fidence to make a difficult journey.
Thus, for underweight people with AN, self-control is strengthened while awareness (imagination) of food and its taste is dampened and fear centers are excessively active. Behaviors that everyone–including the victims– attributed to conscious choices could be seen to activate furious activity in deep brain structures involved in decision making, controlling behavior, evaluating primal danger, and evaluating food. These findings help explain what people with AN must overcome in order to recover.
Gene x environment interactions
The specific environmental triggers that activate AN genes point to its function for hunter gather bands (52). High levels of estrogen are often required in addition to weight loss for the genetic program to manifest (52, 53). AN genes are more rarely activated in males or in prepubertal girls. This indicates that it was a better bet for teen-aged girls than for small children and males to travel in times of famine. Why would that be? According to ethnographic records, when travelers encountered an enemy band, a reproductive female was more likely to survive and be adopted into the new group; molecular genetic evidence also supports the idea that females migrated farther in the Paleolithic (54). The preponderance of females developing anorexia nervosa has often been explained by female weaknesses. These gene and environment interactions suggest a very different conclusion; during Paleolithic famine, brave, self-controlled young women searched for better lands for their bands.
Over-controlled or self-controlled?
Before AN derailed them, patients were typically high-achievers on track to a successful life. Their premorbid personalities were typically ascetic; in one study 23% had autism spectrum traits (55). However, in their brothers the same scholarly and anxious childhood temperament often leads to success in technically demanding fields, while the same traits in their anorectic sisters is retroactively deemed pathological.
In general self-control is a positive trait. Mischel and his colleagues’ longitudinal research found, “Resisting temptation in favor of long-term goals is an essential component of social and cognitive development and of societal and economic gain”(56). Yet, these very traits are seen as causative factors for AN. When patients first present for treatment they usually exhibit high levels of anxiety, depression and compulsivity, and clinicians and researchers commonly attribute the disorder to their over-controlled, anxious and perfectionist traits (9, 57). However, Ansel Keys’ landmark starvation study found that healthy subjects develop pathological anxiety, depression, obsessions and compulsions when starved that remitted with re-feeding (58). We believe that observers have mistaken the pathological psychological sequelae of starvation for a predisposing and psychogenic pathological trait.
Preponderance of evidence
“The weight of evidence for an extraordinary claim must be proportional to its strangeness.” Pierre-Simon Laplace (59)
The adapted-to-flee famine hypothesis is a radical departure from today’s paradigm guiding eating disorders research and treatment. Anorexia researchers refer to the genetically-controlled biological changes they find as dysfunctions, deficits, dysregulation, impairment and defects, in other words, “bugs” in energy homeostasis, reward, fear, executive control or other regulatory systems. Many speculate about finding the biological change that explains AN, ignoring dozens described by others (9, 60).
A number of facts indicate that the biological changes are not mistakes but rather “features” arising from natural selection. First, loss of function is the usual result of dysfunctions, but these particular alleles give ordinary people, even children, extraordinary self-control over hunger, increased pain tolerance, athletic ability and endurance (61). Super abilities come from accidents only in comic books.
Second, when starving, the drive to eat is normally too fierce to be denied; a hunger strike is a powerful mora