By Catherine Bishop

It would be a very frightening feeling to watch someone you care about fading away in front of you and very frustrating when they often refuse to do the one thing that you know they need to do.  It is hard to understand the mindset of someone with anorexia nervosa.  How can they possibly continue to starve themselves when it is apparent that they are deathly thin?  Why are they being so stubborn you may ask?  Why won’t they just eat?  It is not stubbornness, to understand a bit more about why someone with anorexia nervosa does not eat even when they are extremely unwell from starvation we need to delve into the brain.  Yes this is a heavy topic, but an important one for both individuals with anorexia nervosa and their loved ones to understand.  So here we go…

There is a part of the brain called the insula that is crucial in keeping us alive by regulating our appetite and eating.  It is kind of like how when we hold our breath we will eventually breathe even if we are trying our hardest to hold it, our brain kicks in and makes sure that we do what we need to do to survive.  With eating, if we attempt to starve ourselves, our body’s natural instinct is then to eat.  This is one of the reasons why individuals with bulimia nervosa binge eat, the brain’s natural response to not eating is to fight back with more eating (more on this another time).  Unfortunately, in individuals with anorexia nervosa the insula does not seem to be working as it should so the natural instinct to eat does not kick in and the person is able to continue to starve themselves. 

And if you do manage to get them to eat something, which is clearly an essential part of recovery, they will become extremely anxious and not just because they may put on weight (although this is certainly a part of it).  Individuals who have recovered from anorexia nervosa are found to have high levels of a chemical in the brain called serotonin.  High levels of serotonin is implicated in the experience of anxiety.  And how do we get serotonin in the brain? What we put into our body later gets transformed into serotonin, so if the individual with anorexia nervosa starts to eat again they will get a flood of anxiety and what takes this anxiety away is to not eat.  What’s more is the anxiety on resuming eating again will be higher than what they experienced prior to starving themselves, as the brain responds to starvation by making more spots in the brain to pick up the serotonin and this takes some time after resuming eating again to go back to normal.  So it is very important to understand that for an individual to recover from anorexia nervosa they need to experience a great deal of anxiety before things get better (but things definitely can get better!).

Eating and regaining weight is one of the first steps to recovery but an incredibly challenging one and your loved one (whether this be your child, partner, friend) will need a lot of patience and support over this time (and it is likely to take some time).  Please note that this is just a brief overview of what occurs in the brain for someone with anorexia nervosa and there are certainly additional factors than what has been highlighted here.  If you need support in caring for someone with anorexia nervosa do not hesitate to get in touch with a mental health professional to guide you through the process as this can be a challenging time for everyone involved.   

*Note I have used the word she as anorexia nervosa occurs predominately in females, however males can of course also experiences this condition. 

Catherine Bishop is a clinical psychologist at Healthy Mind Centre Launceston.