A new study that received national media coverage uses brain scans to interpret the underlying intention of eating disorder behavior. The researchers' conclusion seems reasonable based on the limited scientific data and on corresponding clinical information: eating disorder symptoms are habit rather than willpower.
The current societal bent towards describing eating patterns as willpower stems from persuasive marketing by the diet and food industry for decades. Rather than understand the complex, innate nature of hunger and fullness, these industries surround us all with irresistible goodies and then perpetually blame us for not resisting them, thereby increasing profit.
This mistaken understanding bleeds over into the general public's concept of eating disorders with two mistaken ideas: restricting food is about willpower and these people suffering from eating disorder are not sick but have actually mastered the ability to resist hunger.
Nothing is further from the truth.
Clinicians who treat people with eating disorders will not find anything ground breaking in this study. It is the clever translation of accepted clinical knowledge into a simple research study, namely that the thought and behavior patterns of an eating disorder are habit.
This core knowledge does inform the treatment and recovery from an eating disorder. Simply educating a person about the risks of an eating disorder and explaining the health benefits of normal eating never influence recovery. Neither of these facts can change a habit.
Two aspects of recovery are necessary to put into place a process that will change ingrained habits. That process is slow and arduous but, with consistent practice, will lead to new habit formation.
The first step is accountability. Someone else other than the person with the eating disorder needs to be aware of the day-to-day events around food. Habits are by definition largely unconscious behaviors. If there is minimal conscious thought about the habit, the behaviors will not change. Accountability forces the person to pay conscious attention and make an active decision to continue the behaviors or not, thereby addressing the conflict around continuing the habit and recognizing the consequences. This conscious experience already starts to break the circuit in the brain reinforcing the habitual behavior by inserting debate over whether or not to engage.
The second component of treatment is behavior replacement. If there is no thought process or new behavior to change the habit, then there is no way anyone can resist doing the same thing every day. In terms of brain science, this means reinforcing a new brain circuit will weaken the old one.
The combination of a conscious decision to choose the habit combined with an alternative behavior that feels within their grasp gives the person with an eating disorder a reasonable chance each day to learn a new habit.
The media coverage that eating disorders have nothing to do with willpower is important and necessary. This information already informs a large part of successful eating disorder treatment and gives the clinical community an opportunity to educate the public about this growing problem in our society.