Advances in the diagnosis of anorexia nervosa and bulimia nervosa using brain imaging

Abstract

Introduction Anorexia and bulimia nervosa are severe psychiatric disorders and the availability of brain imaging techniques hold promise that those techniques will be useful in clinical practice. Areas covered In this review I describe currently available brain imaging techniques and focus on the brain imaging methods functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Those techniques have helped describe alterations in brain circuitry in AN and BN that related to anxiety and reward processing. Novel computational models help further define brain function in relation to particular neurotransmitters. Expert opinion Brain imaging techniques are exciting methods to learn about brain function and progress has been made to identify in healthy populations brain circuits that code behaviors. These techniques have been used in AN and BN over the past decade and have improved our understanding of brain function in those disorders. Still, human brain imaging is not at a point yet where it could be used diagnostically. However, with the refinement of imaging hardware as well as improved models that describe brain function we will get closer to our aims to not only better understand the neurobiology of those disorders, but predict illness development, treatment response and long term prognosis.

Prediction error and somatosensory insula activation in women recovered from anorexia nervosa

“…52,53 A problem, though, might be the typically different methods used across studies of eating disorders specifically 54 and psych iatry research in general, and it is probably still too early to develop more comprehensive models. 55 However, building on the aforementioned publications, 52,53 our results in recent years using similar methods suggest larger orbitofrontal cortex volume in individuals with anorexia nervosa across ages and states of illness, as well as greater insula response to the prediction error model task.…”

Advances from neuroimaging studies in eating disorders

“…Brain imaging will continue to be an important tool for brain research in EDs, although it is not ready to be used yet as a diagnostic tool or for directing intervention. 100 The studies conducted over the past decade have furthered our understanding of the pathophysiology of EDs in various ways. First, studies show that it is highly important to carefully select study subjects and control for nutritional status and comorbid conditions in order to identify brain regions that have functional importance and are not only a reflection of dehydration and malnutrition.…”

The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders

“…For example, individuals with AN may have a paradoxical response to negative energy balance (i.e. taking in less energy than one expends, Bulik, ), such that caloric intake is associated with dysphoric mood (Frank, ), whereas caloric restriction evokes a calming, anxiolytic or euphorigenic effect (Bulik, ; Kaye, ; Kaye, Wierenga, Bailer, Simmons, & Bischoff‐Grethe, ). Non‐typical responses to other behaviours such as physical activity and purging (as both positively and negatively reinforcing) are also reported in individuals with eating disorders (Berg et al, ; Giel et al, ; Kaye, ; Klein et al, ).…”