Inside the brain of someone with an eating disorder

Eating disorders are widely misunderstood. Many people think they’re caused by vanity, selfishness, or issues with self control, none of which could be further from the truth.

As a psychiatrist who works with eating disorder patients every day, I feel it’s important for everyone to know that eating disorders are serious and dangerous psychiatric illnesses. Yes, they include problems with food and disturbed eating behaviors, but the root of the issue is something much more complicated and, so far, difficult to treat successfully over the long term.

What’s an eating disorder?

Before I delve into the causes and consequences, let’s make sure we’re on the same page about the term “eating disorders.” The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Anorexia nervosa always involves weight loss, and both bulimia nervosa and binge-eating disorders include eating large quantities of food quickly. Purging behaviors such as vomiting, compulsive exercise, and laxative dependence, as well as severe food restriction, can occur in both anorexia nervosa and bulimia nervosa.

Of course, there are other eating disorders and many more symptoms associated with these disorders, but these are the most prevalent among the 30 million people in the United States who suffer from eating disorders.

Health consequences

These disorders are dangerous in many ways, but, put simply, every part of the human body requires a consistent supply of calories, nutrients, vitamins, and minerals to survive. The gastrointestinal tract, the reproductive system, the bones, and the heart are most commonly damaged as a consequence of an eating disorder— problems that can be deadly.

Is there any good news here? The answer is yes. Modern research is helping us understand these disorders better, and we are able to dive deeper into the more complicated etiology I mentioned earlier. 

Where it begins

It’s becoming clear that eating disorders start in the brain. For the past 10 years, my team and I have conducted studies using MRI to examine the neural circuits (brain activity) involved in people’s understanding of themselves (self-perception) and how they think other people see them. We’ve studied the brains of healthy people and individuals with eating disorders, comparing the neural circuits of women with an eating disorder to those who have recovered from an eating disorder, allowing us to understand how self-perceptions change in recovery.

Our work has identified two recovery targets: a tendency for patients to think badly about themselves and about what other people think of them. We are now piloting studies of a group intervention that forces people to interact with others in a specific way, hopefully leading to more positive ways of thinking about themselves and others.

In addition to the main areas of current treatment – nutrition education, therapy, and support programs – we are now exploring ways to target the appropriate neural circuits and modulate them to help improve patients’ self-perception. We hope that eating disorder behaviors will stop as people learn to engage these neural circuits. I am excited to be doing this work at UT Southwestern.

Volunteers needed

Do you have an eating disorder or know someone who does? We need female volunteers (women ages 18 to 46) to participate in our research and help us further understand how to treat and cure these disorders. Contact us at 214-648-4617 or edresearch@utsouthwestern.edu for more information or to get involved.