165 Psychopathological and neurobiological overlap between anorexia nervosa and self-injurious behavior METHODS AND OUTLINE We conducted this narrative review according to the steps described by Demiris e.a. (6). To answer the above questions we first summarize the literature on the psychopathology (clinical picture and psychological theories on the etiopathogenesis) and the neurobiology of AN and NSSI separately. For this search we used various combinations of search terms regarding ‘Anorexia nervosa’ ‘Self-destructive behaviour’,‘NSSI’ AND/OR ‘psychopathology’ AND/OR ‘neurobiology’. We chose relevant articles that focus on the combination of and/or overlap between the two. Because this search did not reveal many relevant hits we expanded the search with ‘Eating disorders’ AND ‘Self-destructive behavior’ for topics on which there was no literature specific to AN. We scanned reference lists of included articles for additional relevant literature. First, we summarize the psychopathology and neurobiology of AN and NSSI separately. In chapter 3 we discuss the commonality between AN and NSSI on a psychopathological and neurobiological level, leading to a reward centered hypothesis on this overlap. We made the somewhat artificial distinction between psychopathology in general and neurobiology in specific for reasons of clarification from a research perspective. Finally we propose three conceptual hypotheses explaining the relationship between AN and NSSI, integrating psychopathology and neurobiology. RESULTS: PSYCHOPATHOLOGY AND NEUROBIOLOGY OF AN AND NSSI RESPECTIVELY Anorexia nervosa Psychopathology of AN Anorexia nervosa (AN) is an eating disorder characterized by (1) an intense fear of gaining weight or becoming fat; (2) persistent behavior that interferes with weight gain, potentially leading to self-starvation and severe somatic complications; (3) and a misperception of one’s body weight or shape (and often also the seriousness of the malnutritive state of the body). There are two subtypes of AN: the restrictive subtype (AN-R), characterized by restrictive eating; and the binge eating/purging subtype (AN-BP), characterized by restrictive energy intake but also binging and/ or purging (self-induced vomiting, misuse of laxatives and/or diuretics) (7). AN typically has its onset in adolescence (8) and the female-male ratio is 4:1 (9). AN has a prevalence of 1-4% and (9, 10). With a mortality rate of 5.6% per decade (resulting from medical complications and suicide), AN has the highest mortality rate of all psychiatric disorders (9, 11). Psychiatric comorbidity is high: comorbid psychiatric disorders are reported in over 70% of AN-patients and include affective disorders, obsessive compulsive disorder, personality disorders, and
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