Table Of Content2
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Decoding Anorexia
Decoding Anorexia is the first and only book to explain anorexia nervosa from a biological point of view. Its
clear, user-friendly descriptions of the genetics and neuroscience behind the disorder are paired with first
person descriptions and personal narratives of what biological differences mean to sufferers. Author Carrie
Arnold, a trained scientist, science writer, and past sufferer of anorexia, speaks with clinicians, researchers,
parents, other family members, and sufferers about the factors that make one vulnerable to anorexia, the
neurochemistry behind the call of starvation, and why it’s so hard to leave anorexia behind. She also addresses:
How environment is still important and influences behaviors
The characteristics of people at high risk for developing anorexia nervosa
Why anorexics find starvation “rewarding”
Why denial is such a salient feature, and how sufferers can overcome it
Carrie also includes interviews with key figures in the field who explain their work and how it contributes to
our understanding of anorexia. Long thought to be a psychosocial disease of fickle teens, this book alters the
way anorexia is understood and treated and gives patients, their doctors, and their family members hope.
Carrie Arnold is a freelance science writer and blogs daily at EDBites.com. She is an advisor to the advocacy
organization FEAST (Families Empowered And Supporting the Treatment of Eating Disorders) and
regularly appears at national and international eating disorder conferences.
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Decoding Anorexia
How Breakthroughs in Science Offer Hope for Eating Disorders
Carrie Arnold
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First published 2013
by Routledge
711 Third Avenue, New York, NY 10017
Simultaneously published in the UK
by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2013 Taylor & Francis
The right of Carrie Arnold to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other
means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation
without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Arnold, Carrie, 1980–Decoding anorexia : how breakthroughs in science offer hope
for eating disorders / Carrie Arnold. p. cm. Includes bibliographical references and index.
ISBN 978–0–415–89866–9 (hardback) – ISBN 978–0–415–89867–6 (paperback)
1. Anorexia nervosa. 2. Eating disorders–Psychological aspects. I. Title.
RC552.A5A75 2012616.85’262–dc23
2012015294
ISBN: 978–0–415–89866–9 (hbk)
ISBN: 978–0–415–89867–6 (pbk)
ISBN: 978–0–203–08817–3 (ebk)
Typeset in Minion
by Swales & Willis Ltd, Exeter, Devon
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To Stephanie Milstein, Ph.D.
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Contents
Foreword
CYNTHIA M. BULIK
Introduction: Off the Couch and Into the Brain
1 From Starving Saints to Dieting Divas
2 Interoception and the Insula
3 Climbing the Family Tree
4 Anorexia’s Poster Children
5 When Anorexia Brings Friends
6 Starvation Becomes Obsession
7 Adapted to Flee Famine
8 Gym Rats
9 Stepping Up to the (Dinner) Plate
10 Oops, I Did It Again …
11 Standing at the Buffet of Life
References
Index
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Foreword
My first thought when I heard the title “Decoding Anorexia” was “What a great title!” Anorexia nervosa is
such an enigma—to clinicians, researchers, parents, partners, and sufferers themselves. If only we had a
decoder ring or an Enigma machine to decrypt the mysterious language of anorexia nervosa that can perplex
us all.
Carrie Arnold has provided us with a masterful code cracker that triangulates three perspectives in a unique
way. As someone who has suffered from anorexia nervosa, as a trained scientist, and as a science writer, Carrie
brings together her three perspectives to present a digestible chronicle of anorexia nervosa from the inside out,
emphasizing the biological perspective.
When some readers see the term “biology” they may think about running for the hills; but don’t! Carrie
provides us with a clear and user-friendly description of all facets of the biology of anorexia nervosa, from
genetics to neurobiology. She then pairs the biological explanations with her own, rich, first-person
description of what those biological differences feel like to someone with the disorder. She also weaves in the
personal narratives of several women and men who have either survived or succumbed to the illness. Finally,
she incorporates rich interviews with many of the key figures in the field. But these are not canned interviews.
Sometimes speaking to doctors and researchers can be supremely frustrating. You want to just stop them,
rewind, or take some sort of Rosetta Stone course to be able to translate what they are saying. In her
inimitable way, Carrie got them to talk in real terms, offering rich analogies, telling stories, and providing
vivid illustrations of the work they do and how it contributes to our collective understanding of anorexia
nervosa. Whether she’s talking to Walter Kaye about neuroimaging, to me about genetics, to Jim Lock about
set-shifting, or Kelly Klump about hormones—reading her capture of the scientists’ words is like having them
all sit around in your living room talking to your grandparents, in terms they can understand, about the
science of anorexia nervosa.
Decoding Anorexia doesn’t shy away from the difficult topics and it does not sugar-coat the reality that is
anorexia nervosa. Carrie takes on the complicated topics, such as what is recovery, psychiatric commitment,
and the fact that there might be something different about the brains of individuals with anorexia nervosa that
influences how they experience starvation.
Her anthropomorphizing of brain parts provides a clever mnemonic to understand how different parts of
the brain work together to do something as simple as choosing what to eat. She illustrates the total breakdown
of the orchestra when the conductor is too hungry to lead the various brain sections in their respective roles in
that decision-making process.
Carrie’s frank accounts of her own relapses serve as warnings to others about how treacherous the food
deprivation and excessive exercise trap can be and how you can slip back into destructive patterns before you
are even aware of what is happening.
Most importantly, Carrie underscores in so many ways the critical role that anxiety plays in vulnerability to
anorexia nervosa. Well over half of individuals with anorexia nervosa suffer from anxiety disorders and, of
those who do, the majority report that the anxiety disorder predated the eating disorder, suggesting (and
vividly illustrated in Decoding Anorexia) that anxiety is a pathway into the disorder … and finding alternative
ways to manage anxiety is a pathway out.
In the end, Carrie offers hope. Understanding biological differences and how hard-wiring might make your
experience of the world different from others’ provides a comforting explanatory model for many individuals
with anorexia and their families who have struggled to decode this perplexing illness.
If you happen to be a little biology-phobic, take the book one chapter at a time. But in so doing allow
Carrie to enlighten you about the biology, take time to integrate what she discusses into your own experience
of the world, and benefit from her ability to expertly unite her three unique traits as a sufferer, a scientist, and
a writer to provide one of the more lucid descriptions of the experience of anorexia nervosa ever chronicled.
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Once you are done, you too will have cracked the anorexia code and have greater compassion for yourself or
for someone you care about who has the disorder.
Cynthia M. Bulik, Ph.D., FAED
Director, University of North Carolina Eating Disorders Program
Author of The Woman in the Mirror: How to Stop
Confusing What You Look Like with Who You Are
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