The “Connection Error” Between Eating Disorder Science and Eating Disorder Science Reporting

This week, my inbox and Twitter feed were flooded with updates about a newly-found “connection error” in the brains of women with anorexia nervosa. These are some examples of the articles and their titles:

‘Connection Error’ in Brains of Anorexics

Do Anorexic Brains contain Connection Errors?

Anorexic women misjudge their body shape due to a ‘connection error‘ in the brain

The research itself is fascinating. It is always bewildering when people with anorexia insist that their body is huge, even in the face of overwhelming contradictory evidence (their small clothing size, the low number on the scale). How can their perception of their body size clash so dramatically from your perception of their body size?  The researchers (Boris Suchan, Denise Soria Bauser, Martin Busch, Dietmar Schulte, Dietrich Grönemeyer, Stephan Herpertzd, Silja Vockse) thought that women with anorexia might have different connections between brain areas devoted to analyzing images of human bodies.

They set out to answer this question by using two tools: (1) functional magnetic resonance imaging (fMRI), which scans brains and measures which areas of the brain are activated, and (2) dynamic causal modeling, a statistical model that allowed them to estimate the connections between brain areas that are activated. Essentially, dynamic causal modeling estimates how much two brain areas “talk to each other” during a task. The researchers showed women with and without anorexia pictures of bodies while in the fMRI scanner, and they discovered two really interesting things. First, they found that the brain area devoted to identifying visual stimuli as a human body (the extrastriate body area) and a brain area involved in processing whole body forms (the fusiform body area) “talked to each other” in a different way in women with anorexia. Second, they found that the greater the difference between how a woman with anorexia perceived her size and her actual size, the less strong the connection was between these two areas (the extrastriate and the fusiform body areas). The more she thought her body was huge when it actually was quite small, the worse the connection was between these brain areas.

Let’s get back to how this study was described in the media. The main words that appear over and over again are “anorexics” and “connection error.”   But at no point do the words “anorexics” and “connection error” appear in the original scientific article. Those words would never pass through the peer review process that all scientific articles go through (and for good reason)!  Using words like anorexics to describe any person with anorexia is stigmatizing: it conflates a person with their disease. We don’t refer to patients with cancer as cancers or people with heart disease as the heart diseased. See what I mean?  Moreover, “connection error” doesn’t accurately describe the results of the study. It’s not that these body processing brain areas weren’t connected. They were just connected in different ways, and the strength of the connection was smaller. However, I don’t imagine a press release with the title, “Women with anorexia misjudge their body size because the connection between their body processing areas aren’t as strong” would garner as many hits online. Headlines with a lot of punch generate lots of curiosity, but the science often gets misreported or watered down in the process.

I wonder whether the push towards open access science publishing will improve the quality and accuracy of these articles. Right now, if you wanted to read the scientific article, you would have to pay $42 to buy it or find someone with access through his or her university affiliation. In the future, with more open access journals, anyone with an internet connection would be able to access the original text. However, until then, the vast majority of readers will rely on press releases and the subsequent articles that repackage the press release to learn more about new studies of eating disorders. This places an even higher burden on popular press articles to avoid eating disorder stigma and portray scientific results accurately.

By: Dr. Stephanie Zerwas