The Impact of Eating Disorders on the Brain and Academic Performance

You don’t know what to do. You’ve never had to worry about your twelve-year-old son before. His school report cards consistently reflect his conscientiousness, situating him comfortably at the top of his classes. He demonstrates the same drive outside the classroom, where he’s established himself as a dependable scorer for the school’s soccer team.

But something’s been off lately, giving you a gnawing feeling in your gut. Your son seems to be regressing to the picky eating of his childhood. His palette is increasingly limited these days, and he alleges digestive problems when asked to gather with the family for dinner. He used to have a tight-knit group of friends, but recently has been declining birthday party invitations and isolating himself. His soccer coach has called you and suggested your son take a leave from the team—he fainted during this evening’s practice.

You know you need to act, but you’re facing pushback from your son. He meets your concerns with heightened defensiveness, firmly denying that anything is wrong. He’s doubling down on his already rigid study schedule, convinced that any disruptions will derail his high-achieving track. You understand that school can wait, but you’re struggling to get your son on board with taking the time for treatment. Is it possible his reaction and this resistance are related to his unusual food behaviors? You reason it would be easier for him to continue his top performance if he wasn’t battling these food issues, but you can’t be sure. You need guidance from those who have walked this path before—that’s where we come in.

The Neurobiology Of Eating Disorders

Eating disorders are serious, brain-based illnesses that emerge from a combination of sociocultural, psychological, and biological factors. While eating disorders can affect anyone, they are more likely to impact individuals with specific biological and psychological risk factors. This is why some people may engage in disordered eating behaviors—such as dieting, overeating, or restrictive eating—without developing a full-blown eating disorder.

Research shows that restrictive-type eating disorders, including anorexia nervosa, bulimia nervosa, and Avoidant/Restrictive Food Intake Disorder (ARFID), are consistently linked to perfectionism, obsessive-compulsiveness, rigidity, hypersensitivity, anxiousness, impulsiveness, sensitivity to reward and punishment, and competitiveness.

It’s important to note that what leads to an eating disorder doesn’t always maintain it. Genetics/neurobiology, experiences of trauma, and social influences (e.g., thinness ideal, weight teasing) can predispose some people to eating disorders. However, without precipitating factors (e.g., dieting, stressful life events, transitions) to trigger these risk factors, someone who is biologically susceptible might never go on to develop an eating disorder.

For instance, during puberty, some children with certain eating disorder-linked traits will undergo brain development, changing hormones, stress, and other biological factors, which, when they occur alongside a change in dietary intake and/or activity, can trigger the emergence of an eating disorder.

Driven adolescents who might normally pour their energy into their academic or athletic pursuits may suddenly turn their attention toward their eating habits as a way to manage the stressors of a changing body or school, feel productive, or cope with anxiety. This new way of eating and reacting to food, such as overeating, adopting rigid eating habits, or restricting food intake, can stick if perpetuated over time. Biological changes can occur due to these eating disorder behaviors, reinforcing brain patterns of rigidity, anxiety, and/or impulsivity.

The Eating Disorder Brain

The brain is one of the strongest mediators in developing and maintaining eating disorders. When a body is starving or malnourished, the brain becomes rewired in a different and more dominant way. These alterations in neurological function can give rise to a cycle of disordered patterns that may be challenging to break away from without appropriate treatment.

Unfortunately, the majority of existing studies covering the neurological impacts of eating disorders exclusively relate to more restrictive-type eating disorders such as anorexia. There is significantly less research on the physiological effects of other types of eating disorders, such as binge eating disorder. While there is still much to be learned, it is clear that each illness has negative impacts.

Research has found that eating disorders may cause the following:

• Abnormalities in neurotransmitter activity, particularly serotonin and dopamine, both of which play a role in mood regulation and can lead to dysfunctional appetite, mood, and impulse control
• Altered volumes of gray and white matter in the brain, which can result in impulsiveness, memory impairments, and a distorted perception of the body and self, along with intensified habit formation (as seen in the maintenance of one’s disordered eating habits)
• Insula dysfunction, causing skewed processing of taste sensations and emotions, a loss of sight of the “big picture” (e.g., trouble setting priorities), and decreased body physiologic awareness (the ability to sense one’s own bodily signals and evaluate cues, such as hunger, taste, and fullness)
• Increased activation of the amygdala, leading to an oversensitivity to real or perceived threats and keeping one on continuous high alert
• A dysregulated nucleus accumbens, which is linked to decreased enjoyment in life, less satisfaction with achievements (having to work harder to get the same reward effects), and decreased motivation, all of which may lead to depression, irritability, and isolation
• An affected frontal cortex (a key area for executive functions), seen in an inability to think flexibly and screen out intrusive thoughts, an increase in indecisiveness, and behavioral problems, “analysis paralysis,” and over or under-eating
• In individuals with anorexia: inhibited impulses and delayed gratification associated with the caudate nucleus, where thoughts and feelings can merge—this skewed response encourages a need for rules to guide behaviors
• Failure in the frontostriatal circuits that regulate behaviors, which can manifest as difficulty with inhibition control (e.g., substance abuse, shoplifting, and self-injury)
• A dysregulation of the parietal cortex, leading to impairment of visual memory and size/shape assessments, as well as an inability to accurately evaluate body size and an overemphasis on and distortions related to numbers

Implications For Academic Performance

It should be clear that the scope and severity of changes in brain chemistry that can occur with starvation, bingeing, purging, and/or other eating disorder behaviors must be taken seriously.

While the eating disorder genetic traits of perfectionism, competitiveness, and a heightened sense of self-responsibility have long been linked with high achievement, poor nutrition to the brain can greatly hamper success, both within and outside of the classroom. A study found that individuals with eating disorders did not report significantly higher grade point averages (GPA) unless they received specialized treatment.

As outlined in the previous section, malnutrition is correlated with cognitive and linguistic deficiencies, which can greatly curtail academic success. Students with eating disorders face massive brain-based disruptions and challenges to their learning, including:

• An inability to concentrate
• Poor decision making
• Brain fog
• Delayed processing
• An increase in black-and-white thinking
• Poor task prioritization
• Impaired mood regulation
• A lack of motivation
• Difficulty switching tasks
• Suspended brain development

Even for those who appear to be doing well in school amidst their diagnosis, academic achievement is not a reliable indicator of the severity of an eating disorder. Your child can be very unwell and still strive for perfection at school. In fact, some ill students may even credit their academic success to their eating disorder.

Remember that a starved or malnourished brain cannot accurately gauge the seriousness of its own condition. It’s helpful to keep this in mind when facing denial or resistance from your child about their behaviors.

Treatment Can’t Afford To Wait

Without prompt and sufficient treatment, the consequences of malnutrition on the brain and body can be irreversible. Fortunately, various studies have shown that brain matter, volume, and neurotransmitter pathways return to normal in most patients during recovery. Committing to recovery can reverse many of the damages associated with these illnesses, including curbing the detrimental effects on academic functioning. Still, some research indicates that the degree of brain shrinkage correlates with the duration of illness, which is one more reason why early treatment is so vital.

Secure the best possible outcome for your child by not delaying care. Connecting with specialized, multidisciplinary care can help your child shift their disordered patterns of behavior and thinking before they become too deeply entrenched.

The disruption of treatment pales in comparison to the high mental, psychological, and physical costs of a misfiring brain. A healthy brain can get your child back to what matters most to them—academics-related and far beyond.

An eating disorder’s impacts on the brain are serious and far-reaching, but they don’t have to be permanent. If your child is showing signs of an eating disorder, please reach out to The Emily Program today. Complete our online form or call us at 1-866-396-2903 to get your child started on the path of recovery.

Jillian Lampert, PhD, MPH, RD, LD, FAED (she/her) is the Vice President of Communications and Brand for Accanto Health, the parent company of The Emily Program and Gather Behavioral Health. Dr. Lampert completed her doctorate degree in Nutrition and Epidemiology and Master of Public Health degree in Public Health Nutrition at the University of Minnesota. She earned a Master of Science degree in Nutrition at the University of Vermont and completed her dietetic internship at the University of Minnesota Hospital and Clinics. She has an expansive range of policy, clinical, research, education, teaching, and program development experience in the area of eating disorders. For more information about The Emily Program, please visit emilyprogram.com.