Anorexia can be as much a metabolic disorder as psychiatric

A study by researchers at King's College London and the University of North Carolina at Chapel Hill found that eating disorder anorexia nervosa is not only a psychiatric condition, but also has a physical element driven by metabolic differences between patients.

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Anorexia nervosa is generally perceived as a serious psychiatric disorder. At present, a large-scale international study has shown that some differences in the DNA of people with anorexia have altered the way they treat fats and sugars, so as to facilitate their starvation.

The discovery, dubbed "revolutionary" by the Charity for Beat eating disorders, could help explain why doctors have struggled to treat this disease and could pave the way for new therapeutic approaches devastating disorder. This can also lead to new ways of predicting who is most at risk for developing the disease.

What is anorexia nervosa?

Anorexia Nervosa is a potentially life threatening eating disorder, with a death rate that is the highest of all psychiatric disorders. It is more common among women than men, affecting between 1% and 4% of women and about 0.3% of men.

Disease outcomes include: dangerously low body weight, weight gain phobia, and deformed body image.

While some patients eat so little that they die of hunger, others follow a regular diet, but exercise as they burn more calories than they have absorbed. In the long run, this potentially fatal disorder can muscles, bones, organs and fertility.

Common therapeutic approaches include psychological interventions such as cognitive behavioral therapy (CBT) and dietary plans to restore a healthy weight, but these interventions often fail.

Screening for genetic changes common to anorexia

For the present study, more than 100 researchers worldwide evaluated the DNA data collected from the Anorexia Nervosa Genetics Initiative and the Eating Disorders Task Force for 16,992 people with anorexia and compared them. with those of 55,525 unaffected persons.

They then evaluated the dataset, which covered 17 countries in North America, Europe, and Australasia, to search for more common genetic mutations in anorexic individuals.

As reported in the newspaper Nature Genetics, The researchers discovered eight genetic variants badociating anorexia nervosa with depression, anxiety and obsessive-compulsive disorder, psychological disorders that could be expected.

However, they also detected mutations that affected the metabolism of blood glucose and body fat in the body, including calorie burning, physical activity, and type 2 diabetes resistance. " There is something about these systems that went wrong, "says Janet Treasure of the Institute of Psychiatry of King's College London.

What does this mean for patients?

"The metabolic abnormalities observed in patients with anorexia nervosa are most often attributable to starvation, but our study shows that metabolic differences can also contribute to the development of the disease," says co-investigator and geneticist Gerome Breen. metabolic factors may play a role almost as important as purely psychiatric effects. "

The authors suggest that anorexia is now considered a "metabo-psychiatric disorder", referring to this disease as a disease of both mind and body.

What our study means is that we can no longer treat anorexia, and perhaps other eating disorders, as purely psychiatric or psychological. Anorexia has the expected correlations with anxiety, depression, and OCD, but it also contains this set of seemingly healthy metabolic correlations that we do not see in any other psychiatric disorder. "

Gerome Breen, co-author

Breen and his colleagues have not yet fully studied the role of discovered genetic changes, but they suspect that they facilitate the starvation of the anorexic person, since the signals usually triggered by weight loss to induce hunger no longer arouse. the urge to restore a normal set point.

What is the significance of the results?

"This is very important because it is difficult to know what anorexia disorder is … Over time, uncertainty about the definition of anorexia nervosa has been uncertain because of the mixture of characteristics. physical and psychiatric.

"Our results confirm this duality and suggest that the integration of metabolic information could help clinicians develop better methods of treating eating disorders," says Treasure.

Andrew Radford, chief executive of the Beat Charity, said the research was groundbreaking, explaining that it dramatically improved understanding of the genetic origins of this serious illness.

Radford says that the charity strongly encourages researchers to look at the results and think about how they could contribute to the development of new treatments that can end the pain and suffering of people with eating disorders.

Next to the agenda: Anticipate relapse for early intervention

The eight genes identified in this study account for only a small fraction of anorexia; there are probably hundreds or even thousands of additional genes that contribute globally to the risk of developing the disease.

Breen is now asking researchers to study the metabolism of people suffering from anorexia and other eating disorders to determine whether new metabolism – based therapies can be developed and whether they are safe. It is possible to locate patients at risk of relapse, a common problem in Latin America. Anorexia: "Predicting relapse is one of the most valuable things we can do."

Rebecca Park, consultant psychiatrist at Oxford University, says that over time, such discoveries would not only lead, hopefully, to new therapeutic interventions, but would also begin to tip over. a culture of blame where one expects patients to suffer outside of that.

We know that we need more effective treatments for anorexia nervosa. The key is to try to end the famine, but often this process does not work. The most important message is to intervene early, at the very beginning. "

Rebecca Park, Consultant Psychiatrist

If you have an eating disorder or if you know someone who has been diagnosed with anorexia, you can contact the Beat Hotline at +448088010677 or visit the website by clicking here. For families and friends, we also have a dedicated support page.