might get them the respect and attention they deserve, as well.
Ashley @ Nourishing the Soul
805 days ago
Katie, I definitely agree that other disorders require a focus on the brain as well, and in fact, in my experience, the ones you mention are often considered “brain disorders” – more often than eating disorders are. You are absolutely right that all mental illnesses deserve attention and respect!
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Carolina
804 days ago
So, can my dad’s alcoholism genes and my mom’s depression genes be part on the eating disorder that I have?
thanks
Carol
Ashley @ Nourishing the Soul
804 days ago
Carol, that’s a really complex question, but there is certainly evidence to suggest that mental health issues in families can be related. We do think that people with family history of mental illness can be more at risk for developing these issues themselves, though the pathways are not always clear. It may be something to talk about with a therapist or your doctor.