So, what changes in the brains of ED patients? One of my favourite changes to discuss is what happens to the amygdala and the limbic system. This is the part of the brain involved in emotions. Studies show that these areas are smaller or less stimulated in patients with ED, highlighting the difficulties that patients have with emotion and expressing them. At the same time, these areas are not stimulated during eating, which is supposed to be an enjoyable time for humans.
Throughout the brain, there is a decreased activation and sensitivity to dopamine, which we know is involved in reward patterns. This is important because it tells us a lot about patients with ED. First, they are not rewarded when they eat because their brains do not register this is as being fun or pleasurable. Furthermore, patients often do not feel happy or pleased with things that usually or normally cause joy, such as social time, relationships, laughing, etc. Again, we can relate this to the lack of dopamine or its malfunctioning in the brains of ED patients. This is commonly called anhedonia: a lack of pleasure from things that normally cause pleasure.
We also know that serotonin doesn't work properly either. Serotonin, or 5 HT, is involved in mood. There has been shown to be decreased 5HT in patients, which can help us explain the depression, anxiety, or bad moods that ED patients experience. New research is also finding a connection between 5HT and eating - namely, in patients with ED, 5HT works to make eating less enjoyable. Thus. when patients with ED eat, the lack of 5HT may actually cause negative emotions, discomfort, anxiety, a sense of doom, etc.
There are many other changes that have been observed, studied, and researched. I won't get into them because it would take me years to explain them all - and I am still learning as well. But what I want you to get from this post is that ED is a mental illness. What is important to understand as well is the fact that changes in the brain occur in patients with ED. What does this tell us? First, that ED is a REAL illness and not simply a choice that people make. It also helps us understand some of the symptoms and signs associated with ED. Moreover, we can empathize with patients and learn that what they are feeling and experiencing is very real - they are not trying to be difficult or starve themselves; rather, it is changes in the brain and other factors of the illness that change their behaviours and moods and contribute to the illness.
Finally, this helps us realize that the treatment of ED is more complex than simply feeding the patient and getting their weight stable - recovery, if it is to be successful, must address the many different factors that have been found to be implicated in ED. This may include medications, food, therapy, massages, etc. We cannot expect to 'fix' a patient with ED if we simply feed them and neglect that there are other things we must address: moods, behaviours, changes in hormones, self harm, suicidal thoughts, self-esteem, motivation, and more (please note, however, that food is VITAL for all people, including patients with ED. Studies have shown that with proper nutrition and adequate food intake and weight restoration, many changes in ED patients can become reversible and treated. FOOD IS MEDICINE!). Perhaps this is why recovery is so complex, and why it takes so long. But what keeps me hopeful is that all of this does not end in despair, as I am proof that true recovery is possible. It takes work, social support, love, and determination. Things often feel that they get worse before they get better. But just keep going. When a door closes, don't waste your time staring at it - look for another one. And if all doors are closed, look for an open window. Just don't give up.