Illuminating the Neural Basis of Anorexia

Anorexia nervosa is a serious psychiatric disorder characterized by a severe restriction of food intake and an abnormally low body weight. The rates of hospitalization are high, especially among young people, and mortality rates are among the highest of any psychiatric disorder. 

While research has made significant strides in recent decades, there is still much to learn about the complexities of the disorder, and the quest for effective treatments remains ongoing.

At the Eating Disorders Research Clinic at Columbia University Irving Medical Center/New York State Psychiatric Institute, a research team, led by Joanna Steinglass, MD, is investigating the neural mechanisms of persistent, restrictive eating behaviors in individuals with anorexia.

The team's work reveals that individuals with anorexia nervosa use different brain systems when deciding what to eat. Where people without an eating disorder use mostly reward systems when making food decisions, for individuals with anorexia nervosa, choice is guided by a deeper brain system—the dorsal striatum.

Dorsal habit systems guide restrictive eating choices

The group's findings suggest that routines that perpetuate illness have characteristics of habits (in the neuroscience sense of the term) in that routines are set off by specific cues and the outcomes are not factored in as much. Finding that the dorsal habit systems guide restrictive eating choices in patients with anorexia nervosa—and not in healthy peers—is consistent with notions of a habit component of anorexia nervosa. These neural mechanisms of illness have pointed the way to identifying new therapeutic tools.

“It's an exciting time for eating disorders in that there's been a lot of knowledge developed in the last decade to understand the brain mechanisms. In our group, we have been able to identify specific targets related to maladaptive habits and how these relate to challenges in eating, and then we have gone on to find some ways to change those habits and improve treatment,” said Dr. Steinglass. 

$100K research gift from Huberman Podcast Lab  

In recognition of Dr. Steinglass's innovative work, the Huberman Lab Podcast recently gifted Columbia’s Eating Disorders Center with a donation of $100,000 to further research in eating disorders. Dr. Steinglass is one of the first of a handful of investigators to receive funding from Andrew Huberman, MD, a neuroscientist and professor at Stanford School of Medicine who hosts the popular podcast. 

Dr. Steinglass said that the Huberman funding will allow the group to test out novel approaches to treatment, find the right ones, and figure out what approaches are most likely to be successful in larger trials.  "Eating disorders affect up to 10 million Americans in their lifetime and affect people from all walks of life,” Dr. Steinglass said. “We need to find treatments that work.”

To learn more about Dr. Steinglass’s collaborative work with Evelyn Attia, MD, director of Columbia’s Eating Disorders Center, read the article Tackling Eating Disorders through Habit Circuitry, published in Psychiatry Advances, a publication of NewYork-Presbyterian Hospital.