The influence and importance of biology is an interesting and controversial topic in the field of eating disorders. When I was first diagnosed with anorexia ten years ago, the debate centered more on if biology was involved. Now, it's pretty widely accepted that biology is a factor in eating disorders. The question that remains is how important is biology.
We don't have percentages. No one can say that biology is 75% important, and environment is 25%. Every person I have met with an eating disorder has at least one (and often several) tick marks in each category. For me, in the biology category, I have
- impaired set-shifting
- loss of appetite under stress
- temperament traits of harm avoidance, low novelty-seeking, high persistence
- thin-is-in culture
- tried to lose weight
- teased (weight was among those topics, but not always the focus)
- achievement-oriented culture
- fat phobic environment
Even the researchers who specifically study the neurobiology of anorexia don't say that culture is irrelevant. They say (and I would agree) that culture doesn't cause eating disorders. But that's far from some sort of robotic, reductionist view that life is just some biochemical soup. The study of biology in relation to eating disorders has added volumes to our knowledge about the subject. Biology is a powerful thing. We shouldn't take it for granted, nor should we scoff at it as an easy way out. If it's biology, you're either stuck with it, or you just take a pill and All Better!
Which is really funny because none of the researchers I know think anything even close to that.
This is why I was really chagrined to read this article on addiction and eating disorders. It starts as follows:
These days researchers and writers like to boil all maladies down to the biochemical level. The medicalization of all things sure makes life simple: if it’s just faulty brain chemistry, then there’s eventually going to be a pill for it.
But there is no pill to erase the feelings that grip Katherine’s gut when she walks into her childhood home for Thanksgiving. The Marlboro stench of the old curtains, the worn areas on the carpet, the heaviness on her mother’s hips and in her voice, the back bedroom filled with unopened boxes from QVC shopping binges, her father’s palpable misery about his job, the bathroom where she first learned to throw up…
I will say that when neurobiological studies were first published maybe 20 or 30 years ago, people probably did hope that we could take a pill and cure all of our mental ills. We've gotten a lot older and a lot wiser since then. No one remotely believes that you take a pill and bye-bye eating disorder (or depression or anxiety or whatever). Medications can help, but they're not a cure-all.
Secondly, there's a growing body of research related to PTSD of what happens to the brain during stress and during traumatic events. Psychologists have long known that environmental cues are a huge factor in relapse in drug addiction. It's environmental (you see or hear something that reminds you have your drug use) AND it's also biological (this triggers memories and cravings and dopamine and what have you).
Memories are powerful. One of the times I was most powerfully triggered was when I spoke with the boss I had from when I was most acutely ill. I was shaking when I hung up the phone. I wanted to throw up. I never wanted to eat again. Her voice immediately took me back to that place. It's another reason I avoid the gym. Memories of my exercise addiction trigger cravings for more exercise.
Researchers are looking for ways to help the brain unlearn the traumatic response to an event, and some of these methods may involve pills. But a pill isn't going to cure PTSD, it's not going to cure anxiety and depression, and it's not going to cure eating disorders.
Walter Kaye is probably the top neurobiologist in the eating disorder field. And he doesn't give out pills at this San Diego clinic. He delivers therapy. Therapy changes the brain.
Biology isn't a dirty word. It's not the lazy way out, and it's not ignoring or neglecting environmental influences. And it is important.