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

  • Rosa Behar Universidad de Valparaiso; School of Medicine, Faculty of Medicine; Department of Psychiatry
  • Marcelo Arancibia Universidad de Valparaiso; Cochrane Centre
  • María Isabel Gaete Universidad de Chile; School of Medicine, Faculty of Medicine; Department of Psychiatry
  • Hernán Silva Universidad de Chile; School of Medicine, Faculty of Medicine; Department of Psychiatry
  • Nicolás Meza-Concha Universidad de Valparaíso; School of Medicine; Faculty of Medicine
Keywords: Anorexia nervosa, delusions, body image, neurobiology, phenomenology

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.

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Published
2018-02-01
How to Cite
Behar, R., Arancibia, M., Gaete, M., Silva, H., & Meza-Concha, N. (2018). The delusional dimension of anorexia nervosa: phenomenological, neurobiological and clinical perspectives. Archives of Clinical Psychiatry, 45(1), 15-21. https://doi.org/10.1590/0101-60830000000148
Section
Review Article