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hy would a predisposition to anorexia survive in the gene pool, especially when one de?ning feature of anorexia is that a

female stops menstruating for at least three consecutive cycles? Therapist Shan Guisinger, who is af?liated with the

University of Montana, speculates that the answer may lie in the bene?ts of anorexia for helping early humans cope with

famine. A female whose genes made her more energetic when she was starving might well have helped her clan survive

times of scarcity: she could scout and forage for food when no one else could. Traits of perfectionism and

overachievement, moreover, could have helped her on difficult foraging journeys. Famine might even have activated her

anorexic condition. And, Guisinger’s theory goes, when food became plentiful again, the tribe would feed her enough for

her to reproduce. Although such a theory is impossible to prove, espousing it can be therapeutic. Telling a woman who

suffers from a disease marked by misery and low self-esteem that she is genetically programmed to be Joan of Arc (who

may have suffered from anorexia, according to Guisinger) may help her see herself as a hero rather than as a failure. She

may then under-

In one theory of the origins of anorexia, the af?icted are likened to French heroine Joan of Arc (above).

stand that anorexia might have once been an asset in emergencies but is an illness in a culture that emphasizes

thinness at all times. “The explanation makes sense of their experience,” says Guisinger, who has used the concept in her

therapy. “It explains why they feel virtuous resisting hunger, see fat on their emaciated bodies, and feel driven to

exercise. Patients tell me, ‘It helped me to recover.’” —T.G.

type of cognitive-behavior therapy (CBT) to anorexia. Originally developed to treat depression, CBT is designed to help

an anorexic patient change both his or her destructive eating habits and the mental state that led to them. Kaye’s group

and others are exploring psychotherapy strategies that either help anorexics feel pleasure or use incentives for adopting

eating behavior that is geared toward immediate rewards rather than long-term results. Another experimental frontier

involves the use of the hormone leptin, produced by fat cells, to help women with a history of anorexia resume

menstruation and possibly also develop healthier attitudes about food and life. In aIDition, Compan and her colleagues

are testing a compound in mice that blocks the activity of one type of serotonin receptor in hopes of reducing its

inhibitory effects on appetite in the nucleus accumbens. As these and other treatment ideas move forward, their origins

trace back to the neurobio-

logical, psychological and endocrine roots of disease that may have formed as early as embryonic development. “Until

we better understand the biology of these conditions,” Kaye says, “we can’t devise better treatments.” M

(Further Reading)
N Puberty Moderates Genetic In?uences on Disordered Eating. K. L.

N

Klump, P. S. Perkins, S. A. Burt, M. McGue and W. G. Iacono in Psychological Medicine, Vol. 37, pages 627–634; March 2007.

The Genetics of Anorexia Nervosa. C. M. Bulik, M. C. Slof-Op’t Landt, E. F. van Furth and P. F. Sullivan in Annual Review of

Nutrition, Vol. 27, pages 263–275; April 2007. Anorexia Induced by Activation of Serotonin 5-HT4 Receptors Is Mediated

by Increases in CART in the Nucleus Accumbens. Alexandra Jean et al. in Proceedings of the National Academy of

Sciences USA, Vol. 104, No. 41, pages 16335–16340; October 9, 2007. Altered Reward Processing in Women Recovered from

Anorexia Nervosa. Angela Wagner et al. in American Journal of Psychiatry, Vol. 164, No. 12, pages 1–8; December 2007.

Intrauterine Hormonal Environment and Risk of Developing Anorexia Nervosa. Marco Procopio and Paul Marriott in

Archives of General Psychiatry, Vol. 64, No. 12, pages 1402–1408; December 2007.

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