Abstract
BackgroundIndividuals with anorexia nervosa (AN) are often cognitively rigid and behaviorally over-controlled. We previously showed that adult females recovered from AN relative to healthy comparison females had less prefrontal activation during an inhibition task, which suggested a functional brain correlate of altered inhibitory processing in individuals recovered from AN. However, the degree to which these functional brain alterations are related to disease state and whether error processing is altered in AN individuals is unknown.Methodology/Principal FindingsIn the current study, ill adolescent AN females (n = 11) and matched healthy comparison adolescents (CA) with no history of an eating disorder (n = 12) performed a validated stop signal task (SST) during functional magnetic resonance imaging (fMRI) to explore differences in error and inhibitory processing. The groups did not differ on sociodemographic variables or on SST performance. During inhibitory processing, a significant group x difficulty (hard, easy) interaction was detected in the right dorsal anterior cingulate cortex (ACC), right middle frontal gyrus (MFG), and left posterior cingulate cortex (PCC), which was characterized by less activation in AN compared to CA participants during hard trials. During error processing, a significant group x accuracy (successful inhibit, failed inhibit) interaction in bilateral MFG and right PCC was observed, which was characterized by less activation in AN compared to CA participants during error (i.e., failed inhibit) trials.Conclusion/SignificanceConsistent with our prior findings in recovered AN, ill AN adolescents, relative to CA, showed less inhibition-related activation within the dorsal ACC, MFG and PCC as inhibitory demand increased. In addition, ill AN adolescents, relative to CA, also showed reduced activation to errors in the bilateral MFG and left PCC. These findings suggest that altered prefrontal and cingulate activation during inhibitory and error processing may represent a behavioral characteristic in AN that is independent of the state of recovery.
Highlights
Anorexia nervosa (AN) is characterized by severe emaciation, a relentless drive for thinness, and distorted body image
Demographics and clinical assessments anorexia nervosa (AN) and comparison adolescents (CA) individuals were of similar age and intelligence (Table 1), but as expected, participants with AN had lower BMI and elevated measures of core ED symptoms compared with the CA group
Behavioral analysis When averaged across all trials, there was no significant difference in the prescan mean reaction time (MRT) (t(20.89) = –1.41, p = 0.2, g = – 0.6) between AN (6086159 ms) and CA (702 6162 ms)
Summary
Anorexia nervosa (AN) is characterized by severe emaciation, a relentless drive for thinness, and distorted body image. AN typically has a narrow range of age of onset (early adolescence), a relatively stereotypic presentation of symptoms, and tends to be female gender specific. It often has a chronic and relapsing lifethreatening course [1,2,3], with the highest death rate of any psychiatric illness [4]. The understanding of the pathophysiology of AN and other eating disorders has lagged behind other major psychiatric disorders, a growing body of evidence suggests that AN is a neurobiologically based disorder characterized by alterations in neurocircuitry supporting inhibition and cognitive control [9,14,15,16,17,18,19,20,21]. The degree to which these functional brain alterations are related to disease state and whether error processing is altered in AN individuals is unknown
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