Neural processing of food and emotional stimuli in adolescent and adult anorexia nervosa patients.

Silja Lindsiepe,Julie Roesch,Oliver Kratz,Holmer Graap,Nouchine Hadjikhani,Clemens Forster,Hartmut Heinrich,Gunther H. Moll,Arnd Dörfler,Stefanie Horndasch

doi:10.1371/journal.pone.0191059

Abstract

BackgroundA constant preoccupation with food and restrictive eating are main symptoms of anorexia nervosa (AN). Imaging studies revealed aberrant neural activation patterns in brain regions processing hedonic and reward reactions as well as–potentially aversive–emotions. An imbalance between so called “bottom-up” and “top-down” control areas is discussed. The present study is focusing on neural processing of disease-specific food stimuli and emotional stimuli and its developmental course in adolescent and adult AN patients and could offer new insight into differential mechanisms underlying shorter or more chronic disease.Methods33 adolescents aged 12–18 years (15 AN patients, 18 control participants) and 32 adult women (16 AN patients, 16 control participants) underwent functional magnetic resonance imaging (fMRI, 3T high-field scanner) while watching pictures of high and low-calorie food and affective stimuli. Afterwards, they rated subjective valence of each picture. FMRI data analysis was performed using a region of interest based approach.ResultsPictures of high-calorie food items were rated more negatively by AN patients.Differences in activation between patients and controls were found in “bottom up” and “top down” control areas for food stimuli and in several emotion processing regions for affective stimuli which were more pronounced in adolescents than in adults.ConclusionA differential pattern was seen for food stimuli compared to generally emotion eliciting stimuli. Adolescents with AN show reduced processing of affective stimuli and enhanced activation of regions involved in “bottom up” reward processing and “top down” control as well as the insula with regard to food stimuli with a focus on brain regions which underlie changes during adolescent development. In adults less clear and less specific activation differences were present, pointing towards a high impact that regions undergoing maturation might have on AN symptoms.

Highlights

Anorexia nervosa (AN) is a chronic mental disorder that often has its onset in adolescence
“top down” control areas for food stimuli and in several emotion processing regions for affective stimuli which were more pronounced in adolescents than in adults
Different cerebellar regions seem to contribute to food related processing: a similar mid-cerebellar region as activated in our study in controls to a greater extent than in AN patients was activated in healthy participants for high-calorie food items, possibly reflecting the integration of sensory and visceral signals [22]

Summary

Introduction

Anorexia nervosa (AN) is a chronic mental disorder that often has its onset in adolescence. A metaanalysis of a total of nine fMRI studies on food processing in AN revealed greater activations in patients compared with controls in emotion-processing regions [2]. The meaning of increased–or, in some cases, decreased– activation of emotion-processing regions is still unclear. Those regions are involved in many aspects of emotional processing including that of stimuli with positive valence Imaging studies revealed aberrant neural activation patterns in brain regions processing hedonic and reward reactions as well as–potentially aversive–emotions. The present study is focusing on neural processing of disease-specific food stimuli and emotional stimuli and its developmental course in adolescent and adult AN patients and could offer new insight into differential mechanisms underlying shorter or more chronic disease

Methods

Discussion

Conclusion