This is your brain on an eating disorder

"That girl is so skinny, she must be anorexic."
"Ugh, I can't believe I just ate that huge dinner.  Maybe I'll just go puke and feel better."
"I am so jealous of people who are anorexic!  I wish I could have that kind of control, just for a couple of weeks so I could lose this weight."
"She's been in the bathroom a long time.  Haha, I bet she's throwing up!"
"People with eating disorders are so stupid.  It's not that complicated: eat when you're hungry, don't eat when you're not."

How many times have you heard comments like these?  How many times have you said things like these (or thought them, but didn't say them out loud)?  Maybe while you read this blog, you think things like, She doesn't look anorexic..., or Really, Cait?  What is the big deal about food?  I'll be honest, I had a lot of hesitations about "coming out" with my eating disorder on this blog, and one of the biggest reasons was that I was afraid people would look at pictures of me and dismiss the whole idea; say I'm exaggerating, I'm faking it, I don't really have a problem because I'm not wasting away in a hospital bed at 66 pounds.  All I know is, I wouldn't wish my daily battles with food on my worst enemy.  I don't have all the answers to the endless array of questions you could ask, that's for sure.  But there is a lot of information out there that may help combat the confusion and misconceptions that surround eating disorders in our culture.  Allow me to elaborate.

1.  People with eating disorders do not choose to have them.  If you want to read a great blog entry about this very fact, go here.  In a nutshell:
A.  Anorexia is a phobia of food.  It's a dangerous phobia, because we need food to survive and we can't just avoid food like how someone with a phobia of spiders can stay out of musty basements and not go to see Spiderman on Broadway.  Telling someone with anorexia to Just eat, is like telling someone with a phobia of heights to Just get over it and climb the ladder.
B.  The compulsions behind bingeing and purging in bulimia and binge eating disorder are akin to the compulsions behind OCD.  It is not a choice we make, to eat compulsively, without stopping to breathe.  It is not a choice to then go and throw it up.  It is a compulsion that is as impossible to fight as the need for a person with OCD to wash their hands repeatedly, or count, or have certain rituals. 

2.  Eating disorders are based in genetics.  Genetics is the loaded gun, and environment pulls the trigger.  It's no use - and it trivializes the issue - to blame the media, or society, or celebrities for the presence of eating disorders in our culture.  This delegitimizes the struggle that everyone with an ED faces, because it insinuates that since we are all exposed to the same culture, those who have eating disorders must be weaker than others or more susceptible to those messages.  People with eating disorders have a genetic predisposition towards them.  Things like emotional trauma, the onset of puberty, mental illness, and a host of other things can be the spark that initiates the use of an ED behavior, and the use of these behaviors solidifies the existence of the eating disorder itself.  It's not my fault that I have an eating disorder.  It's not my parents' fault, it's not my friends' fault, and it's definitely not society's fault.  I got stuck with a genetic hand of cards that is chock full of mental illness.  That's just the way it is.

3. The use of eating disorder behaviors (restricting, bingeing, purging, and excessive exercise) are all coping mechanisms.  They help the body and mind deal with certain situations, stress, anxiety, and trauma to prevent a "system shutdown."  The use of them reinforces their own power, and in so doing, trains the brain to need them in order to cope with everyday life.

4.  There is endlessly complex biology behind how these behaviors function as coping mechanisms and here is the short version.  The important chemicals involved here are endorphins, the neurotransmitter serotonin, and the hormone vasopressin.
  
Endorphins are pretty well-known.  What releases endorphins?  Exercise!  (And lots of other things.)  Someone with an eating disorder who over-exercises does it as a means to flood their system with endorphins, again and again and again.

Serotonin is a fun guy.  Antidepressants work on serotonin, by preventing cells from sucking it back up, and instead making it hang out for longer in our synapses (the space between neurons) so it can do its thing.  Serotonin is kind of complicated, but when it comes to mood, suffice to say that it's good stuff.  It keeps us feeling good - balanced, not anxious, and generally even-keeled.  SSRI's (selective serotonin reuptake inhibitors, i.e., most antidepressants) are the most commonly prescribed drug in the US.  So you can see that serotonin is pretty crucial.
A.  Restricting works with serotonin in this way: when a person severely restricts their food intake, not only do they lose weight, but their brain actually shrinks.  As the brain shrinks, though, it doesn't alter the levels at which it is producing neurotransmitters.  So all of a sudden, an adult who is heavily restricting is flooding their smaller, shrunken brain with enough serotonin for a much larger brain.  Hello, feel-good stuff!  Hello, positive reinforcement to keep restricting in order to keep up the serotonin flood!  Your brain can actually compel you to continue restricting in order to maintain the serotonin flood that has begun.
B.  Bingeing works with serotonin quite differently: people who binge almost without exception report bingeing on carbohydrate-heavy foods.  There is a biological compulsion going on here.  The precursor to serotonin is an amino acid building block called tryptophan.  When we eat carbs, the insulin that is released causes the uptake and processing of everything except tryptophan.  Tryptophan hangs out in the blood and enters the brain where it gets made into gads and gads of serotonin, flooding the brain with feel-good stuff.

Vasopressin is a hormone that is crucial to the body's functioning, especially the heart.  Purging acts on vasopressin in a very compelling way.  When you vomit (self-induced or not), there is a huge release of vasopressin in the blood.  It does three very powerful things in regards to the brain: it acts as a sedative, an anxiolytic (anti-anxiety) and an antidepressant.  This is why purging, the eating disorder behavior that is often the most difficult for anyone to understand, is so addictive.  Your brain experiences a huge rush of chemicals that calms it, lifts its mood, and decreases anxiety the instant you purge.  Now, because the brain is constantly adapting, as time goes on, it requires a higher and higher level of purging in order to get the same effects from the vasopressin (much the same way that an alcoholic must drink more and more in order to get drunk and feel better).

An eating disorder is based in biology.  It's an illness, just like diabetes or cancer is an illness.  It's also a hell of a ride.  Food is everywhere.  It's necessary for survival.  It permeates every social setting, every gathering, every aspect of our culture.  When you fight battles with food, every meal, every day, all day long, it's enough to make you want to be anywhere but here, doing anything but living life in your body that is alien to you, in your mind that has turned against you.  Please try and remember this and look with compassion on those who may be struggling around you.  We didn't choose this.  We're just fighting like hell to get though it.