**6. Etiology**

*Weight Management*

**4. Prognosis**

course of anorexia.

**5. Epidemiology**

being the most common among them [27]. Problems related to anxiety like social phobia and obsessive-compulsive disorders are highly associated with anorexia [28]. Trauma-related problems are more prevalent in the binge eating/purging type [29].

Prognosis of anorexia is difficult, and full recovery is only possible in almost half of the cases [31]. Even when the physical symptoms are treated and the weight is maintained within the normal ranges, cognitive, emotional, and behavioral aspects of anorexia might continue. A complete recovery is only possible when all the symptoms are gone and especially when a positive body image is developed [10]. For this reason, recovery is considered as a long process that may take several years. Recurrent episodes of relapse are prevalent and accepted as within the nature of the disorder. Moreover, deficits in treatment motivation are quiet common, which causes a high rate of dropouts and chronicity of the problem [15]. Several factors may affect prognosis. For example, a very low BMI and a prolonged time before applying for treatment may worsen the process of prognosis [32]. Therefore, early detection and providing evidence-based treatment approaches are crucial to the

Estimating the prevalence of anorexia nervosa is problematic because it is a rare problem. The course of illness is variable, and sufferers are usually reluctant to report their situation or take part in studies [33]. Lifetime prevalence of DSM-5 diagnosis of AN in the West varies between 1 and 4% [27], but it has also been recently increasing in the non-Western world such as in Asia and the Middle East [34]. The problem is that most cases do not meet the full diagnostic criteria; resulting subthreshold EDs are more common in at-risk populations like high school and college samples [35]. Anorexia nervosa diagnosis is the most sexually based psychiatric problem, and the stereotypical patient is usually considered to be a young, white female from a higher socioeconomic class. This stereotype is not true all the time. However, the vast majority of the cases are women and the current malefemale ratio is standing at 1:10 [5]. Nevertheless, recent studies show that between 3 and 20% of AN cases are male [36, 37]. Underdiagnoses of AN in men are a result of several factors that include sociocultural expectations towards women and the difference in symptom presentation in men. The mean age of onset is 17 in AN and the risk decreases with age [38]. However, onset of the disorder can be after age 40 or even later in some cases [39]. AN has been found to be less common among Black than White Americans [40], possibly due to underrepresentation in specialist eating disorder services and under detection in primary care [41]. Other than that, there is no systematic association between ethnicity/race or socioeconomic status and eating disorder occurrence [42]. Being in a sexual minority is a risk factor for EDs which is general for both women and men [43, 44]. In conclusion, it is noted that anorexia can affect people of all ages, genders, races, ethnic origins, socioeconomic

Comorbid psychological problems have a negative impact on prognosis and predicted suicide attempts [30]. As a result, AN is a chronic condition accompanied with a range of physical and psychological problems that interfere with daily

functioning, and it has a high mortality rate.

**70**

status, and sexual orientations [45].

Several theories have been proposed to understand the etiology of AN. Although these theories will be presented individually, it is recognized that a multidimensional approach is helpful to understand the causes of AN, even though such a comprehensive model has not yet been developed. Biological, psychological, and social factors interact with each other in the etiology. Prominent models include the genetic and neurobiological model, the psychodynamic model, the sociocultural model, and the cognitive behavioral model. Significant life events, personality, and a family system approach are also productive in understanding the causes of anorexia.
