Saturday, 17 August 2013

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.


  1. Before I studied psychology and searched more and more I was calling every body behaving extreme whether substance abuse or ED ,silly.Yes me Marina myself I was calling them silly,stupid etc.
    Now I know this is brain disorder in thinking and decision making that makes victim chose the wrong choice and behaving in abnormal way and act against their own benifts without knowing and sometimes jusify what they are doing by just twisting facts and listen only to their own horns.

    This is an excellent post Marina full of scientific info.
    With my humble respect


  2. I am a mother and I could not understand why my daughter was doing this to herself.I thought she hated herself and was punishing herself.I thought she wanted to die to punish me or her dad who left us when she was a child .
    This went on years before I met you over this blog and you ,Marina told me and knowing how to support and comfort her through your advise ,she is much better now and I can say she is normal.

    A Thankful Mother

  3. I rather live with less endorphin and deal with pain rather than without food and no pain.
    I know as you articularly explained in your blog and this post that ED mind is different than our minds (assuming that We are free from ED)


  4. I am impressed to know DA theory as this make lots of sense to me.
    This explains why all of us who do not have ED,enjoy foods,drinks,and snacks.
    This definetly explains why victims of ED do not enjoy foods or drinks(no rewrad from lack of DA release)
    I hope with recovery DA start to respond normally to our normal body physiology so that people can enjoy what is not enjoyable but necssary to our health and brain and immune system function(food)
    I think this post made my brain secretes and retained lots of DA.

    Kelly W

  5. Thank you for this hopeful message .
    Let me also share my hope.Now 6 years after my recovery without relapse ,I can tell my DA is now normally rewarding me when I eat and shuts off when I am hungry.
    Yes I took years but slowly but surely will return back.
    Marina keep on your track ,you are haeding there ,heading to where you deserve to be ,,,healthy body enjoy and get rewarded by food.

    Recovred ED victim

  6. Marina
    Even though,I do not feel that my DA is as strong now .I do enjoy my meals with the family most of the time but I agree with you ,still occasional I can feel this.
    Hopeful new ,I will go away slowly and our body,feelings and thoughts will be completely from ED scars.


  7. Now because I know ED is a menatl illness that mislead the brain and thoughts ,I will never ever blame my cousin for not eating and hating food( now she is recovered)
    I used(same like all families and friends of hers) to blame her and frankly telling her go and eat ,you are crazy,you are idiot etc.
    Now I feel guilty and I apologize to her and to all ED victims


  8. Marina
    I suffered a lot not only from ED but from every body was around me was blaming me for not eating .
    No body even the closest member of my family could ever believe me or understood the seriousness of my problems.
    However all of them offered help and pushed me to see doctors and I was afraid .
    Now I am same like you guys ,happier and eating better and it seems like my DA not acting against me as slowly I am enjoying my food and feeling hungry close to my meal time and many times I feel craving for certain meals and I ask my mom to cook it for me.
    I started to accept friends invitations and I started to enjoy eating with strangers and friends and not only with family.
    What a change a year can make.
    Thanks to you Marina


  9. Why people tend to blame sick person .Didn't they know once day they will be in either same or worse as the pesron whom they blame.
    The lease people can do when know somebody not doing well is prayers,good wishes,listening and understanding.


  10. Some people not willing take responsibility and so easy to blame as doctors who do not take responsibility to help clients with ED and just tell them go and eat or parents who just blame and hurt feelings of their children telling them We have lots of food and you do not eat.
    Lack of knowledge and not able to admit the faiure are behind they belligerent blame.
    I hope they can read your message and apologize.
    Thankfully with recovery ,ED can eat and feel the hunger and enjoy the meals and DA will respond to hunger cues as normal



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