The unhealthy pleasure of anorexia
It seems anorexia is not about the fear of getting fat – it’s about the pleasure of losing weight…
Anorexia nervosa is a devastating eating disorder where sufferers starve themselves, unnaturally thin and sometimes with fatal results. The condition typically affects teenage girls and young women, although boys and young men are not entirely immune. There is no pharmacological treatment available – the only cure involves careful counseling and sometimes weeks or months of therapy.
It has long been thought that the cause of Anorexia is a phobia of gaining weight, and in today’s super-model sexually driven media culture, the irrational fear of being fat. Up to now, the condition has been associated with major psychological distress, but this may not be the case after all.
A new and controversial view is that the pleasure and the thrill of losing weight excites the pleasure centres of the brain in the same way as addiction to drugs or for that matter, food itself. This stimulation of the pleasure centres might just turn out to be the real culprit because it acts as the reward for losing weight. In other words, patients feel pleasure at achieving thin, which outweighs the fear of becoming fat.
Professor Philip Gorwood, head of the Clinic for Mental and Brain Diseases at the Sainte Anne Hospital in Paris, has challenged the conventional notion of fear of weight gain as the catalyst for anorexia. Gorwood’s diagnosis is based on the three internationally accepted criteria of anorexia – restriction of food intake resulting in weight loss, a distorted perception of weight and body shape and an intense fear of becoming fat.
Professor Gorwood’s team has also been working closely with colleagues from the Paris Descartes University, have focused on these clinical criteria.
In order to better understand the condition, researchers used a ‘skin conductance test’ in which exposure to certain images leads to a rapid and automatic increase in sweating.
70 female patients at Sainte Anne Hospital were shown images of people of normal weight as well as people who were overweight. For these 70 patients, all of whom were of varying weight and different degrees of disease severity, viewing these images caused much the same reaction they did in healthy subjects.
However, when they were shown images of thin bodies, the 70 patients showed positively elevated emotions, whereas healthy subjects had no particular reaction. Professor Gorwood and his team conclude that future research should be geared towards reward systems rather than phobic avoidance. Anorexics addiction to feelings of reward experienced from achieved weight loss are significant.
These findings were published in the journal Translational Psychiatry.
This is a game-changer for therapists – it certainly moves the goalposts because now we have to rethink our approach and mindfulness therapy might be a first step in the right direction.
In the meantime, experts at the University of Illinois at Chicago and UCLA, led by Dr. Alex Leow have put a different spin on the causes of anorexia. They think that anorexia might be caused by the sufferer’s lack of awareness about the true state of their own physique – it might be that people with the disorder have an abnormality in the brain preventing them from recognizing their own body shape and physical appearance, so they fail to see that the disease is harming them.
It is widely accepted that body dysmorphia is related to psychiatric conditions that trigger obsessive thought and poor insight and this intensifies sufferers’ misperception of their own physical state.
In their study, the researchers found more connective abnormalities in brain regions linked to error detection, conflict monitoring and self-reflection in anorexic patients than those with no trace of the condition. It seems their brains are unable to recognize high-risk life threatening behaviour taken for granted in healthy individuals, even in the face of stark evidence.
Self-reflection for example, appears to be absent in anorexics, as it is in sufferers of OCD, who often perceive problems where none exist, such as thinking the house has been left unlocked, even after checking it numerous times.
A possible solution would be to train anorexics to have realistic insight into their physical condition.
The research team studied 29 participants all of whom suffered from body dysmorphic disorder, and 31 healthy control participants. None were receiving psychiatric medication at the time of the study, but insight and delusional thinking were measured using specially designed questionnaires. To avoid error, the non of the participants were grossly underweight so that active and ongoing starvation would not exert an impact on results (long-term starvation itself has a profound impact on the brain and could contribute to abnormal connectivity in brain networks.)
The researchers imaged each participant’s brain using structural MRI scans and diffusion-weighted imaging. Next, they constructed maps for each participant that showed which areas of the brain exhibited high and low levels of connectivity. They found poorer connectivity in the brains of those with anorexia nervosa compared to healthy participants. The researchers also discovered that individuals with anorexia nervosa also had abnormal, overlapping brain networks involved in reward and compulsive behaviour. Participants with body dysmorphic disorder showed similar, although weaker, abnormalities in the same regions.
Improving anorexics ability to detect the mismatch between their perceptions of self and reality may be the key to helping some recover. Standing them in front of a mirror and getting them to compare their own shape with that of normal people obviously doesn’t work. I believe the answer may perhaps partly lie in support from the sufferer’s peer group.
The irony is that any anorexic patients, even those with poor insight, appear to be fully able to understand that someone else’s severe behaviour is very dangerous for that person, yet they can’t see it for themselves – even when they are doing exactly the same thing.
Providing better visual feedback signals could be a way to get the error message across.