The Neural Correlates of Body Image Processing in Anorexia Nervosa and Bulimia Nervosa: An Activation Likelihood Estimation Meta-Analysis of fMRI Studies

Abstract

Body image concerns are key prognostic and pathogenic factors of anorexia nervosa (AN) and bulimia nervosa (BN). This study aimed to investigate the neural mechanisms underlying body image perception across its two domains of estimation and satisfaction in anorexia and bulimia patients and healthy controls (HC). Systematic searches were conducted across eight databases, including PubMed; Cochrane Library; Ovid; Google Scholar; Sage Journals; Scopus; PsycInfo; and ScienceDirect, from database inception until the 23rd of April 2023. The sample pertained to 14 functional magnetic resonance imaging (fMRI) studies and 556 participants, with tasks primarily including image and silhouette-based body estimation and satisfaction paradigms. ALE meta-analysis was conducted to investigate significant clusters of activation foci across the different studies. Shared activations were observed between HC, AN, and BN patients in cortical regions related to object manipulation and recognition, visuospatial awareness, and memory and negative affect regulation. Differential activation in interoceptive and higher-order cognitive or affective control regions likely hold the key to pathological body distortion. This study outlined commonalities and differences in the correlates driving healthy body mapping and eating disorder pathology. Our findings provide pertinent implications for future research, current clinical interventions, and therapeutic outcomes.