The Brain Chemistry of Eating Disorders

Jo, Year 13, explores what is happening chemically inside the brains of those suffering from eating disorders and shows how important this science is to understanding these mental health conditions.

The definition of an eating disorder is any range of psychological disorders characterised by abnormal or disturbed eating habits. Anorexia is defined as a lack or loss of appetite for food and an emotional disorder characterised by an obsessive desire to lose weight by refusing to eat. Bulimia is defined as an emotional disorder characterised by a distorted body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by fasting, self-induced vomiting or purging. Anorexia and bulimia are often chronic and relapsing disorders and anorexia has the highest death rate of any psychiatric disorder. Individuals with anorexia and bulimia are consistently characterised by perfectionism, obsessive-compulsiveness, and dysphoric mood.

Dopamine and serotonin function are integral to both of these conditions; how does brain chemistry enable us to understand what causes anorexia and bulimia?

Dopamine

Dopamine is a compound present in the body as a neurotransmitter and is primarily responsible for pleasure and reward and in turn influences our motivation and attention. It has been implicated in the symptom pattern of individuals with anorexia, specifically related to the mechanisms of reinforcement and reward in engaging in anorexic behaviours, such as restricting food intake. Dysfunction of the dopamine system contributes to characteristic traits and behaviours of individuals with anorexia which includes compulsive exercise and pursuit of weight loss.

In people suffering from anorexia dopamine levels are stimulated by restricting to the point of starving. People feel ‘rewarded’ by severely reducing their calorie intake and in the early stages of anorexia the more dopamine that is released the more rewarded they feel and the more reinforced restricting behaviour becomes. Bulimia involves dopamine serving as the ‘reward’ and ‘feel good’ chemical released in the brain when overeating. Dopamine ‘rushes’ affect people with anorexia and bulimia, but for people with anorexia starving releases dopamine, whereas for people with bulimia binge eating releases dopamine.

Serotonin

Serotonin is responsible for feelings of happiness and calm – too much serotonin can produce anxiety, while too-little may result in feelings of sadness and depression. Evidence suggests that altered brain serotonin function contributes to dysregulation of appetite, mood, and impulse control in anorexia and bulimia. High levels of serotonin may result in heightened satiety, which means it is easier to feel full. Starvation and extreme weight loss decrease levels of serotonin in the brain. This results in temporary alleviation from negative feelings and emotional disturbance which reinforces anorexic symptoms.

Tryptophan is an essential amino acid found in the diet and is the precursor of serotonin, which means that it is the molecule required to make serotonin. Theoretically, binging behaviour is consistent with reduced serotonin function while anorexia is consistent with increased serotonin activity. So decreased tryptophan levels in the brain, and therefore decreased serotonin, increases bulimic urges.

Conclusions

Distorted body image is another key concept to understand when discussing eating disorders. The area of the brain known as the insula is important for appetite regulation and also interceptive awareness, which is the ability to perceive signals from the body like touch, pain, and hunger. Chemical dysfunction in the insula, a structure in the brain that integrates the mind and body, may lead to distorted body image, which is a key feature of anorexia. Some research suggests that some of the problems people with anorexia have regarding body image distortion can be related to alterations of interceptive awareness. This could explain why a person recovering from anorexia can draw a self-portrait of their body image that is typically 3x its actual size. Prolonged untreated symptoms appear to reinforce the chemical and structural abnormalities in the brains seen in those diagnosed with anorexia and bulimia.

Therefore, in order to not only understand and but also treat both anorexia and bulimia, it is central to look at the brain chemistry behind these disorders in order to better understand how to go about successfully treating them.

 

Why using your five senses is the key to practising mindfulness at school – 19/10/18

Lucy (Year 8) looks at how our senses can be used to help us to practise mindfulness within the school day and the potential benefits this can have on our overall mental health and wellbeing.

The word mindfulness can conjure up an image of a class doing yoga or meditating.  But its key essence is about deliberately bringing one’s attention to experiences occurring in the present moment. It is about turning ourselves off autopilot, and noticing our present being. In the life of a busy Wimbledon High girl, this can be a challenging and daunting prospect. Focusing on our five senses will bring us into the ‘here and now’, and might be the crucial tool for dealing with stressful and anxiety inducing situations.

The senses are how we understand the world, and to obtain the most positive experience from the present moment we need to employ them in everything we do. Studies by Dr. Patrizia Collard (Sensory Awareness Mindfulness Training in Coaching: Accepting Life’s Challenges, Collard & Walsh, 2008) demonstrate that focussing on our senses, and non-judgementally on our current situation, results in a significant improvement in a range of conditions such as anxiety, depression and stress disorders.

A simple mindfulness exercise that could be practiced during the day at school, and without the use of a yoga mat, is the 5-4-3-2-1 tool. This exercise is an effective method of regaining control of your mind when anxiety or stress threaten to take over and reminds us to interact with the world using our five senses. It requires you to think of five things that you can see (e.g. a picture on a classroom wall).  Then you think of 4 things that you hear (e.g. the orchestra rehearsing in the Senior Hall), three things you can touch (e.g. your earrings), two things you smell (e.g. tea or coffee) and one thing you can taste (e.g. breaktime snacks).  This exercise can help you become more aware of your present situation and reduce potential stress.

Good mental health is something we should all aim for, and psychologists around the world are investigating ways to maintain a consistent level of positive mental health. Using our five senses and practicing mindfulness can help us be resilient when going through a time of stress and help keep us grounded in reality. Learning to focus on the external factors present around us helps avoid excessive focus on internal issues and can moderate extremes of feeling or emotion. Consistency and balance are crucial when aspiring to have good mental health.

However, mindfulness should not be a tool reserved only for stressful situations. Just like training for a sport, mindfulness needs to be practiced and developed to make it the most effective it can be.  Using the 5-4-3-2-1 technique and your five senses are a simple way of practicing mindfulness because you do not need equipment, a long time, or any external help. Our body has the tools we need to master mindfulness, we just need to trust them and exercise them.

For further reading, see the book “How to be yourself” by Clinical Psychologist Ellen Hendriksen (buy it here for a paper by Harvard Medical School about the benefits mindfulness has on stress and anxiety levels.

Transitions: stepping in to Year 7

Head of Year 7 Jenny Lingenfelder reflects on encouraging emotional agility during the ‘transition’ phase from Year 6 into Year 7.

We prefer ‘Stepping In’…… I fondly call my new cohort of Year 7s on their first day (or should I say term?), ‘turtles’…. their backpack has their life in it and appears to dwarf them as they wide-eyed, set off down school corridors navigating their way around what will be ‘home’ for the next 7 years.

Even for the majority who are eagerly awaiting the increased independence and exciting changes ahead, transition from primary to secondary school is well known to come with its challenges – both academically and emotionally. One aspect we have been focusing on in the Year 7 pastoral team is that of emotional agility and how to resolve conflict when the ‘friendship issues’ emerge once they have settled in. These are a common and developmentally crucial feature of adolescent life and so our focus is primarily how to navigate them effectively.

Brene Brown’s research into shame and vulnerability over the past twenty years is insightful and brings a wealth of authentic guideposts which can be easily adapted for pastoral care. The crux of her book ‘Daring Greatly’[1] focuses on how we build shields up to protect ourselves from feeling vulnerable such as perfectionism, foreboding joy, playing the victim or the Viking to name but a few. Traits we as adults can all recognise but which start to emerge when we are in the playground. Her strategies to break down these shields include practising gratitude, appreciating the beauty in the cracks, setting boundaries, cultivating connection, being present and moving forward all of which resonate deeply with our pastoral vision at WHS for our young girls in today’s society.

All well and good but how does this work in practice?

Nicola Lambros’ contribution to the GL Assessment Children’s Wellbeing report[2] this year clearly lays out the correlation between wellbeing and impact on learning. Whilst genuinely complimenting schools on their support for the mental health of their students, she compares some of this help to that of taking paracetamol for a headache – whilst alleviating the pain, it doesn’t help uncover the underlying causes. She has a point. So how do we avoid putting a plaster over these issues? How do we bring about a deep, raw and authentic cultural shift in how we manage teenage behaviour in an ever increasingly sexualised, intrusive and pressurised society where comparison is the killjoy of creativity? How do we go about ensuring the girls develop emotional agility from a young age? And develop self-efficacy which is authentic and whole-hearted, a firm foundation for the teenage years and life in general?

Big questions, but ones we relish in the Year 7 team, especially with the knowledge that scientific research has now proven that the teenage brain has a further burst of growth at this time allowing for the reprogramming of those learnt behaviours which were previously thought of as hardwired and unchangeable. With this understanding, it is an exciting prospect to know we can equip our girls from an early stage with the tools on how to be emotionally agile throughout their teenage years and beyond.

Here are some reflections outlining where we are seeing some fruit:

  1. Practising proactive intervention. When a friendship issue arises, at times getting those involved around the table for a mediation is the best option. It’s uncomfortable (initially) but that vulnerability enables authentic conversation, breaks down walls and provides a way of moving away from blame and forging a pathway forward. Another strategy we have used is the ‘Support Group Method’ which encourages collective responsibility: with the individual’s permission, spilt the form into small groups, share what the problem is and ask for ideas on how to move forward. Getting students to write down their ideas and pop in a box enables more freedom of thought.[3]
  2. The not so nice emotions and how we describe them. Psychologist Susan David in her TED talk ‘the gift and power of emotional courage’[4] maintains ‘tough emotions are part of our contract with life’ and more poignantly ‘discomfort is the price of admission to a meaningful life’. Enabling girls to experience this on their level with a friendship fallout is crucial in helping them develop emotional intelligence. She also stresses that we own our emotions, they don’t own us. So, rather than ‘I am stressed’ using the phrases ‘I’m noticing’ and ‘I’m feeling’ can help embed emotional agility in the long term.
  3. Use of coaching methods. Whether in PSHE lessons or pupil meetings these can equip girls with tools to reach their full potential and prevent bad habits from setting in early. Top performance coach Sara Milne Rowe’s new book ‘The Shed Method- Making Better Choices When It Matters’[5] is illuminating on this topic. She maintains ‘mind energy is the fuel that fires our brilliant human brain and is at the heart of building any new habit- be it a body habit, mood habit or mind habit’ and provides practical examples of how to set goals and achieve them; strategies which can be translated easily into the school setting.
  4. Listen to pupil voice. Whether it is touching base after the first couple of weeks, canvassing opinions on the Year 7 PHSE programme or at the end of a term, we ask our Year 7 girls for feedback regularly which helps enormously to know what is really going on during this phase. One notable occasion is asking the girls to nominate who and why they want to give the Speech Day ‘Grit’ Awards to in the year group. Reading the nominations has each year brought me both to tears and chuckles and reminds me that we wouldn’t have known about the small acts of kindness or bravery that happen on a daily basis unless we asked our girls to tell us.
  5. Thinking creatively. We took Year 7 to see Wicked this year and have incorporated the story into how to approach friendship issues and ideas around acceptance in the wider world. The staff enjoy this just as much as the girls!

It’s an organic and evolving process and one that excites me greatly. Sometimes ensuring a smooth transition process does require a paracetamol or a plaster. However, building emotional agility takes time and effort to adopt as a habit. It is not (as is often perceived) the case of putting on resilient armour reading for battle. Vulnerability is at the core of this approach and that takes real courage. But it is worth it and I feel privileged to work in a place where girls and staff are willing to give it a go.

Jenny Lingenfelder

Head of Year 7

[1] Brene Brown ‘Daring Greatly. How the Courage to be Vulnerable Transforms the Way we Live, Love and Parent and Lead’, 2012

[2] GL Assessment Children’s Wellbeing: Pupil Attitudes to Self and School Report 2018

[3] See Ken Rigby University of South Australia for more detailed information on different intervention approaches, March 2010

[4] Susan David TED talk ‘The Gift and Power of Emotional Courage’, Nov 2017 https://www.ted.com/talks/susan_david_the_gift_and_power_of_emotional_courage

[5] Sara Milne Rowe ‘The SHED METHOD Making Better Choices When it Matters, 2018

 

Japan- a culture to die for? Cultural attitudes to suicide in Japan and the West

Wimbledon High History

Gaining publicity following Youtuber Logan Paul’s video filmed in Aokigahara, one of Japan’s suicide hotspots, the extremely high suicide rate in Japan has been featured increasingly in Western news. In this article, Jess Marrais aims to explore possible historical and traditional reasons for both Japan and Western attitudes towards suicide.

The world of YouTube and social media crossed over into mainstream media on 1st January 2018 following a video uploaded by popular YouTuber, Logan Paul. Paul and a group of friends, while traveling around Japan, decided to film a video in ‘Aokigahara’, a forest at the base of Mt Fuji, famous as the second most popular suicide location in the world. The video, which has since been taken down, showed graphic images of an unknown man who had recently hanged himself, and Paul and the rest of his party were shown to joke and trivialise the forest and all that it represents.

Unsurprisingly, Paul received a lot of backlash, as did YouTube for their lack of response in regards to the video itself. This whole situation has restarted a discussion into Japanese suicide rates, both online and in mainstream media sources such as the BBC.

In the discussions surrounding the problem, I fear that little has been said in the UK about the cultural attitudes in Japan towards suicide, and how drastically they conflict with the historical beliefs entrenched in our own culture.

In Christianity, suicide is seen as one of the ultimate sins- to kill oneself is to play God, to decide when a soul should leave the Earth, and breaks one of the 10 Commandments (‘Thou shall not murder’). Historically, those victim to suicide were forbidden from having a Christian funeral or burial, and it was believed that their souls would have no access to heaven. As a result of this, it makes sense that in Christian countries suicide is frowned upon. We in the West view the high suicide rate in Japan, and other East-Asian countries, through our own cultural understanding; while in actual fact, the problem should be seen within the context of the cultural and historical setting of the countries themselves.

In Japan, the history of the samurai plays a large role in attitudes towards suicide. The samurai (military nobility) had monopoly over early Japan, and they lived by the code of ‘Bushido’- moral values emphasising honour. One of the core values of Bushido was that of ‘seppuku’- should a samurai lose in battle or bring dishonour to his family or shogun (feudal lord), he must kill himself by slitting open his stomach with his own sword in order to regain his- and his family’s – honour in death. Due to the prominent role the samurai played in Japanese society, this idea of killing oneself to regain honour seeped into all aspects of society, thanks to personal and familial honour being a central part of Japanese values, even today.

More recently, this warrior attitude to death can be seen in the famous World War II ‘kamikaze’ pilots- pilots who purposefully crashed their planes, killing themselves and destroying their targets (usually Allied ships). These pilots were typically young, and motivated by the prospect of bringing honour to their family and Emperor in death. During the war, 3,682 kamikaze pilots died, spurred on by the samurai code of Bushido.

In modern day, suicide is seen by many in Japan as taking responsibility. Suicide rates in Japan soared after the 2008 financial crash, reaching their highest at the end of the 2011 economic year. Current statistics say around 30,000 Japanese people of all ages commit suicide each year, as opposed to 6,600 per year in the UK.  Increasing numbers of Japan’s aging population (those over 65) are turning to suicide to relieve their family of the burden of caring for them. Some cases even say of unemployed men killing themselves to enable their family to claim their life insurance, in contrast to the UK where suicide prevents life insurance being from claimed. Regardless of the end of the samurai era and the Second World War, the ingrained mentality of honour drives thousands of people in Japan to end their own lives, motivated not only by desperation, but also the desire to do the right thing.

If anything can be taken away from this, it is to view stories and events from the cultural context within which they occur. While suicide is a tragic occurrence regardless of the country/culture in which it happens, social pressures and upbringing can – whether we are aware of it or not – influence a person’s actions. If this lesson can be carried forward to different cultures and stories, we will find ourselves in a world far more understanding and less judgemental than our current one.

Follow History Twitter: @History_WHS

Suicide hotlines:

  • PAPYRUS: support for teenagers and young adults who are feeling suicidal – 0800 068 41 41

Further reading:

Mindful revision: how to make the best of the revision period

wimbledon logo

As mock exams start, Suzanne East, our Mindfulness Lead, looks at how we can manage the pressures of examination revision to achieve our best and stay healthy.

As the Christmas holidays approached and the festivities were beginning to get into full swing, I wished my Y11 tutor group Merry Christmas and asked how they were planning on spending the holiday period; “revision”, they groaned in reply. In their eyes was written the despair at the prospect of sitting alone in garret-like bedrooms struggling with never-ending lists of dates whilst the sounds of forbidden parties drifted up to torment them.

Faced with this, I sought ways to encourage them, and found that mindful practise offered some practical suggestions. So here are my top five tips on how to survive revision, especially revision during the holiday period, in a most mindful way!

  1. Acceptance

At the end of the day, it is what it is and you will not feel any happier by constantly thinking of other things you could be doing. Being constantly updated on the fun that others are having will not help, so put the device away and get on with it!

  1. Focus

Mindful practice encourages you to bring the focus of your attention back to a chosen point, perhaps the breath. We all get distracted but we can improve our attention with regular practice – a vital skill in completing any task! Remember to be kind (you will not be able to focus all the time) but notice the drifting away of attention and gently bring it back to the job in hand.

  1. Self-awareness

Away from the routines of school this is a time when students may be alone for long periods and need to take responsibility for their own care. Mindful practice encourages paying attention to yourself, how are you feeling physically, mentally and emotionally. By getting to know yourself you can make sure you stop and eat when hungry, get some exercise when sluggish and meet up with friends when feeling lonely.

  1. Savouring the good

It is easy to let revision seep into all aspects of the day. Even when not actually doing revision it can hijack your thoughts; regretting not doing more or dreading going back.  Mindfulness practice teaches how to be fully in the moment, so if you are doing some revision, pay attention and do it, but equally when you are having a break really have a break. Immerse yourself in a long soak in the bath, enjoy chatting with your friends when you meet up for coffee, savour that chocolate and get out and be in the world that is buzzing away with life all around you.

  1. Kindness

Remember mocks are a practice run. Things will not always go to plan, and this is almost certainly true of revision plans. Mindful practice encourages students to explore areas of difficulty and to accept that life can make you feel sad, angry and frustrated. No one likes to feel like this, but these are feelings we cannot escape from. Get to know them and learn how you can move forward, being as kind and supportive to yourself as you would to a good friend.

Of course, none of the above come easily.  Regular practice is essential in building mindful habits, but the rewards can be quite life changing, especially when the going gets tough.

Follow @DHPastoralWHS for regular Pastoral updates at Wimbledon High.