196 Summary and discussion vation, purging, and excessive exercise - these behaviors can be subsumed under a broader category of self-destructiveness. One of the participants of our study expressed this by saying that her eating disordered behaviors were giving her a form of satisfaction because of the ‘active’ balancing on the edge of life and death. Historically, self-destructive behavior has been considered a symptomatic feature of various psychiatric disorders, such as borderline personality disorder. Alternatively, the self-destructive behaviors evident in AN could be conceptualized as a form of non-suicidal self-injury (NSSI), a category increasingly acknowledged as a separate disorder related to affect regulation and reward mechanisms. The hypothetical models we propose in this thesis illuminate alternative perspectives: AN as an isolated diagnostic entity, and AN as a form of expression of reward-driven disorder of self-destructiveness. It is crucial to underscore the speculative nature of our models; the act of comparing two divergent, nosographically and conceptually distinct constructs inevitably introduces bias and complicates any efforts to draw definitive conclusions. Nonetheless, we posit that our hypothetical models may offer novel avenues for empirical validation. Modulating the reward circuitry through DBS could prove efficacious not merely in the treatment of AN but also in addressing self-destructive behaviors more broadly. Moreover, supplementing DBS treatment with psychotherapeutic interventions targeted at underlying issues of emotion and impulse regulation could potentially amplify the therapeutic impact of DBS in AN, thereby improving clinical outcomes. Integrating findings - ethics and philosophy on a scale Employing an invasive, experimental neural intervention on a highly vulnerable patient population suffering from AN elicits a range of ethical and philosophical questions (15). Central to the discourse on medical ethics is the principle of equipoise. Our DBS-AN study was categorized as high-risk due to several factors: the experimental nature of the investigation, the invasiveness of the procedure, and the critical medical condition of the patient population, which exhibited severe underweight conditions (BMI < 15 kg/m²). The unique convergence of these variables renders risk-benefit calculations highly complex. However, in severe and enduring AN the exploration of innovative, albeit high-risk, therapeutic interventions seems warranted. AN has relatively clear neurobiological underpinnings, has high morbidity and mortality rates, has a proclivity for a chronic trajectory in a significant subset of patients, and evidence-based treatment modalities are scarce.
RkJQdWJsaXNoZXIy MjY0ODMw