Dr. Julie O’Toole, founder of Kartini Clinic, a pediatric eating disorder treatment clinic in Portland, OR, is a former primary care pediatrician who has been treating eating disorders exclusively since 1998. She's the author of a new book, “Give Food a Chance,” with a radical suggestion: Parents and the media have nothing to do with the causes of anorexia.
In fact, drawing on research and clinical experience, O’Toole argues that anorexia is an organic, brain-based disorder (one caused by a quirk in the brain's wiring) rather than a psychosocial disorder (one caused or influenced by life experience and maladjustment)—a disorder more like epilepsy than anxiety or OCD.
While anorexia is traditionally considered a psychosocial disorder, O'Toole recasts it as "a brain-based biological disorder with profound psychosocial ramifications."
Today, YouBeauty is talking with Dr. O’Toole about what this means for eating disorder treatment and why it’s so important that we change the way we think about anorexia.
MORE: Eating Disorders Among Older Women
YB: A lot of people tend to blame parents or the media for eating disorders but I was struck by your book because you really take a different approach.
Dr. O'Toole: Right. One of the great insights of the late 20th century was that mind and brain are not even opposite sides of the same coin—they are the same coin. Eric Kandel, who won the Nobel Prize in medicine, says, “Mind is a range of functions carried out by the brain.” So the kind of brain/mind dichotomy that we all grew up thinking about and believing is just irrelevant and wrong.
I like to explain to people that if you look at Type 1 diabetes, where the pancreas doesn’t produce insulin adequately, the whole system is affected. There are profound psychosocial ramifications, but it’s not primarily a psychosocial illness. Anorexia nervosa is like that, but the organ that’s affected is the brain. As the pancreas produces insulin, so the brain produces behavior.
The behaviors—the refusal to maintain body weight, the refusal to eat adequately—these are merely symptoms of what’s going on in the brain. In fact, the latest thinking is that this is probably a neurobiological or developmental disorder that has its roots in earliest life, possibly even prenatal life.
YB: What would going on in the prenatal environment to cause an eating disorder?
Dr. O'Toole: I think the short answer is that we really have no idea. But we do know that there is a strong genetic component to anorexia nervosa. Without a genetic predisposition, no environmental trigger or stressor will produce anorexia nervosa. But in a person who has this genetic vulnerability, something happens to alter the brain’s wiring. Is that something a virus? Is it stress hormones? Heavens, we really have no idea.
YB: So you don’t support the idea that anorexia could be caused by cultural images of very thin women?
Dr. O'Toole: I think it’s a giant red herring. But I do think it affects people with eating disorders the way it affects all of us. People do not think clearly about body shape and weight. We just don’t. Part of the reason for that is this excessive emphasis on thinness. So while I don’t think it causes anorexia nervosa or has anything to do with the cause of anorexia nervosa, it does make getting better a lot more difficult.
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