Dopamine and Responses to Food in EDs

'Why is recovering from ED so hard?'. It can be difficult to understand why and how eating can be so difficult for someone. If you have read around this blog, you will likely have noticed that I am very interested in the brain/hormone changes that occur with ED. You will have also noticed that there are many of these changes, thus partially accounting for the changes we see in people who battle EDs.

Well, yet another study now gives us more insight into why eating for ED patients is so hard (http://onlinelibrary.wiley.com/doi/10.1002/eat.20937/full). This study found that in patients with ED, eating does not stimulate the 'reward' centre in the brain (the dopamine system, DA). In people without ED, eating causes DA release, which makes our brains realize that it is 'happy' or 'good'. As a result, our brains learn that food = happy and food = reward and food = good. But, what if our brains DID NOT release DA when we ate? What would happen? We would think food = bad, food = not exciting and food = not rewarding. So, why would we want to eat? We wouldn't. And it appears that this is exactly what goes on in the brain of a patient with ED.

This finding also helps to explain why patients with ED find that restricting helps alleviate anxiety or stress. Think about it: if dopamine (DA) is released and this makes us feel happy, we would not feel anxious at that time. So, if DA is NOT being released in response to food, we would feel anxious. When presented with food, patients with ED feel anxious, angry, and frightened. Why? Perhaps because of the DA malfunction. The brain seems to sense that food is dangerous and unrewarding. As a result, the patient truly is fearful of eating - their brain is telling them so! What this also implies is that if their brains are saying that food = bad, it might also be saying that no food = good. This would help to explain why starvation is a symptom of ED - patients seek out restriction and stop eating because it really DOES feel 'good' to them. The reward centre in the brain is altered and no longer recognizes food as being enjoyable - and this seems to explain why patients with ED restrict, but also why recovering from ED is so hard. To recover means to eat, and the patient does NOT want to do this...plus, their brain is giving off signals that food is not rewarding. If it isn't rewarding, why would anyone possibly want to eat? AHA! So now we can come to see why this is hard for ED patients.

I like this kind of information because once again, it gives hope to people with ED. This is proof that this is not 'all in their head'. It really is a mental illness, and sadly, the brain and body seem to adapt to restriction in such a way that works against the patient in recovery. In simpler terms, because the patient's brain is telling them that not eating is rewarding, they find it very hard to eat in recovery because eating does not feel good or rewarding. Imagine doing something that you don't like. Then doing it again and again, almost six times a day. Does that sound fun or easy? No. This is exactly what ED recovery is like for patients. Not fun. Not easy. Not enjoyable.

But it comes with its rewards in the long run. Of course, recovery is not easy. Eating may mean that the person feels full, uncomfortable, and anxious. It may be associated with weight gain if that is what the patient requires – and this is very difficult for the patient with ED to accept and be comfortable with. However, it is definitely worth it. This is what people with ED need to constantly remember: pain and challenges now will certainly bring positive and desired results soon! But you must keep going.

Recovery is challenging because one must 'ignore' what the brain and body are saying for a while (ex. Not being hungry but still eating according to a timed schedule, cruising through the anxiety of gaining weight and feeling full, not feeling excited or happy to eat, etc.). But over time, the body and brain start to adjust and it becomes a habit. Over time, the brain will start to realize that food = good, food= strong, and food = life. And soon enough, food = freedom from ED. It may take time – and unfortunately, no one knows how long that will be. But one thing is for certain: it is possible, doable, and worthwhile. In the meantime, keep fighting. Surround yourself with people who love and care for you, and can support you during this time. Find ways to cope with difficult feelings. Pamper yourself, and use distractions. Do whatever you can to keep pushing…trust me, it is worth it. And you can – and WILL do it.