A pining for dining: A brief overview of Gourmand Syndrome
In 2005, an article in the May 8th issue of the New York Times magazine reported the case of an unnamed European political journalist who had a stroke that caused some damage to the right frontal lobe in his brain. The journalist made a full recovery but experienced an unexpected side effect – he developed an unusual passion for gourmet food (that he didn’t have prior to his stroke). He capitalized on his strange new behaviour and became a food columnist. Similarly, a 2011 article in the Huffington Post reported the story of Kevin Pearce, a snowboarder who sustained right hemispheric brain damage following an accident that nearly killed him. Waking up from a coma he developed a craving for basil pesto (something that he never did prior to his accident). Both of these cases are examples of a rare disorder that has been named Gourmand Syndrome, a strange behaviour first written about (clinically and academically) in the mid-1990s. Gourmand Syndrome basically comprises individuals becoming totally preoccupied and obsessed with food and ‘fine dining’.
This rare (and benign) condition only seems to occur in people who have sustained brain injuries involving the right frontal lobe and was first described (and named) by neuropsychologist Dr. Marianne Regard and neurologist Dr. Theodor Landis in a 1997 issue of the journal Neurology (one of only two empirical papers on the topic). The authors noted that hyper-orality is part of other conditions such as the Kluver-Bucy syndrome that occurs in patients with bilateral mesial temporal lesions (and which I examined in a previous blog).
Regard and Landid described the cases of two individuals who both had partial damage to the right anterior cerebral hemisphere of the brain. The first case was the political journalist briefly mentioned at the start of this article. He became totally preoccupied with gourmet food and continued after he had been discharged from hospital. The second case that Regard and Landis wrote about was a businessman who (following a stroke) also developed a passion for gourmet food. However, his preoccupation with gourmet food was part of a wider disturbance of impulse control as he also made repeated sexual advances towards the female nursing staff at the hospital he was in. (Interestingly, a later 2003 study by Regard and Landis on 21 pathological gamblers – and published in the journal Cognitive and Behavioral Neuropsychology – reported that 38% of them [n=8] were reported to have Gourmand Syndrome, again suggesting that these impulsive behaviours are highly inter-linked).
Having named this type of behaviour as Gourmand Sydrome, Regard and Landis then conducted a prospective study examining the frequency and the clinical and anatomical correlates of the syndrome. Over a three-year period, and using a self-constructed checklist, they carried out 723 neuropsychological examinations of patients with known (or strongly suspected) cerebral lesions. The specific criteria for Gourmand syndrome were: (i) the presence of a significant change in a person’s eating habits (i.e. preoccupation with the preparation and eating of fine-quality food), (ii) the onset of which was associated with a single cerebral lesion in the absence of other medical or social conditions, and (iii) previous eating disorders; or other neurological or psychiatric illness. A total of 36 people fulfilled the criteria for Gourmand Syndrome (5%).
Of those identified fulfilling the three criteria, 94% of them (n=34) appeared to have right hemisphere damage in the brain (in particular, the right anterior part of the brain involving basal ganglia, cortical areas, and limbic structures). Most of the individuals’ symptoms were caused by tumours (although there were other causes including focal seizures, head trauma [with focal concussion], haemorrhage, and cerebrovascular accidents). The authors concluded that:
“Most patients with the ‘gourmand syndrome’ had clinical and anatomical evidence of a unilateral right-sided lesion, mainly involving anterior cortico-limbicregions. The strong clinical-anatomical correlation suggests that gourmand eating can represent a neurological sign of diagnostic value. The eating behavior does not correspond to any known category of eating disorders. At most, it could be classified as a benign, non-disabling form of hyperphagia, but with a specific preference for fine food”
A later case study of Gourmand Syndrome by Dr. Mary Kurian and her Swiss colleagues was published in the journal Epilepsy and Behavior. They reported the case of a 10-year-old boy with epilepsy (and who had hemispheric brain damage (i.e., “right temporoparietal hemorrhagic lesion”). As with previous adult cases, he developed Gourmand Syndrome and experienced a significant change in his eating habits, or as the authors put it, an “abnormal preoccupation with the preparation and eating of fine-quality food…without any previous history of eating disorders or psychiatric illness”. More specifically, the boy’s parent’s noticed that he began to avoid eating at fast-food restaurants and would only eat or cook the finest foods. The authors argued that their case study confirmed previous observations relating to the importance of the right cerebral hemisphere in disturbed eating habits, not just in Gourmand Syndrome but eating disorders such as anorexia and obesity.
Both of the published empirical papers noted that Gourmand Syndrome includes an obsessive component along with other behavioural consequences typically associated with addiction (e.g., cravings, preoccupation, salience, etc.). They also notes that one-third of the 36 patients identified in their prospective study had symptoms of mania (e.g., aggression, diminished impulse control, disinhibition, affective lability). In recent a review of Gourmand Syndrome by trainee psychiatrist Alexandros Chatziagorakis in the Neuropsychiatry News concluded that:
“Owing to the rarity of further articles and reports of Gourmand syndrome, its diagnostic significance is yet to be proven. It would be worth using Regard [and] Landis’ checklist during neuropsychological assessment of neurological patients to establish its frequency and its clinical and anatomical correlates. At the same time, it would be worth performing a psychiatric assessment to determine whether Gourmand syndrome presents in the context of an already defined psychiatric syndrome such as mania. This will tell us whether Gourmand syndrome has indeed a diagnostic value as a neurological or even neuropsychiatric sign”.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Chatziagorakis, A. (2012). Gourmand Syndrome. Neuropsychiatry News, 5 (Spring), 23-24.
Holt, T. (2005). Of two minds. New York Times (Magazine), May 8. Located at: http://www.communicationcache.com/uploads/1/0/8/8/10887248/the_way_we_live_now_-_of_two_minds.pdf
Huffington Post (2011). The Gourmand Syndrome: Brain Damage Can Trigger Food Obsession, Huffington Post, October 9. Located at: http://www.huffingtonpost.com/2011/07/11/the-gourmand-syndrome-food-obsession_n_894629.html
Kurian, M., Schmitt-Mechelke, T., Korff, C., Delavelle, J., Landis, T. & Seeck, M. (2008). “Gourmand syndrome” in a child with pharmacoresistant epilepsy. Epilepsy and Behavior, 13, 413-415.
Regard, M., Knoch, D., Gütling, E. & Landis, T (2003). Brain damage and addictive behavior: A neuropsychological and electroencephalogram investigation with pathologic gamblers. Cognitive and Behavioral Psychology, 16, 47-53.
Regard, M. & Landis, T (1997). ‘Gourmand syndrome’: Eating passion associated with right anterior lesions. Neurology, 48, 1185-1190.
Uher, R. & Treasure, J. (2005). Brain lesions and eating disorders. Journal of Neurology, Neurosurgery and Psychiatry, 76, 852–7.
Posted on January 20, 2013, in Case Studies, Culture Bound Syndromes, Eating addiction, Eating disorders, Mania, Obsession, Psychiatry, Psychological disorders, Psychology and tagged Brain injury, Eating disorder, Eating syndrome, Fine dining disorder, Food disorder, Food obsession, Gourmand Syndrome, Gourmet food, Hyper-orality, Hyperphagia, Klüver-Bucy syndrome, Neurological disorders, Stroke. Bookmark the permalink. Leave a comment.