What if Anorexia Nervosa could be Diagnosed with a Blood Test?
What would it be like if we could add a blood test to our evaluation of a patient with anorexia nervosa? This might sound an outlandish question but recent published research on schizophrenia, another severe mental illness (i.e. brain disorder) suggests that this may not be far off.
Groundbreaking work led by Sabine Bahn, MD, director of the Cambridge Institute of Psychiatric Research at the University of Cambridge, as reported in Chemical & Engineering News up to 40% of changes that occur in the brains of schizophrenic patients also occur in other body parts. Scientists are studying biomarkers in the skin, immune cells, and serum to find samples that give a real-time picture of the disease in a patient. Previously, studies of schizophrenia have focused mainly on examining potential biomarkers in brain tissue harvested at autopsy.
So what exactly is the implication for diagnosis and treatment of anorexia nervosa?
Well, as regular readers of this blog will surely know, anorexia nervosa, like schizophrenia, is a brain disorder. And this isn’t just an opinion; it’s the official statement of the National Institute of Mental Health (NIMH), whose director, Dr Thomas Insel, stated as early as 2006, anorexia nervosa to be “a brain disease with severe metabolic effects on the entire body. While the symptoms are behavioral this illness has a biological core, with genetic components, changes in brain activity and neural pathways currently under study.”
Because anorexia is also a brain disorder, a diagnostic test (with the patient still alive, thank you!) clearly would revolutionize eating disorder treatment. It would change everything: suddenly anorexia could be treated with the respect and awe this life-threatening illness deserves. Perhaps most crucially it would allow us to move away from anorexia being “a mere professional opinion” to a diagnosis that could be (independently) substantiated in the laboratory. It would enable providers to identify early cases and improve treatment before the illness had a chance to ravage a person’s brain and destroy their social/familial/professional life. Ultimately, anorexia nervosa would be added to the list of rare but severe human ailments, rather than as something that wealthy, Western, "self-involved" women and girls choose as a way of “dealing with life.”
So are there persons and organizations who may be resistant to the implications of this scientific research? Sure. I imagine those who make a living addressing this illness as a “life-style choice,” a “control issue,” etc., would feel the scientific ground shift beneath them disconcertingly.
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This is VERY exciting, indeed!
Not only would this revolutionize eating disorder treatment from the perspective of how the medical community handles this disease, it would also revolutionize the way those with anorexia perceive their illness. While a blood test certainly wouldn't take away the agonizing body image dysmorphia or "delusions" of this disease, it would provide quantitative evidence (aside from a number on a scale which we all know is no evidence of illness to someone with anorexia) that would make it much harder to deny or refute the diagnosis. I think that those with anorexia will be more apt to allow themselves to accept the diagnosis if they are not able to dismiss the diagnosis as merely "opinion".
CT
In my own experience, I wasted several valuable weeks (months, maybe even years) of treatment in denial that I even had an actual, true, without-a-doubt case of anorexia. Surely there was a misdiagnosis made, I told myself. I couldn't (or wouldn't) believe that I was "sick enough" to have the disease. The first time I was in the hospital I caught myself thinking that the other children had "real diseases" and that I was somehow the victim of a bad opinion (sorry Dr. OT). Even after accepting my diagnosis, going through treatment wholeheartedly, and living in remission, I still sometimes have a "voice" in the back of my mind that on occasion wonders if it was all some big medical error. This is ludicrous, I know that logically. I can shake myself into reality now and realize that I'm just having what I like to call "an anorexic brain trick episode".
I imagine that had someone showed me some lab results (such as in the case of diagnosing cancer or diabetes), I would have spent much less time trying to trick myself and everyone around me into believing that I had been wrongly diagnosed.
I can't wait to see how this research advances!
I really appreciated what you had to say about denial. I am a parent of an anorexic and I find myself denying her problem as well. As you put it -- she isn't as bad off as others, she doesn't have a "real disease", that she isn't sick -- just stubborn:) It has been very hard for me as a parent having these thoughts, I can't imagine what it's like for you kiddo's. My thanks to those that study the cause, symptoms, and treatments of anorexia and mental issues in general. It would be easier to believe if we had the PROOF! (blood test or whatever is needed!)
Amen to that!