Asked about his research, Kaye said he and fellow researchers have conducted some fMRI imaging studies, one of which looked at taste.3
Most people who diet to an extreme will experience a strong drive to eat and a tendency to return to their previous body weight, Kaye said. In contrast, the eating patterns of individuals with anorexia are often puzzling. Although they are obsessed with food, they fear eating, particularly palatable foods, and can maintain an emaciated state.
For the fMRI study, 16 women who had recovered from restricting-type anorexia were compared with 16 control women. Researchers measured their brains’ reactions to pleasant taste (10% sucrose) and neutral taste (distilled water). Study subjects were also asked to rate their anxiety and the pleasantness of the taste stimuli. Compared with the control group, the women with remitted AN had a significantly lower neural activation of the insula, including the primary cortical taste region, and ventral and dorsal striatum to both sucrose and water. Insular neural activity correlated with pleasantness ratings for sucrose in the control group, but not in the recovered group.
The study results indicate that the “sensory hedonic aspect of food is altered in individuals with anorexia, so that they are just not getting the message they are hungry or are not driven to eat.” Such brain imaging studies, according to Kaye, will provide new insights into the pathophysiology of anorexia, which has the highest death rate of any psychiatric disorder (10%), and will ultimately facilitate development of more effective therapies.
“There are no proven pharmacological treatments for anorexia,” Kaye said. “Emerging evidence from controlled trials raises the possibility that some atypical antipsychotics may be useful for anorexia.5 It is not because people with anorexia are psychotic. Perhaps, atypicals may be helpful because of their effects on dopamine(Drug information on dopamine)rgic and serotonergic function in anorexia.” Larger controlled trials are needed to definitively prove whether atypicals are useful for treating anorexia.
There have also been a few controlled trials of fluoxetine(Drug information on fluoxetine) (Prozac) for anorexia, particularly in preventing relapse after weight recovery. Kaye said, “The findings are mixed, with one but not another study, suggesting this drug might be helpful for patients with anorexia after they recover. There is little evidence that SSRIs are useful in the emaciated state.”
Kaye and his team have developed a “treatment laboratory” to test new treatments for eating disorders, such as new medications. While inpatient or residential settings can be lifesaving, in terms of reversing malnutrition and providing weight restoration, Kaye noted that the relapse rate is very high after discharge. In order to improve outcome in adolescents with anorexia, Kaye has developed a unique intensive family treatment program.
“When a child suffers from this devastating illness, all members of the family, and the relationships between them, are profoundly affected. Some of the latest research points to potentially unprecedented levels of success when families become centrally involved in the treatment process,” Kaye said. “This program teaches parents the tools necessary to understand and successfully manage their child with anorexia at home. In addition, insights from neurobiological studies are used to teach adolescents with AN how to understand the symptoms that they are having and develop more effective coping strategies. Optimally, parents, the patient, and siblings take part in the program, which may last 1 week or longer, at UCSD. Since many families cannot find anorexia experts in their local communities, the program incorporates a number of treatment components, including medical and psychiatric evaluation as well as Maudsley-based family therapy, contracting, psychoeducation, and parent coaching.”
Because anorexia is a somewhat chronic disorder, at least in terms of personality and temperament traits, Kaye said, his team is helping people understand their personality and temperament traits and develop constructive coping strategies. “Many people who have recovered from anorexia [between 50% and 70% recover] do well in life, because some of the traits that got them into trouble can be beneficial, and even highly associated with achievement. . . . These are people who are high achievers, who are very focused and detail-oriented . . . do well in professions that reward those qualities, such as medicine, research, engineering, and academia.”