Tackling Anorexia Nervosa – understanding habits

Abstract

Background: Anorexia Nervosa (AN) is a severe, potentially even life-threatening eating disorder. It is characterized as a multifactorial psychiatric illness with persistent course of weight-loss behaviors, and with high relapse rates – even after accomplishing the treatment successfully and achieving normal BMI. Despite new and different psychotherapeutic and pharmacological treatment approaches for the past decades in the medical field, the efficacy of existing treatments has stayed limited in preventing the relapses, especially in chronic AN patients. There are different theories trying to underlie the development of AN. In the past 15 years, cognitive neuroscience has developed a theory-based model, which is aiming to explain why and how the progression of Anorexia Nervosa occurs: the weight-loss behavior is essentially habit-based, which makes it resistant to change. One of the key articles to review this topic is written by B. Timothy Walsh in 2013, “The Enigmatic Persistence of Anorexia Nervosa”. In this literature review, this theoretical model is referred to as a habit-model. This review will analyze and summarize studies and researches, that will focus on whether the positive correlation between habitual behavior and progression of AN can be proven. More importantly, if behavior in Anorexia is shown to be habit-related, there should be a re-evaluation of the possible interventions to tackle the persistence of anorexia. Methods: a literature review of anorexia nervosa and relevance of habit-based learning, was conducted between January-March in 2025, using the keywords “Anorexia Nervosa”, “habit(s)” or “habitual”. Electronic databases that were used PubMed and ProQuest. The search with keywords and exclusion terms, provided in total 1073 papers. After applying exclusion and inclusion criteria, 57 articles remained. Finally, through screening for the relevancy of this literature review, 25 were eligible and chosen for this review. Together with the article by B. Timothy Walsh, the total of 26 articles were reviewed. Results: a total of 26 articles were reviewed and included. Results showed that there are several studies that by different, yet specific, methodological approaches show the positive correlation between habit-based behavior and progression of anorexia. Conclusions: In summary, the articles and studies in this literature review were able to display that habit-based behavior is positively associated with the progression of Anorexia Nervosa. This was proven by different, yet specific, methodological approaches that were involving both behavioral (subjective vs. objective methods) and neural aspects. Ultimately, longitudinal studies are required in the future in order to evaluate the time needed for habit-formation and the role of developmental status.