What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure

Abstract

Two decades have elapsed since our publication of ‘What kind of illness is anorexia nervosa?’. The question remains whether our understanding of anorexia nervosa and its treatment thereof has evolved over this time. The verdict is disappointing at best. Our current gold standard treatments remain over-valued and clinical outcomes are modest at best. Those in our field are haunted by the constant reminder that anorexia nervosa carries the highest mortality rate of any psychiatric disorder. This cannot continue and demands immediate action. In this essay, we tackle the myths that bedevil our field and explore a deeper phenotyping of anorexia nervosa. We argue that we can no longer declare agnostic views of the disorder or conceive treatments that are “brainless”: it is incumbent upon us to challenge the prevailing zeitgeist and reconceptualise anorexia nervosa. Here we provide a roadmap for the future.

Energy expenditure during nutritional rehabilitation: a scoping review to investigate hypermetabolism in individuals with anorexia nervosa

“…The reality faced by patients with AN is often a bleak one—with approximately one third of individuals with AN still not reaching recovery after 22 years of illness [ 83 ]. Decades of research into psychological and pharmacological interventions have left all those in the AN field—patients, caregivers, providers, and researchers alike—in need of more viable treatment options that provide a more promising future [ 84 ]. In a continued effort to shift the treatment paradigm, we propose that now is the time to finally understand the perplexing and remarkably resilient metabolic adaptions that occur in AN.…”

Temperament impact on eating disorder symptoms and habit formation: a novel model to inform treatment

“…Researchers in the field of ED are expressing increasing concern regarding the limited diagnostic focus on ED behavioural symptoms and advocate for an expansion in our way of thinking about this severe range of illnesses [ 14 ]. Novel ED models are needed that reflect current research.…”

Examining the role of artificial intelligence to advance knowledge and address barriers to research in eating disorders

“…Despite advances in our understanding of genetic, environmental, and risk factors of EDs (Barakat et al, 2023), responses to gold-standard outpatient treatments remain modest at best, with large proportions of patients remaining symptomatic decades after being first diagnosed (Couturier et al, 2013;Culbert et al, 2015;Eddy et al, 2017;Kass et al, 2013;Solmi et al, 2024). These issues relate to a number of factors, including an incomplete understanding of the etiological mechanisms driving illness presentations, a paucity of surveillance and large clinical data sets available to guide new discoveries, the presence of contributing comorbid mental health (MH) diagnoses, challenges relating to measurement of clinical and outcome variables, and fragmentation of clinical care that occurs as patients navigate varying intensities of service across different programs (Hay et al, 2019;Norris et al, 2010;Radunz et al, 2020;Touyz et al, 2023;Wade et al, 2024). This may also be due to the recognition that conducting robust research trials of ED treatments is challenging for many reasons (Norris et al, 2007).…”