Have you ever eaten “comfort foods” to calm yourself down? What about having a little ice-cream when feeling sad or depressed? Or does the thought of eating chocolate cake after a meal totally stress you out with anxious thoughts about your body? According to the latest research into neuroscience, there are reasons for these feelings and responses. While recently at the International Association of Eating Disorder Professionals (IADEP) conference, I was struck by the way discoveries in the field of neuroscience can help us understand the brain biology of disordered eating. After learning about the brains of people with eating disorders, I now see with more compassionate understanding how difficult it is to change one’s eating patterns, heal body image distress, and feel motivated to turn toward doing the difficult work of recovery. The good news is if we hang in there, there is hope.
Anorexia and Fear
When working with clients recovering from anorexia, I can now clearly see why they are so resistant to eating what is considered a “normal amount” or eating what they consider a “fear food,” such as chocolate. The brain of an anorexic signals that certain foods or amounts of food are dangers that will their threaten well-being. In someone with a brain predisposition to anorexia, food actually generates a “risk signal.” In this system, eating less (or not eating) reduces anxiety and eating more increases anxiety. (Kaye, 2003; Strober, 1995; Vitousek, 1994; Steinglass 2010).
These clients are not deliberately being rigid or resistant. They can even be at the stage of wanting to gain weight and recover, but still be struggling with very high levels of anxiety that are triggered by what is required to recover. This helps us have a more accurate understanding of what recovery looks like for eating disordered people. As one recovering woman said “‘I’m so f*cked up,’ turns into ‘Oh. That’s just the way my brain is wired!’” There is a reason for it! So when she goes out to dinner and her partner is excited about dessert and her anxiety starts to skyrocket, she can understand from a place that is a bit free(er) from shame and self-judgment.
Binge Eating and Pleasure
For bulimics and binge eaters, overeating (particularly foods that trigger dopamine—the pleasure neurotransmitter) will relieve symptoms of depression and anxiety. In bulimia, overeating is thought to relieve dysphoria (depression) and/or anxiety, and there is an exaggerated “reward” drive to eat. (Abraham, 1982; Kaye, 1986; Johnson 1982; Smyth, 2007; Crosby, 2009; Haedt-‐Matt, 2011)
Since this dopamine release tends to come from sugar and/or carbohydrates, that also explains why most people will tend to binge on cookies, ice cream, pastries, chips, etc rather than on cucumber or carrots. Think about how many people eat when they are stressed. There is a reason for it. Although this may sound obvious, for someone who struggles with secretly bingeing or bingeing and purging, this can help alleviate the shame and the feelings of chaotic lack of control associated with the behaviors.
How Body Image and Motivation Fit In
Work being done currently at the Laureate Institute of Brain Research (LIBR) is showing that the insula region of the brain is of particular interest for eating disorders. This part of the brain is related to one’s “introspective awareness”(sense of self) and therefore affects body image distortion, lack of recognition of symptoms of malnutrition, and a decreased motivation for change.
Aha! I’ve always known intuitively that when a drastically underweight anorexic looks at her/himself in the mirror and views themselves as fat, they are having a “funhouse mirror,” experience—but now there is empirical evidence that their brain is causing them to see this way. It also explains why anorexics who have recovered can look back and see why they were not feeling motivated to recover and were in denial about the severity of the malnourished state of their body.
So Why Is There Hope?
I often use the analogy of butterflies when working with women in the recovery process. Caterpillars transform themselves into butterflies by intuitively knowing when and how to go about doing this. They turn toward the transformation although they know they will lose themselves as they currently exist. And, after creating the container of a cocoon (container= therapy/treatment/support) they turn themselves into soup. Yes, it’s liquid soup inside the cocoon. For a long time. (Soup=uncomfortable feelings such as anxiety, fear, inadequacy, depression, anger, and grief). Then, as they gather new strength, they re-form themselves from this soup into a newborn butterfly body with crumpled-up, wet wings (wet wings=early recovery). Then they push themselves out and split open their cocoon. If you cut a butterfly out of its cocoon, it very likely will not survive, because it needs to split itself out to develop the strength to pump all the liquid from its body into its wings (wings=the freedom of later recovery). What I like to focus on here is the metaphor of the body and the psyche knowing and trusting itself. When someone is ready to recover, they know it. And they know it isn’t necessarily going to be easy. Some part of their body and their psyche knows that it is time, they are ready.
Neuroscience is now offering empirical evidence that gives us new, more powerful insight into what a person recovering from an eating disorder is facing. Once shame is decreased, the deeper work of acceptance and change can occur. It’s not that you won’t have to travel difficulties and go into the discomfort of caterpillar soup to recover. But it is that you can do it, it’s not your fault, there is help, and there is hope. You may even learn how to love yourself, respect yourself, and turn into a butterfly in the process.
 Thank you to: Walter H. Kaye MD, Professor of Psychiatry Program Director Eating Disorder Treatment and Research Program University of California San Diego
Eatingdisorders.UCSD.EDU for his talk “Using Neurobiology to understand traits and improve treatment” at the 2014 IADEP conference
 Thank you to:
Scott E. Moseman, MD Board Certified Child and Adolescent Psychiatrist Medical Director, Laureate Eating Disorders Program Investigator, Laureate Institute for Brain Research and his talk “Neurobiology for Clinicians” at the 2014 IADEP conference
Here is a link to the brain research institute findings:
Obesity (Silver Spring). 2011 Aug;19(8):1601-8. Epub 2011