192 Summary and discussion Our analysis revealed robust empirical support for this hypothesis, as we observed significant and consistent alterations in oscillatory power across all patients. Within-subject these alterations were affecting a broad range of frequencies and extending across multiple brain regions and networks - even when the DBS device was deactivated. These observations substantiate the notion that the neuromodulatory effects of DBS extend beyond localized regions, impacting broader pathological neural networks. Additionally, our findings suggest that the brain, following an initial period of disorganization, adapts to the perturbations induced by DBS, potentially reorganizing into a functionally more stable state. In Chapter 7 of our study, we investigated the endocrine and metabolic effect of deep brain DBS in patients with AN. Our pilot study posited that DBS would induce time-dependent alterations in endocrine and metabolic indices, correlating with AN and concurrent weight gain. We observed statistically significant reductions in testosterone (by 21.47%) and cortisol levels (by 47.39%). Other changes did not reach statistical significance, which may be attributed to the study’s limited sample size and the pronounced individual variability. The observed, albeit non-significant, elevation in leptin among DBS-responsive subjects further implies potential implications of DBS - or the weight gain it induces - on endocrine and metabolic profiles. These observations necessitate additional studies to unravel the intricate relationships among physiology, disordered eating behavior, and neuromodulation. Although the generalizability of these data to broader AN or DBS populations is restricted, our exploratory study provides foundational insights into endocrine and metabolic shifts potentially induced by DBS. Part V As delineated in Chapter 3, we noted a statistically significant increase in self-destructive behaviors among the AN patients undergoing DBS treatment. In an effort to elucidate the potential relationship between AN and self-destructive tendencies, specifically non-suicidal self-injurious behavior (NSSI), we undertook a comprehensive review of extant literature (Chapter 8). According to prevailing academic discourse, both NSSI and eating disorders (EDs) exhibit associations with emotional dysregulation, maladaptive coping strategies, and a dysfunctional reward system. Within the framework of this conceptual review, we advance a reward-centric hypothesis elucidating the common features shared between AN and NSSI. To further refine our comprehension of the interplay between AN and NSSI, we advocate for the adoption of three distinct methodological paradigms, each amalgamating elements of psychopathology and neurobiology: (1) a nosographical approach, (2) an approach based on Research Domain Criteria (RDoC), and
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