Anorexia Can Actually Change Brain Structure

The brains of people with anorexia nervosa can alter in shape and size, but can again change when the patient is in recovery, new research suggests.

A new major study has analyzed brain scans from people with anorexia around the world. Researchers found that people with anorexia are more likely to show noticeable reductions in three key measures of the brain.

These three measures are cortical surface area, cortical thickness, and subcortical volumes—this suggests that there’s either a loss of brain cells or a loss of the connections between cells.

Why Anorexia Changes Brain Structure

Brain structure can also change in people with other conditions, like depression, ADHD, OCD, and stress. However, the reductions noted in people with anorexia are between two and four times larger than the reductions in people with other conditions.

Though there’s no conclusive evidence yet, it’s thought that the decrease in brain size may be due to reductions in body mass index (BMI) of people with the condition.

As a result, researchers have said that getting early treatment for anorexia is important in order to avoid long-term changes in brain structure. There’s evidence that, with early treatment, brain structure can change for the better.

"Early intervention for anorexia is key to the safest and fastest recovery," says Christian Buckland, PsychD, psychotherapist and counselor.

"An accurate assessment looking at both the medical and psychological aspects of the illness is important to ensure that the appropriate medical investigations are conducted, as an eating disorder can significantly negatively impact the daily functioning of the body," he says.

He describes a typical assessment as including blood tests and an electrocardiogram, as well as referrals to an eating disorder dietician and an eating disorder psychologist or psychotherapist.

"The aim is to better understand the underlying psychological reasons behind the weight loss and to help identify more appropriate coping strategies to replace aspects such as food restriction, excessive exercise, or laxative use," he explains.

There are a variety of treatments for anorexia, from forms of psychotherapy to hospitalization in more serious cases, while some patients may also be prescribed antidepressants.

However, therapy is probably the most common early treatment, be it cognitive behavioral therapy, group therapy, or family-based treatment for younger patients.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), a U.S.-based non-profit organization, 9% of the U.S. population or almost 30 million people will have an eating disorder in their lifetime, with 10,200 deaths each year resulting from an eating disorder. 

What Does the Research Suggest?

In a press release, lead researcher Esther Walton, PhD, of the Department of Psychology at the University of Bath said, "Being able to combine thousands of brain scans from people with anorexia allowed us to study the brain changes that might characterize this disorder in much greater detail."

"We found that the large reductions in brain structure, which we observed in patients, were less noticeable in patients already on the path to recovery. This is a good sign, because it indicates that these changes might not be permanent. With the right treatment, the brain might be able to bounce back."

Another study from earlier this year looked at brain damage in women in long-term recovery from anorexia. It found that the brain can repair itself over time after recovery, with little difference noted between the women with a history of anorexia and the women with no history of anorexia.

While it’s best to prevent anorexia in the first place—Dr. Buckland points out that "there are studies highlighting that impairment in the cognitive aspects of memory can continue even after weight restoration"—the importance of early treatment cannot be understated. 

"Eating disorders can significantly impact the mind and the way we think because starvation affects how we process information," he adds. "In addition to the mind, eating disorders can also impact the brain as these conditions straddle both a psychological and physical illness, and the physical complications can directly cause damage to organs including the brain."

"Starvation can result in the body taking essential nutrients and energy from muscle groups including the heart. Prolonged starvation can also lead to neurons in the brain being broken down in order to preserve other specific aspects of the brain, which can decrease the gray matter volume," he explains.

"The gray matter of the brain plays a vital role in enabling us to function in our daily life. Therefore, it is extremely important to restore weight safely to reduce the impact starvation can have on the body."

This study might well be the largest, but it’s not the first to suggest that anorexia can noticeably affect brain structure. A study published last year found that patients showed cortical thinning—the thinning of gray matter—in areas of the brain involved with memory and imagery.

Meanwhile, another study a few months later suggested that there is a smaller volume of gray matter in the brains of patients with anorexia when compared to healthy patients.

Anorexia is a serious condition, but with early treatment, recovery is possible.

As Dr. Buckland explains, "The most effective treatment is through a multi-disciplinary team approach as mentioned above, so that the physical, psychological, and social aspects of the illness are all attended to in a caring and compassionate manner, in order for the safest recovery possible."