The framing of care pathways involved in management of anorexia nervosa have undergone many changes over time. In the 19th century it was mainly physicians who managed these cases and produced behavioural change through a change in setting. Later social and psychological formulations were introduced. The most recent paradigm shift has been driven by genetic studies which have shown correlations with metabolic as well as psychiatric and psychological disorders. These findings align with longitudinal studies which show lifetime patterns of leanness and depression and anxiety. This complex mix of somatic and neurobiological risk at a critical time of development can lead to a lethal, or enduring illness. The cognitive interpersonal model (Schmidt & Treasure, 2006) emphasises valued and visible maintaining factors which interact with the neurobiological underpinnings (Treasure & Schmidt, 2013; Treasure et al 2020).
Targets for treatment can be derived from the model. For example, we have defined the consequences on close others (including health professionals) of living with the illness and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. Also, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression and neuroadaptation. Thus, anorexia nervosa develops a life of its own, resistant to treatment. In this talk I will describe some of the neurobiological foundations and how these interacts with social systems and how these can be remediated by treatment.