The Dopamine Dynamics of Eating Disorders

Dopamine is all around us. It’s in the girls bathroom at 1am when you’re deluged with the unmatched “I love your dress!” and “what’s your instagram?” combos. It’s on your phone screen when it lights up with a highly anticipated reply and in the first bite of a Lune Croissant you waited 20 minutes in line for. It’s the pathway to pleasure, deeply rooted in reward and reinforcement. Because if something makes you feel that good, you’re going to want to tap into it again, and again - right?

I never thought of dopamine in the context of eating disorders, presumably because I never associated them with a “feel-good” chemical. How could such a draining, isolating disorder be driven and maintained by the one certain thing that is scientifically proven to make us feel good?

In recovery, I think it is helpful to think of things on a molecular level sometimes. It can be a useful tool in recognising that you are not your thoughts, and certain behaviours are not reflective of you but of something much deeper and more complex. I also think it aids in removing the stigma.

While eating disorders such as anorexia nervosa have long been coined a “choice”, “attention seeking” or merely some sort of “fad diet” for petulant teenage girls, directing the attention back to the science almost legitimises the disorder in a way. Long-standing proof that the “choice” to not eat is rather partially entrenched in chemical imbalances, not a personal drive to be difficult.

A great study that explores the role dopamine plays in anorexia nervosa’s onset and maintenance is from Front Psychiatry, called The Rise and Fall of Dopamine: A Two-Stage Model of the Development and Entrenchment of Anorexia Nervosa. In this 2022 study, Jeff Beeler and Nesha Burghardt hypothesise that caloric restriction combined with excessive exercise triggers an escalating spiral of increasing dopamine within the brain. This increased dopamine offers sensations such as a sense of control, motivation and reward, acting as a catalyst to further caloric restriction and exercise whilst also facilitating the behavioural plasticity necessary to reinforce these behaviours.

The changes that occur in dopamine levels as a result of the eating disorder behaviours can send the individual down a slippery slope. Those struggling will often exhibit addict-like cognitions and behaviours that have them constantly chasing that initial “high” they got when they first lost weight or restricted their intake. They find themselves in a dangerous space where they are consumed by the false notion that they will be satisfied when they get to a certain weight - an ever-shifting landmark that will never provide them with the level of reward they are chasing.

The study also explores the similar patterns that exist between stimuli effective at releasing dopamine, such as drugs, and the restrictive eating patterns seen in anorexia nervosa, proposing that a similar reduction in dopamine function exists with chronic, repeated exposure. This means that as starvation persists, dopamine becomes impaired and behavioural plasticity decreases. The individual becomes increasingly inflexible and resistant to change, to the point their compulsion surrounding food and weight interferes with their daily activities and social relationships, not dissimilar to an addict.

We can’t change the chemicals our brain produces, but being aware of the patterns that increase and decrease their levels is valuable. Knowing that dopamine levels reduce with chronic repeated exposure to restrictive eating behaviours highlights the importance of early intervention for the treatment of eating disorders, before patterns become ingrained and rigidity in the individual is established. Look out for early warning signs in those around you, and if you feel like you may be at risk, don’t be afraid to seek professional help early. If the surrounding stigma is stopping you, let yourself rely on the science. You’re not going crazy, but your dopamine levels might be, and catching it early on will give you the best prospects of recovery.

By Emma Campbell