Perceptions of mental health: how helpful are biological models of eating disorders?

Anorexia nervosa is an extremely debilitating eating disorder, and has the highest mortality of any psychiatric disorder. Shockingly, a review of the Prevalence and Incidence of Eating Disorders estimated that only one third of patients suffering from anorexia nervosa, and about 6% from bulimia nervosa, receive adequate mental health care. Here, Jenny [Leng, EDIT Lab placement student] explores the contributions that biological models have made to address the stigma associated with eating disorders.

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I recently attended a seminar at the IoPPN, where they were discussing the use of deep brain stimulation for the treatment of the anorexia nervosa. This is an admittedly extreme but validated neurosurgical technique designed to target specific brain areas believed to be involved in eating disorders. As the debate progressed, a lady in the audience asked the question I feel most lay people were thinking: “why are we talking about biology – do eating disorders not develop from the media?”

The response from someone who had suffered from anorexia was simple: “it helped me understand my problem was real. I wasn’t mad.”

The assumption that biological models can be helpful rests on this exact idea that it moves the blame away from the patient and their families. Simply knowing the root cause of an illness is half the battle in knowing how to tackle it and seek the appropriate treatment. Having an organic bio-genetic cause effectively discourages the assumption that somehow the patient is to blame for their development of an eating disorder.

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But how appropriate is this medical model?

The medical model of mental health seeks to view mental illness in the same way as a broken arm, i.e. with a physical, organic cause. Whilst there is no single blood test for eating disorder as there is for diabetes, at least not yet, advancements in genetic testing have improved the classification of mental disorders, and research has made massive progress in identifying the specific genetic basis for an array of psychiatric disorders.  I am currently working in collaboration with the EDIT lab at the BRC BioResource, collaborating with the Charlotte’s Helix charity and AN25K initiative, to collect 25 thousand genetic samples from anorexia nervosa sufferers worldwide. Whilst traditionally viewed as sociocultural, there does seem to be a substantial genetic influence, and while these results are in their infancy, they are certainly promising in changing the very way we view these disorders.

“…research has made massive progress in identifying the specific genetic basis for an array of psychiatric disorders…”

Ignoring the contributions of biological models, and continuing to think of eating disorders as somehow being an active choice, only highlights the various misconceptions which surround the disinhibiting condition. These misconceptions (such as the ones listed below) can prevent many from seeking treatment, or from understanding the suffering of their friends or families.

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Key misconceptions

  • People somehow did this to themselves. People do not get to ‘choose’ whether or not they want to suffer with an eating disorder that day, and saying “they just need to eat more” is doing nothing to help the patient with their anxiety or weight.
  • “They are just being attention seeking.” Though eating disorders are often blamed on social pressures, the pathological obsession with weight is often much more complex than “gaining attention.” In fact bulimia, despite being the most prevalent eating disorder, is extremely difficult to spot amongst friends, as the pattern of bingeing and purging make weight levels fairly stable, despite highly erratic eating behaviours.
  • “It’s just a phase.” Full recover from an eating disorder is not a matter of weeks or even months. Anorexia takes an average of five or six years from diagnosis to recovery, and up to 30% do not recover

So are eating disorders purely genetic?

Of course it would be extremely reductionist to assume the environment is in no way involved. Society is hugely influential, and in fact a purely biological explanation risks increasing deterministic thinking, making sufferers feel more pessimistic about their outcome.

 “…a purely biological explanation risks increasing deterministic thinking…”

One issue with psychiatric disorders is black and white thinking about genes and environments alone, when they are multifaceted constructs. Instead, the interplay of both bio and social must be incorporated into how a disorder, such as anorexia, is developed, maintained, and ultimately treated.

So what is the answer?

Genes do not work in isolation. A study which I believe encapsulates this interplay effect quite nicely is about interaction between genetics and environment in the aetiology of major depression. A study published in 2015 investigated the gene SERT, which regulates the amount of serotonin in the brain: the so-called “happy chemical.” However, it wasn’t the case of simply not producing enough serotonin. It was the specific interaction of a particular variation of this gene and severe childhood abuse which successfully predicted depressive symptoms.

Interplay between biological and environmental factors is fundamentally important in shaping our risk of developing psychiatric disorders like anorexia nervosa.  This also stands for anxiety, depression, schizophrenia and other disorders. Something as complex as eating disorders will never come down to a single gene. Research aiming to identify the appropriate biological basis, develop drugs which alleviate symptoms and provide targeted psychological help, whilst combating some of the stigmas and misconceptions surrounding this fatal disease,  is work worth doing.

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