174 Chapter 8 AN and NSSI: a nosographical approach Although there is considerable overlap between AN and NSSI, there are also differences. AN is a well-defined psychiatric disorder with specific diagnostic criteria. Although self-starvation, purging and over-exercising are highly self-destructive, the body image distortion and denial of the severity of the somatic condition in AN are not seen to this extent in people engaging in NSSI and seem to be specific to AN. NSSI on the other hand is increasingly being considered as a distinct disorder instead of a symptom of other disorders in the DMS-5. Based on these characteristics and differences in clusters of symptoms (i.e. a different classification of symptoms) it can therefore be hypothesized that NSSI and AN are two separate disorders, with some degree of overlap in neurobiology and functionality, leading to comorbidity (see figure 2a). Figure 2a NSSI and AN as two separate disorders, with some degree of overlap in neurobiology and psychology, leading to comorbidity One might also argue that NSSI is no separate construct or disorder at all. NSSI is prevalent in the context of many psychiatric disorders, especially disorders related to emotion regulation, impulsiveness, identity and interpersonal problems. Self-destructive eating disordered behavior and other forms of NSSI present during the course of AN could thus be seen as a symptom of AN, like NSSI is also often seen as a symptom in borderline personality disorder (see figure 2b). While the initial motivation to engage in food restriction and purging might be a drive for thinness, the existing predominant view of AN as a disorder of fear of weight gain might need to be revised. In accordance with the reward-based hypothesis of AN, AN could be considered as a disorder of emotion regulation and disrupted reward processing, with self-destructiveness, reflected by eating disordered behavior as well as NSSI in general, as a key symptom. Neurobiology Psychology Common factors Hair pulling Burning Cutting NSSI Neurobiology AN Etiological factors NSSI AN Psychology Excessive excercising Cutting Hair pulling Burning Purging Disorder Clinical expressions Emaciation Cutting Burning Hair pulling Disordered eating behavior (purging etc.) Neurobiology NSSI Etiological factors Psychology Disorder Clinical expressions Neurobiology,
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