1. Julia Rice
Registered Dietitian
HDFS Master’s Student at Michigan State University
The Anorexic Brain: Beyond Dieting
Picture By: Luke Lucus

2. What do you perceive to know about E.D.’s?
or F? People with eating disorders can simply start eating normally to reach
a healthy weight again.
or F? The brain’s reward system in someone with an E.D. is the same as that
of a person who is considered obese.
or F? Eating disorders are more prevalent that Type 1 and Type 2 diabetes.
or F? Eating disorders have a genetic component to them.
or F? An adolescent E.D. brain differs from that of an adult E.D. brain?

3. Content
efinitions to Know- look at full list from folder
ruth or False- What Do You (Think You) Know About E.D’s?
rief Overview of Eating Disorders/Disordered Eating and Counterparts
rain Function and and E.D.’s- The Brain’s Reward System
hat Does This Mean for Youth Development Professionals

4. Definitions to Know
This complete list can be found in the ‘Read First’ Folder:
•Eating Disorder (E.D.)
•Disordered Eating (D.E.)
•Anorexia Nervosa (A.N.)
•Bulimia Nervosa (B.N.)
•Negative Body Image (N.B.I.)
•Body Image Dissatisfaction (B.I.D.)
•Binge Eating Disorder (B.E.D.)
•Eating Disorders Not Otherwise Specified (E.D.N.O.S.)
•Restrictive Eating
•Purging vs. Binging
•Satiety/Satiation- the natural feeling of being full after eating.
•Dopamine Receptors
•Re-feeding- clinical term for slowly providing nutrition to someone who is
severely malnourished

5. The Brain, Food and Fat
ur body breaks down food into energy from fats, carbs and proteins
ur brain specifically requires glucose to function
person with A.N. (and other E.D.’s) who starves their body of
nutrients, forces their body and brain into survival mode where it:
• Speeds up metabolism to breakdown store fat, muscle and tissue
n the brain, fat is stored and utilized in the myelin sheath

6. Myelin Sheath
yelin is a fatty tissue that surrounds
nerve cells, in particular the nerve cell
axon. This tissue is formed by other
kinds of cells that support nerve cells
called glial cells (Schwann cells in the
peripheral nervous system and glial
cells in the brain and spinal cord.
y insulating the nerves it helps the
tiny electric signal that conducts
impulses to travel quickly down the
nerve cells.

7. Anorexia Nervosa (A.N.)
serious, potentially fatal, brain disorder characterized by a compulsion for
self-starvation and/or excessive exercise, severe weight loss, distorted body
image and impaired thinking, particularly around issues of food, weight and
body.
he illness can cause severe medical complications- bone loss and heart
dysfunction and is often considered a comorbidity with other psychiatric
disorders, including depression, obsessive-compulsive disorder, self-harm
and suicidal ideation.
any individuals with A.N. have physical wasting and muscle loss and has more
visible side effects of the disease.
elf-Perception Issues
norexia nervosa has two forms- patients may swing between them both
during course of illness:

8. Predisposition to an E.D.?
Multitude of pre-cursors that play a role in development of E.D.’s:
•Depression
•Negative body image/body dissatisfaction
•Lack of control (environmental or literal)
•sexual abuse
•Negative role modeling/environment
•Harm avoidance
•Anxiety
•Behavioral inhibition
•Difficulty with set shifting [easily moving from one mental set to another]
•Tendency to focus on details rather than the big picture
•Perfectionism
What about genetics?

9. Genetic Factor’s in E.D’s?
According to Dr. of Stanford University”
• Women with a first degree relative suffering from an E.D. have a 10-
fold higher lifetime risk of developing an E.D.- i.e. tends to run in
families
•No single gene or groups of genes have been identified as pre-cursors,
however:
• For A.N., there is higher susceptibility in the region the Y chromosome
• Bulimia, there is higher susceptibility in Chromosome 10p (
•Faulty neurotransmitters:

10. Recap on Adolescent Brains
The Learning Brain
By: Sarah-Jayne Blakemore and Uta Frith, Chapter 8
• Change in amount of grey and white matter
• Prefrontal cortex isn’t fully developed (affects decision making,
understanding, comprehension)

11. Brain with E.D. vs. Healthy Brain vs. ‘Obese’
Brain
SUGAR HIGH When an anorexic woman unexpectedly gets a taste of sugar (yellow) or misses out on it (blue), her
brain's reward circuitry shows more activity than a healthy-weight or obese woman's. Anorexics' reward-
processing systems may be out of order. (G. FRANK ET AL/NEUROPSYCHOPHARMACOLOGY 2012).

12. What is Dopamine again? (video)
lease check out this YouTube Clip– we watched this in a previous
week’s required video section.
• https://www.youtube.com/watch?v=n6IzoW9hB9s&feature=youtu.be&list=
PLED5B85573BADBA78

13. The Reward System and E.D. Patients
“The dopaminergic and opioidergic reward pathways of the brain are
critical for survival since they provide the pleasure drives for eating,
love and reproduction; these are called 'natural rewards' and involve
the release of dopamine in the nucleus accumbens and frontal lobes.”
– (Comings, 2000)
•Patients with A.N. process visual food stimuli differently when hungry
and satiated
•This may be linked to reduced reward valency of food and
experiencing these stimuli as disgusting and threathening
•Studies of risk and reward processing in AN and BN suggest that both
disorders have difficulties in evaluating the emotional significance of a
stimulus

15. Did You Know?
•In someone with an E.D, particularly A.N., they have enlarged
ventricles of the brain causing the overall size of their brain to
‘shrink’ or atrophy
•Individuals with E.D.’s have:
• Grey Matter: significantly lower in A.N’s
• White Matter= Nerves covered by myelin sheath (lipids)- significantly
lower in A.N’s
•Atrophy can be reversed with nutritional therapy and re-feeding

16. ‘The Control Center’ and Reward Function
ses fMRI System (Functional Magnetic Resonance Imaging System)-
measures and maps brain activity
ontrol Center= two golf ball–sized chunks of tissue called the
dorsolateral prefrontal cortex, or DLPFC
• The DLPFC help stamp out primitive urges- “They put a brake on your
impulsive behaviors”- Dr. Samantha Brooks
(https://www.sciencenews.org/article/anorexic-brain)

17. Continued…
maging studies suggest that individuals with anorexia have an imbalance between
circuits in the brain that regulate reward and emotion (ventral) and circuits that are
associated with consequences and planning ahead (dorsal).2 Brain-imaging studies
also show that individuals with anorexia have alterations in those parts of the brain
(eg, anterior insula) involved with interoceptive self-awareness that may be
implicated in disturbed bodily sensations.3 In addition, altered function of other
related regions may contribute to altered sensing of the rewarding aspects of
pleasurable foods. Individuals with anorexia may literally not recognize when they
are hungry.
he neurotransmitters serotonin and DA are primary targets of study, according to
Kaye. “Simply put, the serotonin system tends to be inhibitory while the dopamine
system is associated with signals about reward.”
See more at: http://www.psychiatrictimes.com/articles/anorexia-and-brain-
imaging#sthash.SrVz0V6T.dpuf

18. Where Does Our Sensory System Fit In?

19. E.D./N.B.I. Therapies
Cognition:
• A cognition is the process of thought, the faculty for the processing of
information, applying knowledge, and changing preferences. In
psychotherapy cognitive therapy aims to substitute desirable patterns of
thinking for maladaptive or faulty ones.
CBT:
• Cognitive behavioral therapy (CBT) and Enhanced Cognitive behavioral
therapy (CBT-E): A relatively short-term, symptom-oriented therapy
focusing on the beliefs, values, and cognitive processes that maintain the
eating disorder behavior.
• It aims to modify distorted beliefs and attitudes about the meaning of
weight, shape and appearance which are correlated to the development
and maintenance of the eating disorder.

20. Furthering Your Knowledge
ideos to Watch:
• ‘Onslaught’– Found on YouTube
• Media Messages to Kids and Adolescents:
• http://www.heraldsun.com.au/news/more-news/mum-shocked-by-
fat-message-being-sent-to-children/story-fn7x8me2-1226279902827
• Websites:
• Eating Disorder Coalition- currently working on ‘The Truth in Advertising Act’
• Ellyn Satter Institute- http://www.ellynsatterinstitute.org