For individuals struggling and the people who care for them alike, one of the most challenging aspects of anorexia is this baffling question: How can someone seemingly choose to engage in something so painful (i.e. starvation) over time?
It’s a loaded question, for sure. First, there’s the issue of “choice” and what that even really means. Is someone choosing to starve if they have a disease that makes it difficult for them not to do so? To flesh out that question is a blog post for another day (and, not to mention, a lifetime of study), but the idea of the “punishment paradox” is an important piece of the puzzle.
This idea of the “punishment paradox” is explored by Carrie Arnold, freelance science writer and eating disorder expert, in her recent book, Decoding Anorexia. Arnold did some exhaustive research for her book, talking to experts and drawing upon her own experiences. One of the experts she consulted was Charlotte Keating, a researcher in Australia who offered insights into the neurobiology of excessive exercise (a great example of something painful that can seem rewarding).
In Arnold’s book, Keating explains that for people with anorexia, there might be an interesting phenomenon occurring called “reward contamination.” What happens, according to the theory, is that the neurons that are part of telling us what is rewarding and punishing get mixed up in the brain. So for these individuals, what the others might perceive as torturous, they perceive as actually reinforcing. Kind of how watching ten hours of football on a Sunday is my idea of a nightmare, but my husband’s heaven? Or something like that…
Arnold identifies a particularly interesting study that illuminates this concept. In the study, a group of women who had recovered from restricting anorexia and a group of other women performed a gambling task inside a machine that allowed researchers to watch their brain functioning. The result was that winning and losing appeared the same in the brains of women with previous anorexia. The study thus suggested that for people with this eating disorder, it may be challenging to tease apart what feels good from what doesn’t. So skipping lunch may leave one person feeling grouchy and miserable, while it leaves someone else with a feeling of pleasure.
The implications of this line of research are far-reaching when it comes to understanding eating disorders, and I don’t think we’ve fully grasped them all yet. One thing we can deduce, though, is that if someone’s brain is telling them that starving equals reward, it’s going to be tough to stop. It sheds a bit of light onto why the idea of “just eat the cheeseburger!” is not particularly helpful.
That doesn’t mean that restoring health is impossible. Far from it, in fact. Eliciting the support of trusted others — personal and professional — who can say, Hey, I know that this is tough, but this is really hurting you, is an important first step.