Particularly in midlife, higher risks of osteoporosis, diabetes, mood disorders, and other medical complications of eating disorders show that it is imperative to treat both the biological and psychological sides of an eating disorder. While promising, drugs are not cures, says Hudson, especially with anorexia nervosa. No medication thus far has any proven effect on reducing its symptoms.
What begins healing in anorexia is weight gain. What begins healing in bulimia is halting the purges. What begins healing in binge eating disorder is curbing the bingeing. Thus, all treatments, directly or indirectly, need to address symptoms. Often that begins with putting a tight lid on dieting, which seeds so many disorders. Just as overriding one's hunger weakens important body-brain circuitry that controls hunger, body temperature, reproduction, and mood, sound nutrition can repair much of the damage that eating disorders create.
Many eating disorder treatments first work hard to convince a woman to eat three healthy meals and two snacks a day before trying to undertake psychotherapy. Diet and psychological healing have to work in tandem to get at the biology behind these diseases. But psychology, too, can have a biological effect. Psychological treatment means applying better strategies to deal with midlife stresses. It demands increasing selfawareness about how a woman feels in the moment when she is engaged in damaging eating-disordered behavior. And it means discovering faulty thought patterns through cognitive therapy: I ate a piece of cheesecake. I am a failure. And then learning a new and better thought pattern: I ate a piece of cheesecake. I am a failure. No, I am feeding the cells in my brain.
Psychological treatment is about changing the mind in order to change the body, and vice versa. This means honoring the mindbody connection in a very scientific way. The potential can be illustrated by recent studies about body image. Brain researchers have learned that body image is not static; rather, it is an abstraction, slipping and sliding over time based upon experience and sensation. It is a process, born out of an ellipse of brain tissue called the posterior parietal cortex. This region receives visual and sensory impulses and transmits instructions for action.
To understand body image, put your hands at your waist and squeeze. Run your fingers up and down your hips. Your brain will juggle the feelings of fleshiness and contour and organize them into a definition of your shape, be it pear, apple, or hourglass. Based on cultural ideals, your brain may enhance the image with input from emotional and memory cues coming from other centers of the brain. You end up with a feeling about yourself, your body. It might be elation or disappointment. This fits together with all the other feelings arising from your sense of your physical body.
If you had a brain injury in your posterior parietal cortex, your experience of body image would be distorted. If you had an eating disorder such as anorexia nervosa, similarly your body image would be warped. Recently, a study team at University College in London was able to simulate this distortion. The investigators outfitted seventeen people with electronic gadgets that stimulated the tendons in each wrist. The stimulators created the sensation that the subjects' hands were moving inward.
Next, the subjects were asked to place their hands at their waists while wearing a blindfold. Researchers flicked the switch on the stimulator, and voilà, the subjects perceived that their waists were getting thinner. Virtually, of course. Meanwhile, team members were simultaneously scanning the subjects' brains by magnetic resonance imaging. When the deceit took place, the subjects' brains showed a change. They demonstrated increased activity in their posterior parietal cortexes. This illustrates that even when body shape and size do not change, the perception of it can. Working in reverse order, changing perception can change behavior.
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