Article originally published here (21/4/2015)
Oxytocin — the “sex and love” hormone released after orgasm and during childbirth — is dubbed “liquid trust” because of its proven ability to promote openness and bonding. The hormone’s powerful effects have led scientists to experiment with it as a treatment for everything from autism to schizophrenia and have even tested whether it encourages monogamy in men.
Last week, researchers at the NYU Langone Medical Center reported that the way the hormone amplifies neural signals in the brain meant it could “one day be used to treat social anxiety, post-traumatic stress disorder, speech and language disorder and even psychological issues stemming from child abuse”. Meanwhile, at King’s College London a trial is under way examining its efficacy as a pharmaceutical treatment for anorexia.
Professor Janet Treasure, the coordinator of the trial, is 62, with a kind face, perceptive eyes and short, luminously white hair. The head of adult psychiatry at King’s, she is a world expert on the subject of anorexia and has an OBE for her services to people with eating disorders. Over a paper-strewn table in her basement office, she explains how she hopes that the “bonding hormone” will help patients “become more interested in connecting with others” and be able better to manage social anxiety, which she considers to be “an important bridge to recovery”.
Patients with anorexia usually have lower than normal levels of oxytocin. This is associated with increased anxiety and depression. “At one time we were all rather bored with things that seemed to be just a secondary effect of starvation,” Treasure admits, “but it isn’t boring. I’ve turned myself around because if it keeps you stuck, we’ve got to try to reverse that sort of sticking, maintaining factor.”
The two-day trial is double blind: each day, participants self-administer ten squirts of nasal spray (alternating between nostrils at 45-second intervals) and complete two hours of medical tests and tasks. One day the spray contains the hormone and on the other it’s a placebo, but only the pharmacist knows in what order the two are prescribed. At frequent intervals throughout the trial, researcher Jenni Leppanen wraps a paediatric blood-pressure monitor around the upper arm of each volunteer and records the reading.
The monitor, which is decorated with a pink outline of a little girl despondently trailing her teddy, is familiar to me. As a teenager and young adult I was treated in this clinic for anorexia nervosa, and have had it wrapped around my arm many times. Today I am participating in this trial as a recovered patient.
“Have you done this before?” asks Leppanen, as she passes me the nasal spray. Yes, I reply, eager to be seen as competent. Actually, no. Do I inhale and spray, or just . . . “It should go straight up,” says Leppanen, matter of factly, “but by all means inhale.”
The spray has a bleachy generic medicine smell, not exactly an aphrodisiac. And the tasks I perform after administering the spray are somewhat stranger than expected. First I am videoed while watching the bit in Four Weddings and a Funeral where Rowan Atkinson just about manages to marry David Haig to Sophie Thompson. This is amusing the first time round; rather less so on day two.
I then rate my feeling of pleasure (on a scale of one to 100) when Leppanen strokes my arm with a make-up brush while showing me a series of faces on her laptop. The potential awkwardness of this task is in no way alleviated by the large cardboard box placed over both our arms. “This isn’t my favourite test,” says Leppanen apologetically. On day two I offer to click through the faces while Leppanen strokes my arm. “I’d rather you didn’t,” she replies. “I’m a bit of a control freak.”
On both days I complete a series of computerised tasks, one of which I like to think of as “the psychopath test”. It involves deciding which emotion best describes the face on the screen in front of you. Except you can only see the eyes and eyebrows and have to choose between four often wildly inappropriate feelings. Would you say the wide-eyed young woman with thick eyelashes and immaculately waxed eyebrows was “alluring”, “threatened”, “defiant” or “insisting”?
I get the concept, though. I understand that my social and sensory reactions are being tested. Treasure tells me that starvation “hits everything” and can deplete hormone levels, which may be exacerbating sufferers’ sense of isolation. I hesitate, though, when Treasure asks me how I found the experience. In truth, the hormone neither gave me an uncontrollable desire to embrace Leppanen like an old friend, nor did I feel an urge to order a Domino’s vegi supreme straight to the clinic.
I don’t know which day I had the oxytocin on, I reply tentatively, but I think I felt better on the second day? Treasure is unruffled by my ambivalence: oxytocin has a stronger effect on underweight participants whose hormones are “flat” and, she says with excitement, “some people really notice big changes”.
In the context of the low recovery rates for eating disorders, the “big changes” noticed by some participants can only be good news. For although younger patients can respond well to family-based interventions, statistics collated by the eating disorders charity Beat suggest that more than half of anorexia and bulimia sufferers never recover fully.
Anorexia also has the highest mortality rate of all mental illnesses, since one in five patients will die prematurely. The situation isn’t helped by certain policy decisions, says Treasure. Given that the illness begins at around age 15 and lasts until the sufferer is about 30, she finds the division between child and adult services at 18 “a bit crazy”. As for the refusal by some eating disorder services to accept patients until their BMI drops below 15, she says: “Is that nutty or is it not? It’s crazy. Utterly crazy.”
I’m personally indebted to King’s for saving my life. According to my first consultant, I was one of the most severe cases of adolescent anorexia nervosa to have walked into the clinic in years. My treatment required two in-patient admissions, the second of which was to the adult eating disorder unit overseen by Treasure.
Here I lived alongside adults with “severe and enduring eating disorders”. After suffering for so long, many of these adults’ disorders had “snowballed” — to use one of the professor’s metaphors — and acquired comorbidities (one or more simultaneous additional disorders). While on the ward I met a man blinded by bulimia and other patients who were profoundly affected by their illnesses in other ways.
One morning after breakfast a youngish woman, pinched and emaciated — you might mistake her for a heroin addict in her forties — called me into the “quiet room”. She was on her 27th admission. “Everyone in here,” she told me, “makes the mistake of trying to be ‘the best anorexic’, the ‘most unwell’ and least willing to change. They are wrong; I was wrong. The real competition is to be ‘the worst anorexic’, to obey the rules and challenge your illness. To leave the unit and never look back.” The 17-year-old me was offered a glimpse into the future; the only future an eating disorder could offer me.
This woman’s generous insight helped my recovery, but few treatments are successful in treating severe and enduring cases such as hers. A recent London-based study concluded that inpatient treatment “is costly, has high relapse rates and may be associated with poor outcomes, even once severity of symptoms is accounted for”. If the challenge of reforming this service and developing new treatments wasn’t great enough, Treasure says that she must also contend with “the rest of psychiatry stigmatising eating disorders” because the field “is considered silly”.
When I query this assertion, Treasure cites the disparity in funding between anorexia and chronic fatigue syndrome, which she says receives “tons of money” in grants from the Medical Research Council, and says, “That’s allowable but somehow with eating disorders people don’t . . . They think it’s vanity. And I think doctors are just as stigmatising and the powers that be just don’t really understand it.”
Treasure believes that psychiatrists have in the past made the mistake of trying to “treat people with enduring [eating disorders] in exactly the same way as we do the early cases, which doesn’t work”. They have also employed treatments used for other mental health conditions, regardless of their effectiveness. The attitude within psychiatry, she says, has been one of, “Oh, CBT [cognitive behavioural therapy], that’s worked in depression, let’s try it here”, but that no one has properly considered “the particular problems of the particular illness”.
CBT is one of only four psychological treatments approved by the NHS for the treatment of anorexia, so I’m surprised when Treasure says she thinks that “CBT doesn’t really work that well because people with anorexia are just as good, if not better, than their therapist”. I’ve never made this connection before, but I realise that it makes complete sense. At the start of my illness, I trained my brain to take pleasure in calorie deprivation. “I think people with anorexia are very good at CBT,” she responds. “That is what they do.”
The government recognises the need to “transform the current system” of eating disorders treatment for children and adolescents. In the autumn statement, the deputy prime minister Nick Clegg pledged to invest £150 million (£30 million a year for the next five years).
The human cost is also accompanied by an economic one: according to a report undertaken by PwC and commissioned by Beat, eating disorders cost the country more than £15 billion a year. King’s procured funding for its trial from the Swiss Anorexia Nervosa Foundation. When I ask Treasure what she thinks of investment in mental health, she seems sympathetic. Politicians, she says, “talk about all this ‘parity’, don’t they? ‘Parity of esteem’ and the like, and I must admit they are starting to try.”
By developing new models for eating disorders such as oxytocin, Treasure hopes to devise specialised treatments that will prove more effective in treating this complex network of disorders. She also hopes that the results from her trials and those from separate genetic studies will finally “stop this idea that [an eating disorder] is just vanity, which is what a lot of the stigma about it is”.
She tells me about somebody with a different perspective, a woman who had anorexia at the age of 13 and who later trained to be a psychiatrist. “It was a beautiful, personal view. She said: ‘If I were to say it in one word it’s: isolation.’ And that’s what the illness is, you know? It’s just isolating you, and that builds up more and more.”
