One of the most common myths about eating disorders is that they are a choice or that they are the individual’s fault. I struggled with this misconception a lot, especially when people would tell me to “just eat!” and I couldn’t explain to them why that felt impossible. I got stuck in a spiral of shame and self doubt as I convinced myself my eating disorder was my fault and therefore wasn’t valid. Thankfully, after years of hard work, I am able to recognize that this myth is frankly irrational, because who would deliberately choose this illness that has the potential to wreak havoc on one’s mind, body, and life in general? No one.
This myth is based on outdated cultural stigmas that developed when diet culture was running rampant and eating disorders were viewed as just an extreme weight loss method. Luckily, with new advances in medical technology and people who have committed themselves to raising awareness for this disease and achieved success, researchers are discovering that eating disorders are brain-based illnesses. They are no one’s fault, they are a product of one’s physiological makeup or neurotransmitters gone awry. While research has not reached a definite conclusion, it represents so much progress being made!
I am not an expert on this topic by any means, just a neuroscience nerd who is passionate about mental health advocacy. For this reason, I will not attempt to fully explain the information I have found. I will include links to articles and summarize their main points so you can do some investigating of your own!
Inside the brain of someone with an eating disorder: provides information about findings from several MRI studies done on healthy patients and those with eating disorders. They have concluded that a main focus is differences in the neural circuits of people with eating disorders which affect their self-perception.
Neurotransmitters: individuals with anorexia have altered serotonin systems. They have lower amounts of serotonin metabolites in their cerebral spinal fluid, which is likely a consequences of starvation. Serotonin is synthesized from food, so as the individual starves themselves, the level of available serotonin in the brain decreases. As they continue to starve themselves, their brain then provides more serotonin receptors to utilize the low level of serotonin. In conclusion, as they starve themselves, they actually feel better. Additionally, scientists have hypothesized that individuals with anorexia have an overproduction of dopamine in their brain so they are able to go without “pleasurable things” such as food.
Understanding the Neuroscience of Appetite for Anorexia Nervosa: Serotonin can also create anxiety. As someone with anorexia starves themselves, they are relieved of obsessive thoughts because of decreasing serotonin (an interesting contradictory opinion to the above article). A different study found a slowing down of the hypothalamus which detects hunger, the amygdala which plays a role in fear response, and the anterior insula which is responsible for awareness of the body and emotions. Another study (which is so so interesting!) suggests that people with anorexia have and increased prefrontal cortex (decision-making) and decreased somatosensory (body awareness) response when thinking about food which suggests they do not consider their appetite when making decisions about what to eat.
Eating Disorders and the Brain: there are disturbances in the pathways of the brain that manage emotions, reward, and fear. There is also altered function in the areas of the brain that play a role in body perception which can affect body image and the feeling of being overweight. Alterations in the brain of young people who begin to struggle with an eating disorder as a result of starvation can make recovery much more difficult. (This article is very comprehensive and thorough so it is difficult to summarize every point made but I highly suggest it!)
New insights on eating disorders: eating disorders tend to be highly heritable. People with anorexia have different reward processing systems and are oversensitive to punishment. For example, when studying the brain in people with anorexia playing a game, there was more activation in their reward-processing circuits when they lost the game than when they won. Dopamine also plays a role. The release of dopamine that occurs when one eats something particularly good is responsible for the pleasurable feeling they get. However, in people with anorexia, it is hypothesized that a release of dopamine triggers anxiety rather than pleasure when they eat.