brain of anorexia sufferers distorts body image

Bryan Lask and colleagues have a theory that would help explain why people with anorexia share certain personality traits, body image distortion, difficulty nourishing themselves, and thinking patterns. He hopes the NORA Hypothesis will generate research questions and data.

I find the hypothesis compelling, myself, with my limited understanding of the neurobiology. Most important is the necessity of bringing together all the information we know about the disorder and look at it as a whole, rather than focusing on one aspect at a time or even from the perspective of one discipline at a time.

As a matter of fact, it strikes me that thinking about eating disorders has suffered from many of the same cognitive deficits in this theory: black and white thinking, difficulty changing thought patterns, insensitivity to pain, anxiety management, multi-tasking, and ability to block out negative thoughts! 

Professor claims blood flow in brains of anorexia sufferers distorts body image even as they get better 


  1. Dr Lask’s hypothesis takes the onus of blame away from the parents who are often blamed for causing anorexia by the way they feed or look at their children - well yes, it does, although it doesn't have to be proved correct surely to take the blame away. The blame can be wrong, unhelpful and dealt with whether this hypothesis is proved in the end or not.

  2. I really like Bryan Lask and I think the research he and his colleagues are doing is very interesting. But does it explain my history of AN? No, it doesn't.

    For a start off, I didn't have distorted body image while severely underweight with AN, nor as I gained weight. I did (and do) have a number of the personality traits he describes. But these personality traits are also seen within my father and brother, neither of whom had AN.

    Nevertheless, it is an intriguing theory and I look forward to seeing the data from future studies that build upon the NORA hypothesis.

    Oh, and I also agree with Marcella, above - in that blame is somewhat futile, whatever the cause of AN.

  3. See also this:

    Must admit that the talk by Marylin Lawrence sounded like hypothetical bollox.

  4. In addition to distorted body image, Lask finds that “'weight-recovered' patients still had difficulties with visual and spatial memory, screening out intrusive or negative thoughts and multi-tasking." I think this is important work for developing a better understanding of anorexia that doesn't blame parents, and also doesn't blame the sufferer for not being able to eat or having problems concentrating. Thanks for sharing.

  5. A lot of this fits my daughter...then (10 years ago) and even now, except for the visual and spatial memory difficulties. I don't think she has ever had that. If they are going to the idea of working with the processes of thinking, rather than working with negative thoughts, this sounds more like executive function and theory of mind stuff and less like CBT. My daughter still has body image concerns 10 years post-AN and fully weight restored. Maybe this explains it. How does one "expand the insula"? I'd be interested to know!


  6. I think it would be interesting to determine what definition of recovery was used in this study (i.e. physical, behavioural and psychological requirements) -- these matter because they likely have different underlying neurobiological mechanisms. . .

    In addition, I think this theory might be a bit overly simplistic. Certainly, there has been extensive research on the insula and AN -- but I also don't think we can rule out differences in receptor densities and neurotransmitter levels (I am thinking of Dr. Kaye's serotonin/dopamine hypothesis), appetite regulation and activation of the HPA axis -- AN patients are also shown to have hyperactivity of the HPA axis (perhaps due to lack of negative feedback at the hypothalamus/pituitary) and this activation has been known to have appetite suppressive functions. . .

    In addition, although genetic studies have been inconclusive, there have been some replicatable studies related to the serotonin transporter (SERT), other genes that regulate serotonin neurotransmission and some polymorphisms in genes that regulate appetetite

    I would be concerned that this could simply be an effect of starvation -- and perhaps the fact that this was observed in recovered patients means that it is a "scar" trait or that the study did not allow for adequate recovery time or have an adequate definition of recovery. . .

    In addition, to attribute reduced blood flow to pathophysiology of AN sounds sketchy to me -- Surely this would be expected given weight loss, brain shrinkage/general physiological effects on the body. . .


  7. My daughter has been weight restored for a solid three years, and her body dysmorphia still remains. Even though there are times she feels more confident than others, she is still 'seeing' a distorted image of herself. I cannot say her memory has been affected with the exception of the memory of the worst of her behavior during recovery, for which I am grateful she does not recall.

    She continues to struggle with screening out intrusive thoughts, and her younger sister does as well (who does not have an eating disorder.) I have attribute the 'OCD' behavior to anxiety as the primary cause and in fact the primary leader of the ED itself.

    The fact that my younger daughter exhibits the same type of behavior that my daughter (recovering AN) did before she was ill, and that some of the particular anxiety/OCD behavior exhisted before AN daughter was ill proves to me that the underlying anxiety is a physical, hereditary trait and I really like this theory...

    I will anxiously wait for further findings... (no pun intended - lol)

  8. I think the reporting of the study is awful and his research. I've looked him up on PubMed, nothing note-worthy with regard to what was reported, but perhaps it is going to be out soon. I mean, the studies were WAY underpowered, 9 people in one that is likely the one being reported on. No proper control groups, only 7 people showed a difference. The difference was just in unilateral blood perfusion on the insular cortex. So what? There's no control with the non-ED population. They just looked at 9 girls and that group of girls 4 years later, weight-restored. A difference in blood flow, in 7 of them, doesn't mean anything that the writer of the post says it does. It can, but, nothing in his research thus far, supports that. fMRI measure blood flow, people forget that, I think.. they want some grand explanation. fMRI studies are also fraught with bad statistics and bad data in general (see Daniel Bohr's post and the discussion that follows, especially replies by prominent scientists like Nancy Kanwisher).

    It is just the same as the "gene for [insert complex personality trait]". Genes code for proteins! Boring things like subunits of receptors, or cell-cycle genes, or structural building blocks of cells. Not eating disorders, sexuality and whatever else the media reports.

  9. Great comments, all. Lask calls it a hypothesis and he's started the process of putting it out there for people to test and disprove, as science is supposed to do.

    Few researchers interested in EDs have funding for the size we need - even the DNA folks are stuck because they have the samples but not the money to analyze them!

    These preliminary studies, and hypothesis building, are the first step. They also exist in a field where there are so many hypotheses but little data - that are being used in practice!


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