Eating disorders are biologically based brain illnesses influenced by environmental and psychological factors. Environmental risk factors for developing an eating disorder include weight and appearance pressures, media messaging, and weight bullying. Biological factors include dieting/food exposure, genetics, neurochemistry, neurobiology, and hormones (notably estrogen). Psychological factors include stress, life transitions, identity, trauma, anxiety, depression, and substance use.
While risk factors predispose certain individuals to eating disorders, precipitating factors such as significantly altering how one eats or stressful life events make may an individual more likely to develop and eating disorder. Once an eating disorder is present, maintenance factors take over. These factors that maintain an eating disorder include biological changes that occur as a result of disordered eating and psychological factors that are connected to the eating disorder behaviors that then turn and reinforce a person’s repetitive, disordered behaviors.
What makes certain individuals vulnerable to developing an eating disorder?
Eating behavior is mediated by a large network of interacting neural circuits that include numerous areas of the brain, including the prefrontal cortex, anterior cingulate, insula, and the amygdala. We know that our eating behavior is determined by several signals that come into our brain through our mouth or through our gut. The experience of eating (Does this food taste good? Am I hungry? Where am I?) then propels us to keep eating, to stop eating, or somewhere in between. For example, if you are hungry and the food you are eating tastes good, you most likely will decide to keep eating. If you are eating loud food but are in a quiet meeting, you may choose to stop eating and eat your food following the meeting as to not disturb anyone.
In addition to this understanding, our gut also influences our eating experience. While research on the gut microbiome is still emerging, we know this is an essential component of eating that affects our eating behaviors. For example, if we feel ill upon eating certain foods, we may alter our eating behaviors in order to address this and prevent feeling sick.
Two experiences of eating
There are two parts of eating, “liking” and “wanting,” that inform our understanding of why people keep eating even when they are not satisfied and how the reward of eating may be exaggerated or scant. The wanting part of the eating experience is our appetitive system that motivates us to go get food. It says, “I’m hungry, go get food.” This is involved in the anticipatory reward of eating. If we are hungry and know we are going to get food soon, there is likely a reward associated with the knowledge we will be eating soon. As we understand now, we believe dopamine is involved with this wanting and drives us to seek out food.
The liking centers come in after wanting—they are what happens after we get the food. The “liking” is a response to eating. This liking reaction is reinforcing if we like something and not if we don’t. For example, if we are hungry and eat a meal we enjoy, our liking reaction reinforces that we enjoy that type of food. However, for those that struggle with eating disorders, they may “want” something but once they get it, they may not find it enjoyable.
How does the brain change for those with eating disorders?
For those with eating disorders, the brain changes in response to the eating disorder based on the type of eating disorder present.
Anorexia. Those with anorexia, who are actively ill, have a significantly different brain response to eating than those without an eating disorder. Individuals with anorexia have an altered response to reward, they are less motivated and less interested in eating food and are less likely to enjoy the experience of eating. There is an absence of pleasure—they may be scared, terrified, anxious, or sad about eating. Food, for those with anorexia, causes anxiety and fear, not pleasure. These individuals appear to have a decreased sensitivity to the rewards of eating and an increased sensitivity to punishment and negative feelings.
Bulimia. In bulimia, we see people who are eating a large amount of food but not digesting it due to purging (or for those with diabetes, omitting insulin). Stress and negative moods are often seen to trigger bulimia as research shows that these individuals are likely escaping negative feelings. Individuals with bulimia seem to have an exaggerated reward that drives their desire to eat more than typical. They have a heightened response to taste, even when they are fully fed. They are significantly more interested in food and eating than those with anorexia.
Binge eating disorder. For those with BED, they often have an exaggerated wanting and drive to eat, but a minimized experience of liking. Eating is not as pleasurable and individuals often feel the need to keep eating in order to find some degree of pleasure. They don’t experience the reward to eating in a way that they thought they would, which can be disappointing, and may lead to increased bingeing.
These differences in the brain of those with eating disorders compared to those without eating disorders tell us about what parts of the brain are affected for those with eating disorders. For example, the amygdala, which is in involved in the experience of emotions, wanting, and pleasure.
How we can reframe traits in illness to traits in recovery
Traits that are commonly seen in those with eating disorders include persistence, perfectionism, obsessive tendencies, a drive for thinness, harm avoidance, and impulsivity. These traits are often seen as less desirable and may negatively impact a person’s life. However, these traits can be reframed in recovery in order to more positively view oneself and one’s abilities. Those who are persistent can be refocused to being committed—a great trait that is needed in recovery. Those who are perfectionists have high standards, a positive trait in order to achieve and find lasting success. We can’t change an individual’s wiring, but we can help them to understand how to manage their traits in an advantageous way.
One example of reframing traits is to imagine that you are working with someone who is impulsive and resistant to structure. You can reframe this trait by assisting them in bringing some structure to their days and eating, without creating an entire day’s schedule. You can introduce a pre-meal plan that brings structure to the experience, which may bring a sense of calm and order. This pre-meal plan may include meditation or setting an intention.
Another example is if someone is harm-avoidant and has anxiety about eating and getting it “just right.” We can help soothe this anxiety by using sensory interventions such as yoga, mindful breathing, aromatherapy, or something that helps an individual to calm. These individuals are often anxious pre-meal, so it is suggested to have a plan put in place for before meal times, such as taking 10 mindful breaths prior to eating a meal or snack.
Early detection of eating disorders
Those who are risk for eating disorders can be identified. Specifically, traits such as anxiety, perfectionism, impulsivity, and chaos are often put people more at risk for developing eating disorders. We can discourage the development of an eating disorder and manage these symptoms early, in order to prevent an eating disorder. By taking extra time to manage anxiety and negative feelings, individuals are less likely to develop an eating disorder.
When and where to get help
For those struggling with eating disorders, it’s essential to get support as soon as possible. Getting support early has a strong correlation with a lasting, lifelong recovery from eating disorder behaviors. It is recommended that individuals seek specialized treatment for eating disorders from centers that are equipped to address everything that goes into developing and maintaining an eating disorder. It’s also important to remember that recovery is not only possible with treatment, it’s plausible.