What is the pathophysiology of anorexia nervosa?

Updated: Jun 10, 2019
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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A typical case of anorexia nervosa involves a young person (teenager or young adult) who is mildly overweight or of normal weight and who begins a diet and exercise plan to lose weight. As he or she loses weight and receives initial positive reinforcement for this behavior (eg, compliments by peers on his or her appearance), the reward is high and causes an inability to stop this behavior once an ideal weight is achieved.

Anorexia nervosa may be difficult to resolve due to persistent starvation from abnormal eating behavior resulting in treatment resistance due to the neuroadaptive changes causing increases in angiopoetin-like protein 6 (ANGPTL6) that cause anorexia nervosa to more likely become chronic and persistent. [17, 2]

Malnutrition subsequent to self-starvation leads to protein deficiency and disruption of multiple organ systems, including the cardiovascular, renal, gastrointestinal, neurologic, endocrine, integumentary, hematologic, and reproductive systems.

The impact of anorexia nervosa on neuropsychological functioning has been found to include what are likely estrogen-mediated impairments in learning and memory tasks, such as cognitive inflexibility (poor set shifting), weak central coherence, and social-emotional processing difficulties that may in part be due to low energy intake causing lack of available energy. [18] New research horizons include an upcoming double blind placebo controlled study looking at hormonal supplementation in females with anorexia nervosa to help restore normal neuropsychological functioning. [19]

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