Anorexia shrinks the brain - study

Anorexia shrinks the brain more than any other mental health condition, according to a new study involving LJMU.

The School of Psychology collaborates in the ENIGMA Consortium Eating Disorders Working Group which carried out the largest study to date of the eating disorder’s impact on the brain. More than 700 females with the condition underwent MRI scans and it was found that reductions in brain volume ranged from between one and five per cent in people who had anorexia.

But it was not all bad news for people living with AN; changes in brain size might be attributed to reductions in Body Mass Index, and re-nutrition can reverse the atrophying of our grey matter.

We spoke to Dr Samantha Books, reader in Cognitive Neuroscience and a member of the ENIGMA consortium. The study is also reported in The Daily Telegraph.


Q - You and your colleagues appear to have found abnormalities in the brains of people living with anorexia nervosa. Is that a surprise? 

A - We've clarified with a larger sample - we usually see reduced brain volume due to starvation - but smaller studies can create extreme results.  Large samples are more robust - so this paper is likely to be cited above all others for the moment.


Q – How serious are these changes and do they cause the individuals to lose certain faculties? 

A - Yes, there are some specific cognitive deficits (see the Ravello Profile), which are somewhat, but not entirely, reversed upon recovery. There are a host of behaviours associated with this, including rigidity, perfectionism, attention to detail (at the expense of bigger picture), empathy deficits.


Q – Are the changes permanent, do we know?

A - Brain alterations are reversible (upon re-feeding), and most cognitive deficits recover too - but it does appear that obsessionality/ruminations remain and are present, including perfectionism, prior to the onset of illness, which is usually in adolescence.


Q – Do many conditions/diseases alter the make-up of our brains? Why does that happen – is it the brain cutting its losses or regrouping, so to speak?

A - This is an interesting question, and a bit of a chicken or egg. Do brain alterations cause the condition or does the condition lead to alterations.  Both are probably true.  Cindy Bulik in Sweden shows some interesting genetic susceptibility data for anorexia (Genome wide association studies). Other conditions are linked to brain alterations - schizophrenia is a great example. And factors in gestation, for example fetal alcohol and tobacco syndrome, can alter neural tube development right from the start. Probably the brain is adapting based on its’ best guess at trying to cope with perceptions built from environmental stimuli.


Q – How might this new knowledge be useful, do you think?

A - Our anorexia paper is a robust finding demonstrating which brain areas are most susceptible to anorexia - some of these regions were already found by smaller studies.  We know, for example, that the prefrontal cortex is associated with excessive control of appetite/impulses/emotions - so changes to this region tell us something about the experience of a person with anorexia.  The parietal cortex appears retarded in its growth in people with anorexia - and it occurs in adolescence with anorexia, once they start exhibiting the condition.  The idea here is, is that excessive prefrontal cortex control prevents the body sensations from being effectively processed (dampened, if you will) to cope with emotions that people susceptible to anorexia find difficult.


Q – More generally on the subject of Anorexia, how much is medicine making progress to help people with the problem?

A - Very little.  The standard treatment is the Maudsley Model of cognitive behavioural therapy with anti-depressants or low-dose antipsychotics (for delusions about self and body).

Learn more at Sam's website


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