Reconceptualizing and Renaming Eating Disorders as Anankastic Eating Disorders

Abstract

Eating disorders is fundamentally an obsessive-compulsive disorder with eating-related symptoms, focusing on feeding, body shape, size and weight. Obsessive-compulsive personality disorder (OCDP) traits are commonly associated with eating disorders (EDs), with evidence indicated that these traits predispose and exacerbate the ED illness course. In any case, ‘Anorexia’ is not the central pathogenic feature in the so-named ‘anorexia nervosa disorder’. These patients do not loss appetite; in fact, they restrict feeding. It is obvious that these patients suffer from a specific and severe form of an ‘anankastic personality’, having the aberration of restrict feeding, which indicate an ‘anankastic eating disorder’. We need to rethink about ED from an obsessive-compulsive disorder (OCD) perspective, and reconceptualizing and renaming ED as ‘Anankastic Eating Disorders’. Placing eating-related symptoms in an OCD/OCDP framework could help focusing more on reducing ED-associated compulsions and avoidance behaviors, as the primary treatment targets. This aspect will suggest, among others, on medication selection and dosage, such as high-dose and long period SSRIs, for targeting eating-related obsessive/compulsive symptoms. This will also encourage relevant research, e.g. within RDoC, having the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.