Abstract
Functional imaging data in adult patients with anorexia nervosa (AN) support a dysfunctional signal in the ventral striatum as neural signature of AN. In the present study, development of this signal was investigated with the prediction that a characteristic pattern of ventral–striatal signalling will be shown in response to cues associated with food restriction that reflects the evolvement of starvation dependence over time. The signal was assessed in adolescent patients with AN, whose duration of illness was about five times shorter relative to the adult sample. During functional magnetic resonance imaging subjects were required to estimate weights of body images (underweight, normal weight, overweight) and to process each stimulus in a self-referring way. Relative to age-matched, young healthy controls, underweight stimuli were already associated with greater activity of the ventral striatum, and processing of normal-weight stimuli elicited already reduced signalling. Subjective preferences showed exactly the same pattern of results. Relative to adult AN, the present data reveal a developing dysfunctional signal that, if untreated, will essentially contribute to the maintenance of AN. We discuss putative mechanisms that may play a crucial role in the development of AN, and also deduce new hypotheses about the involvement of the midbrain dopamine system, of which illness-related alterations may contribute to the development of AN.
Highlights
Anorexia nervosa (AN) usually develops around the onset of puberty
A repeated-measures analysis of variance for rating scores from the ‘weight’ and ‘feel’ tasks revealed a significant interaction of all main-factors group, task and stimulus (F(2, 50) = 17.04, P o0.0001; significance of P o 0.05 (FWE-corrected) in the ventral–striatal region of interest (ROI)
anorexia nervosa (AN) patients had higher positive scores relative to healthy controls (HC) interaction was constrained to the ‘feel’ task only, because the for the underweight stimuli (P o0.001) but gave underweight effects of the different task types were not part of the main focus stimuli the same preference compared with normal-weight stimuli of the study
Summary
Anorexia nervosa (AN) usually develops around the onset of puberty. There is a negative relation between illness duration and treatment outcome, and treatment is needed as early as possible.[1] Systematic identification of the early eating-disorder symptoms of AN reveals a subgroup of patients characterized by excessive exercise and extreme eating-disorder attitudes.[2] This aligns with ‘activity-based’ animal models, where diet and hyperactivity were suggested to contribute to the onset and maintenance of AN via involvement of the ventral striatum.[3] As part of the mesolimbic dopaminergic system the ventral striatum is crucially involved in the processing of reward and motivational salience.[4,5,6,7,8,9] In animal models conditioned activity in this system was associated with increased self-starvation,[10] emphasizing the addictive quality of AN as starvation dependence, much like drug dependence.[11]
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