Emphasizing that anorexia is a material and biological disease caused by the disruption of the brain’s body image networks, Prof. Nevzat Tarhan stated, “This condition is not merely psychological but neuropsychological. In the past, it was believed that individuals could recover if they wanted to. However, recent brain studies reveal that the neural networks of these individuals are impaired.”
Noting that the fear of gaining weight essentially blocks the individual’s brain, Prof. Tarhan said, “The mortality rate in anorexia is high: 15 out of every 100 cases result in death. I have seen many patients who dropped to 29 kilograms, lost all hormonal balance, but recovered completely with appropriate treatment.”
Pointing out that the previous belief was “if the person wants treatment, they can be treated; if not, they can’t,” Prof. Tarhan added, “In cases such as anorexia, refusing treatment is actually a passive suicide behavior. Therefore, compulsory treatment must be applied. If necessary, the process of hospitalization by court order should be initiated.”
President of Üsküdar University and Psychiatrist Prof. Nevzat Tarhan discussed the topic of eating disorders and anorexia nervosa in depth.
Anorexia nervosa is not a simple obsession with thinness
Stating that anorexia nervosa is not a mere obsession with losing weight but a serious neuropsychiatric disorder that distorts body perception and carries a 15% mortality rate, Tarhan said, “There is a global increase in anorexia cases, and this rise is clearly observed in Türkiye as well. Anorexia nervosa is not only an eating disorder but also a neuropsychiatric illness. A person who has fallen to 29 kilograms may perceive themselves as weighing 150 kilograms due to the tricks played by their brain. At this point, advice is of no use, this is a passive suicide, and compulsory treatment is necessary.”
Highlighting that anorexia, often misunderstood in society as “attention-seeking” or “showing off,” is actually a biological and neurological disorder caused by disruptions in the brain networks related to body image, Tarhan said, “This condition is not merely psychological but neuropsychological. In the past, it was believed that these individuals could recover if they wanted to, but recent brain research shows that their neural networks are impaired. Today, with brain mapping methods such as SW-LORETA, we can compare the functional areas of a person’s brain with eating disorder databases. These mappings clearly reveal the impairments. Showing patients their brain images also makes it easier for them to accept treatment.”
The illness often begins as a simple eating disorder
Explaining that the illness often starts as a simple eating disorder, Prof. Tarhan said, “In the early stages, treatment is relatively easier. However, as the disease progresses, the brain’s neuroplasticity deteriorates. Neural pathways that are normally like small trails become like highways when it comes to body image. The brain begins to automatically perceive this pathological condition as normal. From this point on, advice, persuasion, or reasoning becomes ineffective; long-term hospitalization and multidisciplinary treatment protocols are required. When a person’s body mass index (BMI) falls below 18, an anorexia diagnosis can be made. However, even at this point, the individual may perceive themselves as healthy and normal. When body dysmorphic scales are used, even when the person is shown their own body image, they may still perceive it as healthy.”
“The brains of substance addicts and anorexia patients show significant similarities”
Prof. Tarhan said, “We also apply genotyping to such patients. In their brains, serotonin and dopamine gene polymorphisms can be found. The genes related to happiness appear polymorphic, meaning that the brain is observed to consume dopamine rapidly. When the need for dopamine increases under stress, the individual begins to seek more pleasure and becomes more sensitive to it. If the person has grown up in a cultural environment that sanctifies physical appearance, they may pursue this pleasure through their body. Other individuals, however, try to satisfy the same mechanism through substance use. In fact, the genetic sub-mechanisms in the brains of substance addicts and those of anorexia patients show significant similarities. The slow functioning of the serotonin transporter gene also makes a person more sensitive to stress. Such individuals can develop depression or anxiety even under minor stress. These are risk genes, not direct disease genes. However, this genetic structure forms the biological dimension of the illness, and this has been scientifically proven. If a biological predisposition is detected in an individual, we proceed with treatment in a much more systematic and determined way. Of course, a person can become anorexic even without biological predisposition. In such cases, the individual’s search for meaning and life philosophy become critically important.”
High mortality rate in anorexia
Emphasizing that the fear of gaining weight practically blocks the patient’s brain, Prof. Tarhan said, “For this reason, we usually feed patients through a nasogastric tube; in some cases, feeding is provided directly into the stomach through the abdomen (via gastrostomy). Patients are never left without nutrition. However, the mortality rate in anorexia is high: 15 out of every 100 cases are lost. Menstrual irregularities emerge, heart rhythm is disrupted, and blood values drop. Even when all these findings are shown to the patient, they may still say, ‘I won’t eat,’ because the distorted perception of ‘I’m overweight’ persists. This is not a conscious choice but the result of a distorted brain perception. At this point, strong neuromodulation treatments and individualized interventions that take genetic polymorphisms into account come into play. I have seen many cases where patients who had dropped to 29 kilograms, with completely disrupted hormonal balance, recovered fully with appropriate treatment. Therefore, no patient should ever be deemed beyond recovery.”
Those who refuse to eat must be fed via tube or intravenously
Prof. Tarhan stated that the fact a patient may pass away within as short a period as one month during treatment, despite all supportive methods, shows how rapidly and destructively the condition can progress. He emphasized, “In individuals who refuse to eat, feeding must be ensured through a nasogastric tube or intravenously (parenteral nutrition). This is not only a medical necessity but also a vital one.”
He also noted that anorexia is quite rare in men, but that does not mean it never occurs.
VR (virtual reality) glasses as part of treatment
Stating that the measure of value has changed today, that what is now popular and visible is regarded as valuable, Prof. Tarhan continued, “This situation plays a major role in the emergence and deepening of eating disorders. In treatment, especially in the early stages, we try to instill the concept of ‘body neutrality’ in our patients. That is, the individual is encouraged to adopt the mindset: ‘I exist not because of my body, but through the function of my body. My body is a tool that allows me to sustain my life.’ Using VR (virtual reality) glasses in the hospital, we show patients a three-dimensional image of their own body. This image often triggers intense anxiety. However, through exposure therapy to this image, the person gradually becomes desensitized, and the brain begins to develop a new perception in response to this fear. This process should be carried out not only with classical therapy but also with neuropsychiatric interventions.”
The individual’s perception of self-worth being tied solely to physical appearance
Explaining that during treatment, family dynamics are always examined, Tarhan stated that if the family environment glorifies or even sanctifies physical appearance, the child develops the perception of “If I am physically beautiful or thin, I am valuable; if not, I am worthless.” He continued, “This causes the individual to base their self-worth solely on appearance. In fact, this is the result of a global system that sanctifies popularity. Moreover, this situation is often presented under the guise of artistic freedom.”
Rejecting treatment is passive suicide
Prof. Tarhan pointed out that the old understanding used to be, “If a person wants treatment, they receive it; if not, they don’t,” and said, “Today, this understanding still persists in many societies. However, this approach is now invalid. In cases like anorexia, rejecting treatment is actually a form of passive suicide. Therefore, compulsory treatment must be applied. If necessary, the process of hospitalization by court order is initiated.”
He also noted that in such cases, families and close circles often adopt an overly soft and emotional attitude, saying, “Good-intentioned but misguided approaches like ‘Let’s convince them, let’s not do anything they don’t want’ may emerge, whereas in reality, the patient is living in a different reality.”
The family’s compassionate attitude can also cause harm
Prof. Tarhan said, “It is impossible to convince them, because their brain operates in a different universe. This is not freedom; it is the result of a malfunctioning brain process. In such situations, a compulsory treatment consent form is obtained from the family, followed by hospitalization under a court order. This approach has been shaped in light of current information provided by neuroscience. In the past, such cases were seen as the person’s freedom to harm themselves or as a kind of euthanasia. But now we know that this is an illness and the person’s brain biology has changed. Families make this mistake not because they don’t love their children, but because they show too much compassion. When they say, ‘Oh, don’t force them into treatment,’ they actually create a ground open to the abuse of compassion. Yet sometimes true compassion means having the courage to do what is right.”
Illegal slimming injections increase the risk of early-onset dementia and Alzheimer’s
Prof. Tarhan also stated that some illegal slimming injections currently on the market cause serious damage to the brain’s hunger-satiety centers: “These substances increase the risk of early-onset dementia and Alzheimer’s. Users think they are making the right decision when taking these drugs because their pleasure system is active at that moment, and the brain perceives it as a reward. At this point, the impact of digital showcases, that is, social media, is enormous. Individuals who admire the body images presented on these platforms lose their own body perception. When a person learns to manage their emotions, they gain the ability to say ‘no’ to these fake showcases.”