I hate ED. I hate him with a passion I save only for truly horrible people. He’s hurt me. He’s hurt my mother, my aunt, and other family members. He’s killed clients of mine. He’s wounded countless others. He is a monster. But like so many monsters we see in our midst, we have to come to grips that it’s a brain disease that drives their sickness. It’s a brain abnormality.
Recently we had a client in our program who stepped down from residential care to our IOP and was dropping weight like a stone. We did all that we could to show her that we believed in her ability to get back on track, restore to her healthier weight, and progress into full recovery. But her denial of her weight loss was too great for us to get past. She chose to leave treatment rather than go back to a higher level of care, and the treatment team was crestfallen and beating themselves up. It was timely then that an article on the subject came out on the web site Sciencedaily.com.
Researchers at the University of Illinois at Chicago and UCLA scanned the brains of patients with anorexia and found they had more connective abnormalities in the region of the brain linked to error detection, conflict monitoring, and self-reflection. These scans were done on anorexic patients who were weight restored, so as not to confuse the finding with those of a starved brain.
What the researchers believe is driving the hallmark presentation of anorexic patients, persistent lack of recognition of the seriousness of the behaviors and weight, is this abnormal formation of the brain. What’s fascinating is that these same patients can recognize the danger in others, just not themselves. When it comes to the evidence presented to them about their own high risk of health complications and death, they simply can’t believe it. It’s not that they don’t want to, it may be that they can’t.
A couple years ago, a young man was in my office with his parents who were beside themselves with fear as they watched their son deny he had an eating disorder even as he wasted away. I had them get a full lab workup, and bring the results in. I showed the young man the clear results of how sick he was. The numbers were right there on the paper. He looked at it, flipped it over to the back, then to the front again. Over and over he did this, saying, “I don’t believe it. It doesn’t make sense. This isn’t true.” It was heartbreaking.
He couldn’t make the cognitive leap to understand what he was being shown. First, he had to recognize the conflict of being underweight despite the fact he saw himself as fat. Then he had to reflect and process what that meant – that he was malnourished and his body was failing to work properly anymore. Then he had to be able to process if he didn’t get help, he’d get sicker and sicker until he died.
He had to have insight to understand he needed to make an adaptive decision to go against what his mind was telling him (I’m fat) and get into treatment to restore weight and get healthy again. But without that insight, he was not going to do it. And his brain, like so many others with anorexia, had a wiring issue that made that incredibly difficult.
The key to helping someone with anorexia is to consistently work with them to find connections between their self-perception and reality. Some studies are being done to try integrating virtual reality into treatment to aid in that. Other techniques commonly used include body tracing where clients draw on a large piece of paper how big they think their body is and then have their bodies traced over it to reveal the significant disparity between the two.
I hate ED. But the only way to really beat him is to fully understand him. We’re getting there step by step.
By Andrew Walen, LCSW-C, LICSW, CEDS - Founder and CEO at The Body Image Therapy Center. If you would like to get in touch with Andrew please call 877-674-2843 or email firstname.lastname@example.org.