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Eating Disorders and the Brain

ISBN: 978-0-470-67003-3
254 pages
September 2011
Eating Disorders and the Brain (0470670037) cover image
Why is the brain important in eating disorders? This ground-breaking new book describes how increasingly sophisticated neuroscientific approaches are revealing much about the role of the brain in eating disorders.  Even more importantly, it discusses how underlying brain abnormalities and dysfunction may contribute to the development and help in the treatment of these serious disorders.
  • Neuropsychological studies show impairments in specific cognitive functions, especially executive and visuo-spatial skills.
  • Neuroimaging studies show structural and functional abnormalities, including cortical atrophy and neural circuit abnormalities, the latter appearing to be playing a major part in the development of anorexia nervosa.
  • Neurochemistry studies show dysregulation within neurotransmitter systems, with effects upon the modulation of feeding, mood, anxiety, neuroendocrine control, metabolic rate, sympathetic tone and temperature.

The first chapter, by an eating disorders clinician, explains the importance of a neuroscience perspective for clinicians. This is followed by an overview of the common eating disorders, then chapters on what we know of them from studies of neuroimaging, neuropsychology and neurochemistry. The mysterious phenomenon of body image disturbance is then described and explained from a neuroscience perspective. The next two chapters focus on neuroscience models of eating disorders, the first offering an overview and the second a new and comprehensive explanatory model of anorexia nervosa. The following two chapters offer a clinical perspective, with attention on the implications of a neuroscience perspective for patients and their families, the second providing details of clinical applications of neuroscience understanding. The final chapter looks to the future.

This book succinctly reviews current knowledge about all these aspects of eating disorder neuroscience and explores the implications for treatment.  It will be of great interest to all clinicians (psychiatrists, psychologists, nurses, dieticians, paediatricians, physicians, physiotherapists) working in eating disorders, as well as to neuroscience researchers.

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Preface xi

List of contributors xiii

Acknowledgements xv

1 Why clinicians should love neuroscience: the clinical relevance of contemporary knowledge 1
David Wood

1.1 Introduction 1

1.2 The legacy of mind–body dualism 2

1.3 Free will and determinism 3

1.4 Clinical implications 3

1.5 Restriction of energy intake and increase in energy output 4

1.6 Non-eating-related concerns 5

1.7 In-the-beginning questions: the problem of aetiology in eating disorders 6

1.8 The temporal, ‘vertical’ aetiological dimension 7

1.9 The spatial, ‘horizontal’ aetiological dimension 11

1.10 The importance of a neuroscientific aetiological framework 13

1.11 Conclusion 15

References 16

2 Eating disorders: an overview 19
Beth Watkins

2.1 Introduction 19

2.2 Clinical descriptions 20

2.3 Comorbidity 24

2.4 Epidemiology 25

2.5 Aetiology and risk factors 27

2.6 Treatment 35

2.7 Course and outcome 40

2.8 Conclusion 41

References 41

3 Neuroimaging 56
Tone Seim Fuglset and Ian Frampton

3.1 Introduction 56

3.2 Structural imaging 56

3.3 Functional imaging 90

3.4 Conclusion 101

References 101

4 Neuropsychology 106
Joanna E. Steinglass and Deborah R. Glasofer

4.1 Introduction 106

4.2 Intellectual functioning 107

4.3 Attention 108

4.4 Memory 110

4.5 Visuospatial processing 111

4.6 Executive functioning 113

4.7 Conclusion 116

References 117

5 Neurochemistry: the fabric of life and the fabric of eating disorders 122
Kenneth Nunn

5.1 Introduction 122

5.2 Five aims 122

5.3 Five propositions relating neurochemistry to the field of eating disorders 123

5.4 Five implications of these propositions 127

5.5 Five directions for future research 127

5.6 Conclusion 127

Acknowledgement 128

References 128

6 Body-image disturbance 129
Maria Øver°as

6.1 Introduction 129

6.2 What is body image? 130

6.3 How is body image constructed in the brain? 130

6.4 Body-image disturbance in eating disorders 133

6.5 The neuroscience of body-image distortion in anorexia nervosa 134

6.6 Conclusion 138

References 139

7 Conceptual models 142
Mark Rose and Ian Frampton

7.1 Introduction 142

7.2 Conceptual models in anorexia nervosa 143

7.3 Conclusion 161

References 163

8 Towards a comprehensive, causal and explanatory neuroscience model of anorexia nervosa 164
Kenneth Nunn, Bryan Lask and Ian Frampton

8.1 Introduction 164

8.2 The model 164

8.3 Critical appraisal 173

8.4 Clinical implications 175

8.5 Conclusion 177

Acknowledgements 177

References 177

9 Neurobiological models: implications for patients and families 180
Ilina Singh and Alina Wengaard

9.1 Introduction 180

9.2 The emergence of neurobiological models 180

9.3 Anorexia nervosa and illness representations 181

9.4 Impact of a neurobiological model on families’ understandings of anorexia nervosa 183

9.5 Conclusion 188

References 189

10 Implications for treatment 191
Camilla Lindvall and Bryan Lask

10.1 Introduction 191

10.2 Psychopharmacology 192

10.3 The educational context 193

10.4 Psychological treatment 194

10.5 Conclusion 205

References 205

11 Future directions 207
Ian Frampton and Bryan Lask

11.1 Introduction 207

11.2 Cause 207

11.3 Assessment and diagnosis 208

11.4 Treatment 210

11.5 Prevention 211

11.6 Future directions 212

11.7 Conclusion 215

References 216

Index 219

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Bryan Lask FRCPsych, FAED, M.Phil, MB,. BS
Hon Consultant and Emeritus Professor of Child and Adolescent Psychiatry, Great Ormond Street Hospital for Children, London, UK; Research Director, Ellern Mede Service for Eating Disorders, London, UK; Visiting Professor, Oslo University Hospital, Norway

Ian Frampton BA(Hons) D.Clin.Psych. Dip.Clin.Neuropsych. C Psychol.
Hon Consultant Psychologist, Great Ormond Street Hospital for Children, London, UK; Visiting Research Consultant, Regional Eating Disorders Service, Oslo University Hospital, Norway

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"Congratulation on excellent book: informative, readable, broad in its coverage, and very useful to those of us who are not neuroscientists.I particularly appreciated the several concluding chapters that articulated and evaluated the nature, strengths, and shortcomings of models."
(Dr Michael Levine, Emeritus Professor of Psychology, Kenyon College, Gambier, USA, November 2102)


“This is a very good contribution to the psychiatric literature that will help clinicians, researchers, and neuroscientists in general to understand eating disorders from a biopsychosocial perspective. It gives a very explicit definition of eating disorders as well as treatment options and future overviews.”  (Doody's, 25 May 2012)

"Well written and well edited, nicely balanced between academic reviews and integrative theoretical syntheses, the readable chapters will inform readers who lack deep knowledge about biological aspects of eating disorders as well as those who are better informed. Chapters are scholarly without being stuffy, and contributors summarize pertinent studies in structural and functional neuroimaging, neuropsychology, and the neuroscience of body image.

For serious eating disorders clinicians as well as academicians, there’s much in this book to study and ponder." - EATING DISORDERS REVIEW

“There has been an important paradigm shift in thinking about eating disorders in that the brain is receiving  more  attention.  The Academy of Eating Disorders has published a position paper placing the brain more centrally within these highly complex multifaceted disorders.  This book is an important addition to the literature: the authors are all expert communicators and are able to make the topic simple, enjoyable  and easy to understand.”  - Janet Treasure, Professor of Psychiatry, Guy’s, King’s & St Thomas’ Medical School, London, UK

“There has been an important paradigm shift in thinking about eating disorders in that the brain is receiving  more  attention.  The Academy of Eating Disorders has published a position paper placing the brain more centrally within these highly complex multifaceted disorders.  This book is an important addition to the literature: the authors are all expert communicators and are able to make the topic simple, enjoyable  and easy to understand.”  - Janet Treasure, Professor of Psychiatry, Guy’s, King’s & St Thomas’ Medical School, London, UK

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