EATING DISORDERS WITH THE FOCUS ON OBESITY
- Factors playing a role in obesity
- Psychological factors
The psychological attribute is a well-known factor in eating disorders. Struggling with mental health, negative thinking, poor emotional management, self-esteem, or poor body image, avoidance or suppression of emotions may result in anxiety, depression, and eating disorders, poor self-care, and little interest in regular exercise due to a lack of motivation and or low mood.
An individual may be conditioned to seek comfort in food. Children are often kept quiet and out of the way in front of the TV with a dummy or comfort food. Therefore, if the parent withholds attention the child finds consolation/compassion in food, and several kinds of food may offer tranquillity. Eating, therefore, becomes part of the addiction, reward, or pleasure network on which they learn to rely.
Our psychological state and how the body signals to us when we are hungry, saturated, or satisfied plays a significant role and that includes self-criticism, negative core beliefs, feeling depressed, isolated, or alone and are factors that play a role in binge eating.
Binge eating is part of a vicious cycle of binging and self-loathing that causes a feeling of being trapped and consequently results in feelings of shame and guilt. Negative feelings are instantly suppressed by a pleasurable sensory experience via taste.
Depending on the amount of guilt, shame, and negative feeling, one may secretly binge on vast amounts of food, even when you are not hungry, to the point of feeling uncomfortably saturated.
This may create intense cravings for sugar and a physiological drive to eat, setting one up for another binge episode. With an individual’s physiology and emotions in chaos, one may feel trapped in what feels like a constant binge eating cycle.
A binge-eating disorder may be conceptualized as an impulsive/compulsive disorder, with altered reward sensitivity and food-related attentional biases
- The role brain networks play
Bulimia Nervosa refers to difficulties in several psychopathological dimensions, including self-regulation or impulsive control, taste rewarding, and body image processing. These are considered core factors that promote the initiation and maintenance of binge eating and purging behaviours.
According to Dr Robert Thatcher Author of Handbook of Quantitative Electroencephalography and EEG Biofeedback 2013 Anipublishing Co. St. Petersburg, Florida the addiction network is also the reward network in which the positive valence of environmental stimuli and internal representations create “pleasure.” This refers to being addicted to eating.
Rewards generally present over time, but addictive behaviours such as binging (even with drugs) provide a shortcut, flooding the brain with dopamine that plays a vital role in the reward pathway in the brain. This takes place in the ventral tegmental area (VTA) in nerve cell bodies and from there it is released into the nucleus accumbens and prefrontal cortex where the execution of the binging behaviour is motivated. The brain does not have an easy way to withstand the onslaught and prefers the quick manner of enjoying the reward.
At this stage, the compulsion takes over. Even though the pleasure associated with the behaviour (binging) may have subsided, the memory of the desired effect persists. This is where the hippocampus and amygdala store the information and these memories support the creation of conditioned responses or intense cravings whenever there is a stimulus.
The networks involved in the addiction or pleasure network includes:
1.2.1 The VTA or Ventral Tegmentum Area
The VTA is located around the midbrain and contains mainly neurons that produce Dopamine that participates in addiction and is linked to reward prediction.
1.2.2 The ventral striatum or nucleus accumbens
The nucleus accumbens which is in the basal forebrain between the caudate and putamen and is part of the basal ganglia and contributes to the reward circuit of the brain whether it is food or drugs. The dopamine neurons are activated and project to the nucleus accumbens and dopamine levels are increased. External contributors such as drugs/food reach desired dopamine levels faster than via natural dopamine production.
1.2.3 Aspects of the caudate, the putamen, and core of the accumbens nucleus and amygdala, stria terminalis are involved in feelings of pleasure and happiness. The caudate-putamen is involved in habit-based learning which may drive compulsive behaviour or binging.
1.2.4 Hippocampus
Studies indicate that the hippocampus is the focal region for the formation and maintenance of long-term memories that support pleasure- as well as non-pleasure associations and underlies memory and learning.
1.2.5 Prefrontal cortex
his Review focuses on functional neuroimaging studies conducted in the past decade that have expanded our understanding of the involvement of the PFC in drug addiction. Disruption of the PFC in addiction underlies not only compulsive drug taking but also accounts for the disadvantageous behaviours that are associated with addiction and the erosion of free will.
his Review focuses on functional neuroimaging studies conducted in the past decade that have expanded our understanding of the involvement of the PFC in drug addiction. Disruption of the PFC in addiction underlies not only compulsive drug taking but also accounts for the disadvantageous behaviours that are associated with addiction and the erosion of free will.
his Review focuses on functional neuroimaging studies conducted in the past decade that have expanded our understanding of the involvement of the PFC in drug addiction. Disruption of the PFC in addiction underlies not only compulsive drug taking but also accounts for the disadvantageous behaviours that are associated with addiction and the erosion of free will.
his Review focuses on functional neuroimaging studies conducted in the past decade that have expanded our understanding of the involvement of the PFC in drug addiction. Disruption of the PFC in addiction underlies not only compulsive drug taking but also accounts for the disadvantageous behaviours that are associated with addiction and the erosion of free will.
The involvement of the PFC in any form of repetitive behaviour such as binging accounts for the loss of self-monitoring and impulse control and the erosion of free will.
1.2.6 Cingulate gyrus
The cingulate gyrus is involved in working memory and the ability to shift attention and adapt to change and to monitor flexibility of thought and reasoning, otherwise result in the stuckness of specific thought processes and pleasure habits. The cingulate gyrus is also involved in over-control of which OCD or repetitive actions and thoughts are noted as compensatory actions and forms part of the addiction or pleasure network.
1.2.7 Occipital & temporal
Individuals suffering from eating disorders experience a distortion of the body image due to a distorted functioning of the somatosensory and visuospatial networks specifically with Bulimia Nervosa in the occipito-temporal cortex. Viewing their bodies occurs in the occipital cortex and experience of their body size, which is distorted, occurs in the temporal lobes, and is emotionally based. So the processing of the self-referential information is affected by emotional information
- Therapeutical strategies:
1.3.1 Cognitive-behavioural Strategies (CBT) to calm down the uncontrolled need to eat and enhance a feeling of control and develop skills to improve managing negative emotions without food.
- Applicable psychotherapy include Psychoanalysis and Psychodynamic Therapies, Cognitive therapy, Integrative or Holistic therapy, and Schemata Therapy
- Psychotherapy is needed to disconnect early unhealthy behaviour and emotional patterns that got rewarded in order to manage stress; to develop a fine balance in the eating patterns and adopt healthy patterns and develop a new system of healthy self-management as well as a new perception of the person’s body features which has been influenced by social and cultural factors throughout the person’s life.
- Brain Working Recursive Therapy– is ground-breaking, but a natural, and a relatively new form of therapy that supports an individual to rewire one’s thoughts in terms of fears or uncomfortable feelings. Brain Working Recursive Therapy (BWRT) is a one-to-one talking therapy that gives you the tools to reprogram your emotional or habitual responses, through the power of your thought alone. The best thing is, this rewiring can be so effective that you may only need a few sessions and is not a long-term therapy.
1.3.4 Nutritional support by the Dietician and or Nutritionist may be needed in case you have a nutritional deficit or shortage
- Neurofeedback (NF)
NF is a form of treatment to address the different Brodmann areas that are associated with binge eating networks.
What is NF?
The brain is powered by electricity and produces electrical patterns or brainwaves, which determine the level of arousal of the brain. The more stable the level of arousal of the brain, the more effective is the function. NF is a non-invasive form of therapy that focuses on enhancing the stability of the brain to ensure effective processing of the brain.
In terms of eating disorders with the focus on binge eating, the over-aroused brain results in high-tension levels. The under aroused brain results in under-performance which is typical of depression or low mood.
Brain waves are monitored by placing sensors or electrodes on the scalp, which register the electrical signals inside of the brain across specific associative areas.
The goal of NF, in eating disorders is to help an individual move from one brain state to another and NF embodies a process of neuronal self-regulation and re-education, leading the brain to find new and beneficial states and ways of processing new information and feeling.
Different forms of training exist based on a quantitative EEG which highlights specific areas in the brain called Brodmann areas (refer to the areas discussed in para 1.2 which are addressed during NF training and attempts to stabilize the function of the Brodmann areas including OCD, poor impulse control and binge eating.
NF meets the criteria specified by the American Psychological Association to be classified as an evidence-based intervention.
Dr Annemie Peché
082 33 561 33 apeche@vodamail.co.za www.neurofeedback-therapy.co.za