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October 2018

Reward System Abnormalities in Anorexia Nervosa: Navigating a Path Forward

Author Affiliations
  • 1Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
  • 2Department of Psychiatry, New York State Psychiatric Institute, New York
JAMA Psychiatry. 2018;75(10):993-994. doi:10.1001/jamapsychiatry.2018.1924

Anorexia nervosa (AN) is associated with the highest mortality rate of any psychiatric illness1 as well as significant health care costs and lost wages. While there have been notable advances in understanding biobehavioral mechanisms of AN, the brain systems that underlie the illness remain poorly understood. Clinically, it is widely accepted that the critical first step in treatment is renourishment—that is, restoring individuals to a healthy body weight. Yet knowing that the primary medical intervention is simply to eat does not, in itself, change behavior. In fact, even after full weight restoration, individuals with AN continue to restrict caloric and fat intake, which is associated with poor longer-term outcomes.2 The severity and persistence of this illness makes understanding the pathophysiology and neural mechanisms of AN a research priority.

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