A lot of attention is paid to how anorexia affects the body, from the focus on weight to the long-term risks of organ failure or death. But, many forget that anorexia is a mental disorder first and foremost, and treatment needs to focus on the brain as much as the body.
New research published in the American Journal of Psychiatry shows just how important mental rehabilitation is. According to the report, anorexic teenagers need additional rehabilitation time to regain normal brain function and avoid relapse – even after weeks of treatment and weight gain.
The team of researchers from the University of Colorado Anschutz Medical Campus say persistent brain alteration after rehabilitation leaves teenagers at risk for possible relapse and more time is needed to properly address this alteration.
For this study, the team assessed 21 female adolescents before and after they received treatment for anorexia. They found that the group all showed elevated reward systems in their brains compared to 21 participants without the eating disorder.
“That means they are not cured,” said Guido Frank, M.D., senior author of the study and associate professor of psychiatry and neuroscience at the University of Colorado School of Medicine.
“This disease fundamentally changes the brain response to stimuli in our environment. The brain has to normalize and that takes time.”
Using brain scans, the team showed that anorexia nervosa patients have heightened central reward circuits associated with appetite and food intake. These systems remained elevated once the patients had their weight restored and were otherwise “rehabilitated.”
However, the reward systems showed a small amount of normalization in most who underwent treatment, suggesting rehabilitation just needs longer to properly let these systems return to normal.
The study also found widespread changes in other areas of the brain, such as the insula which processes taste and body self-awareness. The more severe the alterations in the brain were, the more difficult it was to treat the illness in each patient.
“Generalized sensitization of brain reward responsiveness may last long into recovery,” the study said. “Whether individuals with anorexia nervosa have a genetic predisposition for such sensitization requires further study.”
Frank and colleagues say more research is needed to understand how these reward systems are affected by anorexia and how to best normalize them after anorexia. However, they provide a possible avenue for increasing rehabilitation effectiveness and understanding anorexia.
“Anorexia nervosa is hard to treat. It is the third most common chronic illness among teenage girls with a mortality rate 12 times higher than the death rate for all causes of death for females 15-24 years old,” Frank said.
“But with studies like this we are learning more and more about what is actually happening in the brain. And if we understand the system, we can develop better strategies to treat the disease.”