Addicted to Starvation: The Neurological Roots of Anorexia

Without reservation, I think this is the best article written for the public to explain the current science on anorexia so far, ever:

Addicted to Starvation: The Neurological Roots of Anorexia: Scientific American

Bravo to Gura, to Scientific American, for a real, science-based overview.

To parents new to this: read this article FIRST.


  1. Good article by Gura. However, on her website that you link to, she says eating disorders are "often an assertion of control by an individual who feels otherwise powerless." That's news to me. I thought people with anorexia feel unable to control the power of the illness. That's the opposite of an assertion of control. I wonder what her evidence is?

  2. I find it interesting as well. Let's ask her! (I'll follow up here and let you know - you do the same?)

  3. Anonymous, and all - a message from Trisha Gura:

    My response is:

    “When I say ‘control’ in this context, I mean that the eating disorder is a misguided attempt to impose control on a situation over which a person feels they have no control i.e. a divorce in the family. I might say, “I won’t eat” because I can control what goes in my mouth, not whether my husband leaves me. For a time, such a strategy seems to work. I might distract myself from the real pain of separation by focusing on food. But as anorexia takes hold of the person, he or she can no longer stop the behaviors, even as they destroy lives. The evidence is both psychological and, in brain studies of recovered women with anorexia, biological.”

  4. Trisha -- I'm still confused. It sounds like you're saying that dieting is a misguided attempt to impose control. But a true eating disorder, such as anorexia nervosa, is different from dieting. No? Also, on your website you say that the "mix of factors" causing eating disorders includes "family upbringing." How does family upbringing cause the neurobiological changes you describe in your article? Also, you say in the Myths & Realities page on your website that your sources include "research from treatment centers such as Remuda Ranch and the Renfrew Center." Can you give us citations to that research? Thanks so much.

  5. Is this "addiction to deprivation" why my daughter only wears old clothes and doesn't buy herself anything new? Is it why she is an INCREDIBLE ARTIST, but it was years before she felt it was 'okay' to enter her artwork in competitions (which she has won major recognition for her work)? Is it why she has great trouble giving and receiving gifts and has since she was quite young? Is it why she saves, saves, saves money, but rarely spends it on herself? Is it why she picks up trash everywhere she goes and feels compelled to recycle it? Is it why she often sleeps without a blanket or goes in the cold without wearing a coat? Should my list go on?

    I have always felt anorexia was more than just "not eating".

  6. I think parents are far better off looking at Walter Kaye's information on the neurobiology of eating disorders on the UCSD website. I'd recommend they read THAT first and look into lots of the other good information available for parents before they get around to Gura's website which mixes science with lots of sloppy thinking and pseudoscience.

    --a different anonymous

  7. Anon 1,

    Yes. Yes. Yes. and so on. Those ascetic traits are absolutely part of the personality traits found in anorexia. Does it predispose, or is it caused by the anorexia, or are both just caused by the some other factor? I don't think we know yet. But we do know that FULL recovery - nutritional and behavioral, helps these traits abate - and allows the patient to cope with and grow away from them.

    Anon 2,
    I should make clear that I'm pointing people to the article in SciAm. I have been quite open with Gura about my different take on the issues of control and parenting - my position on them is pretty well known. But the article is a pretty big step in ED media coverage. Rarely is there a piece that brings together the state of the science on this issue.

  8. Hi Laura,
    I am not impressed with Gura or her research. What I've seen of her research seems sloppy to me as well. And her take on anorexia seems unconvincing and unappealing to me. If parents want science I would stick to Kaye, Le Grange, and Bulik's work, much of which is accessible and easy to understand. I fear parents who read this first, as you recommend, will come away feeling very conflicted and confused.

    Sorry--but I had to put in my 2 cents. :-)


  9. I hardly think Gura's article is "sloppy", it is well written, documented and quite clear. So ONLY the work done by Kaye, LeGrange, et al can be read and given credit? PlEASEEEE!

    Sometimes it seems like there is such a divisive character to some who claim to be "advocates" or "journalists" and maybe write one or two articles a year that don't get the notoriety, or hightlight that those like Gura may receive... is that what this slamming is all aboout? Because in reading the article there is nothing that appears disorganized, careless or uniformative.

    If Gura's work was "sloppy" I hardly think she would be writiing for prominent periodicals and Gurze. For heavens sake, the woman is a PhD, she's obviously earned her due.

  10. I guess having a PhD makes you infallible, and makes your work impervious to debate.

    Gura also wrote a book about midlife anorexia. Having done quite a bit of research on that subject myself, I am not impressed with her research or conclusions on that topic, either. I suspect she is "finding" research that supports her hypothesis, rather than searching out research and *then* drawing conclusions.

    I don't want to hijack Laura's blog with my opinions. Everyone is entitled to her own thoughts on the matter. I just wanted to point out that not everyone agrees with this assessment of Gura and her work, and that there are other resources out there.

  11. Hi from Anon 1 again,

    I think we need to think of eating disorders like so many other spectrum disorders along a continuum of behaviors and severity and even multiple causes. Personally, from my own experience twice over, I can more easily link Gura's article to my daughter's experience than my sister's. I definitely feel that depriving herself soothed my daughter's guilt complex and anxious personality style. It extended into so many aspects of her life and, sadly, still does to some degree.

  12. I'm the original anon and would just like to say that I think it's important to separate Gura's article in Scientific American, which is a pretty good summary of some of the neurobiological research, from her website and book on midlife eating disorders, which don't meet the same scientific standards and unfortunately perpetuate a lot of myths. In other words, the article in Scientific American should be judged on its own merit, apart from other work by the author. Having said that, I'd like to hear Trisha's response to my questions (above) if she's still on the line. I'm especially interested in her citation to "research" by Renfrew and Remuda. To me, "research" by those corprations is about as reliable as research by the tobacco companies on the health effects of cigarettes. Both the R's have a financial motive to brainwash the public into believing that anorexia is caused by families; that's how they convince parents that they should send their adolescents away for residential "treatment."

  13. From Trisha Gura:

    Wow, what a thread.

    Let me see If I can respond in a short comment to your questions.

    "Is dieting is a misguided attempt to impose control?"

    It can start that way.

    "A true eating disorder, such as anorexia nervosa, is different from dieting. No?

    Absolutely. Otherwise the incidence of eating disorders would be 100-fold higher.

    "How does family upbringing cause the neurobiological changes you describe in your article?

    It does not, as far as we know. But a child with a certain predisposition lives in the context of his or her family. In cases where incest by a family member is involved, the trauma can help awaken the latent eating disorder. Also, the way that experts have put it to me, families don't cause eating disorders, but therapists normally take family dynamics into account during therapy. The idea is that when a family member has an eating disorder, it significantly alters family dynamics. Therapy helps to teach family members how best to cope and help the member with an eating disorder to cope in the context of their family.

    "You say in the Myths & Realities page on your website that your sources include "research from treatment centers such as Remuda Ranch and the Renfrew Center." Can you give us citations to that research?

    They don't publish their research. Instead, I spoke to Edward Cumella, the director of education, and he sent me tables and graphs that they have gleaned from their patient records. The rest came from interviews.

    As to the book versus the article, Sci Am Mind is very good about letting me write more scientifically. It seems this blog group has a much more sophisticated grasp on eating disorders and the science. Bravo! You are a good readership for this article. Harper Collins has a very different readership. Most readers don't even understand that eating disorders are diseases let alone all the nuances you are addressing. Visitors to my web site have the same basic ignorance. My goal was to bring people into the world of eating disorders and better understand their causes and correlations. Sometimes simplification as has to be done for today's short-attention-spanned audience, can seem "sloppy" or condoning a "myth." But all is grounded in science, as best as science can tell us what is happening to those who suffer.

    For the record, my book, "Lying in Weight" addresses eating disorders not only in midlife (it's only one chapter), rather through the lifespan. The oldest woman in the book is 92, the youngest, 15. It is meant for people, physicians, and general therapists who don't specialize in eating disorders.

    Harriet, we have spoken before. In our conversation, your main beef with the book was my premise that eating disorders can be chronic illnesses. Not a sloppy premise. Just one difficult to prove prospectively, but retrospectively, there is evidence for the premise. Congrats on your book deal.

  14. Hi Trisha. Original anonymous back. A few quick thoughts:
    If it is dieting, not eating disorders, that is about "control," then I suggest modifying your website accordingly.
    Your reference to incest in the context of families causing EDs is offensive. There's no evidence that incest "can help awaken the latent eating disorder" as you say. Incest is terrible. We can all agree it needs to be condemned. But your suggestion it causes EDs is speculative and damaging because it makes it harder to convince insurance companies that EDs are real illnesses that should be covered by medical insurance, and more difficult to say to funding agencies that more money should be allocated for scientific research. It also perpetuates stigma and therefore makes sufferers and families more reluctant to step forward and get help. Please consider modifying your website to delete the reference to "family upbringing" as a "cause" of EDs.
    Many therapists do have a goal, as you say, of helping families "cope" with the ED. The better therapists, however, have a goal of utilizing the strength and resources of the family to help the sufferer overcome the ED. There's a huge difference between coping with the illness and recovering from it.
    Can you publish the data you received from Mr. Cumella? Has there been any peer review or other check on its quality? And why rely on unpublished, unscientific oral interviews with unnamed "experts" when dealing with such serious illnesses? Would you feel comfortable posting on a website similar unscientific information about other illnesses, such as cancer? Finally, please don't justify publishing erroneous information about eating disorders on the grounds that your readers are not sophisticated enough to understand the truth. It comes across as condescension.


Post a Comment

Popular Posts