Making sense of the physical explanation behind AN – the biological root of AN.
Recent brain research Prof. Bryan Lask and Dr. Ian Frampton shows how the brain of anorexics (these are sufferers that meet the DSM IV criteria) works. Their research shows that AN symptoms seem to be located in different parts of the brain; they identify at least 8-10 regions1. The research is indicating that the insula has a dysfunction. The insula is part of the brain that connects brain regions responsible for emotional life, bodily experience and communication and is of particular importance for complex behavior. For example, ‘the insula will be involved in helping ensure that we eat what we need to feel less hungry, that we enjoy what we eat, and that we do not disgrace ourselves in the way we do it’.2
The advancement of technology has shed a light on how insular dysfunction in the brain appears to be the biological root of AN. The good news about this discovery is that such dysfunction in the brain is not permanent. In recent years, science has also began to understand the neuroplasticity of the brain – the ability of the brain to change itself, its possibility to change throughout the life and how it is possible to become the architect of our own brain.3
Here is a biological reason for early intervention (in addition to the psychological one in not allowing AN to form into a habit*), as it is more effective in changing the brain development where AN has been present for a shorter amount of time while the brain connectivity is still not fully ‘hard-wired’.
1 Dr. Mark Warren. Living with Food: the Science Supportin Eating Disorder Treatment (http://www.eatingdisorderscleveland.org/blog/bid/86558/Eating-Disorders-and-the-Insula)
² Nunn, Frampton, Gordon, Lask. The Fault is Not in Her Parents but in Her Insula – a Neurobiological Hypothesis of Anorexia Nervosa. European Eating Disorder Review, 16, 353-360 (2008)
³ Marie Pasinski, M.D. Nurture the Miracle of Neuroplasticity. Huff Post Ted Weekend October 9, 2013 (inspired by Dr. Jill Bolte Taylor, TEDTalk, “My Stroke of Insight”
* Please read Early Intervention Part 2/3 in Practical Tips Section.
Making sense of the ‘helplessness’ engulfing a person with AN.
When I was watching my daughter go into the spiral of AN I did a lot of reading and observing and thinking. What I saw was something very strange, very compulsive and completely irrational, much like the spontaneous reaction of anxiety I experience before making a speech.
Let me explain. When I am about to do a speech generally I have planned it, written it, practiced it, yet like the vast majority of people, I still get anxious. It is not logical or rational but this ‘flight or flight’ mechanism happens spontaneously as we accept that it is a survival instinct that has been passed on from our ancestors and remains with us today – our bodies prepare us for facing a perceived threat.
What I saw in my daughter was something that looked like this. At one point, her dieting behaviours seemed to switch; they became involuntary and illogical. To everyone this seems strange – eating is basic to survival. Why would your body tell itself to starve? As I scoured through information to understand what was happening to my daughter, I stumbled upon a theory by Dr. Shan Guisinger. I felt her explanation fitted what I was seeing and made intuitive sense. When our ancestors were hunter gatherers, they needed to migrate over vast distances. During these journeys, their bodies would go into a ‘migratory mode’ where they were required to expend large amounts energy despite eating very little food in order to complete the distance and arrive to a more plentiful environment. This ‘migratory mode’ appearing in AN symptoms happens spontaneously as a survival instinct that has been passed on from our ancestor and remains with us today – our bodies prepare us for facing a perceived famine.
My daughter was just as confused as I was as to why she just couldn’t eat. Dr. Guisinger’s explanation makes sense as to why this was happening to her. Her impulse not to eat and that she could not explain appears as primal as the anxiety a person feels waiting to do a big speech, where their body is in a mode where nothing is making sense.
AN does not affect all of us, but for the ones it does, weight loss is the trigger to start the body into the spiral of AN – what science considers abnormalities in today’s world – a remnant of a ‘migratory mode’ from our ancestors. At such migration, the ability to keep going on very little reserves would have needed great determination and self-motivation. Perhaps this is why we typically see people with AN also possessing high-achieving personalities that have everything going for them – other than not being able to eat. They are survivors: my perspective is that if you have AN, you are also gifted with the determination and self-motivation to do something about it.
Making sense of why AN is happening to predominantly high achieving individuals and is irrationally driving the person to starvation.
If AN is heritable, why would anorexic ‘genes’ be passed on as it seems contradictory to the the basic survival mechanism for a species. Indeed in modern context where food is plenty, the odd behaviour of anorexic’s refusal to eat does not seem to make sense at all. However in genetic evolution time, it is relatively recent that humans exist with the luxury of food abundance.
Hidden among the myriads of information out there, one explanation proposed by Dr. Guisinger in the journal of Psychological Review seems to make sense and connect all the dots of AN symptoms ¹. Her interpretation examines our ancestral roots a bit deeper. At least 10,000 years ago, it was necessary for our hunter gatherer ancestors to travel a distance in search of food. This quest for survival put them into ‘migratory mode’, requiring them to move energetically and ignore hunger until they reach the land of plenty. Some migrating animals such as gray whales are known to be starving while they are on the move². For genetically predisposed persons with AN, weight loss that acts as a signal of famine to the body put them into this ‘migratory mode’.
With this explanation, we may start to understand how people with AN can starve well³ yet consequently find the path forward to:
¹ Anorexia Nervosa: A Guide for Anorexics and their Loved Ones (www.shanguisinger.org)
Adapted to flee famine: Adding an evolutionary perspective on anorexia nervosa.
Guisinger, Shan. Psychological Review, Vol 110(4), Oct 2003, 745-761
² N. Mrosovsky, D.F. Sherry, Science 207, 837 (Feb 22, 1980)
³ Regina Casper points out that AN hyperactivity is remarkable because in normal starvation humans conserve their energy. (R.C. Casper, Int J Eat Disord 24, 381. Dec 1998; R.C. Casper, J Affect Disord 92, 99. May 2006)