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Ke$ha goes to rehab: Eating disorders have many potential sources

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The Associated Press reports that Ke$ha (music performer and reality TV personality Kesha Rose Sebert) has checked into a rehabilitation facility for the treatment of an undisclosed eating disorder. The performer offers a short statement: "I'm a crusader for being yourself and loving yourself, but I've found it hard to practice." Although the Allentown Family Health Examiner has no inside information regarding Ms. Sebert's illness, recent scientific research sheds light on two schools of thought regarding the causes of eating disorders. It seems likely that a holistic approach to treatment is the optimal way to uncover the source of an individual's particular problem and remediate it.

The most common belief about an eating disorder such as anorexia or bulimia is that it is a problem with a psychological source: perhaps an inaccurate body-image, or a need to exercise control over some aspect of one's life. An article in the November 2013 issue of the Journal of Abnormal Psychology elaborates on different subtypes of anorexia nervosa, including "fat-phobic" and "non-fat-phobic." Research published in a German psychological journal indicates that the body image disturbance that often accompanies late adolescent and adult eating disorders is often not part of young adolescent eating disorders.

Psychological treatment of eating disorders focuses on trading unhealthy habits for healthy ones, such as monitoring one's own eating and moods and developing healthy ways to handle stressful situations. Psychologists Jim Harris and Ashton Steele argue that the "psychosocial" etiology of eating disorders should not be dismissed as treating physicians consider other sources of the problem.

What are these other sources? They are generally grouped under the heading of neurological chemical imbalances. Research to be published in the February 2014 issue of Current Psychiatry Reports asserts that dyfunction of the hypocretin system (a group of neurons in the hypothalamus and their associated neuropeptides) underlies eating disorders, schizophrenia, and addiction. An article published in the December 2013 issue of Eating and Weight Disorders contends that adiponectin, an adipokine (cell signaling protein secreted by fatty tissue), is responsible for modulation of the desire to eat, and that misregulation of this protein may be involved in eating disorders.

However, it is possible that a problem other than a psychosocial one or a neurological one underlies some individuals' unhealthy eating behaviors. Recent research published in Gastroenterology Research and Practice indicates that "celiac disease ... and not gastrointestinal-related symtoms or psychological factors may contribute to pathological eating behavior in celiac adults." The researchers report that eating disorders are more common in young women with celiac disease than in men with celiac disease or gastrointestinally healthy women. They mention hormones and carbohydrates as compounds possibly involved in the etiology of eating disorders in this segment of the population.

What about getting better? Certainly, identifying the source of the problem is crucial. However, the motivation of the patient to regain her health also plays an important role. In an article published in Eating Disorders, researchers note that the three most important factors in the recovery of female athletes from eating disorders may be "the desire to be healthy enough to perform in sport, support from others, and shifts in values / beliefs." These factors are likely important in the successful treatment of an eating disorder, regardless of the source of the problem.

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