In women with a history of anorexia, there were fewer differences; winning and losing felt very much the same. Kaye suspects this neurological effect applies to eating, too. “For anorexics, perhaps it is difficult to appreciate immediate pleasure if it does not feel much different from a negative experience,” he told a BBC interviewer. By contrast, the part of the brain that links actions to outcomes and planning lit up far more in the recovering anorexics than in the healthy women, reflecting high levels of anxiety about making mistakes and worries about negative consequences.
“There are positive aspects to this kind of temperament,” Kaye points out. “Paying attention to detail and making sure things are done as correctly as possible are constructive traits in careers like medicine or engineering.” Taken too far, though, such traits can hurt more than they can help.
The language of neurobiology describes the nexus between brain chemistry and behavior. It’s observational and nonjudgmental, a far cry from the pronouncements of Minuchin, Bruch, and so many others. What it boils down to, in Kaye’s words, is that “circuit-based abnormalities” lead to changes “related to appetite, emotionality, and cognitive control.” Cause and effect (though it’s hardly that simple), seen as a series of system malfunctions, glitches in the hardware that affect the software. There’s no blame or shame attached, just descriptions of where the system gets wonky or goes astray.
On the other end of the spectrum from Walt Kaye, some researchers are investigating parallels between anorexia and autism. Nancy Zucker, a psychologist at Duke University Medical Center in Chapel Hill, North Carolina, believes that both people with anorexia and people with autism show impairments in what scientists call social cognition—attachment, anxieties, and interpersonal relationships. She published a paper in 2007 suggesting that looking at the social deficits of people with anorexia might help researchers devise better treatments for the illness. But since so many of the “social impairments” seen in anorexia are a function of long-term malnutrition (think of the volunteers in Ancel Keys’s study, who became depressed, anxious, withdrawn, and aggressive), I’m not sure how useful this line of research can be. And I don’t see how comparing anorexia to autism helps people with either disease. The last thing people with anorexia need is another stigmatizing label slapped on them.
One of the most intriguing theories about what causes anorexia comes from Shan Guisinger, a psychologist in Missoula, Montana. Guisinger wondered why anorexia nervosa developed in the first place, what biological function it fulfilled, and why it’s persisted, given its high mortality rate. She came up with what she calls the adapted-to-flee-famine hypothesis, which explains the illness in terms of evolutionary biology.
According to Guisinger, the symptoms of anorexia—the inability to see one’s own extreme thinness, the hyperactivity and restlessness, the aversion to eating, the ability to function on very little food—make sense if you think of them as strategies for surviving famine. Thousands of years ago, she suggests, before humans started farming, they were nomadic, often traveling great distances to find food. In times of famine, malnourishment made people lethargic, weak, and depressed—unable to forage successfully. Guisinger theorizes that the whole group benefited from having a few members who reacted paradoxically to starvation. These evolutionary outliers stayed energetic, becoming restless rather than lethargic during times of scarcity. They didn’t see themselves as dangerously thin and, therefore, stayed optimistic and motivated to survive. All of these qualities made them natural leaders in times of food shortage, leading the drive to find greener pastures. In this context, says Guisinger, the characteristic abilities of anorexics to work hard, delay gratification, and ignore suffering to achieve a goal would have been essential to the group.
To support her theory, Guisinger points to a number of factors: The fact that anorexia nervosa appears across cultural, ethnic, and socioeconomic lines, which suggests that it is biological rather than cultural. The fact that anorexia seems most common in peoples who were more recently nomadic—Hispanics, Caucasians, and Native Americans—and least common among Asians and African Americans; in Africa over the last hundred thousand years, Guisinger argues, “it was probably better for starving people to stay put, conserve energy, and keep searching locally for food, as traveling could result in encounters with hostile neighbors.” Finally, the fact that anorexia affects primarily women. In other primate species, says Guisinger, males who wander from their own territory are typically killed, but females are often accepted and integrated into a new group. So females make the best migrators, in a way.
If the