The brain is a body part
This recent study, titled "Psychopathology in underweight and weight-recovered females with anorexia nervosa," beautifully articulates something that I've struggled to put into words. The study found that weight recovery in people with AN dramatically decreased psychopathology.
No, no--it's not that weight restoration cures everything! Because my life right now is an obvious example that this isn't exactly true. I would never say that weight gain isn't necessary, just that it's the necessary first step towards a meaningful recovery. If weight gain "cured" anorexia, then there wouldn't be the tremendously high rates of relapse that we see. The difficulty with weight gain is consequently keeping the weight on for long enough to get physically used to your new body and to begin the mental healing process.
But I digress.
The reason I find this article so incredibly interesting is how it managed to examine the relationship between somatic factors (ie, weight) and psychological factors (ie, ED psychopathology). Usually, the mind/body connection is seen as something very heebie-jeebie and New Age-ish, an idea sprung from the mind of a few pot-smoking hippies reeking of patchouli. But the brain was connected to the rest of the body- at least the last time I checked. The brain is an organ, just like your heart or your liver.
The mind/body separation in Western culture has been around for hundreds of years and has resulted in some rather interesting separations in medicine. The need for mental health parity is one of them, although that could also be interpreted the machinations of a bunch of cheap-ass insurance companies. With eating disorders, the assumption was that the ED thinking caused the behaviors that caused malnutrition and weight loss. It was a one way street. Although this is somewhat true (most people with AN don't start out malnourished no matter how catastrophically they end up that way), the opposite is also true. Low weight can cause ED thinking, which causes ED behaviors and a further increase in malnutrition, and I think that's what they call The Perfect Storm.
The body and mind aren't separate. Your brain uses approximately one quarter of the calories you eat (500/day) and is essentially a glucose hog. If you starve your body, you starve your brain. I managed to shrug many of the physical effects of anorexia off, but the cognitive effects really got to me. The knowledge that I can't preferentially shunt calories to my brain has helped me resist urges to restrict. I know I'm not the next Einstein, but my job requires a lot of intense, deep thinking, and anorexia would grind that to a halt. I don't miss being caught in the circular ED thinking, worry about what I ate, what I will eat, what I might eat, and exercise and fat grams and everything. If I delay my meals or snacks for any length of time, I notice a return of the anxiety and ED thinking, even if I don't notice a difference in my hunger levels.
It seems odd to think that something as simple (though fraught with challenges for those of us with ED) as eating could improve state of mind. It's not a cure, but it should stop being so surprising to so many people.
(An interesting note: the one area of psychopathology that didn't improve with weight gain was perfectionism, which emphasizes how this is a long-standing personality feature of many with EDs rather than limited to the time when one is acutely ill with ED.)
7 comments:
"If I delay my meals or snacks for any length of time, I notice a return of the anxiety and ED thinking, even if I don't notice a difference in my hunger levels."<---me too.
I don't think that anyone would argue that re-feeding and adequate glucose availability are essential for recovery of anorexia nervosa (AN). Re-feeding has always been the primary goal of treatment in AN. In fact, in the 1970s when I developed AN re-feeding was really the ONLY goal. Re-feeding alone didn't work for me.
However, some people, like me, start to restrict food because they cannot cope with life. I felt I couldn't cope with life because of: (1) bullying by peers; (2) earlier sexual abuse; (3) fear of growing up.
Immersing myself in anorexic rituals diverted my attention away from those fears - and the terrible accompanying anxiety + depression - and I felt I could cope. That's why I stuck in AN! In contrast, re-feeding made me able to to think too much.
In order to recover, working painstakingly through my past life experiences was essential for me. Without this psychological support I would have relapsed. Re-feeding cured my ED symptoms/behaviours, but it didn't assist my state of mind and my ability to cope with life.
So, in my case (and I imagine some other cases too), there were traumatic life experiences that triggered an ED.
I have mulled over the issue of 'nature vs. nurture' A LOT during and after my recovery from AN. I possess all the temperament + character traits that make a person vulnerable to developing AN, and food restriction 'strengthened' my obsessive-compulsive/ASD characteristics, but my AN could not be explained by starvation alone.
The recent genetic, neurophysiological and biomedical explanations of AN are essential to understanding the development and maintenance of this illness, but when the triggers for the onset of food restriction involve trauma, then the individual needs more than just re-feeding to recover.
As a side note, I wrote my PhD and a handful of academic papers when my BMI was 14 and I was restricting like crazy. My capacity to think deeply and to analyse was not adversely affected by starvation, despite all the contrary evidence to this...
Totally relate to this and interestingly, was one of the main motivations in my recovery and also keeps me on the straight and narrow now.
A really important message.
This is a really important message, I agree with the study! Like the comment above it was one of my main motivators after 12 years of AN along with the physical effects of osteoporosis. I couldn't concentrate on anything from a book to a TV show..it literally felt like my brain wouldn't work. Thanks for highlighting this Carrie.
Yep, this is right on in my book. I don't think I was fully anorexic when I started restricting, but the restricting led to more and more anorexic thinking. It fueled itself. I'm glad you made note of the fact that perfectionism sticks around. I was a perfectionist before I had any symptoms of anorexia, and I continue to be (though I've cut back on the self-beating quite a bit). I've accepted certain traits are just part of me. They don't have to be channeled in an unhealthy way. Like you, having brain power is a big motivator for me. I was so jittery during anorexia that I maintained high achievement, but I could tell it was really draining. Being at a healthier weight makes me feel way less anxious and jittery so I can focus in a calmer way.
Thank you for this post, and to those who have commented. I'm struggling right now, and in the midst of getting my Ph.D., and it's just nice to know that someone else understands what I'm going through. :)
Cathy,
Your points are very interesting--I think the reasons behind everyone's ED are very different. For me, anorexia was an outcrop of my perfectionism and OCD (it was an egosyntonic ritual) as well as a crutch to my almost non-existant self-esteem (ie, if I couldn't be good at anything else, at least I could be good at losing weight/eating well/exercising). And I think most EDs involve both a psychological viscious circle and a physiological viscious circle. Yet the point of this research is to say that separating them is futile because the psychology of AN and the physiology of AN are so interwoven.
I think the psychology is naturally going to vary more than the physiology--the body only has so many ways to physically adapt to malnutrition. Yet I find the psychological aspects of EDs utterly fascinating: what sense do we make of our symptoms? What do they mean? How do we interpret them and through what lens? But I have to take pains to remind myself that these questions aren't entirely separate from the physiology of EDs, either.
Anon,
Glad I could help. I never got a PhD, though I have two master's degrees, and struggling through school with an ED is a b*tch. It always frustrated me when I couldn't grasp what I knew were relatively simple concepts--although my solution was to eat less and exercise/purge more, which only made things worse. ::eye roll:: Good luck!
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