Special Issue: The Anorexia Enigmas

Although not exhaustive, this thematic issue offers a broad overview of the main positions that have attempted to account for the relationship between perceptual and cognitive aspects of AN. In providing at least some important answers to the questions outlined in this introduction, they represent fundamental contributions to our understanding. The editors’ introduction “The Anorexia Enigmas” 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 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. The first article included in the thematic issue – Stephen Gadsby’s “Anorexia Nervosa, Body Dissatisfaction, and Problematic Beliefs” – puts forward a model explaining AN based on perceptual, epistemic, and evaluative aspects within a cognitive perspective. In concluding reflections, Gadsby expresses scepticism towards positions that place emotions at the centre of explanations of AN. This is a controversial view which is not shared, for example, by Somogy Varga & Asbjørn Steglich-Petersen in their “Body Checking in Anorexia Nervosa: From Inquiry to Habit”. Varga & Steglich-Petersen explain AN by the emotions that characterize it. Drawing inspiration from the symptomatology described in the DSM-5 (APA 2013), the authors suggest that AN is distinguished by a particular emotion, described as a strong, recalcitrant fear of becoming fat or gaining weight or of being fat or overweight. An attempt to give space to emotions and simultaneously clarify the role of body perception in explaining anorexia is undertaken by Sarah Arnaud in her paper, “Teasing Apart the Roles of Interoception, Emotion, and Self-Control in Anorexia Nervosa.” The type of perception that Arnaud and colleagues focus on is not related to body representation but to interoception. The debate on perceptual anomalies in individuals suffering from anorexia extends beyond interoception and encompasses various sensory modalities. A synopsis of the main phenomena under study in this regard is presented by Mara Floris & Matteo Panero in their work “I’m not hungry: Bodily Representations and Bodily Experiences in Anorexia Nervosa.” Their review extends from interoception in a broader sense, to hunger, to the representation of body size, to the visual perception of food and to tactile sensations. Focus on the symptoms of AN in previous contributions adopted an epistemic approach that we can characterize as based on the third-person point of view. Michelle Maiese’s work, “Anorexia Nervosa, Bodily Alienation, and Authenticity,” considers the origin and manifestation of anorexia from a different perspective, and centres around the qualitative dimension of the experience individuals with AN have of their own body. While the contributions considered so far primarily focus on the perceptual and emotional components of AN, with Kyle De Young’s work “Causal Connections between Anorexia Nervosa and Delusional Beliefs,” attention shifts to the beliefs that characterize AN. De Young’s ultimate goal in this work is to understand the relationship between AN and delusions from the perspective of their aetiology. Delusions arise to restore a sense of coherence and cognitive rationality and to regulate emotions. However, once established, they contribute to worsening the pathology and prolonging its duration over time. Nevia Dolcini’s work, “Beyond Cognition and Affect: An analysis of Anorexia Nervosa within the Framework of Addiction,” completes the circle of contributions gathered in this volume by summarizing the main models proposed by philosophical literature to account for anorexia. Dolcini suggests that prominent positions in the contemporary debate revolve around two models: a cognitive approach, exemplified in this thematic issue by Gadsby’s theses, and an affective one, represented here by the work of Varga & Steglich-Petersen. Dolcini argues that both of these approaches have limitations. For Dolcini, one way to overcome this affect-cognition dichotomy is to try to understand AN as an addiction, attributing to it the complex characteristics of this condition.