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YB: So what are the implications of it being an organic, brain-based disorder? How does that differ from a psychological disorder?
Dr. O'Toole: Well for one thing, we can stop blaming parents. I can’t tell you how many times even other physicians will tell me, “Oh, it’s obvious why she has anorexia, I mean look at her mother, she’s a mess.” The implication of this being a neurodevelopmental brain disorder is that parents do not cause it and children do not choose to have it. So this has the potential to be profoundly destigmatizing.
YB: And is this the same for anorexia and bulimia or is it possible that bulimia does have a stronger psychological component and anorexia is a separate disorder?
Dr. O'Toole: Well, since I’m primarily a pediatric eating disorder doctor, we do see patients with bulimia nervosa but the overwhelming majority of our patients have anorexia nervosa.
YB: Why do you think you see more cases of anorexia in younger people?
Dr. O'Toole: Bulimia nervosa is just a rare diagnosis in early childhood. Anorexia is also a rare diagnosis but it’s more common. You really don’t start to see a predominance of binging and purging behaviors until 14 and older, but most of the kids we see are under 12.
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YB: Wow. I didn’t realize that kids under 12 years old could have anorexia.
Dr. O'Toole: Oh, absolutely. I think our youngest patient is six. It’s quite rare, however eight is not as rare and 10 is not rare. So unfortunately, these illnesses can strike kids who are very young, and boys, of course.
Actually, one of the things early on that convinced me that this was a biological disorder was the fact that a 10-year-old farm boy with no access to fashion magazines and all this kind of stuff could get it and it would look exactly like anybody else’s anorexia nervosa. We call those cases paradigm busters. The 10-year-old farm boy causes you to rethink everything that you’ve been taught before.
YB: That’s so sad that such young kids are able to develop eating disorders.
Dr. O'Toole: Well, if we hark back to them being biological disorders, it’s no weirder or sadder than the fact that eight-year-olds get cancer. Which is a pretty shocking and awful thing too. Anorexia is just another of the medical conditions to which humans can be prone.
YB: And do you think it’s empowering for kids or families to think of this as a brain disorder?
Dr. O'Toole: I hope so. If you’ve been told that an eating disorder means you’re superficial or want to look like a model, you’ll feel like a loser. You’ll think, why can’t I just get better? Why am I so concerned with my appearance? To be told, look, this is not your fault. You didn’t sign up for this. You didn’t ask to have this and furthermore, when you look around your family, it’s extremely likely that you will find other affected family members. That allows for compassion to enter the picture.
YB: Do you think that we will one day find a cure for anorexia?
Dr. O'Toole: Absolutely. I think we’re far from it right now, but we’re moving in that direction by trying to understand the biology. That’s the first step.
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