181 Psychopathological and neurobiological overlap between anorexia nervosa and self-injurious behavior RECOMMENDATIONS FOR FURTHER RESEARCH Our models on the possible relationship between AN and self-destructiveness are hypothetical, providing new inroads for scientific substantiation. We recommend the development of research initiatives that study AN and NSSI in the context of RDoC and through the network analysis and dynamic systems approach. This might increase insight in the mechanisms that cause the clinical and neurobiological overlap between AN and NSSI. To overcome nosologic difficulties we suggest to consider NSSI as a behavioral concept independent of diagnosis, and to research the overlap and differences with disturbed eating-related behavior instead of eating disorders or anorexia nervosa. This would lead to a more neuroscientific approach of defining and researching psychopathology conform the Research Domain Criteria (RDoC) Project (59, 62). The involvement of the opioid system in both AN and NSSI is a point of interest, possibly creating an opportunity for new pharmacotherapeutical interventions in AN, NSSI or the combination (63). For example, N-Acetylcysteine is being studied as possible moderator in behavioral addiction (64). A potentially promising intervention that is being researched in patients with severe, chronic treatment refractory AN is modulation of the reward circuitry with deep brain stimulation (DBS). Given the observed high levels of self-destructiveness (eating-disordered as well as non-eating disordered) and the affect regulation and reward-related abnormalities in these patients, DBS might be effective in the treatment of not only AN but also of self-destructiveness in general. Neuroimaging studies focusing on the concepts of self-destructiveness, affect regulation and reward regulation of both AN and NSSI might increase knowledge of the underlying neurobiological substrates, providing tools for the development of new and targeted treatment options for both AN, NSSI and the combination of both.
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