The New England Journal of MedicineAnorexia Nervosa

Unveiling the Complex Interplay of Genetics and Environment in Anorexia Nervosa

Anorexia nervosa, a severe psychiatric disorder characterized by starvation and malnutrition, presents a multifaceted challenge in clinical practice. This comprehensive review delves into the nuances of diagnosis, treatment, and long-term management, offering insights into the psychiatric and medical complexities of the condition. With a focus on evidence-based strategies and the latest research findings, the article sheds light on the intricate balance between genetic predispositions, environmental triggers, and the critical need for personalized care in addressing this life-threatening disorder.

Key Points:

• Anorexia nervosa is a severe psychiatric disorder with a substantial risk of death from medical complications and suicide, characterized by intense fear of weight gain and a high degree of control over food intake.
• The disorder manifests in two subtypes: restricting, and binge-eating with purging, with potential progression from one subtype to another.
• Hospitalization is advised for patients with a BMI ≤15, severe electrolyte imbalances, or significant cardiovascular concerns, with refeeding protocols being a critical component of inpatient care.
• Family-based treatments are emphasized for children and adolescents, showing promise in promoting recovery through structured support and intervention.
• Psychotropic medications have limited efficacy in promoting weight gain or addressing comorbid psychiatric symptoms in anorexia nervosa patients.
• Emerging genetic studies highlight potential risk loci for anorexia nervosa, suggesting a genetic overlap with other psychiatric disorders and metabolic traits.
• Psychological factors like perfectionism, cognitive rigidity, and childhood anxiety disorders are notable risk factors, alongside societal pressures valuing thinness.
• Anorexia nervosa is linked with various medical complications, including cardiovascular, gastrointestinal, and bone health issues, necessitating comprehensive medical monitoring.
• Cognitive-behavioral and psychodynamic therapies offer varied success in adults, underscoring the need for individualized treatment plans.
• Preventative strategies and early intervention are crucial, given the chronic nature of the disorder and the potential for relapse post-treatment.

Recent research indicates that the gut microbiome might play a significant role in the pathophysiology of anorexia nervosa, suggesting new avenues for potential therapeutic interventions.

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