Positive Impulse

integratieve psychotherapie

Anorexia, snel ingrijpen en gewichtsherstel zijn fundamenteel voor voor t slagen van de therapie

By

anorexia nervosaAnorexia nervosa (AN) is an illness defined by restriction of food, often resulting in malnutrition. Malnutrition affects every system of the body, and the brain rarely escapes malnutrition’s impact.

A study by Wagner and colleagues (2005) performed MRI brain scans on 40 women in long-term recovery from eating disorders (subjects included patients with both AN and bulimia nervosa). Their length of recovery ranged from 29 to 40 months (much longer than the Roberto study). Results showed:

  • All brain structures in the recovered women were normal in volume and similar to those of control subjects.
  • This study suggests that structural brain abnormalities are reversible with long-term recovery.

    A study by Chui and colleagues (2008) evaluated 66 adult women with a history of adolescent-onset AN and compared them to 42 healthy female women. The participants received an MRI and a cognitive evaluation. The results showed:

    • Participants with AN who remained at low weight had abnormal MRI scans.
    • Weight recovered patients had normal brain volumes.
    • Participants who currently had lost their menstrual cycles or had irregular menses showed significant deficits across a broad range of many cognitive domains including verbal ability, cognitive efficiency, reading, math, and delayed verbal recall (even if the structural brain changes had resolved).

      Brain Changes Related to Anorexia Nervosa

      AN is accompanied by changes in mood and thinking. Patients frequently have symptoms of anxiety and depression that do not predate the eating disorder or are exacerbated by the AN. Ancel Keys’ Minnesota Study documented that anxiety and depression were among the symptoms that presented in healthy men put on a semi-starvation diet.

      Additionally, individuals with AN often withdraw socially, become more rigid and fixated in their thinking, and frequently have little insight into their illness.

However, even though a brain post-weight restoration may look normal, normal brain functioning may not yet have returned. It seems that menstrual function may be a mediator and a better predictor of cognitive recovery than weight (for females) and that full cognitive functioning may not return until menstruation has been maintained for at least six months

 

Brain Recovery After Anorexia

Taken together, these studies suggest a complex interplay between weight status, brain structure, and optimal brain functioning. Brain matter actually shrinks during AN and takes time to recover. Six months after full weight restoration the brain often is not yet structurally back to normal. Yet with enough time at a healthy weight, the brain seems to fully recover. The research suggests that by three years after achieving weight recovery, most individuals’ brains will likely appear normal physically.

. This is one reason why the return of and continued menses is such an important marker of recovery.

It is important to recognize the catch-22 of AN recovery. Individuals with AN are typically cognitively impaired and require sustained time at a healthy weight for cognitive impairments to fully improve. Yet, it is partly the cognitive symptoms of AN that make sufferers believe there is “nothing wrong” with them and thus reject treatment, which is a condition called “anosognosia.”

Parents of patients with anorexia report a range of time, from six months to two-plus years for full “brain healing” to occur. What parents usually mean when they report brain healing is that they notice an improved state, “like the patient is coming out of a fog.” Furthermore, parents report that brain healing brings around changes in mood and behaviors such that patients seem more stable in their recovery and “back to their former (pre-illness) selves.” One book for parents is even entitled, “My kid is back.”

 

This is likely one reason that family-based treatment (FBT) is often more successful than individual therapy for younger patients. Parents often need to do the heavy lifting for their children who are malnourished. It also illustrates the challenge of treatment for older patients with anorexia who may be trying to achieve recovery with a starved brain. Research supports that only with full and sustained weight restoration are individuals fully able to maintain their own recovery

Reader Interactions