Introduction: The Anorexia Enigmas

The article provides an extensive exploration of Anorexia Nervosa (AN), an eating disorder characterized by extreme weight loss and restrictive eating behaviors, stemming primarily from psychological factors rather than physical causes. It traces the historical recognition of the disorder in Western medicine and suggests that the term “anorexia” (from the Ancient Greek word ἀνορέξις, which literally means "absence of appetite") is actually misleading, as the loss of appetite is a symptom, not the cause, of this condition. The core of the disorder is the psychological obsession with thinness. This study focuses first on the perceptual distortions characteristic of AN, considering the representation of the body in its visual, proprioceptive, and tactile components, as well as how patients perceive their bodily signals (interoception). Secondarily, the article discusses the typical misapprehensions associated with AN, such as the conviction of being too large, not thin enough, or too heavy, expressed by a subject who is visibly thin and measurably underweight. In relation to these, it examines whether patients misperceive their size and shape or perceive them accurately but develop false beliefs about them. Moreover, it analyzes whether these false beliefs should be considered delusional, delusion-like, illusion-based, or as the tenaciously maintained emotional preoccupations affecting identity and motivation, known as ‘over-valued ideas.’ The last part of the work introduces the various contributions that make up the special issue dedicated to “The Anorexia Enigmas” and summarizes the positions these contributions present regarding the perceptual, cognitive (doxastic), and emotional characteristics of this condition. In general, the authors call for a multidisciplinary approach to understanding AN, highlighting the need to investigate the complex interactions between perception, cognition, and emotion in the disorder's manifestation and persistence.