Study sheds new light on women with anorexia

Monday, December 24, 2007
By Mark Roth, Pittsburgh Post-Gazette
Even after they have stopped starving themselves, women with anorexia seem to have trouble enjoying their food and experiencing other pleasures.
That's the thrust of two studies done this year by the University of Pittsburgh's Dr. Walter Kaye and Dr. Angela Wagner of J.W. Goethe University in Frankfurt, Germany.
The first study, published in March in the journal Neuropsychopharmacology, showed that pleasure centers in the brains of women recovering from anorexia didn't respond nearly as strongly to sips of sugar water as the brains of healthy women did.
The second study, which appeared this month in the American Journal of Psychiatry, showed that 13 women recovering from anorexia had much different patterns of brain activation while playing a betting game than 13 healthy women did.
Both studies used functional magnetic resonance imaging, which measures blood flow to parts of the brain while it is performing different tasks.
In the sugar-water study, the brains of women recovering from anorexia showed much lower responses to the sweet liquid than those of healthy women, particularly in the insula, a prune-sized part of the brain associated with social emotions.
That suggests that in women with anorexia, "they don't need to eat because it doesn't reward them," Dr. Wagner said.
In the new study, two groups of women were asked to guess whether a virtual playing card would show a number greater or less than 5. If they guessed correctly, they won $2. If they were wrong, they lost $1. And if they didn't guess in the allotted time, they lost 50 cents.
The outcomes of the game weren't the important part. What mattered was the way different parts of their brains reacted to the challenge.
In the healthy women, an area known as the anterior ventral striatum, associated with emotional rewards, showed much more activity than in the women recovering from anorexia.
But the former anorexics had stronger responses in a brain region known as the caudate, which is associated with planning and calculating future consequences.
That could mean that "the most anxious individuals with anorexia ... may respond in an overly 'cognitive' manner to both negative and positive stimuli and consequently may not be able to process information about rewarding outcomes of action," the study concluded. "Thus, performance -- that is, being right or wrong -- may become more important than [pleasure] rewards."
That fits with the well-known tendency of women with anorexia to try to please others, control the outcome of events and pay great attention to detail, Dr. Kaye said.
A healthy person "has to have a balance between the here and now and future consequences," said Dr. Kaye, an internationally known anorexia researcher. "Some people may be biased toward the here and now and never look at future consequences, but anorexics tend to be biased toward worrying about consequences."
Researchers wanted to study anorexic women who had regained their weight because they didn't want the dietary effects of the disorder to affect the brain imaging, he said.
The studies don't necessarily mean that anorexic women who are recovering will start avoiding food again.
"Our data suggests that once people recover, they rarely relapse, but they will struggle with these other traits for the rest of their lives."
Anorexia affects about 0.5 percent of all women in the United States, and bulimia -- in which women binge and purge -- affects another 1 to 2 percent of women. About half of anorexic and bulimic women will recover, but among the other half, 10 percent will die over a 20-year period, making it the deadliest of all psychiatric conditions.
Dr. Kaye believes 50 to 80 percent of these conditions may be caused by genetic factors, and said that girls who go on to get the eating disorders show signs at age 8 or 9 of such behaviors as being highly anxious or obsessive about details.
The studies suggest it may not be enough to get women to stop starving themselves, Dr. Wagner said.
"In the past," she said, "we have focused on getting them to eat, but we might now want to work on changing their mindsets" as well, through therapy or medication or both.

Confronting The World

Just bringing up a question that came up during Jasmine's presentation. Why is it that you don't say anything to those that are stereotyping you? What is holding you back?

Brian's Post

Sorry about the other post. I wanted to get feedback about my recent facilitation. How good was my verbal communication, the discussion questions/topics, were they qliche or good questions,etc. If you don't remember my facilitation was about clothing styles of teenagers. So far I have seen a lot of questions asked from each group and I like the in depth responses.

Brians Facilitation

Facillitation

I've changed my topic and don't want anyone to know.

Fat v. Skinny

Sure it may not be deep thought BUT we always focus on how fat people are portrayed in the media; jovial, funny beyond comparison, proud etc. but we never ask ourselves what those who we've deemed slim or skinny feel. They are represented in the media too but always as an object of sexual desire or eye candy. How do skinny people fel?

:D

Racism in the media

Yeah sure you might say it's played out or easy to find but I like this topic because it's something you wouldn't expect to see now. Yeah maybe 10 or 15 years ago it was blatant but now with times changing doesn't it seem as if at least the television shows we watch or the magazines we read have become more open and accpeting of various races....we'll see when I facilitate!!

The Facilitations

So far the facilitations that i've seen were great. I like the way that each group went about their lessons. I liked the conversation during the lesson and the work was interesting. I hope my facilitation will go as well as the others and hope to make it fun for all.

Number One Reason For Developing An Eating Disorder

by Joanna Poppink, M.F.T. Hundreds of people have asked me why people develop eating disorders. Of course, there are many issues involved, but as I explore this field, over the years I have concluded that there is one outstanding theme that runs through every person with an eating disorder I have encountered.
Early in their lives they experienced, on a sustained basis, relentless boundary invasion on every level.
When a person's physical, emotional, psychological, intellectual, sexual, and creative boundaries are consistently ignored and penetrated that person experiences total boundary invasion. When that person has no control or way to stop, protest or often even acknowledge such invasions, the person experiences helplessness, despair and a certainty that they are worthless to themselves or anyone else.
The consequences of such total invasion are vast. One consequence is an eating disorder.
Having had so many boundaries disregarded, the person has no knowledge or skills in recognizing or honoring boundaries herself. She will eat or starve for emotional relief. She may eat vast amounts of food for comfort value alone. She may deprive herself of food until her life is in danger. She has no internal limit setter that tells her when she has experienced enough. Being oblivious to any boundary means being oblivious to limits of any kind.
The compulsive overeater eats whenever and whatever she likes. Her choices are based on self-medication issues, not feelings of physical hunger.
The anorexic will not eat. There is no limit to her not eating. She will starve herself to death in search of relief from her emotional pain. She knows nothing of the experience enough. She couldn't say, "Enough," to an invader of her boundaries, and she can't say to it herself. The concept of enough has no meaning to her. She often feels that, if she "disappeared" she might find some permanent relief. I have heard countless anorexic young women talk ethereally, with a lost in a beautiful world of angels smile, of how wonderful it would be to be vapor or a light dancing spirit in the clouds.
Ah, such spiritual bliss, they imagine. In reality, it's the final self-protective act, to destroy their bodies and their lives completely. Then they can truly escape the complexities of being alive.
The bulimic will binge grotesque amounts of food. She will literally assault herself with more food than a body can tolerate. She has no limit at all. The compulsive overeater will, at last, have to stop eating if only because of the pain of her distended stomach. Her body sets a final limit. The bulimic has no such limit. She experiences (in her mind) no consequences for the assault of food. When her body cannot bear more, she will vomit it all out. Then she will continue her binge. She may reach her body's limits many times. Each time she does she can throw up and continue.
Eventually she may stop because she is completely exhausted, or she is in danger of being discovered. "Enough" has no meaning to her. There are no limits and no consequences for disregarding her boundaries.
Realistically, of course, there are plenty of consequences. There is tremendous damage happening to the body. And each time people with an eating disorder assault themselves they destroy more of their spirit, soul, self-esteem, sanity, health and value to themselves and others. Each violation deepens their ritualistic behavior, and they become more entrenched in their disorder. The consequence of this is increasing anguish and despair.
So what do I mean by a history of boundary violations? Blatant and extreme boundary violations involve sexual molestation, sexual abuse and physical abuse. Much has been written about these areas now, especially in material exploring Post Traumatic Stress Disorder (PTSD) and Dissociative Identity Disorder (DID). Use your search engines to find some quality information posted on the internet in these subject areas.
There are other kinds of boundary violations, less dramatic, less discussed and more prevalent which are also devastating to a person's psyche. When, in the name of caretaking, people in authority take over a young person's life, it constitutes boundary invasion. When she has no privacy, when her diary is read, when her things are borrowed or taken without permission, when her efforts in school or sport are overwhelmed by someone else's ideas, goals or personality, when her choices are disregarded or treated with disdain, when she has little or no choice where her personal life, clothes, foods, friends, activities are concerned, her boundaries are being invaded.
Her boundaries are also invaded when, in the name of caretaking, she has no responsibilities of her own and no consequences for her actions. When "the little princess" or the "little prince" can have anything she asks for without putting forth any effort to earn such gifts, she learns nothing about personal effort, limits, consequences or what "enough" means. If she wants something, she gets it. That's all. If someone picks up her clothes, does her laundry, fixes her car, pays her bills, lets her "borrow" money or things and never asks for them back, she experiences no boundaries and no limits.
If she doesn't have to keep her promises, if she doesn't reciprocate with caring activities for people who care for her, she learns nothing useful about herself in relationship to other people. She certainly learns that there are no limits to her behavior or desires.
She doesn't learn that she has meaning and value. She doesn't learn that she can put that meaning and value within her to work to accomplish goals. For example, if she breaks something, whether it is a lamp or a car, her word or someone's heart, it can be up to her to make necessary repairs using her own resources and her own creativity. In such a process she would learn what effort means. She would learn what responsibility and consequences for actions mean. She would learn reasonable limits and reasonable expectations.
Without such learning all she learns are the tricks involved in being cute and manipulative to get what she wants. These are poor and insubstantial tools to rely on when building an adult life.
Somewhere inside, over time, she may gradually realize this. But, having no sense of boundaries, she will only become bewildered and anxious. She will use her eating disorder as a way to numb her feelings of anxiety. She will use her manipulating skills to get what she wants from whomever she can use.
As time goes by there will be less people who will allow themselves to be manipulated. The quality of her circle of associates will decline. She will find herself in bad company. This becomes all the more reason for her to rely on food for comfort. The people around her are less reliable all the time. And finally, they tolerate her presence only because they can manipulate her.
Then she is truly in a total victim position. Her manipulative skills backfire. There are people in this world who are better at manipulating and using than she. She has found them. She has become their target and then their prey. Reliable food or food rituals, including starvation, become her most valuable relationship.
Early in her development she learned through massive boundary invasions (which perhaps seemed so ordinary and unimportant at the time) that she was helpless to assert herself. She learned that she had no private or sacred space to cherish and respect. She also could not acknowledge -- often even to herself -- that she was being thwarted, invaded, controlled, manipulated and forced to deny large aspects of her natural self. She had no recourse except to comply. She complied and developed an eating disorder.
Now that she's older and her manipulation skills are failing her, she only has her eating disorder to rely on. This may be the most crucial time in this person's life. If her pain and despair are terrible enough and she is certain she can not bear this way of living anymore she still has choices. One is to continue down the road of self-destruction. The other is to reach out and get help.
It's a very tough position for her. She would have to recognize that she has had enough. She's never known what enough was. She would have to recognize that she can't bear any more pain. She's never known what a limit was. She'd have to be honest and reach out for genuine help. She has only known about manipulating others.
She's got to feel a lot of anguish and pain before she stretches beyond her life pattern into what might be a real healing and recovery path for herself. She's reaching for something she can't even imagine. No wonder it's so difficult for a person with an eating disorder to decide to get help and allow themselves to begin to trust someone with knowledge of their real personhood. She doesn't know that people exist who do respect and honor boundaries. She doesn't know that there are people who can and will honor and cherish her most private and sacred inner spaces. She doesn't know yet, that someday that trustworthy, respectful, steadfast and competent caretaker she needs so badly can be herself.