173 Psychopathological and neurobiological overlap between anorexia nervosa and self-injurious behavior The imbalance in the cortico-striatal circuit, with a focus on bottom-up processes of the striatal reward system, might be of great relevance for the reward associated learning of self-destructive behavior in AN and NSSI in general. Because of the central role of reward in both NSSI and AN, the reward-associated brain areas and neurobiological mechanisms, we hypothesize that reward is a central and common factor in the pathophysiology of both AN and NSSI. SUMMARY Both AN and NSSI are characterized by disturbances in affect regulation, coping strategies, the psychological constructs of reward, and on a neurobiological level dysregulation of the reward circuitry and the opioid system. DISCUSSION AND CONCEPTUALIZATION AN and NSSI: conceptual hypotheses We acknowledge the fact that in this review, we have placed ourselves in the difficult position of describing links between two constructs that are conceptually and structurally dissimilar. The conceptualization of both eating disorders and NSSI is a topic of much debate. Eating disorders, and AN in particular, may be perceived as disorders of feeding, but also as body-image disorders, psychosomatic disorders, neurotic or obsessive-compulsive disorders or even disorders with a psychotic component. Based on the psychopathological and neurobiological evidence outlined in our review, a reward-related or behavioral addiction disorder perspective seems applicable. Self-destructive behavior has long been considered a symptom of several psychiatric disorders and has only been recently taken into consideration as a separate, affect regulation- and reward-related disorder. Based on the overlap between AN and NSSI summarized above - in epidemiology, comorbidity, clinical picture, functionality, explanatory mechanisms and involvement of (partially) the same neurobiological systems - we propose several hypothetical models of the relationship between AN and NSSI and their underlying neurobiology: (1) a nosographical approach, (2) a research domain (RDoC) approach and (3) a network analysis approach. Central in these models is the overlap between AN and NSSI in affect regulation, body and/or pain disperception, punishment and reward.
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