Neural correlates of eating disorders: translational potential

Abstract

Eating disorders are complex and serious psychiatric illnesses whose etiology includes psychological, biological, and social factors. Treatment of eating disorders is challenging as there are few evidence-based treatments and limited understanding of the mechanisms that result in sustained recovery. In the last 20 years, we have begun to identify neural pathways that are altered in eating disorders. Consideration of how these pathways may contribute to an eating disorder can provide an understanding of expected responses to treatments. Eating disorder behaviors include restrictive eating, compulsive overeating, and purging behaviors after eating. Eating disorders are associated with changes in many neural systems. In this targeted review, we focus on three cognitive processes associated with neurocircuitry differences in subjects with eating disorders such as reward, decision-making, and social behavior. We briefly examine how each of these systems function in healthy people, using Neurosynth meta-analysis to identify key regions commonly implicated in these circuits. We review the evidence for disruptions of these regions and systems in eating disorders. Finally, we describe psychiatric and psychological treatments that are likely to function by impacting these regions.

Blunted neural response to implicit negative facial affect in anorexia nervosa

“…In AN, reduced frontal response to emotional facial expression has been previously reported in an EEG study, which found reduced frontal P300, while viewing negative facial expressions (Pollatos, Herbert, Schandry, & Gramann, 2008). Additionally, reduced activation of lateral and medial PFC regions has been reported in AN while viewing positive and negative social behaviour (McAdams & Smith, 2015). Such reduced PFC reactivity has also been associated with poorer general clinical outcome at 1-year follow-up (Schulte-Rüther et al, 2012).…”

“…A recent review reported reduced response in prefrontal regions, including the lateral and medial prefrontal cortex (PFC), while viewing social behaviour in acute AN (McAdams & Smith, 2015). Further, one of the included studies found that reduced response in the lateral and medial PFC to social behaviour at admission to treatment was associated with poorer outcome at discharge (SchulteRüther, Mainz, Fink, Herpertz-Dahlmann, & Konrad, 2012).…”

Development of a methodology to combine fMRI and EMG to measure emotional responses in patients with anorexia nervosa

“…The value of fMRI–EMG methods for studying social and emotional processes in individuals with eating disorders, particularly AN, is clear. A number of fMRI studies document regional differences in activation to social–emotional stimuli that include lateral and medial prefrontal areas in acute forms of AN (McAdams & Smith, ), and particularly when considering BOLD responses to facial stimuli (Fonville, Giampietro, Surguladze, Williams, & Tchanturia, ). These differences in brain response may have implications for predicting treatment outcome (Schulte‐Ruther, Mainz, Fink, Herpertz‐Dahlmann, & Konrad, ) or identifying vulnerability in people recovered from AN (Bang, Ro, & Endestad, ).…”

“…The value of fMRI-EMG methods for studying social and emotional processes in individuals with eating disorders, particularly AN, is clear. A number of fMRI studies document regional differences in activation to social-emotional stimuli that include lateral and medial prefrontal areas in acute forms of AN (McAdams & Smith, 2015), and particularly when considering BOLD responses to facial stimuli (Fonville, Giampietro, Surguladze, Williams, & Tchanturia, 2014).…”

Blunted neural response to implicit negative facial affect in anorexia nervosa

“…Few studies have examined the neural processes that underlie difficulties in social-emotional processing and reactivity to emotional stimuli in people with AN. A recent review reported reduced response in prefrontal regions, including the lateral and medial prefrontal cortex (PFC), while viewing social behaviour in acute AN (McAdams & Smith, 2015). Further, one of the included studies found that reduced response in the lateral and medial PFC to social behaviour at admission to treatment was associated with poorer outcome at discharge (Schulte-Rüther, Mainz, Fink, Herpertz-Dahlmann, & Konrad, 2012).…”