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Anorexia nervosa

Abstract

Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of ‘thinness’ and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.

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Figure 1: The behaviours and possible underpinning psychobiological features of anorexia nervosa across the various stages of the disorder.
Figure 2: Discovery science in anorexia nervosa.
Figure 3: A neurobiological model for the development of anorexia nervosa.
Figure 4: The neural circuits associated with reward.
Figure 5: The effect of prevention programmes in individuals with anorexia nervosa.
Figure 6: Somatic and psychosocial effects of anorexia nervosa affecting quality of life.
Figure 7: Neuromodulation for anorexia nervosa treatment.

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Contributions

Introduction (J.T.); Epidemiology (N.M.); Mechanisms/pathophysiology (C.M.B. and G.K.F.); Diagnosis, screening and prevention (T.W. and E.S.); Management (J.T., S.Z. and A.C.); Quality of Life (E.W.); Outlook (U.S.); Overview of the Primer (J.T.).

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Correspondence to Janet Treasure.

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Competing interests

J.T. has received royalties from authored books, and an honorarium from Lilly for a presentation at the Diabetes Meeting 2015. She has received research grants from the National Institute for Health Research (NIHR) under the Research for Patient Benefit (RfPB) programme, Mental Health Biomedical Research Centre at South London, the Maudsley NHS Foundation Trust, King's College London, the Swiss Anorexia Nervosa Foundation, Guy's and St Thomas' Charity and the Psychiatry Research Trust. E.S. has received research grants funding from the World Association of Girl Guides and Girl Scouts. A.C. has received a travel grant from Eli Lilly in the past 5 years and won a prize for her work in 2010 at the VI Congresso Brasileiro de Cérebro, Comportamento e Emoções, RS, Brazil, which included support for attending an international conference (registration and travel expenses) by Lundbeck. C.M.B. has received a research grant from Shire Pharmaceuticals and royalties from Walker and Pearson, and acknowledges funding from the Swedish Research Council (VR Dnr: 538-2013-8864). All other authors declare no competing interests.

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Treasure, J., Zipfel, S., Micali, N. et al. Anorexia nervosa. Nat Rev Dis Primers 1, 15074 (2015). https://doi.org/10.1038/nrdp.2015.74

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