I was deeply reassured to see that there has been some recent progress in understanding the underlying mechanism behind anorexia. It is of course a psychiatric disorder, but this recent work coming from Kings College, London has found that there are a number of underlying genetic factors which point to it also being a metabolic disorder.
My response to the recent articles was ‘Of course it is!’
Anyone who has contact with those with anorexia quickly come to realise how complex it is, and, despite the hype, has less to do with dieting and food than you might assume. Those with the disorder are obsessive about their intake of calories, true. They restrict their intake of food to the point of starvation, true. But it isn’t really about weight, but about control. For some ‘hard to understand’ reasons, those with anorexia find that they feel less anxious and more in control when they rigidly keep their weight low. To me, this points to an underlying difference in their cognitive ‘wiring’ or physical make-up.
There is a consistent personality type predisposed to developing anorexia. It is recognised that they are typically bright, high achieving and perfectionist. What might begin as a benign diet combines with an external emotional event such as a bereavement or bullying to trigger the disorder. The weight falls, the periods stop, the anorexia gets a grip. Witnessing it is painful, experiencing it is worse. On top of the extreme challenges it brings, society in its ignorance can blame the sufferers for their vanity or stubbornness.
Psychological treatment, cognitive behavioural therapy, the whole armamentarium of psychiatric approaches do not meet with great success. The disorder is notoriously resistant to long term ‘cure’ with the sufferers often relapsing. The mortality rate is frighteningly high.
I have spoken to leading psychiatrists in the field and they have long been convinced that there is an underlying physiological reason for anorexia, a lack of a feedback loop, a missing neural pathway around craving food, or recognising body image accurately. One doctor said to me ‘To be angry with someone with anorexia is as useful as shouting at someone for being colour blind’.
To say anorexia is a complex condition is an understatement. It is cruel, frustrating and counter-intuitive, but at last now there is some evidence emerging which may lead to more successful treatment, and importantly which may lift some of the stigma and burden that the sufferers feel.
Let’s hope that this new understanding heralds a change in the way that people think about the illness and that more effective treatments are on their way.
The search pinpointed eight locations across the genome that seem to play a role in anorexia. But this is likely to represent only a tiny fraction of all the genetic factors involved in the condition, says Bulik (University of North Carolina). “It’s a complex trait, so we expect lots of genes to each have a small to moderate effect,” she says.