Can Hormones Cause Anorexia?

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Eating disorders are one of the highest profile psychiatric diseases—the Internet is constantly abuzz with speculation about which celebrity has one this week—but also one of the least understood. Laura Holsen, a psychologist at Brigham and Women’s Hospital, is doing research that could help to change that.

Holsen, in collaboration with Elizabeth Lawson, a member of the Massachusetts General Hospital neuroendocrine unit, is doing research into the connection between hormones, hunger, and anorexia nervosa, a complicated but potentially groundbreaking area of study for eating disorders. Holsen and Lawson are focusing their research on two hormones linked to appetite: ghrelin and oxytocin. “Ghrelin is an appetite regulatory hormone which increases in healthy people in response to hunger,” Holsen explains, adding that it helps us know and prepare for when it’s time to eat. “Oxytocin is typically thought of actually as kind of a bonding or social hormone, but it has also been shown in a few studies to be related to appetite.”

So the question is, what goes wrong with these hormones in women who have anorexia? It’s complicated. “In women with anorexia, ghrelin levels are actually paradoxically high,” Holsen says. “It’s possible that they have ghrelin receptor defects or that there’s just some resistance to ghrelin being able to activate the cellular processes that lead to food intake.”

Holsen says the research about oxytocin is less concrete than that for ghrelin, but she says it’s likely that women with anorexia have lower levels of oxytocin than healthy people, which leads to an inhibited appetite. In short, anorexia sufferers have different hormone and brain activity than people in healthy control groups, leading to the difficult-to-answer question of whether hormone levels cause eating disorders.

While Holsen’s research is helping to shed light on anorexia, which she calls “one of the more difficult disorders to treat,” the road to full understanding is long. Holsen says the next step is understanding what these hormone levels indicate about receptors in the brain, and from there figuring out which medications will target those receptors. And while she is quick to point out that the research “might not be immediately translatable into benefits,” it’s important not just for people suffering from anorexia, but for an ever-growing part of the population: the overweight and obese.

Disrupted appetite hormone levels are also likely to blame for the kind of habitual overeating that leads to obesity, she says. “People who are generally overweight or obese, they have slightly different levels of these hormones,” she says. “The factors that lead to that [overeating] are very complex in any given individual. Hormones are part of that and we’re trying to understand that, but it takes a while.”