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Anorexia nervosa and body-image disturbance. Lancet Psychiatry, 2016

Disparate treatments, placebos, and treatments as usual have similar efficacy for anorexia nervosa. A parsimonious dissection of the this issue with Occam’s razor will necessarily challenge the assumptions on which the diagnosis of anorexia nervosa is based. One such assumption is the role of body-image disturbance, which became a key diagnostic symptom of anorexia nervosa in the literature almost five decades ago, long before any empirical evidence was gathered about this symptom. Body-image disturbance is far more represented among therapists and in the hypotheses of researchers than in the minds of patients. Concerns about body image might not stem exclusively from the patient’s underlying motives for refusing food, but might be in part a by-product of the “psychiatrist zeal in searching out motives”, as first recognised before the inclusion of body-image disturbance in the conceptualisation of anorexia nervosa. Body-image disturbance and weight and shape concerns are the result of an acculturation process spread through the therapeutic milieu and the mass media.