The Key to Recovery: What Eating Disorder Recovery Centers are Missing
The prevalence of social media in society today has meant that eating disorders in young people are on the rise. “Thinner” is believed to be “healthier,” and information brought forth by diet culture convinces young people that the solution to happiness is found through weight loss and dieting. The diet culture industry has subtly melded with the nutrition industry, preaching that by “exercising and eating like x, y, and z, you can look like this too!” The reality is, that if everyone worked out and ate the exact same way, we would all still look entirely different. Why? Because health looks and feels different on everyone.
Social media platforms such as Instagram and Tik Tok are riddled with multitudes of diverse communities, two especially notable ones for the purpose of this article being the “foodie” and “fitspo” communities. This little corner of the internet is riddled with orthorexic tendencies and diet culture beliefs; content which is often consumed unknowingly. This has led young people, particularly young athletes, down a path of under fueling and overtraining, ultimately leading to a career plagued by injuries, eating disorders, health complications, impaired brain function, and impaired overall development.
The brain of an individual in malnutrition will be vastly different than that of a healthy individual. The priorities will differ greatly. The focus of a healthy individual will be allocated towards life, relationships, and goals, whereas that of an individual in malnutrition will be solely placed on food, and food alone. Maslow’s Hierarchy of Needs outlines five tiers of basic requirements that dictate human behavior. To offer a quick synopsis; Maslow's Hierarchy of Needs, proposed by Abraham Maslow in 1943, offered the idea that the requirements in which humans operate fall under five separate categories. These five categories differ in a hierarchical fashion, as the primary needs must be satisfied before the subsequent needs can be tended to. The most basic of these needs is that of food, water, shelter, sleep, and warmth. This is known as the Physiological Tier. Until these needs are met, the brain will not be prompted to think about anything else. Hobbies, relationships, and even schoolwork will fall by the wayside.
The brain consists of three basic units; the cerebrum, responsible for voluntary movement and temperature regulation, the cerebellum, responsible for muscle movement, posture, and balance, and the brainstem, essentially the “survival brain.” Surrounding these three units is a tissue composed of neuronal cell bodies, otherwise known as grey matter. Grey matter is imperative for movement control, regulation of thoughts and emotions, and the ability to retain and process memories. The grey matter surrounding the cerebrum is what is known as the cortex, where the cerebral cortex is located. This is the rational part of the brain, responsible for personality, intelligence, and processing sensory information (among a variety of other important functions).
A recent study conducted by the University of Southern California showed that individuals with anorexia nervosa exhibited altered brain structure, with significantly less grey matter than that of a healthy brain. The study was conducted internationally, featuring nearly two-thousand brain scans from patients worldwide. The study concluded that individuals with anorexia nervosa display significant shrinkage in grey matter in both thickness and volume of cortical complexes (1). Individuals in recovery from anorexia nervosa, however, displayed restoration of grey matter, indicating that through nutritional rehabilitation coupled with neural rewiring, the brain can heal itself.
Think about the malnourished brain in the context of Maslow's Hierarchy. When an individual is in starvation, the brain will think about food incessantly. That primal need for survival is not met. It is only natural that an individual with an eating disorder cannot think of anything else. Key points can be drawn from the Minnesota Starvation Experiment for further evidence. Some of the participants in this study went as far as to become chefs because they became so obsessed with food while in malnutrition.
Conducted in 1944 by physiologist Ancel Keys and psychologist Josef Brozek, the Minnesota Starvation Experiment observed the psychological, physiological, and behavioral effects of starvation on thirty-six men. The goal of the experiment was to best understand how to re-feed starving individuals. The experiment was completely voluntary, and thirty-six participants were selected to undergo a year-long observation period. The first three months of the experiment served as a control period, the next six as the starvation period, and the final three were control rehabilitation. An additional two month long period of unrestricted rehabilitation was included at the end of the experiment. During the control period, the men were fed around 3500 calories per day.
When phase two of the experiment began, the participants' caloric intake was halved to around 1570 calories per day. They were also expected to total about twenty-two miles worth of exercise per week, work fifteen hours per week in a lab, and spend twenty-five hours on educational pursuits. The men were fed two times per day, and were not allowed to consume meat during the starvation period. An obsession with food ensued rather abruptly (2).
On average, the men were reported to have lost around twenty-five percent of their natural body weight. In the final three months, the men were split into four control groups, and rehabilitated on varying caloric allowances. During the rehabilitation phase, the men struggled to identify their hunger and fullness cues, and reportedly struggled with body image and feelings of inadequacy. Participants also noted a preoccupation with food and impaired concentration (2). Everything from participants' dreams to their conversations were plagued by thoughts of food. Depression and anxiety was common among the participants, and they became increasingly sensitive and argumentative. The only positive emotional responses elicited were during conversations regarding food or weight (2).
These behaviors ensued as the brain had entered survival mode. The medulla is the part of the brain stem deemed the “survival” or “reptilian” brain, as it is the portion of the brain responsible for regulating heart rhythms, coordinating breathing patterns, controlling blood flow, and levels of oxygen and carbon dioxide in the body. This is the part of the brain that keeps us alive. The medulla differs from the cerebral cortex in the sense that it is instinctual, whereas the cerebral cortex is rational. Upon sensing a perceived threat, the medulla will automatically kick into survival mode, without communication with the cerebral cortex.
The Minnesota Starvation Experiment is a crucial piece of literature in understanding the psychological, behavioral, and physiological impacts of starvation. In the context of eating disorders, it enables us to understand the toll that malnutrition takes on an individual, and the importance of complete unrestricted eating in recovery. It took months, even years, for all of the men to completely recover. Eight men agreed to an additional two months of observation during the unrestricted rehabilitation period. The others received routine examinations. During this period, each participant's intake averaged between 7000 and 10,000 calories per day. This is a normal response to malnutrition (2).
Based on what is known about Maslow’s Hierarchy of Needs and the Minnesota Starvation Experiment, a deeper connection can be made to Shan Guisinger’s Adapt to Flee Famine Theory, otherwise known as the Migration Response. In the case of starvation, this entails a phenomenon known as the “scarcity mindset.” The brain automatically enters this mindset when resources are perceived to be scarce. No food coming in? Excessive movement? Food must be scarce. Migration must ensue. The survival brain has kicked into high gear, triggering the fight, flight, or freeze response, reacting to the present energy deficit.
Essentially, Guisinger proposed three behaviors that indicate a genetic predisposition to developing anorexia, characterizing the famine response. These behaviors included ignoring food, hyperactivity, and denial of starvation, which was accompanied by distorted body image (3). Guisinger hypothesized that when an individual loses at least fifteen percent of their natural body weight, the body identifies a famine in the present environment (3). At the beginning of starvation, the desire for food increases as the metabolism slows, in an attempt to conserve energy. If starvation is prolonged, and that fifteen percent threshold is surpassed, the brains of individuals with this genetic predisposition for anorexia will kick into “starvation mode,” ceasing all hunger cues and further prompting the migration response. This means that the brain has concluded that food is not present, and is compelled to migrate to a place where resources are abundant (3).
Each study stresses the importance of the survival brain and neural rewiring in eating disorder recovery. The brain is neuroplastic; meaning that it has the ability to modify and adapt its structure and function in response to lived experience. Essentially, the brain can form new connections that enable it to be rewired. In the case of eating disorder recovery, this entails the restoration of the balance between the rational and emotional brain, known as the amygdala (4). The amygdala is associated with the basal ganglia, the part of the brain responsible for habit formation, emotional regulation, and recognition of patterns. Once habits are formed, and behaviors become entrenched, the prefrontal cortex is no longer consulted as behaviors have become automatic (4).
Neural rewiring is just as vital to recovery as nutritional rehabilitation. The two go hand in hand, as nutritional rehabilitation is key to repairing the physical damage done to muscles and organs whilst in starvation, and neural rewiring is the key to challenging those seemingly hard-wired behaviors. Without neural rewiring, individuals in recovery will stay in a recovery-relapse cycle until those entrenched beliefs and behaviors are challenged and changed.
The human body will not communicate a need without reason. It is wired for one thing and one thing only; survival. Until the basic survival need that is food has been met, the brain will continue to cue mental and physical hunger until it has re-entered energy balance. Once the brain senses that the body is out of energy debt, and that basic survival needs are met, it will move up that hierarchy and start to have capacity for other things. Eating disorders are to be taken very seriously. The effects of starvation are much greater than can be seen by the naked eye, and it is imperative that the mental implications are understood, as well as the physical. Support is always available and there is always hope.
References
1) Sheehan, S. T. (2022, June 14). Groundbreaking study shows substantial differences in brain structure in people with anorexia: Keck School of Medicine of USC. Keck School of Medicine of USC | Leaders in medical education, research and patient care. Retrieved September 4, 2022, from https://keck.usc.edu/groundbreaking-study-shows-substantial-differences-in-brain-structure-in-people-with-anorexia/
2) Ball, Janet. “The Minnesota Starvation Experiment.” BBC News, BBC, 20 Jan. 2014, www.bbc.com/news/magazine-25782294.
3) Guisinger, S. (2014, March 26). Adapted to flee famine. Adapted to famine. Retrieved September 1, 2022, from http://www.adaptedtofamine.com/
Baker, D. (2013). The psychology of hunger. Monitor on Psychology. Retrieved September 4, 2022, from https://www.apa.org/monitor/2013/10/hunger
4) Duhigg, C. (2012, March 5). Habits: How they form and how to Break them. NPR. Retrieved September 4, 2022, from https://www.npr.org/2012/03/05/147192599/habits-how-they-form-and-how-to-break-them#:~:text=Neuroscientists%20have%20traced%20our%20habit,brain%20called%20the%20prefrontal%20cortex.