Eating Disorders and the Brain

Source: Ground Picture/Shutterstock

There’s been a common misperception for years that external, sociocultural factors drive eating disorders (EDs). These include everything from overbearing, perfectionist fathers and traumatic childhood experiences to pop culture’s “skinny ideal” and the relentless “likes” and “dislikes” across social media platforms.

Those factors can and do play a role in the onset of EDs, but scientific research shows that there’s something else at play that may be more important: the brain. More specifically, the fundamental brain-circuitry changes that occur when EDs are present.

The good news on this? As we get a clearer picture of the neurobiology of EDs, that will improve ED treatments.

Some of that is already happening.

Targeting the Brain During ED Treatment

When people come into the ED unit where I am the chief medical officer, their treatment generally consists of three key prongs: psychotherapy modalities, nutritional and weight restoration, and psychiatric medications if needed. Those last two—nutritional restoration and medications—directly affect brain chemistry. Here’s how.

Nutritional restoration: Almost without exception, people who come to our center have severe nutritional imbalances that exacerbate their ED. For example, people are often depleted in zinc, B-12, magnesium, electrolytes such as sodium and potassium, and vitamin D, among other essential nutrients.

Many of those nutrients act as precursors (building blocks) for neurochemicals such as serotonin, dopamine, and norepinephrine, all essential for normal brain functioning. Bottom line: When nutritional status is poor, the brain doesn’t work as well.

Some examples: When we test our residents who arrive for ED treatment, memory and the ability to concentrate are often poor, speech is often slow, and the brain’s processing speed and executive functioning are both affected.

All of that affects decision-making and other essential tasks, which in turn can exacerbate ED-related behaviors.

Helpful medications: Most people living with an ED are also battling co-occurring conditions such as anxiety, depression, trauma, or obsessive-compulsive disorder (OCD).

These brain illnesses exacerbate EDs. However, people can be successfully treated for co-occurring disorders with medications that target the brain. These include Prozac, Zoloft, Lexapro, and others that are mainstays of a comprehensive ED treatment program.

Important note: Medications for co-occurring conditions must be taken for several weeks before they start working. That’s one of the reasons why people recovering from EDs need to stay in treatment for six to eight weeks or longer before they’re truly ready to leave. Effective ED treatment takes time.

A Cutting-Edge ED Treatment Showing Promise

A small, National Institutes of Health (NIH)-funded clinical trial recently found that deep brain stimulation (DBS) may disrupt brain signals that cause food cravings in people with binge-eating disorders. DBS uses a pacemaker-type device implanted in the brain that sends out impulses that reset abnormal brain circuitry.

Those findings in Nature Medicine showed that DBS may be able to target additional brain circuits to help those with life-threatening eating disorders.

Final Thoughts on EDs and the Brain

Until cutting-edge treatments like DBS become mainstream—and they likely will—the best current treatment for EDs consists of psychotherapy, nutritional restoration, and medication for co-occurring conditions.

Eating Disorders Essential Reads

How Disordered Eating Becomes a Concern in the Neurodivergent

Are Eating Disorders Regulated by Our Endocannabinoid System?

Crucially, sequencing, nutritional restoration, and medication support must happen first. That way, the brain can begin to heal, which makes talk therapy work.

For those three treatment components to be successful long-term, the person with an ED needs to stick with them after they leave residential treatment. That continuity of care may be the biggest key to lifelong ED recovery.