The other day a young patient of mine asked me “which is more important: psychological remission or physical remission?”  Of course she was asking because she wanted to know how she could get out of the DTU most quickly, but it was a good question nonetheless.

Which is more important?  Well, let’s see…which is more important: breathing or heart beating?  Yes, it’s just like that.  There is no psychological remission without physical remission.  That’s been tried.  In fact, we spent most of the 20th century treating patients as if their psychological issues could be treated in the absence of adequate weight restoration.  Therapists and doctors claimed that a patient could not get better “until they were ready” or until they “bought into their treatment”.  And so many patients were allowed to remain in a limbo of under-nutrition and all of its consequences inlcuding lack of menstruation with subsequent poor cognition and weak bones.  

At an AED conference a few years ago Debra Katzman of the University of Toronto presented some of her work showing that amenorrhea (lack of periods) had a greater impact on cognition (intellectual ability, mental processing) than low weight itself.

Clearly if one is cognitively impaired there can be no psychological recovery/remission.  And this deficit will impact not only general clear thinking and coping with stress and the demands of life, but school performance, career success and interpersonal relationships.

While reading around in Pubmed on the subject of hormonal effects on cognition (thinking) I came across a study of female patients with MS and the effects of estrogen and estrogen withdrawal on their cognition.  As an explanation for why estrogen can affect thinking and processing, an article called Estrogen’s impact on cognitive function in multiple sclerosis in the International Journal of Neuroscience, discussed the fact that  “Serotonin (5-HT) mechanisms have been implicated in memory functions and estrogens modulate these functions through an interaction with 5-HT2 receptors in the cerebral cortex and limbic system. It is suggested that estrogen withdrawal induces impairment in cognitive functions through dysregulation of 5-HT2 receptor activity and 5-HT neurotransmission.”

So, no weight restoration, no periods.  No periods, no brain recovery.  

Which is more important, physical or psychological restoration?  You be the judge.