In the last few weeks I have been thinking about the way Anorexia affects some girl very severely. In our clinic most will recover after one year but a handful develop a chronic course with more preoccupation with anorexic thinking, voice hearing and a more depressive experience. 

Imagine a teenage girls or young woman in a starvation state of a dangerously low weight..Then imagine their brain- the physical appearance, the loss of brain cells and the impaired function of the left and right hemispheres. The brain needs to consume at least 500 calories and brain cells are very sensitive and need adequate levels of oxygen and glucose. . Therefore if the brain does not receive enough fuel and oxygen then cells will suffer changes that in turn could account for

1. Enduring change in nerve cell structure, function and connectivity

2. Impaired connectivity between brain regions within and between each hemisphere

3. Reduced right to left signalling in the brain

4. The right hemisphere  functions may be more impaired than the left. 

On the last point if the right side of the brain is off line and less able to carry out its inhibitory role on the left hemisphere then there would be a tendency for the left hemisphere regions to go into autopilot and generate recurrent thinking and voice hearing and the scripts behind anorexic behaviour and suicidal behaviour.

We have noticed that  some young women/girls in recovery from anorexia are then greatly troubled by fear, anxiety, voice hearing and depression with suicidal thinking. In this sense the eating eating disorder creates a dilemma for the young person in recovery because they can be let thinking that they cannot recover weight because the voice will scream at them or they will die by suicide. If the young person then pursues weight loss then they may be thinking that a lower weight state is an escape from the voice and the prospect of suicide. However the low weight state can be fatal. This is one way in which young people are deceived by Anorexia. There is always another way and when they have restored weight then there is the opportunity to find a way to recovery into better family life and relationships with friend and re-connection with life, education and the world, with departure from anorexia and depression.

The attached article is one of the many article that gives us some sense of more precisely anorexia affects the structure of the brain, which in turn will affect the functional and connectivity of neurones.

Recently there have been papers looking at the role of gut bacteria in the neurobiological changes in anorexia, which can also apply to depression. This will be considered in another blog. For now the linked below is to a current research trial on the subject. 

https://doi.org/10.1002/erv.2876