Ameliorating Reward Seeking Behavior and, by extension, Eating Disorders

A newly published study in Nature by researchers at the University of North Carolina at Chapel Hill reveals that
 
using a combination of genetic engineering and laser technology, [they] have manipulated brain wiring responsible for reward-seeking behaviors, such as drug addiction. The work, conducted in rodent models, is the first to directly demonstrate the role of these specific connections in controlling [emphasis mine] behavior.

 

The UNC study, published online on June 29, 2011, uses a cutting-edge technique called “optogenetics” to tweak the microcircuitry of the brain and then assess how those changes impact behavior. The findings suggest that therapeutics targeting the path between two critical brain regions, namely the amygdala and the nucleus accumbens, represent potential treatments for addiction and other neuropsychiatric diseases.

Interestingly, I just completed a course on the brain offered by Dr. Lee Ryan at the University of Arizona as part of the Humanities Seminars Program.  During her three hour lecture with slides on decision making she illustrated the reward path of the brain as beginning in the ventral tegmental area (VTA) that is known for pumping out dopamine that is transmitted to the Nucleus Accumbens and from there to the Prefrontal Cortex.  By infusing minute doses of heroin directly into the Nucleus Accumbens of a rat, researchers observed an increase in the degree of dopamine and its course from the Nucleus Accumbens to the Prefrontal Cortex.  Researchers then electrically stimulated the NA and obtained similar results.  (Once her slides are on line, I'll link them here to illustrate the experiment with the rats.)

The researchers also determined in work with the animal that anticipation of the reward is as good as the reward itself.  This illustrates the increased likelihood that someone who is or was addicted to a substance (heroin, e.g.) or a behavior (such as gambling or binging and purging) will begin to anticipate the reward and indulge in reward seeking behavior as a result unless they have managed to learn how to modify their behavior in this example of a decision making process.

That decision-making process occurs in the Frontal Lobes of the brain where something known as  the Executive Function occurs.  The brain, through training the results of which can become a habit as well, weighs the pros and cons of seeking the reward and hopefully makes the decision, in this case, to reject it.

Research has shown, too, if there is damage to the orbitofrontal cortex, these behaviors to avoid reward are dampened and risk taking as well as reward seeking are increased.  This damage can occur as a result of a stroke.  It would seem (although I have not seen any research yet about this but intend to tap the researching skills of a friend) that starvation during anorexia or electrolyte and therefore chemical imbalance due to binging and purging,  could also lead to the lessening of the positive effects of Executive Function because the brain is starving.  And, of course, genetics can play a role here, too, by increasing likelihood that a person's stimulus/reward system may need balancing through, for example, behavioral modification or medication among other possibilities.

Again, the goal is to develop a habit to reject a stimulus that is harmful.  The researchers in the first report mentioned above are examining ways to interrupt this reward seeking behavior, as well.  For those who for whatever reason simply cannot stop that reward seeking behavior once it begins, the work by those at UNC may lead to a way to stop it.

And, again, a fascinating look at all of these processes can be found in the book Incognito by David Eagleman.  This linked NPR report gives one a sense of the book and includes some material from the first chapter of the  book.

P.S. After reading and then thinking/writing about Brain Over Binge ( Kathryn Hansen's book ) is anorexia another disease or another version of the loss of the ability of a person's executive function to govern eating behavior but in anorexia's case something goes awry in the brain's wiring so that in a perverse way starvation feels good as would a narcotic? 
P.P.S.  After writing the above P.S., Kathryn Hansen sent me a link to an article about the study by Dr. Walter Kaye and his colleagues that indicates those with anorexia feel less anxious when they do not eat; some sort of aberration.  So in a sense starvation does feel good or at least less fear inducing........
And, another PS - Here's an article published in the New York Times on the same subject elaborating on the development of addictions and the brain receptors involved.

The Four Agreements - underpinnings to a better life

We subscribe to Inside Tucson Business, a local weekly business newspaper.  The June 24, 2011 edition carries an article written by Kathy Hibsman in the Women in Business section in which she reflects on the Toltec Four Agreements.  This link provides the full text of the agreements, as well.

I find it worthwhile to review these periodically and the book written by Don Miguel Ruiz sits on my shelf.

Agreement 1:  Be impeccable with your word.

Agreement 2:  Don't take anything personally.

Agreement 3:  Don't make assumptions.

Agreement 4:  Always do your best.

A reminder to those who tend towards perfectionism and get tangled up in it (like myself), doing your best does not mean doing something perfectly.  A wise Al-Anon saying is Progress, not perfection.

Guest Post by Marjie Ruth - Recovery is a Process

"It is good to have an end to journey towards; but it is the journey that matters in the end."

 ~ Ursula K. LeGuin

Dear Family & Friends of the Eating Disordered;

The topic of recovery is one that is almost always on many of our minds in one capacity or another. So, what is recovery? Recovery is what we all want for our loved ones. We want them to get past their addictive behavior, to regain their health and happiness, and to rejoin life as a fully functioning and productive person. For some of us recovery is thought of as simply getting things back to the way they were before we ever even knew about the disorder or suspected it might be a possibility. Webster's tells us that recovery is to "regain a normal position or condition [as of health]". Yes, to get back to normal--that is a most succinct way of putting it.

"Get back to normal". Those 4 words sum up the burden that has been in our hearts and is the bottom line when the maelstrom that is in our minds comes to rest. Some of us, after lying awake in the dark hours of the night and crying quietly into our pillows, know that it is the prayer we whisper through clenched teeth: "Please, please make things normal again!".  But everyone who has studied even a little psychology knows that the word "normal" is a nebulous term at best. Normal is often defined in the eyes of the beholder. What's normal for one family might seem quite ludicrous to another. And the key thing for us to remember is that the eating disorder was developing and occurring even when we thought everything was just fine, normal. Are we just asking to go back to a state of blissful ignorance or do we really want recovery?

Another stumbling block when we talk about recovery is that we are often thinking in terms of a cure. We've cured polio. We're searching for the cure for cancer and the common cold. Is there a cure for an eating disorder, for any addiction? Because many practitioners use the disease model when talking about and treating ED's, we tend to think that a cure is the ultimate goal. But the disease model for mental illnesses and that for physical ailments have some inherent differences. There is no invading virus or bacteria to be isolated and eradicated with an ED. Even the cause of an ED is difficult to cull down to any one thing as it appears to be the result of a whole slew of mitigating factors: genetic predisposition, environmental & experiential factors, hereditary issues, triggering events, hormonal levels, etc. etc. A cure would be great for that would mean the possibility of a vaccine...but neither seem within the realm of possibility at this point.

So, again, what is recovery? If not necessarily a return to the state before we were aware of the disorder and if not a cure, what is left? Recovery is a process. It is a process with the first step being admitting to the disorder and one's powerlessness against it. That might seem like overstating the obvious to those who blanch at the holocaustic appearance of the anorexic or are sickened by the the sight of the binging bulimic and the sound of the purging aftermath. But for the person mired in the disease, it is the first and often most difficult step in a long, long struggle. Denial is the self-preserving force of every addiction. An addiction begins slowly (without the victims' having any intention of becoming addicted) and innocuously hidden in a facade of "this feels good & I can control it". It's only dabbling in a potentially self destructive behavior at that level. By the time the tentacles of the addiction have penetrated and ensnared the mind of its victim, it is so much in control of their physical and mental being that its very nature does not allow for recognition of itself as the invading enemy. Instead, it is seen as the very essence of necessary normal, as needed for life as air to breath. For most addicts the addiction feels to them like that which is keeping them going, while everyone around them watches in horror as the addiction gradually destroys its primary victim.

If you can fathom all of that, you can begin to understand why the recovery process is so very tough to initiate. We often talk about the need to "hit bottom" before real recovery can begin. This is an outsider's way of describing what appears as an addict's downward spiral until, in looking back, we can see the point where they finally began to fight against the disorder, that point where they "bottomed out". This is not something that can be orchestrated by others and is unique to each individual just as each of our mental/emotional constructs is unique. For some, the realization that what they are loosing due to the addiction is greater than what they are getting from it will come sooner--while for others, it may take months or years with increasingly damaging forays into the depths of the disorder. And, most sadly, there are those who will loose their life to the disorder without ever seeing the ED clearly for the killing monster it is. This is true of all addictions.

But, if that process towards recovery can get started, there is the hope (and it has happened for many) that it will progress through a series of levels, each one bringing the person closer to a healthy and functioning place in their recovery process. The 12 step model lays out the series of prescribed phases to further this process. The AB Anon handbook points out very clearly that the first two steps (#1-admitting to being powerless against the addiction and #2- coming to believe that a Power greater than self can restore sanity) are both the most critical --being those upon which all further recovery is predicated--and the most difficult.

Once this process has begun, we--the families and friends of the addicts--must address how we are to deal with the otherdreaded "R" word: relapse.  For those of you who have been through it already, you know how once you learn of the relapse your stomach immediately knots in its very pit, and you feel that sinking-into-a-black-hole feeling of panic all over again. And familiarity certainly does breed contempt in this case. We are nearly traumatized to be revisiting that most horrific of emotional places that we never ever wanted to be in the first time around and had spent countless hours and probably dollars working to get away from forever. I can say nothing to take away the frustration and fear that any one of us would naturally experience. But I can offer some assurance by pointing out that relapse often occurs (according to the AB Anon handbook) because either of the first two steps of the 12 step process had not been fully internalized and dealt with. Think of the analogy of learning to ride a bicycle. Help is required for the first time ride, usually in the form of a parent's firm hand on the rear of the seat while running along with the tentative peddler. The sense of balance is something that must be learned from experience as it really does feel impossible and dangerous to the untrained rider. Training wheels (liken those to residential treatment or intensive therapy) can give a feeling of what riding a two-wheeler is like. But take off those little wheels (leaving the residential setting, dealing with situations outside of the therapist's office), and it is something else indeed. And we've all seen the child who continues to peddle & do just fine when, unbeknownst to them, we have let go of the seat. But then, when they look back and realize they are on their own, their fear overtakes them and they wobble and fall. So, too, an individual can seem to have been doing marvelously in therapy, and we are filled with expectations (recognize the word & recall the danger?) of better things to come. But life assails them, confidence flags, and the urge to resort to the addictive coping mechanisms is screaming in their minds. Relapse can be horrifying and ugly for everyone involved, but it is vitally important that we, the friends and family, do not communicate despair to the person in the battle against the ED. Just as you dusted off the young rider while offering words of praise for what they had undertaken so far and encouragement to give it another go round, so too we must be there expressing love and calm understanding to encourage our loved ones that we understand what a difficult battle they face and that we realize that set backs will be part of the process.

And that leads us to the importance of our own recovery. While we can not do recovery for anyone else, we can not effectively be supportive if we have not worked on our own recovery. And how do we do this? By continuing to increase our understanding of the recovery process including the realities and the possibilities, and accepting that it is all out of our control. Our recovery means coming to recognize and deal with our own emotional baggage about the ED: our anger, fears, frustrations, hopes, worries, and going through the grieving process in order to reach acceptance. It means continuing to work at learning how to cope with while not contributing to the addictive behavior. It may mean working on issues of our own like a tendency towards perfectionism or a need to be in control of others, for example. Recovery for us means learning how to listen, how and when to let go, how to establish healthy boundaries, and nurturing our lives and relationships apart from the ED. While we might have started out thinking that recovery is all about making someone else well, hopefully now we are coming to realize that it is more about understanding the process they will have to work through while applying the same process to our own lives.

To paraphrase the opening quote:

When we understand the recovery is not something to be achieved, but rather a way to live, than the process will become our journey.

Marjie Ruth
sruth1@tampabay.rr.com &/or MarjieRuth1@gmail.com

(727)244-9011 (c)P.S. Wow, congratulations on making it this far!! I know this was a long email...thanks for bearing with. Pls feel free to share this with anyone who might be interested. Do include my email address so they know who to blame for all of this verbosity. If you've received this and would rather be off the list, write back and just say "remove". I'll understand. Questions or comments? Send those my way also.

Dr. Marsha Linehan reveals her own battle with Borderline Personality Disorder

A friend provided a link to this article that appeared in the New York Times last week in which Dr. Marsha Linehan, who developed the therapeutic technique Dialectical Behavioral Therapy, revealed that she, too, has battled Borderline Personality Disorder.

I particularly like this site - DBT Self-Help.

This piece is relevant for those with eating disorders for two reasons right off the top:  first, many who develop an eating disorder have a co-existing brain disorder diagnosis that also needs to be treated; and second, at least 25 percent of those with BPD also have an eating disorder.  I've blogged about BPD elsewhere here.

There are many parents who have spoken up about this disease and who firmly believe, like I do, that this is not a personality disorder but rather a brain disorder of biological origins.  As more and more research continues about the brain, I am convinced that this belief will gain more traction.

In the meantime, I'm reading a fascinating book by David Eagleman who is a neuroscientist at Baylor University.  The book - Incognito - is a must-read for those who are following the progress of understanding the brain.  I'll be writing something about the book once I'm finished with it.  So many dog-eared pages!  I am now in the section titled "Knowing Thyself."  The section on neurotransmitters and especially his thoughts on free will as well as free won't (applicable to the discussion about Borderline Personality Disorder) all add to a better understanding of the workings of the brain and ultimately who we are.