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February 26, 2014

A Review of Eating Disorders and the Brain

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014. Contributions by Sarah Emerman.

One of the most exciting books to recently be published on eating disorders is the book Eating Disorders and the Brain by Drs Bryan Lask and Ian Frampton. A review of the book was recently published by Dr. Joel Yager, a prominent psychiatrist in the eating disorder field. Dr. Yager describes 2 parts of the book which I thought to be extraordinarily important. The first is an early chapter in the book by David Wood on why clinicians should love and appreciate neuroscience. This discussion, which focuses on free will, determinism, how the presentation of an eating disorder makes one think about philosophical, clinical, and medical issues is critically important. This chapter also discusses past assumptions and questions around the origins of eating disorders including genes, attachment theory, cultural theories, social adversity, family issues, maturation, issues of neural networks, and how all of these issues can be seen not as etiologic factors but as factors that must be considered while treating these complex disorders. By moving beyond etiology into understanding complexity, he makes a tremendous contribution to the conceptualization of these illnesses.

The other critical contribution of this book is to take the science of eating disorder development and maintenance to this point and introduce the multiple conceptual models that neuroscience offers us. As described by Yager, these include a neurodevelopmental model, a model that translates neuroscience into clinical practice, a habitual learning cognitive model, a model focusing on the insula, frontal striatal circuit models focusing on neural circuits, and neurotransmitters, and multifaceted integrated neuroscience models. By making it clear that many models have been proposed and that the neurobiology and neuroanatomy of eating disorders is no longer quite the mystery it once was, Drs Lask and Frampton lead us to their integrative model of the origin and maintenance of anorexia. Their book seeks to understand how dysfunction in the insula is related to all of these neurobiological models as well as to the clinical presentation of the illness itself.

We have learned so much about the brain in the last 20 years it is difficult to keep up with all that is happening. New treatments for eating disorders continue to emerge which challenge the patient, family, and clinician to acknowledge the crisis and complicating factors of an eating disorder in order to get the patient into effective treatment. It’s important that clinicians know when to refer, when to treat, and how to know if what they are doing is working. Science is complex and tricky. I usually have to read chapters in this book, and others like it, many times to fully grasp the intricacies and implications of the information. While challenging, is also exciting to think, and sometimes to even know, that for those with eating disorders, life can truly be better. For those who look towards science, this is a book well worth reading. For everyone in the field of eating disorders, this work gives us great hope for the effectiveness of future treatments.


Mark Warren, MD

Dr. Mark Warren is the Chief Medical Officer for The Emily Program and Veritas Collaborative. He is also one of the original founders of the Cleveland Center for Eating Disorders, which became The Emily Program – Cleveland in 2014. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System’s Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, a two-time recipient of the Exemplary Psychiatrist Award of the National Alliance for the Mentally Ill, and a winner of the Woodruff Award. He leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.


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