Abstract
ObjectiveRecent evidence has suggested an increased rate of comorbid ADHD and subclinical attentional impairments in bulimia nervosa (BN) patients. However, little is known regarding the underlying neural mechanisms of attentional functions in BN.MethodTwenty BN patients and twenty age- and weight-matched healthy controls (HC) were investigated using a modified version of the Attention Network Task (ANT) in an fMRI study. This design enabled an investigation of the neural mechanisms associated with the three attention networks involved in alerting, reorienting and executive attention.ResultsThe BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN) areas during alerting compared with HCs. Posterior cingulate activation during alerting correlated with the severity of eating-disorder symptoms within the patient group. Conversely, BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ) and parahippocampus compared with HCs, which was negatively associated with global ADHD symptoms and impulsivity, respectively.DiscussionOur findings demonstrate altered brain mechanisms in BN associated with all three attentional networks. Failure to deactivate the DMN and increased parieto-occipital activation required for alerting might be associated with a constant preoccupation with food or body image-related thoughts. Hypoactivation of executive control networks and TPJ might increase the likelihood of inattentive and impulsive behaviors and poor emotion regulation. Thus, dysfunction in the attentional network in BN goes beyond an altered executive attentional domain and needs to be considered in the diagnosis and treatment of BN.
Highlights
Bulimia nervosa (BN) is a chronic and difficult-to-treat disease with typical onset in adolescence or young adulthood
The BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN) areas during alerting compared with healthy controls (HC)
BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ) and parahippocampus compared with HCs, which was negatively associated with global attention deficit hyperactivity disorder (ADHD) symptoms and impulsivity, respectively
Summary
Bulimia nervosa (BN) is a chronic and difficult-to-treat disease with typical onset in adolescence or young adulthood. It has been suggested that, in addition to behavioral impulsivity, attention problems occur in patients with BN [4,5,6,7] but see Galderisi et al [8] for opposing findings. These attentional impairments are often subclinical [9], BN is associated with increased rates of attention deficit hyperactivity disorder (ADHD) [5,10,11]. ADHD in childhood is associated with more severe eating-disorder symptoms in BN patients in adulthood [5,12,13]
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