The Independent London Newspaper
20th September 2014

Letters

HEALTH: Professor claims blood flow in brains of anorexia sufferers distorts body image even as they get better

Professor Bryan Lask

Published: 29 March, 2012
by AMY SMITH

AN eating disorder expert told a meeting of psychoanalysts that anorexia cannot be cured on the couch and to look to the brain for a better understanding of the condition.

Professor Bryan Lask, president of the Eating Disorders Research Society, revealed details of his latest research at the Institute of Psychoanalysis in Maida Vale, last month.

One in 100 women aged between 15 and 30 are struggling with the debilitating eating disorder. Recovery rates are around 50 per cent, and around 40 per cent of patients relapse within a year of treatment.

Professor Lask has studied the brains of recovering sufferers and has come up with a theory he described as like “lobbing a hand grenade into the discussion”.

He said: “What I ask is, ‘can you offer a better model?’ And no one has done that. None of them explain the entirety of anorexia nervosa.”

Professor Lask and his colleagues measured the brain function of young women with anorexia while seriously underweight, and then during recovery.

They used neuro-imagery to measure the brain’s activity when patients responded to images, language and sensations. Results clearly indicated that blood flow was abnormal to a structure in the brain called the “insula”.

The insula, according to Professor Lask, is like “a busy train station”, because it is connected to most structures in the brain and works as a bridge between the right and left sides of the brain. Because of its complex connections, the insula monitors a wide range of functions that include controlling anxiety, regulating feelings of disgust, communicating feelings of hunger, perceptions of taste, processing the sensation of pain and maintaining an accurate experience of body image.

The findings, according to Professor Lask, help explain some of the familiar characteristics of the condition, such as distorted body image and ability to block signals of hunger and pain.

However, they were shocked to discover that when the patients were restored to a healthy weight, problems in the insula remained.

The “weight-recovered” patients still had difficulties with visual and spatial memory, screening out intrusive or negative thoughts and multi-tasking.

Psychological profiles of anorexic patients prior to their illness commonly reveal a rigid thought process, perfectionism, an emphasis on pleasing others, and “set-shifting difficulties” (the inability to change ways of thinking). These cognitive deficits all indicate an existing insular dysfunction, said Professor Lask.

He said anorexia could be described as an “ego-syntonic illness”, where the sufferer often becomes at one with their illness and almost protective of it.

Professor Lask concluded that treatment should focus on expanding the insula through Cognitive Remediation Therapy (CRT), which concentrates on the process of thinking, rather than the content of negative thoughts.

Dr Lask’s hypothesis takes the onus of blame away from the parents who are often blamed for causing anorexia by the way they feed or look at their children.

• A new support group for carers of people with anorexia has been set up by the national charity Beat. For more information about its meetings in Angel email beatnorthlondon5@gmail.com