Causes of anorexia, explained?

Perhaps, if the folks at the Great Ormond Street Hospital in London are right. New research, which will be presented at the Institute of Education conference this week, sheds light on the brain changes that accompany anorexia. Rather than a size zero fad or an overcontrolling mother, anorexia may be caused by changes to the brain that occur in the developing fetus.

In an article in the UK's The Guardian titled "Anorexia risk 'could be predicted'," lead researcher Ian Frampton says that

"Our research shows that certain kids' brains develop in such a way that makes them more vulnerable to the more commonly-known risk factors for eating disorders, such as the size-zero debate, media representations of very skinny women and bad parents."

Slight quibble: those are stereotypical risk factors. The first two may cause people to diet, which would then trigger an eating disorder, but in and of themselves, they don't have a whole lot to do with EDs. The last has been thoroughly debunked- bad parents don't help you in life, but they don't cause eating disorders, either.

And these brain changes--whatever they may be--don't make you more vulnerable to "the size zero fad and the cult of the super-thin celebrity," as the author writes. Anorexia is deadly, not a fad a little too far by a bunch of vapid teenage girls. The brain changes make you more likely to develop a serious mental illness that might look like a fad, but let me tell you: it ain't about celebrities.

Frampton and his colleagues conducted in-depth neuropsychological testing on more than 200 people in the UK, America and Norway who suffer from the condition...They found that about 70% of the patients had suffered damage to their neurotransmitters, which help brain cells communicate with each other, had undergone subtle changes in the structure of their brains, or both.

One in every few hundred girls may be affected in this way, according to Frampton, who said the condition was random and not the result of poor maternal diet or environmental factors, such as widespread use of chemicals. Imperfect wiring in the brain's insular cortex that may lead to dyslexia, ADHD or depression in other children produces what he calls "an underlying vulnerability" among some young people that makes them more likely to develop anorexia.

This research is, of course, preliminary, and there are many questions I would like to see answered, such as:

  • How do you know these brain changes aren't a result of malnutrition? If the girls being studied are currently in the hospital for AN, they're malnourished, which we know changes the brain. I'm assuming they authors have an answer for this and I am all ears.
  • How do you intend to show that these brain changes came first?
  • Are there other people with these brain changes that don't develop AN? In other words, are these brain changes diagnostic, or just suggestive?
  • If the process is random, why does AN run in families? Did you look at siblings?

These studies are absolutely important, and I'm glad they're being done, but I'm not sold that this study will "revolutionize" anorexia treatment. Yet.

The authors of the study naturally mention screening and prevention, efforts that are no doubt important. However, dieting is ineffective for everyone, and malnutrition is dangerous for everyone. There should be a zero-tolerance for it across society, not just for those with EDs. The stakes are almost certainly higher for those with the genetic wiring for EDs, but that doesn't mean everyone else has a "get out of jail free" card, either.

Still, the take-home message is this: anorexia is the result of differences in neurobiology and neurochemistry that is triggered by things in the environment.

EDITED: I found another story in the Sydney Herald-Sun that had a few slightly different quotes and seemed to portray the research just a bit better, without some of the dodgy paraphrasing by the writer. See the story here. I'm still waiting for the American newsmedia to weigh in (no pun intended).

6 comments:

Jane said...

This is really interesting stuff. I wasn't quite sure what to make of "random" either.

debra said...

I don't know enough about this issue to be critical, but am just curious about your reasoning:

Why assume that anorexia has the same (neurobiological) cause in every case?

Why does considering the cultural causes of anorexia mean writing its sufferers off as vapid celebrity watchers?

And if anorexia's basis is wholly neurobiological, then why is its incidence higher in certain nations and at certain periods of history?

Carrie Arnold said...

Debra,

1) You're right- AN might not have the exact same neurobiological cause in each case. Although there are numerous similarities between sufferers, there are also considerable differences. However, I'm guessing (based on my biochemistry training) is that there is at least SOME similarity in what goes on.

2) EDs don't have a cultural cause. They have a cultural context (what it means to starve yourself today looks different than it did in the Middle Ages), and they have cultural triggers (ie, dieting), but not a cultural cause. I am all for looking at environmental cues and EDs, but many news articles on EDs think that this means skinny models and bad parents.

3) There's no basis that the incidence and prevalence of AN are different in time or around the world. We just don't have that evidence. Are there going to be some differences? Yes. Because although EDs are biological, they also need some sort of environmental trigger. And in areas where dieting/healthy eating is common, not to mention encouraged, there are going to be more chances for the disease to be triggered. But we really don't know for sure how many people actually develop AN, not in the US, not in Europe, not in Africa. Nor do we have good historical data. We just don't know.

These are really good questions to ask, Debra.

Anonymous said...

Carrie,

If you read Dr. Kaye's research on the study of those who had recomvered from bulimia for one year vs. those who didn't have ED and the neurotransitter fidings in the recovered Bulimia patients it's quite interesting.

I believe that research will continue with the neurotransmitter studies and they will show more of a link that is perhaps the neurotransmitter abnormality long before ED symptoms because Dr. Kaye's study shows neurotransmitter abnormality without ED symptoms in those who recovered.

Carrie Arnold said...

Anon,

Oh, I've read those studies, and I do believe differences exist even before diagnosis. That part I'm not doubting. HOWEVER, how do we know that the particular changes seen by Frampton and colleagues are the cause of anorexia, and how do we know whether or not they're the result of the illness. That's the question I'm raising, which wasn't phrased super-well.

Carrie Arnold said...

Then again, I should probably also add that one of the weaknesses of Kaye's studies is that we don't know whether the changes he sees are a result of malnutrition or a cause of it, either.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote



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