Anorexia 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.
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