Practical Neurobiology for Clinicians: Eating Disorder Diagnoses & Neurology – Part VI

environmental factors of Eating Disorders

When looking at individuals with bulimia, there is more dopamine drive in this reward chemical.

As such, you can’t only focus on eating.

You have to also watch for drug and alcohol or sexual addiction, shoplifting, or gambling.

These individuals just want to feel better as soon as possible.

As such, I treat a lot of these patients with an oversensitive dopamine reward system from an addiction model, asking questions such as:

  • Are you sober?
  • Are you finding other ways to take care of your anxiety that’s not going to make things worse in the long-run?
  • Are you eating a regular meal plan?
  • Are you taking care of yourself or your anxiety without making your self-esteem feel worse?

These aspects become really important to understand that their brains are very sensitive to rewards and to try to catch that and use it in positive ways.

Again, then we look at the environmental factors of eating disorders. Some of these are similar to anorexia, such as hormones, puberty, and stress. Finally, looking at the state of the disorder.

In one study that I was involved in, we looked at the middle of the brain, the dorsal mid-insula. We know that, when you ask an individual with depression about their heart rate, stomach, or bladder, it doesn’t work, putting them at higher risk.

In individuals with anorexia, there is higher sensitivity to their stomach than anything else. When we ask these individuals to think about something other than food, such as home, family, friends and then academics and stressors, the same part of the brain lights up.

It seems these individuals anxiety is being misinterpreted through their stomach about fullness and avoidance and causes an underlying problem that makes it harder for them to eat.

This can help us to understand how emotions and physical experiences of the body are related due to brain activity such as getting butterflies when excited or throwing up when nervous.

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For all of this information, it appears the insula is the end-all-be-all area to provide us with information on anorexia.

If we can continue this work to understand how the circuits work and don’t work, we can start to roadmap how these connections result in symptoms around eating anxiety, body image, etc.

Please See

Practical Neurobiology for Clinicians: Eating Disorder Diagnoses & Neurology – Part I
Practical Neurobiology for Clinicians: Eating Disorder Diagnoses & Neurology – Part II
Practical Neurobiology for Clinicians: Eating Disorder Diagnoses & Neurology – Part III
Practical Neurobiology for Clinicians: Eating Disorder Diagnoses & Neurology – Part IV
Practical Neurobiology for Clinicians: Eating Disorder Diagnoses & Neurology – Part V


Virtual Presentation by Scott E. Moseman, M.D., CEDS in the December 8, 2018, Eating Disorder Hope Virtual Conference III: Blasting Through Bias: A Deep Dive into Underserved Populations and Global Issues 2018

Please visit the Virtual Conference page for other presentations.


Scott Moseman MD PhotoScott E. Moseman, M.D., CEDS, has worked with the Laureate Eating Disorders Program since completing his child psychiatry training in 2004, and he currently serves as medical director of the program. He is a board-certified child and adolescent psychiatrist who received his fellowship training at Western Psychiatric Institute and Clinic in Pittsburg, Pennsylvania, where he served as chief fellow.

Dr. Moseman received his medical training from Texas A&M Health Science Center and completed his adult psychiatric training at the University of Arizona. He has spoken throughout the country on topics related to child psychiatry, and he has specific interests in eating, mood and anxiety disorders. Currently, Dr. Moseman is collaborating with Kyle Simmons, Ph.D., at the Laureate Institute for Brain Research to study neural circuits associated with eating disorders using the facility’s state-of-the-art fMRI.

Dr. Moseman has sat on the board for the American Academy of Child and Adolescent Psychiatry as well as co-chaired the special interest group on child and adolescent care for the Academy for Eating Disorders. He currently sits on the board for the Oklahoma Eating Disorders Association.
Editor: Margot Rittenhouse, MS, NCC, PLPC. Learn More About Dr. Scott E. Moseman

Image of Margot Rittenhouse.About the Transcript Editor: Margot Rittenhouse, MS, NCC, PLPC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on January 28, 2019.
Reviewed & Approved on January 28, 2019, by Jacquelyn Ekern MS, LPC

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About Baxter Ekern

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