The last post provides an explanation to the neuroscience of an addiction to energy deficit (or a restrictive eating disorder) using a 'deep learning' model. The deep learning model gives us an understanding of what's happening to the wiring of the brain when someone forms an addiction and overcomes one. As well as understanding the deep learning model, it's also important to consider what's happening to the brain's dopamine levels with an addiction.
Addictions affect the brain’s dopamine balance and it's this that drives the urges to pursue a behaviour or substance, even when the drug being pursued no longer brings pleasure. Changes to the brain’s dopamine balance in someone with an addiction can help to explain why addictive disorders (including eating disorders) are so difficult to overcome.
Dopamine is a key brain chemical involved in motivation and the experience of pleasure and reward. The more dopamine released in response to a substance or behaviour—and the faster it's released—the higher the likelihood that it will lead to an addiction. With the restrictive eating disorder it's likely that you experienced a high surge in dopamine release when you initially engaged in restriction, exercise or other behaviours that created a significant enough state of energy deficit. This dopamine surge quickly led to the addictive nature of the disorder.
Dopamine is released in everyone’s brain to maintain a level baseline at all times. Your brain becomes sensitive to this baseline point and any change gives it important information. An increase in dopamine feels pleasurable and is reinforcing to your brain, creating an urge to pursue whatever caused the increase. A drop in dopamine from baseline creates feelings that are unpleasant, such as anxiety or low mood. This change in how you feel tells your brain to push you to change your current circumstances and seek more dopamine.
The Dopamine SeeSaw
An addiction expert, Dr Anna Lembke, describes dopamine in the brain as being on a seesaw or a balance. If the balance tips in one direction, you experience pleasure, and if it tips the other way, you experience pain. Ultimately, your brain wants to keep the balance level and will do what it can to achieve this.
When the balance of dopamine tips to the pleasure side, your brain will attempt to re-establish balance by reducing dopamine release BUT instead of just returning the dopamine level to baseline so that it's at a stable balance again, your brain will first drop dopamine levels below baseline. This below-baseline drop in dopamine after a pleasurable experience creates the sensation of coming down after a high and feelings of emotional pain or discomfort. These feelings will create an urge to repeat the behaviour to get dopamine levels back up and feel good again. If you wait long enough, dopamine levels will return to normal of their own accord. However, it’s this seesaw dopamine effect that drives people to continue to pursue rewarding behaviours, not just for the rewards they bring but because not doing so becomes uncomfortable.
Using this dopamine seesaw analogy, the important thing to understand is that what goes up will eventually come down to the same degree of change from baseline.
If you continue to bombard your reward system with more dopamine by continuing to pursue dopamine-releasing behaviours, the pleasure side on your dopamine seesaw will go ever higher. However, this also means that the pain side of your dopamine seesaw is becoming more heavily weighted down when you are not in pursuit of the behaviour. Over time, this results in the need to engage in ever-increasing dopamine-releasing behaviours to just feel normal. This is why people with addictions, over time, need to engage in their drug (or behaviours) at higher levels, in different forms or with more intensity to simply experience a feeling of normality, let alone pleasure.
An Addicted Brain & the Dopamine Balance
An addicted brain has developed a chronically tilted pleasure-pain dopamine balance to the pain side because of the ongoing pursuit of the addictive drug. This can also be considered as being in a dopamine deficit state. When this occurs, the ability to experience pleasure or joy in life is diminished. Someone with an addiction will have a reduced ability to enjoy pleasure either from pursuing their drug or from any other usually pleasurable pursuits in life, and they will have a high state of inner pain.
With a chronically tilted dopamine seesaw to the pain side, someone with an addictive disorder will experience an ongoing sense of inner pain whenever they are not using. They will also need to engage in higher levels or more intense forms of the drug, not for reward but just to feel normal.
At this point, whenever they are not engaging in their drug, they will experience all the common symptoms of withdrawal, such as agitation, anxiety, irritability, insomnia, depression and intrusive thoughts of needing to use. These symptoms can also be described as cravings, which drive them back to the drug because the dopamine deficit created whenever they are not engaging in it results in such excruciating inner pain.
Applying the Dopamine Balance Model to Eating Disorders
As a result of the restrictive eating disorder, your brain will be in a chronic dopamine deficit state. This means the dopamine balance in your brain is tilted to the side of pain whenever you are not engaged in the pursuit of your drug, i.e., energy deficit.
When you first developed the eating disorder, engaging in the behaviours that created energy deficit—such as restriction, exercise, purging or other compensatory methods—felt good. In fact, the initial surge in dopamine probably made you feel amazing. When you were not engaging in those behaviours, your dopamine initially just tipped below baseline, making you feel a little uncomfortable and giving you a push to pursue them again. As this cycle went on and you engaged in increasing levels of behaviours that pushed your dopamine seesaw to the pleasure side, the pain side of the dopamine balance in your brain was becoming more heavily weighted down. This means that now, whenever you are not engaging in the disordered behaviours, you feel anxious, depressed and agitated.
Over time, the disordered behaviours very likely lost a lot of their pleasurable effects, but you continue to engage in them because not doing so leaves you with inner pain, anxiety and low mood. On the flip side, pursuing the eating disorder behaviours is the only way to bring your dopamine balance to a point that allows you to feel some sense of inner calm or numbness. It's also likely that you have lost your ability to experience enjoyment from other things in life that were once pleasurable.
Restoring Dopamine Balance
The good news is that your dopamine balance can be reset. The bad news is that as you go through this process, you will have to tolerate a period of feeling the effects of dopamine deficit, such as high anxiety, depression and agitation.
If you do stop the pursuit of energy deficit and all the behaviours that lead to or maintain this, your dopamine levels will initially drop to the deficit state they are currently in. This will feel horrible, but if you continue to abstain and not push on the pleasure side of the seesaw by going back to restriction or compensatory behaviours, then your brain will slowly and naturally restore your baseline dopamine level to the point of equilibrium. When this happens, you will feel calm and stable and get the sense that the real you is returning without needing to use the eating disorder behaviours to achieve this. You will also find yourself able to experience pleasure from the small things in life again.
This is what's called a dopamine reset.
The best way to achieve a dopamine reset is to abstain from the addictive drug long enough to allow dopamine levels to completely restore and rebalance. Of course, this initial period of abstinence, creating a vast dopamine deficit, is going to be very painful. When you go through it you need to be prepared for some very challenging emotions, as well as mental and physical symptoms and seek support to help you cope.
Bringing It All Together
When you have any addictive disorder, including a restrictive eating disorder and addiction to energy deficit, your brain has two significant processes that are driving the addiction:
1. The changes to your brain's wiring and the deep learning it has been through to form the addictive habits and compulsions so they now occur automatically and you have a reduced ability to apply rational thought to override them.
2. Your dopamine system and the intense emotions, cravings and withdrawal symptoms it will create to push you back into engaging in those soothing and numbing behaviours.
Both these processes can be fully overcome as you reprogram your brain to emerge from the eating disorder, but it goes without saying, the journey to do this will not be at all easy.
**The information here is taken from my newly available book, 'Addicted to Energy Deficit - A Neuroscience Based Guide to Restrictive Eating Disorders' which you can buy now!**
If you like to listen, as well as (or instead of read!) then this blog post is the transcript of a podcast episode which you will find on my podcast series,
available on this website, all mainstream podcast platforms and on YouTube!