Scientists discover that anorexia is not just a psychiatric problem | Science



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Scientists have discovered that anorexia nervosa, a devastating eating disorder, was not purely a psychiatric condition, but was also motivated by metabolic problems.

This discovery may help to explain physicians' poor record of treating the disease and pave the way for radical new approaches to predicting and treating those most at risk.

The researchers made this discovery after comparing the DNA of nearly 17,000 people with anorexia and more than 55,000 healthy controls. People suffering from anorexia have submitted their DNA through the Initiative on Genetics of Anorexia Nervosa or the Consortium's eating disorders working group. psychiatry in genomics.

The study revealed eight genes that linked anorexia to anxiety, depression and obsessive-compulsive disorder, factors that were expected. But he also identified the DNA involved in fat burning, physical activity and type 2 diabetes resistance.

"What our study means is that we can no longer treat anorexia and possibly other eating disorders as purely psychiatric or psychological disorders," said Gerome Breen, geneticist at King & # 39; London College, which led the study with US researchers from the University of North. Caroline at Chapel Hill.

"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," added Breen.

Although they appear healthy, the metabolic genes seem to combine with genes related to psychiatric problems to increase the risk of anorexia. About half of the anorexia is explained by genetics, the rest being attributed to life events and other factors.

Anorexia Nervosa is the most lethal of all psychiatric illnesses. It affects between 1% and 4% of women and about 0.3% of men. Affected individuals can have extremely low body weight and distorted vision of the appearance of their body. They can be terrified of gaining weight. While some eat so little that they starve, others eat normally but exercise to the point of burning more calories than they consume.

The disorder can be treated with a combination of psychological interventions, such as Cognitive Behavioral Therapy (CBT), and family-based re-diet programs that aim to bring people back to a healthy weight with support. of their family. But these do not always succeed.

Doctors have long considered the home environment as a factor responsible for anorexia nervosa, but in some cases even widespread beliefs may be wrong. Perfectionism, for example, has been accused of being a cause of anorexia, but recent work suggests that it is the opposite.

"Families of people with anorexia tend to have higher levels of perfectionism, but we think people are wrong about cause and effect. It's not perfectionism that causes anorexia, it's the tendency to have anorexia that is causing increased perfectionism, "said Breen. "What we think is that the family environment and genetics interact."

The eight genes identified in the research account for only a small fraction of anorexia. As in many diseases, it is likely that hundreds, if not thousands, of genes contribute to the risk of developing the disease.

Breen added that it was now necessary for scientists to study the metabolism of people suffering from anorexia and other eating disorders to determine if it was possible to develop drugs. Metabolism-based therapies or to screen people at risk of relapse, a common problem in anorexia. "Predicting relapse is one of the most valuable things we can do," he said. The study is published in Nature Genetics.

Rebecca Park, a consultant psychiatrist who studies eating disorders at Oxford University, said the work did not provide an instant solution, but could lead to new methods of treating anorexia .

"This work adds something really important," she said. "This indicates to patients and their families, as well as to professionals who administer or develop treatments, that anorexia may not be conceptualized as a solely psychiatric illness. On the contrary, metabolic factors may also contribute.

"Hopefully, over time, such discoveries will lead to new therapeutic approaches and begin to shift a culture of blame, which sufferers should simply be able to get out of it."

Park added, "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. "

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