Abstract
BackgroundPrevious fMRI studies show that women with eating disorders (ED) have differential neural activation to viewing food images. However, despite clinical differences in their responses to food, differential neural activation to thinking about eating food, between women with anorexia nervosa (AN) and bulimia nervosa (BN) is not known.MethodsWe compare 50 women (8 with BN, 18 with AN and 24 age-matched healthy controls [HC]) while they view food images during functional Magnetic Resonance Imaging (fMRI).ResultsIn response to food (vs non-food) images, women with BN showed greater neural activation in the visual cortex, right dorsolateral prefrontal cortex, right insular cortex and precentral gyrus, women with AN showed greater activation in the right dorsolateral prefrontal cortex, cerebellum and right precuneus. HC women activated the cerebellum, right insular cortex, right medial temporal lobe and left caudate. Direct comparisons revealed that compared to HC, the BN group showed relative deactivation in the bilateral superior temporal gyrus/insula, and visual cortex, and compared to AN had relative deactivation in the parietal lobe and dorsal posterior cingulate cortex, but greater activation in the caudate, superior temporal gyrus, right insula and supplementary motor area.ConclusionsWomen with AN and BN activate top-down cognitive control in response to food images, yet women with BN have increased activation in reward and somatosensory regions, which might impinge on cognitive control over food consumption and binge eating.
Highlights
Bulimia Nervosa (BN) is defined by recurrent episodes of binge eating of large amounts of food, and compensatory measures to control for weight gain
Written informed consent was required from all participants, as approved by the South London and Maudsley (SLaM) ethics committee, and they were reimbursed for their participation
We applied stringent voxel and clusterwise False Discovery Rate (FDR) correction, to ensure that, despite the small sample sizes only highly significant data are reported, and give effect size data in the table. We provide both behavioural and neural evidence with p values and effect size data where possible, that the subgroups of anorexia nervosa (AN) are similar, and that the binge purging AN (BPAN) subgroup are more similar to the restricting AN (RAN) group than to the bulimia nervosa (BN) group
Summary
Bulimia Nervosa (BN) is defined by recurrent episodes of binge eating of large amounts of food, and compensatory measures to control for weight gain. People with BN have deficient self-regulatory control, represented at the neural level by reduced prefrontal, and increased mesolimbic responses [2,3]. An alternative hypothesis is that there is hyperactivation of reward and somatosensory neural systems in people who binge [7,8]. One way to test these hypotheses is to compare neural activation to food images in people who have eating behaviours on the extremes of cognitive inhibition of appetite (AN) versus reduced inhibition of appetite (BN). Previous fMRI studies show that women with eating disorders (ED) have differential neural activation to viewing food images. Despite clinical differences in their responses to food, differential neural activation to thinking about eating food, between women with anorexia nervosa (AN) and bulimia nervosa (BN) is not known
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