Phobic memory and somatic vulnerabilities in anorexia nervosa: a necessary unity?

Anorexia nervosa (AN) is an intractable illness with a high long-term mortality that affects 1% to 3.7% of the young women [1]. The death rate of patients with AN is up to 30 times greater than that of age-matched normal women. About 20% of AN patients remain chronically disabled [2]. Despite its grave complications, the lack of exact pathophysiology and organic definition, denies AN an independent nosological grade or a status of a neuropsychiatric problem. The various theories that have been proposed to explain the cause or origin of AN can be divided into two major schools of thought, socio-cultural and biological. Until very recently, AN was categorized as a disease of psychogenic origin (e.g., a consequence of unresolved conflicts of the individual psychosocial development) [3]. Many subscribed to the cultural paradigm inasmuch as it was rendered secure from experimental scrutiny. Not surprisingly, pharmacotherapeutic options in AN continue to be limited. For years, the disorder was so refractory that even 'heroic' efforts such as lobotomy, once reserved for treating schizophrenia were attempted [4]. Kennedy and Goldbloom [5] maintained in their review of 1991 that there was little, if any role for pharmacotherapy in AN. Over a decade later and more than 200 studies on the topic, the majority of patients stay refractory to the currently available drugs [6,7]. Therefore, alternative approaches toward AN pathophysiology has to be explored. A small proportion of individuals developing AN and the commonality and influence of socio-cultural pressures only emphasize the need for identifying the vulnerable population.In keeping with this goal, the present article looks at the possibility that AN is associated with intrinsic vulnerability of potassium channels. It is to these channels and to their kinetics that cerebral cells owe their membrane potentials and the many characteristics that control local and distant changes in multiple organ systems. The following provid