بی اشتهایی عصبی: اختلال وسواسی جبری، اختلال شخصیت وسواسی جبری یا هیچکدام؟

Anorexia nervosa (AN) is a severe and often chronic disorder with uncertain aetiology and poor prognosis. New approaches to the understanding of the disorder are needed in order to aid the development of more effective treatments. Several authors have suggested that AN has a considerable overlap with obsessive–compulsive disorder (OCD) and that this may reflect common neurobiological, genetic, or psychological elements. However, more recent studies have suggested that AN may have a closer relationship with obsessive–compulsive personality traits such as those found in obsessive–compulsive personality disorder (OCPD). In this paper, evidence for links between the three conditions is reviewed, suggestions for further research are outlined and possible implications for the treatment of AN are presented.

Since the earliest descriptions of anorexia nervosa (AN), the presence of obsessive and compulsive symptoms in the disorder have been noted (Kaye, 1995). Additionally the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV, American Psychiatric Association, 1994) explicitly describes overvalued ideas about thinness as one of the diagnostic features of the disorder (see Table 1). These overvalued ideas could be understood as obsessions about weight which, coupled with the ritualistic behaviours around food and eating commonly observed in AN, might suggest an overlap with obsessive–compulsive disorder (OCD). However, many of the personality characteristics commonly associated with AN (such as perfectionism, rigidity, and a strong need for control) might also be considered features of another disorder, namely obsessive–compulsive personality disorder (OCPD). This raises the question of whether AN is more closely related to OCD or OCPD, or whether there are subgroups of individuals, some of whom may show OCD-like and others OCPD-like forms of AN. In this paper, we review the clinical, psychological, epidemiological and biological evidence for relationships between AN and OCD, between AN and OCPD, and between OCD and OCPD and explore the clinical implications of these links.