What is the role of biochemical factors in the etiology of anorexia nervosa?

Updated: Jun 10, 2019
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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Individuals with anorexia nervosa maintain a lifelong increased incidence of anxiety, depressive disorders, and obsessive-compulsive disorder. Neurobiologists hypothesize that disruption of both serotonergic and dopaminergic pathways in the brain mediate the development of anorexia nervosa and may account for the frequent coexistence of other psychological disturbances. [36, 37]

Anorexia nervosa is often heralded by a patient’s desire to lose an insignificant amount of weight through dieting. Once the weight loss is in progress, immunologic and hormonal factors, including leptins (involved with signaling satiety) and alpha-melanocyte–stimulating hormone, may play a role in the downward spiraling and maintenance of anorexia nervosa. [38, 10]

During prolonged food restriction in genetically vulnerable individuals, the ensuing malnutrition perpetuated by the biochemical changes induced by weight loss (ie, ketosis) further magnifies the impact of the malnutrition on the brain, owing to it being in a starvation-illness mode. Thus, it is helpful to conceptualize anorexia nervosa as a developmental condition rather than as a purely mental one. Persistent states of starvation may result in biochemically based treatment resistance due to neuroadaptive changes including increases in angiopoetin-like protein 6 (ANGPTL6) that occur that increase the likelihood that anorexia nervosa will become chronic and persistent. [2]


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