'I can't imagine living to old age like this'

Tina McGuff reviews BBC Radio 4's 'Rethinking anorexia nervosa'.

I was lucky. I recovered from my anorexia with CBT, being sectioned, force fed and a reward programme. But one treatment does not fit all, so as I now write about this often misunderstood and fatal illness it’s important to hear of new approaches to treating it. In an incredibly insightful 28 minutes, psychologist Dr Sally Marlow offers so many people hope for the future for their loved ones.

Sara and Linda open the show with their personal accounts of the deeply complex psychological condition of severe and enduring anorexia. ‘Everything is perceived through the lens of feeling completely distressed about your body’… ‘It’s like a funnel… it becomes narrower and narrower and more difficult to get out of it, the more you get entrenched in the eating disorder’. Dr Marlow explains the despair such people feel when treatments fail.

Dr Marlow goes on to explore new and experimental techniques to help people with ‘severe and enduring’ anorexia (around a quarter of all sufferers). Some have had the condition from teenage years until their mid 40 and 50s, with many years of therapy: Linda had experienced refeeding, groups, CBT therapy and interpersonal therapy without success.

Professor Ulrike Schmidt (King’s College London), who describes anorexia as ‘the most lethal of all psychiatric disorders’, talks about how deep brain stimulation to interrupt the pattern of learned behaviours towards food may hold a key. Dr Rebecca Park (Oxford University) describes a growing understanding of the parts of the brain that affect this condition, in particular the limbic system (involved in reward processing), the somatosensory cortex (which plays a part in body image) and the insula (which detects internal states such as pain and hunger). 

Dr Marlow experiences Transcranial Magnetic Stimulation, a technique to excite or inhibit nerve cells which appears to reduce anxiety. Still at the ‘proof of concept’ stage, there have been promising results with trail participants and it’s now set for a randomised trial with sessions five times a week for four weeks. Professor Schmidt feels it may reduce preoccupation with weight and increase engagement with other forms of therapy. 

Over at the University of Toronto, a team are trialing a far more invasive technique, Deep Brain Stimulation. Professor of Psychiatry Blake Woodside and neurosurgeon Nir Lipsman target the subcallosal cingulate, which they call a ‘call centre for emotional processing in the brain’. One sufferer, whose family was planning for her funeral, suddenly announced she would like a piece of pizza once the electrodes were turned on.

The researchers say they have been ‘gobsmacked’ by the results after six months, although they do also caution that Deep Brain Stimulation does not offer a ‘magic bullet’. A key point is that such treatments may increase a person’s receptivity to other, more psychological, forms of treatment.

Dr Parks says she is keeping a very close eye on these results, and continuing their work to develop optimal targets for such treatments. Medical ethicist Dr Jacinta Tan (University of Swansea) reminds listeners that when using novel treatments with such a ‘deeply human dilemma’, the first principle is to do no harm: ‘health professionals and researchers as well have this sense of desperation, we’re just looking for anything.’

Thankfully, Dr Marlow reminds us, ‘necessity is the mother of invention’, and I was personally very encouraged to hear that the treatment of severe and enduring anorexia is being rethought.

- Find further information, support and listen to the programme.       

Reviewed by Tina McGuff - author, mental health and eating disorder campaigner. 

BPS Members can discuss this article

Already a member? Or Create an account

Not a member? Find out about becoming a member or subscriber