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- Eating Disorders: consistency in phenomenology.
- Early descriptions
- Keys Minnesota Starvation Experiment
- Homogeneity in presentation suggests common diathesis
- Differences between AN and BN indicate similar underlying involvement
- What are emotions and why do we have them?
- Cues for readiness for action
- Necessary for survival
- Need to recognize threats
- Need to remember threats
- Need to respond to threats
III. Fear and Eating Disorders
- Overlap with Anxiety Disorders
- Anxiety often precedes ED and remains
- Abnormality in fear based learning (M. Strober)
IV. Neurobiological basis of fear.
- Fear conditioning mediated by
- dorsolateral prefrontal cortex
- ventromedial prefrontal cortex
- hippocampus
- Sensitization of fear circuits
- Extreme sensitivity -> impaired ability to modulate emotional response -> experience emotions as subjectively aversive -> attempts to control or suppress
- When fear mechanisms are activated in limbic system/amygdala, decreased activation in prefrontal cortex.
- Insula and Orbitofrontal Cortex (W. Kaye)
- Impairment in processing interoceptive information
- Sensory integration, decision making, planning behavior
- Neurocognitive Deficits stemming from dysfunction in the prefrontal cortex
- How do we incorporate into treatment?
- Fear Based treatment of ED
- Psychoeducation about starvation and nutrition
- Psychoeducation about anxiety
- Emotion recognition
- Exposure and response prevention
- Deep Breathing
- Anti-fear response
- Broader Somatic Focus
- Increase interoceptive awareness
- Becomes Daily Mindfulness exercise
While there is tremendous variability in presentation from person to person, there is also a remarkable degree of consistency in the psychological dimensions and domains of behaviors that suggest a common underlying diathesis in Anorexia and Bulimia. The phenomenology of eating disorders has been well elaborated, but there is a growing body of evidence elucidating the intricate interaction of our brain’s fear circuitry and higher cognitive processes with important implications for our understanding of the neurobiology of eating disorders. We will attempt to outline some of this neurobiologic evidence and the implications of their accompanying patterns of neurocognitive and behavioral consequences on treatment.
Using our current understanding of the neurobiological mechanism underlying the persistence of symptoms across the eating disorder continuum, we explore how providers of treatment can directly address fear-based treatment resistance in order to make possible the requisite, substantive changes in emotional reactions, thoughts, and behaviors. We present a rationale for an approach addressing this obstacle of fear in treatment, an approach that starts with the interrelationship of medical and nutritional treatment goals and the internal, somatic experience of emotions and distress. And we outline a treatment protocol that reflects how to use this understanding to begin to break anxiety- and fear-based responses in eating disorders; a protocol that starts with deep breathing.
Norman Kim completed his B.A. at Yale University where he received the Mellon Fellowship for Research in Psychiatry. He completed his Ph.D. in Clinical Psychology at UCLA, where he received an individual National Research Service Award from the NIH. He has been involved in large scale, multi-site investigations into autism, adolescent risk behaviors and the longitudinal course of childhood bipolar illness. After training in the UCLA Inpatient Eating Disorders Program, he has been developing an expertise in the assessment and treatment of psychiatrically complex populations, specializing in eating disorders. He is the Clinical Director of Reasons Eating Disorders Center.
