Neurobiology of starvation-reward patterns

When I was sick and did not want to eat anything, many people thought that I was being silly. My family often wondered how I could 'not eat' and why I never 'just put something into my mouth and chewed'. This was not their fault, of course. They were frustrated by my illness, yet they did not understand that the decision to NOT eat was not mine - the ED had taken over my brain and body. I posted before about how in people with ED, starvation actually released endorphins' the 'no pain' neurotransmitter. This means that once I started eating again, all the troubles and pain returned because food = less endorphins in ED victims. According to researchers, this can take years to return to normal, if it ever does. This means that during recovery. the pain (physical, emotional, and mental) pain that we go through is REAL because our bodies start to make less endorphins in response to the food intake. Now, researchers have discovered yet another interesting fact about people with ED: they have higher levels of dopamine (DA) in reponse to starvation or restriction.

DA is the 'reward' neurotransmitter, meaning that it is released in response to rewarding activities. In people without ED, food intake causes the release of DA, meaning that we feel happy or feel rewarded when we eat. However, studies now show that in people with ED, food intake does NOT release DA ( In fact, participants in the study had LESS dopamine when they ate, and MORE dopamine during restriction. What this means is that with ED victims, starvation, on a neurobiological level, truly is 'rewarding'. Eating, on the other hand, results in less DA and therefore less reward. So, why would a patient with ED WANT to eat? The simple answer is, they would not. If eating means that less DA is released, eating will not be rewarding and the patient will not find pleasure or motivation to eat. On the other hand, NOT eating results in more DA release, which makes patients feel comforted or pleased/relaxed.

Some people, myself included, thought, 'well then, why not just give dopamine to ED patients in recovery when they eat?". First, remember that these neurotransmitters are 'strong stuff'. We cannot just go into the brain and start adding and taking away what we want. Also, dopamine is strong and should not be messed around with (although this is used for Parkinson's disease, in which case DA is absolutely necessary and for other reasons not related to reward/pleasure). Also, it would not be wise to give patients DA (aside from all the other side effects) because this would not train/teach them to feed themselves. To me, knowing that there is a DA imbalance in my brain helps me feel comforted because it tells me that I am not trying to sabotage my recovery when I say that I really do NOT want to eat. It means that I truly DO NOT want to because my brain and neurotransmitters are telling me that food = no pleasure while restricting = reward. Although this is challening for me in recovery, it gives me hope because it also helps others around me to understand that my former illness is truly a real, harmful, mental illness. Aside from knowing that, I take comfort in the fact that despite all these wrong messages in my brain, I am doing a good job in my recovery. Even though the DA is sky-high when I DO NOT eat and very low when I DO eat, I am still pushing my way through all my meals. I am eating normally, regardless of the fact that I do not find it rewarding or pleasing.

To top everything off, I love learning about these studies and ED because it shows me just how serious and REAL this illness is. Patients with ED do not mean to starve and kill themselves - the illness takes over. ED causes a series of physical, mental, and emotional changes that the patient can no longer control ot change. Thus, recovery is truly a difficult task because it means fighting all those urges to restrict anf going against what your body and mind tell you is right and rewarding. It also means training myself to ignore what my body and mind tell me because I know that I cannot depend on these hormones or neurotransmitters now. This is why I often tell my family or loved ones that 'eating is not fun for me'. Sometimes they wonder how this is possible, but at other times, they simply nod and say that they understand. Well, now they can REALLY understand why eating is unpleasurable while restricting IS rewarding - it is thanks to imbalances and dysfunctioning of the dopamine-reward system in my brain. Once again, EDs prove to be serious illnesses that challenge their victims to struggle through recovery in order to find health and happiness once more. However, for those patients who are able to fight in recovery, life becomes easier. This study showed that DA might take years to get back to normal, but in some patients, it actually never does. BUT, patients who work hard and have a strong support network are able to continue in recovery, despite this abnormal finding. What this means is that with determination, support, love, motviation, care, God, strength, food, and practice, recovery really can be successful. What a hopeful message.

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