The Cognitive Architecture of Anorexia Nervosa and Associated Eating Disorders: A Meta-Analytic Review of Intelligence, Neuropsychology, and Genetic Correlations

The relationship between high intellectual potential and the pathology of eating disorders (EDs), particularly anorexia nervosa (AN), has captivated clinical attention for nearly a century. From the earliest descriptive psychopathologies to modern genomic inquiries, a consistent thread runs through the literature: the observation that individuals who starve themselves often possess extraordinary cognitive resources. Hilde Bruch, a pioneer in the field, famously observed that her patients were often coined "high achievers" of their families; often discussed as perfectionists, and academically gifted. Yet, this apparent advantage presents a clinical paradox. How can individuals with such high cognitive capacity engage in behaviors that are so objectively destructive? Furthermore, does this "genius" persist through the ravages of starvation, or is the "superior intelligence" merely a premorbid trait that is eroded by the metabolic demands of the disorder?