As I have promised, I'm going to do a few posts on some of the things I learned while at the AED conference last weekend.
The best session I went to was called "Who's Who in the Brain?" and it looked at what neural systems malfunction in anorexia. To try and summarize the talk would be ludicrous, especially since the best part was interactive. Basically, session leaders Bryan Lask and Ken Nunn had us get into groups of 8 (since most of the participants were MDs or PhDs, there was a little bit of eye rolling at this suggestion) and we each took on a role of one of the neural systems profiled, from the nucleus accumbens (the pleasure center) to the prefrontal cortex (PFC, the "executive" or decision-making part of the brain).
We were given the task of trying to decide where to meet for dinner. We each had to play the part of the brain part we were assigned (I was the basal ganglia, which is involved in movement/exercise, precision, and also malfunctions during OCD. I'm pretty tight with my basal ganglia...) in deciding where to meet for dinner. As the basal ganglia, I needed to know exactly where and when to meet, like give me some GPS coordinates, people, and exactly how much money did we have to spend? So perhaps a little neurotic, but I was bound and determined to get us there on time.
The other five group members also provided their feedback, and the insula carried all of our messages to the prefrontal cortex, who made the final decision. We were going to meet at the hip Asian joint down the street at 6:45 pm for drinks and sushi. Ta-da! Decision made.
Then, we had to make the same decision in a malfunctioning anorexic brain. As the basal ganglia, I couldn't find the "perfect" restaurant or the "perfect" entree or be sure that everyone else in the group would agree. The prefontal cortex was also malfunctioning, and pretty much left the five brain parts to rule in anarchy. The insula was simply missing in action and none of the brain parts could talk to anyone else.
Skip dinner. All around the room, the groups returned with the same verdict: no dinner. With a malfunctioning brain, the decision was just too complicated, and so the "brains" defaulted on not eating.
Our group decided we'd get tattoos instead (there was some sort of inside joke there--it was tremendously funny at the time, but I can't exactly remember why). Another group went to the gym. Mostly, people retreated to their rooms and spent a socially isolated evening on their own.
Lask and Nunn referred to this conundrum--an endless shouting by the various parts of the brain while the prefrontal cortex merely shrugged its shoulders and the insula had long since left the building--as analysis paralysis. Wikipedia defines it as:
over-analyzing (or over-thinking) a situation, so that a decision or action is never taken, in effect paralyzing the outcome. A decision can be treated as over-complicated, with too many detailed options, so that a choice is never made, rather than try something and change if a major problem arises. A person might be seeking the optimal or "perfect" solution upfront, and fear making any decision which could lead to erroneous results, when on the way to a better solution.Figuring out where to go for dinner seems like a pretty simple decision. It's not like figuring out where to move or whether to take that job or how much to invest in your 401(k). It's just dinner. Yet the decision making process, though it can happen lightning fast, is also very complicated. If the brain can't share and process information--if the insula isn't working properly--the brain gets stuck on the simplest of decisions, like a scratched record or CD.
The insula is known to malfunction in anorexia. Starvation reduces blood flow to the brain, which makes other areas of the brain malfunction as well. Soon, the simplest questions cause paralysis and the brain defaults to a simple answer: no. I already ate. I'm not hungry. I'm busy. No thanks. I'd rather not. No. No. No.
It's our way of avoiding analysis paralysis. Our brains, Nunn said, are rather like Congress. Lots of bickering, lots of going back and forth, and without strong leadership, nothing gets done. Actually, even with strong leadership, things don't always get done in Congress, but I digress. Even if the insula alone isn't working properly, the entire brain is affected, and it gets stuck in analysis paralysis.
The solution is for other people to step in and act as the insula and prefrontal cortex of the person suffering from anorexia, whether it's parents, caregivers, friends, or therapists. It's often too complicated to decide what to eat, and so it helps for someone else to do a bit of the decision making, sometimes in the form of making all food choices, or giving guidelines in others. Eventually, the brain regains enough function to begin to take over those decisions, and being able to easily make decisions is a sign of recovery.