Individuals diagnosed with Anorexia Nervosa with concurrent significant depression whose weight was restored show significant improvement in their depression without the use of medication to treat their depressive symptoms. The lessening of cognitive impairment and improvement in psychological functioning subsequent to weight restoration is also well documented. (Meehan, et al. Int. J Eat Disorders. 2006.)
The argument for anorexia nervosa as a strictly brain disorder is substantiated by the effects of malnutrition and starvation; if the brain is starved how can one function normally. One famous and routinely recognized study conducted in Minnesota in 1950, unrelated to eating disorders, examined the effects of starvation on “behavior, personality, psychological health, and eating patterns.” “During the the semi-starvation period, the healhy male voluntters became progressively more preoccupied and obsessed with food. They played more with their food, ate over longer periods of time to savor the taste, spent more time reading cookbooks and menus, and spent most of their day planning their food intake. Though initially psychologically healthy, subjects reported feeling more depressed, irritable, angry, and anxious and became socially withdrawn and isolated during the semi-starvation phase (51). “ Keys A, Brozek J, Henschel A, et al. The biology of human starvation. Minneapolis:University of Minnesota Press, 1950.
If we follow a “nature” only cause of eating disorders then genes and biology drive the etiological bus. However, no gene to date has been found and the most promising news on the biology frontier is that certain individuals are likely destined to develop an eating disorder – generally, those who have depression and anxiety in their family history or “gene” pool.
Yet, when we assess and evaluate individuals for the presence of an eating disorder, we often discover that their depression, cognitive impairment and psychological functioning, including interpersonal and familial issues, existed before, sometimes way before, the emergence or hint of their eating disorder.
Often people with eating disorders have deficits in self-worth and self-esteem, familial issues that have left them vulnerable or have impacted their psychological development or a variety of other interpersonal issues that impact their ability to feel safe and trusting in relationships.
Lately, within the eating disorder professional community, we have begun to address the chasm that has developed between those who primarily or exclusively support the biological causation of anorexia versus those who trend away from a “one size fits all approach.” Eating disorder professionals are working through our own “all or nothing” thinking regarding the etiology of eating disorders. It is remarkable, perhaps ironic, that we are struggling with the exact same issue that we work routinely to help our patients dismantle in their own thinking and lives.
Eating disorders are complex; their causes are as unique to the sufferer as is the sufferer a unique individual. It behooves us to not shy away from any sound theoretical approach or treatment that makes sense and that is helpful for our patients. Unfortunately, the research remains lacking on the theory that supports relational and psychological causes of eating disorders; it is difficult to quantify for research purposes qualitative experiences of individuals. We are fortunately moving forward and there are some promising studies coming out of Ottawa, Canada in particular and a recent article by Michael Strober who addresses the issue of nature, nurture and the environment. (International Journal of Eating Disorders. March 2012.)
Nevertheless, as we work with our patients to listen to their own internal voice and experience it is generally always best to follow similar advice. Listen, keep an open mind, trust that the individual will tell us all (loved ones and therapists) what their needs are and accept that nature may be the source for some as to the cause of their eating disorder, and a combination of nature, nurture, experience and environment may be the source for others.