Recovering from an eating disorder is a complicated endeavor because of the interplay between genetic predisposition, symptom severity, environmental/lifestyle factors and often, the patient’s ambivalence about changing behaviors they both ‘want’ and hate.
I have attended several presentations by Ovidio Bermudez, MD, the Medical Director of Child and Adolescent Services at Eating Recovery Center in Denver and a world renowned expert in eating disorders. He makes the case for how important “brain rescue” is in order to promote short-term and long-term recovery. What many don’t consider is how much the brain is compromised by eating disorder behaviors, not just starvation alone.
Eating disorder behaviors – bingeing, purging, restricting, laxatives, excessive exercise – and usually a combination of these or others causes an insult to the body’s nutritional status. When this happens, metabolic functions, or the processes in the body necessary for life, shift into ‘survival mode’ and all organ systems (heart, kidneys, liver, stomach, etc.) are negatively affected — including the brain.
When the body is malnourished, the brain atrophies or shrinks. This can actually result in the heightened persistence of ED behaviors. In other words, eating disorder thoughts and behaviors get worse the longer malnutrition occurs. Patients often argue that they aren’t ‘malnourished’ because they still eat. Malnutrition is defined as “the condition that occurs when the body does not get enough nutrients” as is the case with those who have eating disorders.
Malnutrition affects the brain by disrupting the neurotransmitters, or brain chemicals, that regulate mood. This often causes or exacerbates depression and anxiety. Regulating emotions like the fear of eating and shifting maladaptive beliefs about food, weight and body image becomes much more difficult. In other words, a brain not receiving adequate nutrition makes trying to recover more than an uphill battle for both the body and the mind.
Rehabilitating a person’s nutritional state and normalizing weight within a normal range allows for biological and metabolic recovery — the organ systems depleted by malnourishment are regenerated, so things like building back muscle mass, the return of menses, the repair of myocardial (heart) tissue, return of normal digestion and regaining normal brain size and volume occurs.
In order to rescue the brain, appropriate nutrition to treat the malnourishment as well as reaching a normal weight are absolutely key as well as very challenging. When recovery from eating disorders is the goal, treatment must first “get the brain out of trouble and keep the brain out of trouble” as Dr. Bermudez contends.
Only with healthy brain function from normalized eating and a normal weight is the potential for long term recovery possible. That means all involved – the patient, family and treatment team – have to do their best to work together in effort to rescue the brain. If you or a family member is receiving treatment that is not focused on improving nutrition and weight as a primary goal, seek other providers who understand the importance of treating the medical aspects of eating disorders.
Burmudez, Ovidio. “Reflections on Treatment and Recovery: Putting Art and Science into Action.” 6th Annual Eating Recovery Center Foundation Eating Disorders Conference. Denver. 15 August 2014.
Burmudez, Ovidio. “A Primer for Understanding Eating Disorders.” Aurora Psychiatric Hospital Workshop, Wauwatosa, WI. 20 June 2014.
Roberto, C.A., Mayer, L.E.S., et.al. Brain tissue volume changes following weight gain in adults with anorexia nervosa. Int J of Eating Disord 2011; 44:5, 406-411.