The paper presents a comparison of the two most commonly used diagnostic tests for orthorexia – ORTO-15 Questionnaire and BOT (Bratman Orthorexia Test) – that use data-mining methods. Orthorexia nervosa is perceived as a new, unclassified eating disorder, which is characterized with pathological fixation on the consumption of healthy foods. In order to assess the coherence of the aforementioned tests, a method from the data-mining group, i.e. correspondence analysis, was used in addition to traditional statistical methods. (...) On the basis of the obtained results, only average correlation between ORTO-15 Questionnaire and BOT test was found. More cases of orthorexia were diagnosed with the use of ORTO-15 Questionnaire, which may result from its higher sensitivity. It was also noted that the coherence of tests increases with increasing BMI values, despite no relationship between BMI and the presence of orthorexia having been proved. Diagnosis of an orthorexia case with the use of BOT test implies that there is a high probability that it will also be diagnosed with the use of ORTO-15 test, but not necessarily the other way around. The performed correspondence analysis confirmed a not very strong coherence of the results of both tests. (shrink)

The COVID-19 pandemic is negatively impacting people’s mental health worldwide. The current study examined the effects of COVID-19 lockdown on adult women’s eating, body image, and social media habits. Furthermore, we compared individuals with and without signs of orthorexia nervosa, a proposed eating disorder. Participants were 143 women, aged 17–73 years, recruited during a COVID-19 lockdown in Canada from May-June 2020. Participants completed self-report questionnaires on their eating, body image, and social media habits during the pandemic. The Eating (...) Habits Questionnaire assessed symptoms of orthorexia nervosa. Compared to the period prior to lockdown, women with higher total orthorexia nervosa scores reported eating a lot more than usual, feeling greater pressure to diet and lose weight, thinking about food more often than usual, experiencing greater weight gain, and perceiving more pressure from social media specifically to lose weight and to exercise, compared to their healthy counterparts. We examined associations between individual EHQ subscales and perceived changes to eating and weight. Women who scored high on EHQ-Problems reported seeing more weight loss content on their social media than those who reported fewer orthorexia nervosa symptoms. Conversely, those who scored low on EHQ-Feelings reported feeling a lot less pressure to lose weight, somewhat less or a lot less pressure to lose weight or to exercise from social media specifically, and trended toward less laxative use during lockdown, compared to those who scored higher on orthorexia nervosa. And those who scored low on EHQ-Knowledge reported feeling somewhat less or a lot less pressure to lose weight than those who reported more orthorexia nervosa symptoms. Together, the findings suggest that women with symptoms of orthorexia nervosa are experiencing an exacerbation of disordered eating thoughts and behaviors during COVID-19, and that social media may be a contributing factor. (shrink)

The article aims to summarize the literature about the profile of risk of orthorexia in athletes using the ORTO-15 questionnaire. The search was performed at PubMed, Embase, Web of Science, and Sport Discus databases, using the terms “orthorexia” AND “athletes” with the respective entry terms. A multistage process of selection followed the PRISMA 2020 recommendation. A total of 688 articles were identified, and six studies were available for the final process. The prevalence of risk for orthorexia was (...) assessed by the articles by the ORTO-15 questionnaire and ranged between 38 and 35 points. The comparison between male and female athletes and, athletes and non-athletes was not significant in the six articles. In conclusion, the review highlights that athletes from different sports, included in the review, do not present a risk of orthorexia nervosa considering the cutoff of 40 points, but not 35 points. Also, athletes present the same orthorexic behavior compared to non-athletes, demonstrating that orthorexia is an issue that needs to be considered in the general population. Moreover, a special focus should be given on the ORTO-15 questionnaire, about the sensitivity to diagnose the prevalence of orthorexia, especially in athletes. (shrink)

Orthorexia Nervosa has gained increased attention in academia since 1997. However, like other “Exia” conditions, there is debate around its inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This study aimed to examine the experiences of those following a diet indicative of ON in the United Kingdom. This information is essential to the development of diagnostic criteria and classification of ON. Behavioural Reasoning Theory was used to explore reasons contributing to the development of ON. Ten individuals, (...) aged 23–35 years, took part in semi-structured interviews. Inductive thematic analysis was used to analyse the results. Four themes emerged from the data—journey, social, rules/control, and ethical considerations which highlighted contributing factors to the development of ON behaviours, the impact of these behaviours on individuals' social lives, and a strive for control. These findings are the first to suggest that ON involves a more complex set of behaviours than current definitions and proposed diagnostic criteria suggest and highlight the need to consider a variety of reasons for restricted diet when developing diagnostic criteria, screening tools, and classification in the DSM. (shrink)

This is a preprint draft. Please cite published version (DOI: 10.1111/mila.12385). The aim of this paper is to provide a novel analysis of anorexia nervosa (AN) in the context of the sense of agency literature. I first show that two accounts of anorexia nervosa that we ought to take seriously— i.e., the first personal reports of those who have experienced it firsthand as well as the research that seeks to explain anorexic behavior from an empirical perspective— appear to (...) be thoroughly in tension with one another in their descriptions of anorexic actions. Rather than proceeding at this point by way of disregarding anorexic testimony as meaningless or insincere, I instead offer a positive account of the sense of agency in anorexia nervosa that renders these two depictions compatible. The resultant picture of anorexic behavior is one that accommodates current empirical findings while also providing valuable insight into how it is that anorexics can sincerely report feeling fully in control over their food restriction. (shrink)

Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that (...) conceptualizing anorexia nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot’s specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive–behavioral therapy, and clinical and ethical issues associated with treatment refusals. (shrink)

Body dissatisfaction has long been considered an integral component of and driving force behind anorexia nervosa. In this paper, I characterise body dissatisfaction in terms of problematic beliefs about body size and the value of thinness. I suggest two methods for understanding these beliefs. Regarding body size beliefs, I suggest focusing on certain forms of misleading phenomenal evidence that sufferers of anorexia nervosa are exposed to. Regarding beliefs about the value of thinness, I suggest focusing on the benefits (...) of such beliefs. (shrink)

It feels like there’s two of you inside—like there’s another half of you, which is my anorexia, and then there’s the real K [own name], the real me, the logic part of me, and it’s a constant battle between the two. The anorexia almost does become part of you, and so in order to get it out of you I think you do have to kind of hurt you in the process. I think it’s almost inevitable. We came to the (...) concept of authenticity belatedly, one might say. We had been talking to people who had a diagnosis of anorexia nervosa about their experiences of living with their condition, and though we had not raised issues of authenticity or identity ourselves, they often did. They struggled with questions of .. (shrink)

Anorexia nervosa remains an enigma among Western cultures. Various causal explanations have been offered, encompassing biological, psychological, and sociocultural models. These explanations, however, focus on the immediate or proximal mechanisms of causation. A more thorough understanding of anorexia nervosa can be achieved by understanding the relationship between these factors and ultimate causation, the level of explanation which deals with individual reproductive fitness. This paper reviews the biological, psychological, sociocultural, and evolutionary models and indicates a necessary synthesis between proximate (...) and ultimate levels of causation in examining the anorexia nervosa puzzle. (shrink)

This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter “AN: the diagnosis”) several ethical issues are revealed. Firstly, “AN: the diagnosis” influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, “AN: the diagnosis” impacts on how treatment and treatment efficacy are (...) defined and the ethical justifiability of paternalism. Thirdly, “AN: the diagnosis” can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. “AN: the diagnosis” can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty. (shrink)

Orthorexia is a condition in which the subject becomes obsessed with identifying and maintaining the ideal diet, rigidly avoiding foods perceived as unhealthy or harmful. In this paper, I examine widespread cultural factors that provide particularly fertile ground for the development of orthorexia, drawing out social and historical connections between religion and orthorexia (which literally means “righteous eating”), and also addressing how ambiguities in the concept of “health” make it particularly prone to take on quasi-religious significance. I (...) argue that what makes this sort of disordered eating destructive to both men and women is ultimately a common urge to transcend rather than to embrace the realities of embodiment. In sum, I believe that orthorexia is best understood as a manifestation of age-old anxieties about human nitude and mortality—anxieties which current dominant sociocultural forces prime us to experi- ence and express in unhealthy attitudes toward healthy eating. (shrink)

Body checking, characterized by the repeated visual or physical inspection of particular parts of one’s own body (e.g. thighs, waist, or upper arms) is one of the most prominent behaviors associated with eating disorders, particularly Anorexia Nervosa (AN). In this paper, we explore the explanatory potential of the Recalcitrant Fear Model of AN (RFM) in relation to body checking. We argue that RFM, when combined with certain plausible auxiliary hypotheses about the cognitive and epistemic roles of emotions, is able (...) to explain key characteristics of body checking, including how body checking behavior becomes habitual and compulsive. (shrink)

This article will explore whether the law should allow people with anorexia nervosa to refuse nutrition and hydration with special reference to the English decision in Re E (Medical Treatment: Anorexia). It argues that the judge in that case made the correct decision in holding that the patient, who suffered from severe anorexia nervosa, lacked capacity to make valid advance directives under the Mental Capacity Act 2005 of the United Kingdom, and that medical procedures that are apparently against (...) her wishes should be carried out for the sake of preserving her life. The law should generally not permit patients with anorexia nervosa to decline nutrition and hydration, precisely because their autonomous ability to make such decisions has been substantially circumscribed by this psychiatric condition. (shrink)

People who suffer from eating disorders often have to be treated against their will, perhaps by being detained, perhaps by being forced to eat. In this paper it is argued that whilst forcing compliance is generally acceptable, there may be circumstances under which a sufferer's refusal of consent to treatment should be respected. This argument will hinge upon whether someone in the grip of an eating disorder can actually make competent decisions about their quality of life. If so, then the (...) decision to refuse therapy may be on a par with other decisions to refuse life‐prolonging therapy made by sufferers of debilitating chronic, or acute onset terminal illness. In such cases, palliation might justifiably replace aggressive therapy. The argument will also draw heavily on the distinction between competent refusal of therapy and passive euthanasia, and the distinction between incompetent and irrational decisions. Both distinctions will then be applied to decisions to refuse food. The extent to which sufferers from anorexia nervosa can be categorised as either incompetent or irrational will be examined. It is against this background that it will be argued that at least some of those who suffer from eating disorders should have their refusals respected, even if they may die as a result. (shrink)

Anorexia nervosa is a psychiatric disorder that seems to be closely related to the identity of the person suffering from it. This is referred to in the vast literature on anorexia nervosa by specifying the quality of symptoms as ‘egosyntonic’ (e.g., Vitousek, Watson, and Wilson 1998). The pursuit of excessive thinness is part of a search for identity in which the control of the body—its size and needs—becomes central (Gillett 2009). This need for control seems to be triggered (...) by a state of bodily alienation in which the body is perceived to be foreign and horrifying to its bearer. However, the relentless dieting and excessive exercise pursued by the anorexic person eventually lead to a state of starvation in which .. (shrink)

The principles that usually direct ethical decision making are not easily or straightforwardly applicable to the care and treatment of anorexia nervosa, particularly the care and treatment of severe and enduring anorexia nervosa, where the sufferer seems to be recalcitrant to treatment and where the condition has become life-threatening.There are exceptional circumstances that characterize this puzzling and still scarcely understood condition; I suggest that these exceptional circumstances provide moral reasons for partial derogation from the usual principles of ethical (...) decision making.In what follows I argue... (shrink)

In this insightful and well-argued article, Osler aims to provide a more fine-grained, phenomenological account of anorectic bodily experience. She notes that although anorexia nervosa often is understood in terms of a distorted body image, this approach does not exhaustively or accurately reflect many subjects' bodily experiences, and also unduly privileges a third-person perspective over first-person accounts. In addition, focusing primarily on body image gives rise to the impression that AN is a form of radical dieting gone wrong as (...) a result of misperceiving or misjudging one's body size or shape. Osler emphasizes that AN is not a static disorder, but rather involves numerous stages. To account for the... (shrink)

In a searching analysis, Radden elucidates key problems in justifying coercive treatment in anorexia nervosa despite a common intuition that it should have a place. Indeed, AN, perhaps more than any other condition, challenges the validity of a test purporting to provide a justification. Our generally accepted model for involuntary treatment is based on impaired decision-making capacity and "best interests." A treatment refusal by a person with "capacity" is to be respected, regardless of the consequences. (I exclude here the (...) criteria under conventional mental health law—a diagnosis of a "mental disorder" coupled with a risk of harm to self or to others—because they discriminate against people with a... (shrink)

Existing phenomenological accounts of anorexia nervosa suggest that various forms of bodily alienation and distorted bodily self-consciousness are common among subjects with this condition. Subjects often experience a sense of distance or estrangement from their body and its needs and demands. What is more, first-person reports and existing qualitative research reveal struggles with authenticity and a search for identity. Is there a connection between the two? I argue that to gain a fuller understanding of anorexia nervosa, how it (...) is experienced by subjects, and why many of them express concerns about authenticity, we need to look more closely at their experiences of bodily alienation and the ways in which they encounter a diminished sense of bodily ownership. After presenting a general overview of the various sorts of bodily alienation that appear to be characteristic of anorexia nervosa, I outline three conceptions of authenticity and introduce some empirical evidence indicating that many subjects with this condition have concerns about identity and authenticity. Then, I examine how different sorts of bodily alienation have the potential to compromise authenticity at various stages of the disorder. Throughout, I draw from several first-person accounts of anorexia nervosa to illustrate and support my claims. (shrink)

In this paper anorexia nervosa is examined through three lenses to determine its possible causes. This paper contains a clinical analysis of the anorexic personality, a psychoanalytic/religious interpretation of the demands of society, and· a feminist reinterpretationof the effects of those demands on the female body. The societal demands to renounce instincts, when examined through a feminist lens, reveals that these demands, in concert with the detrimental effects of feminine socialization and characteristics of the anorexic personality, may lead some (...) women to view their needs as not important, and cause a detachment from and turning against the body in the form of anorexia nervosa. It is concluded that anorexia is not just women taking a diet “too far.” There are other psychological, philosophical, and social factors leading to a prevalence of anorexia nervosa in Western culture. (shrink)

In this paper anorexia nervosa is examined through three lenses to determine its possible causes. This paper contains a clinical analysis of the anorexic personality, a psychoanalytic/religious interpretation of the demands of society, and· a feminist reinterpretationof the effects of those demands on the female body. The societal demands to renounce instincts, when examined through a feminist lens, reveals that these demands, in concert with the detrimental effects of feminine socialization and characteristics of the anorexic personality, may lead some (...) women to view their needs as not important, and cause a detachment from and turning against the body in the form of anorexia nervosa. It is concluded that anorexia is not just women taking a diet “too far.” There are other psychological, philosophical, and social factors leading to a prevalence of anorexia nervosa in Western culture. (shrink)

Imposing artificial feeding on people with anorexia nervosa may be unethical. This seems to be Heather Draper's suggestion in her article, ‘Anorexia Nervosa and Respecting a Refusal of Life‐Prolonging Therapy: A Limited Justification.’ Although this is an important point, I shall show that the arguments supporting this point are flawed. Draper should have made a brave claim: she should have claimed that people with anorexia nervosa, who competently decide not to be artificially fed, should be respected because (...) everybody is entitled to exercise their autonomy, not only ‘in the middle’ of their life, but also at the end of it, or when their own life is at stake, because autonomy also extends to the most difficult moments of our life, and, ultimately, ‘stretches [.*T*.*T*.] far out into the distance’ at the end of it. I explain why Draper should have made the brave claim, and why she has not made it. I conclude that a defence of people's entitlement to competently refuse artificial feeding cannot rest upon the arguments developed by Draper. Whether or not we should respect competent refusal of artificial feeding depends on the normative strength that we are ready to ascribe to the principle of autonomy, to the moral relevance that we ascribe to the circumstances in which a person's autonomy is exercised, and, perhaps, eventually, on our sense of compassion. (shrink)

This is a book that attempts to propose itself as a new trigger in the wide world of anorexia nervosa. The originality of its proposal consists in approaching anorexia nervosa, not only by endocrinological and psychological perspectives, but also by anthropological, philosophical and ethical point of view. In this way it's not only an update of specific literature, but also an integration with a new method to study this condition. The purpose of the book is to approach anorexia (...) nervosa from different points of view, to reach a new interpretation which involves notions from biological and human sciences interpreted in a unique model and which could allow a new method of treatment. (shrink)

Anorexia Nervosa (AN) is a complex disorder characterised by self-starvation, an act of self-destruction. It is often described as a disorder marked by paradoxes and, despite extensive research attention, is still not well understood. Much AN research focuses upon the distorted body image that individuals with AN supposedly experience. However, based upon reports from individuals describing their own experience of AN, I argue that their bodily experience is much more complex than this focus might lead us to believe. Such (...) research often presents an overly cognitive understanding of bodily experience in AN, underplaying the affective, felt experience of individuals with AN, as well as descriptions of empowerment, strength and control reported in the early stages of AN. This paper seeks to enrich our understanding of bodily experience in AN as it progresses throughout the various stages of the disorder. I show how the classical phenomenological distinction between the body-as-subject and the body-as-object, as well as Leder’s conception of the visceral body, can inform our understanding of bodily experience in AN. I suggest that the project of self-starvation is an attempt to overcome the noisy demands of the visceral body, which are experienced as threatening the body-as-subject, through a process of objectifying the body-as-object. By cashing out AN as a project of radical bodily control that, tragically, comes to control the individual, we can capture important aspects of the bodily experience of AN and the temporal progression of the disorder. -/- . (shrink)

Anorexia nervosa involves seemingly irrational beliefs about body size and the value of thinness. Historically, researchers and clinicians have avoided referring to such beliefs as delusions, instead opting for the label ‘overvalued ideas’. I discuss the relationship between the beliefs associated with anorexia nervosa and the distinction between delusions and overvalued ideas, as it is conceived in both European and American psychiatric traditions. In doing so, I question the benefit of applying the concepts of delusion and overvalued idea (...) to anorexia nervosa and raise some issues with contemporary use of the Brown Assessment of Beliefs scale for assessing the level of delusionality associated with the disorder. (shrink)

In this paper, I discuss what I call the oversized experiences that anorexic patients suffer from. It has been known for some time that anorexic patients mentally picture their bodies as larger than reality. While this constitutes one kind of oversized experience, I claim there is another, less explored kind. This is an experience of the body as oversized in relation to the affordances of its environment. I discuss recent evidence suggesting anorexic patients exhibit distorted affordance perception. I then discuss (...) how this distorted affordance perception also constitutes an oversized experience of the body. Along with sociocultural influences, I claim oversized experiences ground negative propositional attitudes regarding body size. (shrink)

The DSM‐5 highlights two essential psychological features of anorexia nervosa (AN): recalcitrant fear of gaining weight and body image disturbance. Prominent accounts grant false beliefs about body weight and shape a central role in the explanation of AN behavior. In this article, we propose a stronger emphasis on recalcitrant fear. We show that such fear can explain AN behavior without the intermediary of a false belief, and thus without the associated explanatory burdens and conceptual difficulties. We illustrate how shifting (...) the emphasis from false belief to recalcitrant fear can supplement a number of different non‐doxastic models of AN. (shrink)

Numerous studies of the beliefs of people with anorexia nervosa (AN) suggest that a subset of such individuals may experience delusions. We first describe what makes a belief delusional and conclude that such characteristics can be appropriately applied to some beliefs of people with AN. Next, we outline how delusional beliefs may relate to the broader psychopathological process in AN, including: (1) they may be epiphenomenal; (2) they may be an initial partial cause of AN; (3) they may be (...) caused by aspects of AN; or (4) they may be sustaining causes, possibly involved in reciprocal causal relations with aspects of AN. We argue that there is good reason to believe that delusional beliefs of people with AN are not merely epiphenomenal, but rather that they’re causally connected to AN. Because of this, empirical studies can be designed to test for the presence of causal relations. We describe how these studies should be designed. The results of such studies have important implications for understanding the experience of individuals with AN and for the treatment of AN. We outline these implications. (shrink)

Anorexia nervosa is a very serious condition because of the suffering and loss of life that it causes. However, the wishes of the people directly involved can be strongly opposed. The person with severe AN may not want treatment, yet her family beseeches professionals to unilaterally intervene and clinical teams are divided over the defensibility of involuntary hospitalization and treatment. The metaphor of a crucible is used in this paper to help identify how much is at stake and how (...) much is in conflict when someone has AN. Frank cautions against ethical analyses that rely mostly on substantive principles or rules and institutional conflict resolution procedures. This paper applies his heuristic concepts of “ethics-as-substance” and “ethics-as-process” to a prototypical AN case to illustrate how process activities can expand understanding of, and responsiveness to, those who are living with this dire condition or those who are obligated to help. (shrink)

We are grateful for these two insightful commentaries, which both see novelty and value in the manner in which we invoke the hypothesis that anorexia nervosa is a passion, to help explain data from the Anorexia Experiences Study, which provides the basis of our inquiry. In this response, we wish to clarify and elaborate on our hypothesis; in particular, the difference between passions and moods, the manner in which our hypothesis touches on issues of authenticity and identity, and the (...) compelling parallel with addiction. We also wish to emphasize that, in proposing the hypothesis that anorexia nervosa is a passion, our primary aim is not so much to exclude or replace alternative theoretical approaches. Our focus, really, is to argue that the hypothesis that anorexia nervosa is a passion adds something rich and unique to our current understanding of that condition, which is not fully or adequately captured by alternative accounts... (shrink)

Anorexia nervosa is a very serious condition because of the suffering and loss of life that it causes. However, the wishes of the people directly involved can be strongly opposed. The person with severe AN may not want treatment, yet her family beseeches professionals to unilaterally intervene and clinical teams are divided over the defensibility of involuntary hospitalization and treatment. The metaphor of a crucible is used in this paper to help identify how much is at stake and how (...) much is in conflict when someone has AN. Frank cautions against ethical analyses that rely mostly on substantive principles or rules and institutional conflict resolution procedures. This paper applies his heuristic concepts of “ethics-as-substance” and “ethics-as-process” to a prototypical AN case to illustrate how process activities can expand understanding of, and responsiveness to, those who are living with this dire condition or those who are obligated to help. (shrink)

현대 사회의 주된 정신장애인 섭식장애에 대한 연구는 주로 심리학과 정신의학 분야에서 이루어졌다. 그러나 최근 철학 분야에서도 섭식장애를 깊이 있게 다룬 연구 논문들이 있어 주목된다. 섭식장애 중 거식증은 다양한 요인들의 복합적인 작용으로 발병하는 것이므로 다양한 관점에서 그 요인들과 원인을 살펴보는 것이 중요하며 철학적, 문화적 관점의 탐색이 필요하다.BR 본 연구는 심리학적 관점을 바탕으로 한 섭식장애에 대한 정의와 진단 기준, 임상적 특징, 발병의 원인 등에 대해 살펴보고 섭식장애의 하위유형 중 가장 심각한 정신장애인 거식증을 중심으로 논의되었던 철학적 논의를 검토해보는 것이 목적이다.BR 홍콩의 거식증은 서구의 (...) 거식증 진단기준과는 사뭇 다른 비전형적인 특징을 보인다. 비만에 대한 두려움이 없고(non-fat phobic) 왜곡된 신체 이미지(distorted body image)를 갖지 않는 동양의 비전형적 거식증 사례는 문화 기반이 다른 지역에서 발생한 정신장애로 매우 주목할 만한 연구 주제라 할 수 있다. 중세의 성녀들의 금식문화는 현대의 거식증과 유사한 측면들이 있는데 이에 대해 논의한 철학적 연구는 흥미롭고 주목할만 하다.BR 본 연구에서는 동양의 비전형적 거식증을 다룬 철학적 논의의 의의에 대해 검토하고 임상심리학적 관점을 제안하였으며 중세의 금식문화와 현대의 거식증에 대한 철학적 논점을 검토하였다. (shrink)

Anorexia nervosa is an eating disorder characterized by intense fear of gaining weight and a distorted body image which usually leads to low caloric intake and hyperactivity. The underlying mechanism and pathogenesis of anorexia nervosa is still poorly understood. In order to learn more about the underlying pathophysiology of anorexia nervosa and to find further possible treatment options, several animal models mimicking anorexia nervosa have been developed. The aim of this review is to systematically search different (...) databases and provide an overview of existing animal models and to discuss the current knowledge gained from animal models of anorexia nervosa. For the systematic data search, the Pubmed—Medline database, Embase database, and Web of Science database were searched. After removal of duplicates and the systematic process of selection, 108 original research papers were included in this systematic review. One hundred and six studies were performed with rodents and 2 on monkeys. Eighteen different animal models for anorexia nervosa were used in these studies. Parameters assessed in many studies were body weight, food intake, physical activity, cessation of the estrous cycle in female animals, behavioral changes, metabolic and hormonal alterations. The most commonly used animal model is the activity-based anorexia model in which typically young rodents are exposed to time-reduced access to food with unrestricted access to a running wheel. Of the genetic animal models, one that is of particular interest is the anx/anx mice model. Animal models have so far contributed many findings to the understanding of mechanisms of hunger and satiety, physical activity and cognition in an underweight state and other mechanisms relevant for anorexia nervosa in humans. (shrink)

Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa. A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on determinations of (...) capacity in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile. (shrink)

In my article "Controlling the noise," I present a phenomenological investigation of bodily experience in anorexia nervosa. Turning to descriptions of those who have suffered from AN, which repeatedly detail the experience of finding their bodies threatening, out of control and noisy, I suggest that the phenomenological conceptions of body-as-object, body-as-subject and visceral body can help us unpack the complex bodily experience of AN throughout its various stages. My claim is that self-starvation is enacted by a bodily-subject who wishes (...) to quell or reassert authority over a visceral body whose demands and needs she finds threatening to her autonomy.The relationship between body-as-object and... (shrink)

There is preliminary evidence, from case reports and investigational studies, to suggest that Deep Brain Stimulation could be used to treat some patients with Anorexia Nervosa. Although this research is at an early stage, the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this paper, we first show how different treatment mechanisms raise different philosophical and ethical questions. We distinguish three potential mechanisms alluded to in the (...) neuroscientific literature, relating to desire, control, and emotion, respectively. We explain why the precise nature of the mechanism has important implications for the patient’s autonomy and personal identity. In the second part of the paper, we consider practical dimensions of offering DBS to patients with AN in certain cases. We first discuss some limited circumstances where the mere offering of the intervention might be perceived as exerting a degree of coercive pressure that could serve to undermine the validity of the patient’s consent. Finally, we consider the implications of potential effects of DBS for the authenticity of the patient’s choice to continue using stimulation to ameliorate their condition. (shrink)