Anorexia nervosa is a complex illness, and everyone’s experience of it is a bit different. At the same time, there is one behavior that is central to the illness: persistent, maladaptive food restriction. In recent years, there has been a lot of progress in understanding the neuroscience of this illness. For example, we now know that when someone with anorexia nervosa decides what to eat, they are using a different part of the brain than someone without anorexia nervosa.

More specifically, dietary restriction is particularly associated with a brain region called the striatum. This part of the brain is involved in habits – a neurobiological basis for stuck behaviors. This may help explain why food restriction in anorexia nervosa is so hard to change. Over time, and repetition, the brain becomes wired to respond to cues and rules around food. This pattern shows up in both adolescents and adults, and it helps explain why anorexia nervosa can be so persistent even when someone genuinely wants to recover.

The good news is that understanding the brain’s role in this illness is opening doors to better treatments. When we stop seeing food restriction as willful behavior and start seeing it as something the brain has learned to do automatically, it changes how we approach care — and gives researchers a clearer target for developing new ways to help.

Joanna Steinglass, MD is a Professor of Psychiatry and the Co-Director of the Eating Disorders Center for Research and Treatment at the New York State Psychiatric Institute/Columbia University Irving Medical Center. Dr. Steinglass graduated from Amherst College and Harvard Medical School. She completed her psychiatry training at Columbia University and the New York State Psychiatric Institute and joined the Eating Disorders Research Clinic in 2003. Dr. Steinglass also serves as Training Co-Director of the Eating Disorders T32 Research Fellowship, and Program Director in Substance Use & Behavioral Health.

Dr. Steinglass’ research investigates Anorexia Nervosa through study of the neural mechanisms of illness and the development of mechanism-based treatments. She conducts interdisciplinary research that uses tools from cognitive and computational neuroscience to apply the latest understanding of the healthy brain to research on Anorexia Nervosa. She applies these insights to the development of behavioral, neuromodulatory, and pharmacological interventions.

Parenting a child with an eating disorder is among the most frightening and exhausting experiences a family can face. Whether caring for a young child, a teenager, or an adult living at home, caregivers often find themselves carefully orchestrating meals to match shifting preferences, laboring to prepare just the right food, and quietly allowing meals to go uneaten rather than face the distress and conflict that eating demands. Many caregivers are also genuinely uncertain about what expectations are reasonable to hold around food, meals, therapy, or tending to household needs, and are unsure whether to push, accommodate, or simply wait. While these responses come from love and a genuine desire to help, they can also inadvertently interfere with progress towards recovery. These behaviors are known as family accommodations, and research finds they are understandably prevalent among caregivers of individuals with eating disorders. While accommodation often reduces distress in the short term, it can quietly reinforce illness-maintaining patterns over time.

This presentation draws on SPACE (Supportive Parenting for Anxious Childhood Emotions), developed by Eli Lebowitz, Ph.D. at the Yale Child Study Center, an evidence-based parent-only treatment model to reduce parental accommodation. The therapy is designed to help parents understand why accommodation develops, what it costs both parent and child, and how to begin responding differently. Participants will leave with practical tools for managing caregiver distress in high-stakes moments, language for responding with both warmth and confidence, and a structured, compassionate approach to reducing accommodation, one targeted change at a time. This talk is designed for parents and loved ones of individuals of all ages, from young children to adults, living with restrictive eating disorders, binge-purge disorders, ARFID, or other forms of disordered eating. The aim is to help caregivers show up for their child in a way that actively supports recovery without compromising their own wellbeing in the process.

Chief Clinical Officer, Center for Evidence Based Treatment

Amy Kalasunas (she/her), LPCC-S, CCMHC, is a behaviorist with over 25 years of experience working within evidence-based treatment models. A DBT-Linehan Board of Certification Certified Clinician, she has extensive training in Dialectical Behavior Therapy (DBT) and its sub-specialty area of DBT for Multi-diagnostic Eating Disorders (MED-DBT), DBT-Prolonged Exposure for Borderline Personality Disorder, and DBT supervision and consultation team adherence practices. In addition to her DBT-LBC Certification, Amy co-chairs the DBT LBC Communications Committee. A sought-after instructor, she consistently achieves the highest evaluation scores when presenting two- and three-day workshops on the topics of comprehensive Dialectical Behavior Therapy (DBT), DBT and Multi-diagnostic Eating Disorders, and DBT-Prolonged Exposure and Eating Disorders. Amy has also developed, piloted, and researched interventions for parents of multi-diagnostic adult children using an adaptation of the Supportive Parenting for Anxious Childhood Emotions (SPACE) protocol and DBT.