Eating Disorders and the Brain

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

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