The delusional dimension of anorexia nervosa: phenomenological, neurobiological and clinical perspectives

Abstract

Background: Delusional characteristics have been largely ignored in patients suffering from anorexia nervosa (AN). Objectives: To review the literature on delusional features in AN from phenomenological, neurobiological, and clinical viewpoints. Methods: Data were obtained through searches of Medline, PubMed, SciELO and Cochrane Library. Results: Distorted beliefs in AN may range from an overvalued idea to an overt delusion, involving affective, personality and/or psychotic disorders. Studies confirm alterations in monoaminergic systems. It has also been seen a decreased integration of visual/proprioceptive information, and alterations in neural networks involved in body processing. It is known that body image distortion may present "delusional proportions" as a consequence of great concern about body. Concomitantly, "embodied defence hypothesis" has been proposed. Restrictive AN exhibits higher levels of delusionality, and a particular delusional type of AN has been suggested, associated with a worse long-term outcome. Low doses of atypical antipsychotics are recommended combined with cognitive techniques. Discussion: Delusional thinking in AN is likely a dynamic and dimensional phenomenon that can vary, both in nature and/or severity, whereas high insight levels, before and after refeeding, result in positive outcomes. Neurobiological research on this topic must be encouraged, since clinical and phenomenological approaches are comparatively more frequently reported.

Co-occurring psychotic and eating disorders in England: findings from the 2014 Adult Psychiatric Morbidity Survey

“…When discussing the symptoms and experiences of individuals diagnosed with ED, researchers highlight similarities with PD. Those with AN are described as having delusional thinking patterns surrounding their body image and weight [ 14 , 30 ]. Behar et al, [ 14 ] state that delusional beliefs in EDs exist on a spectrum from over-valuing body image to overt delusion surrounding one’s body and size [ 30 ].…”

“…Whilst findings from Aragona et al [ 13 ] should be interpreted with caution due to the lack of a control group, other researchers support the existence of delusional thinking in EDs too. Behar, Arancibia, Gaete, Silva & Meza-Concha [ 14 ] found that individuals diagnosed with EDs showed delusional thinking patterns like those observed in PD. Delusions in EDs focus on body image and weight, suggesting that PD and ED may be linked through the shared symptom of delusional or delusion-like ideation [ 13 , 14 ].…”

“…Behar, Arancibia, Gaete, Silva & Meza-Concha [ 14 ] found that individuals diagnosed with EDs showed delusional thinking patterns like those observed in PD. Delusions in EDs focus on body image and weight, suggesting that PD and ED may be linked through the shared symptom of delusional or delusion-like ideation [ 13 , 14 ].…”

Ectodermal disturbance in development shared by anorexia and schizophrenia may reflect neurodevelopmental abnormalities

“…Konstantakopoulos et al (2012) stated that the delusional variant of the disorder occurs at the end of the AN continuum. Indeed, psychotic symptoms have been observed in subjects suffering from eating disorders in some studies (Behar et al, 2018;Miotto et al 2010).…”

Eating pathology and Psychodynamic Diagnostic Manual (PDM-2) diagnostic assessment: Implications for treatment outcomes in a psychodynamic-oriented residential setting.

“…Additionally, the relevance of identity impairment in ED patients is firmly grounded in both the theoretical (e.g., Bruch, 1973) and the empirical literature, which also suggests that identity pathology may contribute to ED development and maintenance (Verschueren et al, 2017). Finally, two narrative reviews suggested that delusional thinking and impaired reality testing might contribute to therapeutic resistance among ED patients (Behar et al, 2018; Konstantakopoulos et al, 2012).…”