The Neurobiology of Recovery with Dr. Jeffrey DeSarbo
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What Is Recovery?
In the field of eating disorder treatment, it’s been difficult for anyone to come to a consensus about what “recovery” means.
So, it’s often looked at from different perspectives. Many people refer to the DSM-5 to decide what defines an eating disorder, and if someone doesn’t meet that criteria, they’re considered in a state of recovery. Insurance companies often do this. (Insert my typical rant about DSM limitations and insurance companies.) 🙄
Other people look at the physical symptoms. If someone appears to be medically stable, they’re assumed to be recovered. Or behaviorally – if someone seems to be eating all of their meals and doesn't seem to be restricting or purging, they’re assumed to be recovering or recovered. (That’s a big one.)
Short aside here. I’m not a huge fan of any of these definitions and for sure not using each definition individually. Recovery is SO MUCH more than not using symptoms and not meeting criteria for an ED. Plus lots of people never have medical complications and still have eating disorders. Read on to hear about nuance.
The neurobiological perspective, however, looks at the cognitive side of things. Questions to ask from this perspective include:
In your free time, how much time do you spend worrying about food, weight, exercise, body image, calories, etc.?
When you think about yourself, how much time do you spend thinking negative self-talk? Ex.: “I’m not deserving,” “I’m not a good person,” etc.
If someone is really struggling, they will usually say 100% of the time… and even if this person is showing physical and behavioral signs of recovery, if they’re having these thoughts much of the time, they are clearly not recovered.
These all-consuming thoughts come from a neurobiological process. The goal is to lower this percentage as much as possible… and when that happens, that’s because there’s a change taking place in their brain on a physical level.
How Eating Disorders Affect the Brain
So a neurobiological process takes place when someone is suffering from an eating disorder, and another process has to take place for someone to recover. Let’s break down EXACTLY what these processes look like (in an easy-to-understand way, promise!).
Some facts to set the stage:
Brains have gray matter, which is involved in many thinking processes.
Brains also have white matter, which basically serves as wiring that connects certain brain regions to other brain regions.
There is significant brain loss that takes place when people suffer from eating disorders. Studies have shown that adults suffering from an eating disorder will lose 4-6% of gray matter, and children will lose 7.5-8%.
Both adults and children suffering from an eating disorder can lose 3% of white matter.
To put this into perspective, the average person may have 100 billion neurons. If you lose even 5% of your brain’s volume, that’s hundreds of millions of brain cells and connections lost. Woah!
Obviously, as you lose brain matter in certain regions, problems can arise. For example, losing brain matter in the anterior cingulate cortex can cause significant problems in how one processes their own emotions and reactions to situations. Their ability to keep calm and collected is lost. Sound familiar?
However, studies show that through treatment, therapy, and food, the volume of gray and white matter begins to restore itself in almost every brain region. Yes, they can be restored!
How the Brain Responds to Treatment
Our brain cells CAN be restored through treatment. In order to achieve this, an individual has to supply all the building blocks for what their body needs to restore the cells.
These building blocks come from food. When someone begins to eat more food, the body and brain go into construction mode.
Of course, though, it takes time for the body and brain to restore itself. When someone’s in treatment and trying to eat consistently, the parts of the brain that deal with difficult emotions lag behind the body’s restoration. Someone in the stage will often feel emotional pain and distress from having to eat consistently, and this is where the treatment team is SO important in helping the person cope.
The treatment team is there in part to remind them it will be very, very hard – but that they CAN do it, and people do make it through.
(Shelf this section and share with family or friends who insist you are “recovered” when you’re eating all your meals and snacks and you feel like sh**.)
Binge Eating Disorder vs. Anorexia Nervosa
This neurobiological process will likely look a little different for someone suffering from a binge eating disorder.
There would be fewer concerns with a lack of nutrients and brain volume, and more concerns with a certain circuitry with the brain’s reward and addiction systems. Someone with binge eating disorder might have a treatment plan that works behaviorally to change that circuitry, and sometimes with medical intervention. Read more here!
Someone with anorexia nervosa might have a more difficult time with treatment. The brain is compromised from a lack of nutrients, and sometimes, this means their brain is too compromised to process the therapy they’re receiving. That doesn’t mean this person is being difficult or belligerent… It means their brain has gone through something incredibly difficult, and recovery might be more difficult (but is totally possible).
Is Full Recovery REALLY Possible?
There’s almost an ongoing debate in the eating disorder world: is full recovery (with zero obsessions) really possible, or will you always have an eating disorder that’s “in remission”?
Full recovery IS possible – for everyone. It requires effort and time as someone goes through all of their individualized treatment. But many people have done it before.
To clarify, someone can be fully recovered and still look in the mirror from time to time and not like the way an outfit looks on them. They can still have something difficult or traumatic happen and have trouble with food for a day or so as a result. That isolated event doesn’t mean they have an eating disorder, even if they had an eating disorder before that.
But once you turn off the brain circuitry that went along with the eating disorder, full recovery is possible (to the point where Dr. DeSarbo’s patients said they didn’t even REMEMBER how they used to think when they had an eating disorder).
And if common treatments aren’t working for an individual, that doesn’t mean all hope is lost. It might just mean some out-of-the-box treatments are in order.
For example, after exhausting evidence-based treatments, treatment providers might look at small study treatments, like electroconvulsive therapy (ECT) and vagal plantation.
The point? Recovery is possible for everyone.
Treatment Time
If you’re scanning this post wondering, “Okay, how long will recovery take?” then sorry… there’s not a straightforward answer.
Everyone is different, and IF everything is done correctly and it goes well, then Dr. DeSarbo says we’re probably looking at 1-2 years. It takes the brain a MINIMUM of 6 months to begin building a foundation for recovery once it has the right building blocks, and then it takes a year to get in a good stable place.
For females, the average length of an eating disorder is 7-8 years. For males, the average is 3-4 years. But that’s the average, and everyone is different. You don’t have to be the average. With the right treatment, it could be less.
Genetics play a role in treatment time as well. Every case is so individual, which is why working with a treatment team is so important.
SEED and Palliative Care
Sometimes, rarely really, with someone with SEED (Severe and Enduring Eating Disorders), the conversation may turn to palliative care – meaning, end-of-life care. These people have usually been through many treatment programs, decades of pain, and might feel like they’ve exhausted all options. The biggest question here is: Is there really nothing whatsoever to do?
One of the risky aspects of going in the direction of palliative care is that it says to the patient that they won’t get better. Now that may be exactly what the person is thinking but we have to think long and hard before we send that message ourselves. Is that actually true? Is SEED just like terminal cancer? Given what we know about neurobiology is it even a decision one can make completely?
I don’t profess to have all the answers but something in my mind says maybe not.
Changing Your Neural Networks
Just because you’ve had an eating disorder for x amount of years, it doesn’t mean you’ll have it forever. Recovery is possible, and often very difficult. But no matter how hard it’ll be, it’s always worth it in the end.
When you change your neural networks, your brain changes on a molecular level. Food provides the building blocks for these processes, and therapy designs the rooms. But your body and brain are very good at knowing how to reconstruct. For more on this, check out Dr. DeSarbo’s video series on the neurobiology of eating disorders.
Tweetable Quotes
“[After suffering from an eating disorder,] adults will lose 4-6% of their brain cells and brain connectivity… children can lose 7.5-8% of their gray matter in their brain.” – Dr. Jeffrey DeSarbo
“[After treatment,] studies show that the volume in both the gray matter and the white matter starts to restore itself in almost every brain region.” – Dr. Jeffrey DeSarbo
“It’s important to me that the treatment team makes it clear to [a patient] that yes, it’s hard. It’s going to keep being hard. That’s one thing I never do – minimize it. It’s easier to say, ‘This is going to be very difficult. You’re going to go through a lot of pain. But you can do it. People do it.’” – Dr. Jeffrey DeSarbo
“[After my patients recover], they’ll usually say, ‘I can’t even remember what I was like. I can’t really remember how I thought like that.’” – Dr. Jeffrey DeSarbo
“Recovery is possible. It’s going to be really hard for most people. But no matter how hard it’ll be, it’s always worth it in the end. I’ve never had somebody say it wasn’t worth it. When you change your neural networks, it changes your mindset on a molecular level, and that’s what recovery is.” – Dr. Jeffrey DeSarbo
Resources
Dr. Jeffrey DeSarbo’s YouTube Channel
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