Laparophobia: a cognitive perspective on appetite control in anorexia nervosa

Abstract

Decades of research have demonstrated that anorexia nervosa (AN) may be associated with aberrant cognition, yet, its role in maintaining stringent dieting has received relatively little attention from mainstream researchers of eating disorders. The purpose of the present article is to highlight cognitive ('top-down') factors that are considered responsible for anticipatory anxiety of stoutness and frank fat-phobia (laparophobia). A cognitive model proposed departs from the formulation suggesting that phobia of over-eating is superimposed on avoidant tendencies ('environmental autonomy syndrome'), whereas excessive exercising becomes a natural coping strategy with laparophobia, an instrument of reward. AN ideation involves complex neuronal circuitries and multiple neurochemical components that may conceivably represent a mirror image of those underlying obesity. The emphasis on phobia and aberrant membrane excitability akin to channelopathies behoves the clinicians to be aware of potential uses of drugs acting at the gamma-aminobutyric acid and the N-methyl-D-aspartate/AMPA [2-amino-3-(3-hydroxy-5-methylisoxazol-4-yl) propionic acid] receptors sites as the adjuncts to conventional agents in managing AN.

Phobic memory and somatic vulnerabilities in anorexia nervosa: a necessary unity?

“…In tardive AN (developing after the age 30), the feared sexuality emerged as being of apparent etiological significance, much as it is with earlier onset AN [11]. Therefore, elsewhere, AN was represented as anticipatory anxiety of stoutness and frank fat-phobia ( 'laparophobia' ) [12,13] mitigated by the efforts to obtain alternative (non-appetitive) reward, such as exemplified by the paradoxical euphoric state and hyperactivity,[14] symptoms of denial, lack of concern, and alleged satisfaction with their state [15-17]. …”