Bioethics Blogs

Anorexia Nervosa and Deep Brain Stimulation: Philosophical Analysis of Potential Mechanisms

By Hannah Maslen, Jonathan Pugh and Julian Savulescu


According to the NHS, the number of hospital admissions across the UK for teenagers with eating disorders has nearly doubled in the last three years. In a previous post, we discussed some ethical issues relating to the use of deep brain stimulation (DBS) to treat anorexia nervosa (AN). Although the trials of this potential treatment are still in very early, investigational stages (and may not necessarily become an approved treatment), the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this post, we show how different possible mechanisms of intervention raise different questions for philosophers to address. The prospect of intervening directly in the brain prompts exploration of the relationships between a patient’s various mental phenomena, autonomy and identity.

DBS could achieve treatment effects in different ways depending on the stimulation site. Which of these potential mechanisms would promote an anorexic patient’s ability to direct their life and express their self in their decisions regarding their eating behavior, and which might potentially compromise these abilities, is in large part a philosophical question. We here discuss three potential mechanisms alluded to in the neuroscientific literature: 1) modification of hedonic properties of food, 2) reduction of the drive towards compulsive behavior, and 3) regulation of aversive mood and affect. The associated consequences for philosophical assessment are, correspondingly, 1) the alteration of a first-order desire for food, 2) the promotion of comparative cognitive control over behavior, 3) the modification of emotional symptoms or traits.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.