psychotherapy (and experience) change the brain

Many people think that if they accept the term "brain disorder" for eating disorders then they are saying that eating disorders are just built in, can't be changed, and would only respond to drug treatments. This is a common misunderstanding and leads to what strikes me as unnecessary static in the conversation.

Calling anorexia, binge eating disorder, and bulimia "brain disorder" simply identifies the organ of the body affected. It implies that the problem is with the brain and not the environment, which is an important orientation, but that would be like saying that diabetes is not affected by behaviors and does not affect behaviors just because the pancreas is affected. Of course brain disorders are influenced by and influence the environment!

Therapy is one of the ways environment affects the brain. Therapy is a really important element of treatment that most patients need or benefit from - but not ANY therapy. Just as you can't thrown any drug you want at an illness, at any dose, psychotherapy has risks and benefits and needs individualization. Some therapy, in the wrong doses at the wrong times, can be actively harmful.

I recommend this really good piece in Psychiatric Times

How Psychotherapy Changes the Brain

Understanding the Mechanisms

By Hasse Karlsson, MA, MD, PhD | August 11, 2011


  1. I like your analysis of this Laura, because as you know, I have reservations about describing various mental illnesses as 'brain disorders', for ethical/moral issues, as well as accuracy and application of the scientific knowledge in this field.

    It would seem quite clear, from available evidence, that in established EDs neural circuits within the brain are disrupted (e.g.) by malnutrition and by feedback of various hormones and the levels of certain precursors for neurotransmitter synthesis that are influenced by diet etc. [Note that I am greatly over-simplifying potential mechanisms in this short comment...]. But at present it is merely hypothetical that there is some inherent susceptibility to EDs other than via temperament and character traits. It is known that the brain is involved, but it is uncertain precisely how it is involved.

    I have recovered (or perhaps I should say 'achieved a state of remission') from longstanding restricting AN without the use of medication whatsoever. My treatment involved re-feeding and a lot of therapy/counselling. I refused to take psychoactive/psychotropic medication on account of having experienced severe side-effects from such medications many years earlier, as well as the fact that such medication didn't help my ED whatsoever. Therefore, I am very much in favour of individualised therapies in conjunction with re-feeding in AN to promote recovery.

    My concerns in relation to viewing mental health issues as 'brain disorders' relate especially to the over-use of medication and the under-use of talking therapies that assist behaviour change. There is not such a thing as 'normal' brain behaviour, and people vary widely in terms of their temperament and character traits. There is certainly no strong evidence that EDs are commonly caused by a primary brain disorder.

  2. Off topic, but I think that this woman's site does much much much more harm than good: . Wish she knew the truth behind EDs, and didn't add to the misinformation.

  3. As an eating-disordered person who views anorexia and bulimia as something to which we're predisposed, rather than something we're bullied into by the media, I don't believe in the popular definition of recovery. While I hope to achieve symptom management someday, I don't believe I will ever "recover" in terms of losing the mentality and the compulsions.

    Though I believe my perspective is valid, it does tend to lead me to adopt a "hopeless" attitude. Fearing that my mind can't change leads me to cling to my behaviors, as they're the only thing that can calm me down when the ED compulsions are there. But reading this post and article have certainly made me think, and slightly revise my attitude.

    Thank you for your wonderful blog!

  4. Catherine,

    I find hope in the knowledge that the brain is affected and can be re-directed and healed. There ARE other things that can calm you, and one of them is symptom management. You CAN recover and lose the compulsions: YOU CAN.


Post a Comment

Popular Posts