Disturbances in Brain Neurotransmitter Systems in Anorexia Nervosa: A Review of CSF Studies

p atients with anorexia appear to have characteristic disturbances of appetite, neuroendocrine function, motor activity, and mood. Since CNS neurotransmitters modulate these systems, it is logical to try to determine whether disturbances of brain chemistry occur in anorexia nervosa. Two major problems, however, have limited progress in investigating brain neurochemistry in anorexia nervosa. First, the technology available to explore brain neurochemistry in living human subjects is limited. Perhaps the best available method is to measure concentrations of brain neurochemicals in CSF. It is difficult, however, to correlate CSF neurochemical values with disturbances of specific brain pathways. Second, while abnormalities of CSF neurochemicals have been found in underweight anorectics, these abnormalities may be secondary to malnutrition or contribute to weight loss and aberrant behavior. Studying anorectics after weight recovery may be one way of circumventing such problems and identifying possible trait disturbances. Despite these problems, a number of CSF studies have been carried out, and in fact, offer some insights into pathophysiolgoic processes in anorexia nervosa. This chapter will review CSF studies to date in anorexia nervosa and discuss the implications of these findings. BACKGROUND