Table 1 Review of the literature on fMRI studies in AN (2010–2015)
From: Functional brain alterations in anorexia nervosa: a scoping review
Topic | Paradigm | Authors | Sample | DSM | BMI (SD) Age (SD) | Aim | Main findings |
|---|---|---|---|---|---|---|---|
Body and appearance | View images of own and another woman’s body | Vocks et al., 2010 [20] | AN = 13 BN = 15 HC = 27 | DSM-IV | 15.8 (1.3) 29.1 (9.8) | Investigate neural correlates of looking at own and another woman’s body, and self-reported emotional response to the stimuli | Reduced activation in the left uncus, superior parietal lobule, medial frontal gyrus, fusiform gyrus, superior frontal gyrus and bilateral parahippocampal gyrus in response to own body. Increased activation in the amygdala in response to another woman’s body |
View images of a distorted body image, own and of another woman | Miyake et al., 2010 [22] | AN-R = 11 AN-BP = 11 BN = 11 HC = 11 | DSM-IV | AN–R: 15.3 (1.8) 22.2 (4.1) AN-BP: 15.9 (1.9) 28.3 (4.5) | Investigate neural correlates of body image perception | Increased activation in the amygdala in both AN-R and AN-BP. Reduced activation in prefrontal cortex in AN –R patients | |
View distorted images of own body | Mohr et al., 2010 [23] | AN = 16 HC = 16 | DSM-IV | 15.9 (1.3) 24.1 (3.4) | Investigate attitude towards the body and body size experience | Increased insula activity during processing of thin self-images | |
View images of underweight, normal weight and overweight female bodies. Told to process images in a self-referring way | Fladung et al., 2010 [24] | AN = 14 HC = 14 | DSM-IV | 16.4 (1.8) 24.4 (7.6) | Examine the ventral striatal system in adults with AN | Increased activity in the ventral striatum to underweight stimuli | |
View images of underweight, normal weight and overweight bodies, estimate body weight, and process stimuli in a self-referring way | Fladung et al., 2013 [25] | AN = 13 HC = 14 | DSM-IV | 16.6 (1.2) 16.0 (1.1) | Examine the ventral striatal system in adolescents with AN | Increased activity in the ventral striatum to underweight stimuli | |
Viewing normal size and distorted pictures of own body | Castellini et al., 2013 [21] | AN = 18 HC = 19 | DSM-IV | 16.1 (1.4) 24.7 (7.6) | Explore neural network activated by processing of own body | Increased activity in the inferior frontal gyrus and middle temporal gyrus when viewing oversized images | |
View images of idealized women, and compare with self | Friederich et al., 2010 [26] | AN = 17 HC = 18 | DSM-IV | 15.6 (1.4) 24.9 (5.6) | Investigate neural correlates of body dissatisfaction | Increased activation in the insula and premotor cortex, decreased activity of the rostral anterior cingulate cortex | |
Negative words concerning body image | Miyake et al., 2010 [27] | AN-R = 11 AN-BP = 11 HC = 11 | DSM-IV | AN-R: 15.2 (2.1) 27.0 (9.0) AN-BP: 15.5 (1.6) 27.2 (4.8) | Investigate functional abnormalities during processing of negative words concerning body image | Increased activity in the amygdala in both AN-R and AN-BP than in BN and controls, increased ventromedial prefrontal cortex in AN-BP and BN than in controls, and increased activity in the inferior parietal lobe in AN-R and AN-BP than controls | |
Body and appearance (cont.) | Viewing images of body checking | Suda et al., 2013 [28] | AN = 20 HC = 15 | DSM-IV | 15.7 (1.0) 27.0 (7.5) | Investigate brain activation to images of body checking | Reduced activation of the anteromedial prefrontal cortex and fusiform gyrus |
Viewing images of faces and houses at different spatial frequencies | Li et al., 2015 [30] | AN-REC = 15 HC = 15 BDD = 15 | DSM-IV | 20.4 (1.6) 23.6 (3.5) | Investigate visual and visuospatial processing in AN and body dysmorphic disorder (BDD) | Both groups had increased activation in secondary visual processing regions and dorsal visual stream | |
Neuropsych functions | Embedded figures test | Fonville et al., 2013 [31] | AN = 35 HC = 35 | DSM-IV | 16.0 (1.6) 23.0 (9.0) | Investigate neural patterns of activity in response to tests of central coherence | Reduced activity in the precuneus, increased activation in the fusiform gyrus |
Stop-signal task | Wierenga et al., 2014 [33] | AN = 11 HC = 12 | DSM-IV | 16.9 (1.5) 16.0 (2.0) | Explore inhibitory processing in AN | Inhibitory processing was related to reduced activity in dorsal anterior cingulate cortex, middle frontal gyrus, posterior cingulate cortex. Error processing was related to reduced activity in the middle frontal gyrus and posterior cingulate cortex | |
Wisconsin card sorting test (WCST) | Sato et al., 2013 [35] | AN = 15 (AN-R = 9) (AN-BP = 6) HC = 15 | DSM-IV | 14.6 (1.5) 23.0 (7.0) | Evaluate brain activity in patients with AN while performing the WCST | Reduced activity in the ventrolateralprefrontal cortex and parahippocampal cortex during set shifting in all AN patients. | |
Serial reaction time | Firk et al., 2015 [36] | AN = 19 HC = 20 | DSM-IV | 15.2 (1.5) 15.9 (1.5) | Examine implicit learning in AN | Reduced activity in the thalamus | |
Letter n-back task | Lao-Kaim et al., 2014 [37] | AN = 31 HC = 31 | DSM-IV | 16.0 (1.6) 23.0b | Investigate the effect of increasing verbal working memory task difficulty on cortical functioning | No significant differences | |
Working memory task, not emotional stimuli | Castro-Fornieles et al., 2010 [17] | AN = 14 (Male/female: 2/12) HC = 14 | DSM-IV | 14.9 (2.1) 15.0 (1.7) | Investigate brain activation during a non-emotional working memory task | Increased activation in superior parietal lobule and inferior temporal gyrus | |
Go/no-go task | Kullmann et al., 2014 [34] | AN = 12 HC = 14 HCA = 12 | DSM-IV | 15.5 (1.5) 23.3 (4.7) | Test the hypothesis that neural correlates of behavioral inhibition are biased by the emotional information of the stimuli (food and physical activity), leading to different inhibitory patterns | Food stimuli were related to reduced activity in the putamen. Physical activity stimuli were related to increased activity in the prefrontal cortex and cerebellum | |
Embedded figures test | Fonville et al., 2014 [32] | AN = 9 HC = 14 | NA | 15.9 (2.2) 22.0 (N/A) | Assess the effect of CRT on central coherence | A decreased task related activation in the fusiform gyrus and middle occipital gyrus | |
Inhibition task | Oberndorfer et al., 2011 | AN-R-REC = 12 HC = 12 | DSM-IV | 22.1 (19.0-25.4a) 29.4 (22-44a) | Investigate a prefrontal-cingulate network that is involved in inhibitory control | Less activation in the medial prefrontal cortex | |
Food | View images of high-calorie food and emotionally neutral images | Gizewski et al., 2010 [39] | AN-R = 12 HC = 12 | DSM-IV | 14.1 (1.8) 27.0 (18-52a) | Evaluate the influence of satiety, BMI and like/dislike ratings on cerebral activation patterns | Increased activation to food images in the dorsal posterior cingulate cortex in the state of hunger |
View images of food and non-food | Joos et al., 2011 [40] | AN-R = 11 HC = 11 | DSM-IV | 16.2 (1.2) 25.0 (5.0) | Clarify frontolimbic dysfunction in AN | Decreased activation in the posterior midcingulum. Increased right amygdala | |
View images of food and non-food | Sanders et al., 2015 [42] | AN = 15 AN-REC = 14 HC = 15 | DSM-IV | AN: 14.5 (1.7) 25.6 (5.0) AN-REC: 21.1 (1.9) 24.3 (5.0) | Test activation of bottom-up and top-down systems (model by Brooks et al. 2012) | In AN, increased activation in the cerebellum, middle frontal gyrus, and decreased activation in the precuneus and superior frontal gyrus. AN-REC showed increased activation in the caudate, cerebellum, middle frontal gyrus, and post central gyrus. | |
View images of food and think about eating it | Brooks et al., 2012 [41] | AN = 18 (AN –R = 11) (AN-BP = 7) HC = 24 | DSM-IV | 15.7 (1.2) 26.0 (6.8) | Examine how cognitive systems interact with reward and appetitive systems in AN | Reduced activation in the cerebellar vermis, and increased activation in the visual cortex | |
Anticipation task viewing images of food and object images | Oberndorfer et al., 2013 [43] | AN-REC = 14 HC = 12 | DSM-IV | 22.0 (1.6) 28.9 (6.6) | Determine whether AN-REC have abnormal anticipatory response to viewing pictures of food | Greater activation in the ventral anterior insula | |
Reward | Reward conditioning task | Frank et al., 2012 [9] | AN-R = 21 OB = 19 HC = 23 | DSM-IV | 16.1 (1.1) 22.5 (5.8) | Test whether they could find brain reward alterations in AN compared with individuals with normal or increased body weight | Increased activation in the anteroventral striatum, insula and prefrontal cortex compared with the HC and OB group |
Social reward Acceptance and rejection | Via et al., 2015 [45] | AN-R = 20 HC = 20 | DSM-IV | 16.9 (1.3) 28.4 (9.3) | Investigate brain responses to social reward (acceptance) and punishment (rejection) | Increased activation of dorsomedial prefrontal cortex during social acceptance and reduced activation in visual areas during social rejection | |
Delay discounting task | Decker et al., 2015 [47] | AN = 30 HC = 22 | DSM-V | 16.8 (1.4) 19.3 (2.5) | Examine neural correlates of delay discounting in AN | Reduced activity in the dorsal anterior cingulate cortex and striatum | |
Monetary guessing task | Bischoff-Grethe et al., 2013 [48] | AN-R = 10 HC = 12 | DSM-IV | 16.4 (1.4) 16.2 (1.8) | Replicate findings of altered reward and striatal response to reward and punishment | Increased activity in the striatum in response to losses compared to wins | |
Monetary reward task | Ehrlich et al., 2015 [49] | AN-REC = 30 HC = 30 | DSM-IV | 21.2 (1.9) 22.0 (3.2) | Interrogate interactions between neural correlates of cognitive control and motivational processes in the reward system | Increased activation in the dorsolateral prefrontal cortex | |
Reward (cont.) | Delay discounting task | Decker et al., 2015 [47] | AN-REC = 23 HC = 17 | DSM-IV | 21.6 (0.3) 27.7 (1.6) | Investigate brain responses to rewards during hunger and satiated states to examine whether diminished response to reward could underlie food restriction in AN | Increased activation in the middle frontal gyrus. |
Emotions | Implicit facial expression processing task (I-FEPT) | Fonville et al., 2014 [32] | AN = 31 HC = 31 | DSM-IV | 15.9 (1.6) 23 (10)b | Examine neural correlations of implicit emotion processing in AN | Increased activation in the fusiform gyrus |
Processing of negative words concerning interpersonal relationships | Miyake et al., 2012 [55] | AN = 30 HC = 20 | DSM-IV | 15.4 (1.7) 27.2 (6.5) | Investigate neurobiological relationship between alexithymia and AN | Increased activation in the superior temporal gyrus | |
Implicit emotion processing task | Phillipou et al., 2015 [56] | AN = 24 HC = 25 | DSM-IV | 16.5 (1.1) 22.2 (5.5) | Investigate facial affect processing and the processing of own face through measures of emotion identification | Increased activation in the right inferior and middle temporal gyri and right lingual gyrus in response to own face | |
Emotional conflict task | Bang et al., 2016 [57] | AN-REC = 22 HC = 21 | DSM-IV | 20.39 (1.66) 27.3 (5.14) | Explore neural responses to an emotional conflict task in recovered AN | Less activation in the bilateral amygdala, hippocampus and basal ganglia in response to emotional congruent stimuli | |
View fearful and happy emotional faces | Cowdrey et al. 2012 [58] | AN-REC = 16 HC = 16 | DSM-IV | 21.3 (2.2) 23.1 (3.6) | Investigate neural processing of emotional faces in AN-REC | No significant differences | |
Taste | Intake of water and chocolate milk | Vocks et al., 2011 [51] | AN-R = 12 HC = 12 | DSM-IV | 14.1 (1.8) 27.4 (10.6) | Examine possible alterations in neural correlates of gustatory processing of food stimuli, and to test the impact of hunger and satiety | Hungry state was related to increased activation in the right amygdale and left medial temporal gyrus, and reduced activation in the right medial frontal gyrus |
Glucose intake | Van Opstal et al., 2015 [50] | AN = 10 HC = 11 | DSM-IV | 15.6 (1.0) 22.1 (3.3) | Elucidate hypothalamic functioning and structure in AN | No difference in hypothalamic activation | |
Taste of sucrose (caloric) and sucralose (non-caloric) | Wagner et al., 2015 [53] | AN-REC = 14 BN-REC = 15 HC = 13 | DSM-IV | 20.9 (2.8) 26.4 (5.4) | Determine whether sensitization effects might underlie pathologic eating behavior when a taste stimulus is presented repeatedly | AN-REC showed a decreased sensitization to sucrose (caloric) and increased sensitization to sucralose (non-caloric) stimuli in the lentiform nucleus and thalamus | |
Taste of sucrose and sucralose | Oberndorfer et al., 2013 [43] | AN-REC = 14 BN-REC = 14 HC = 14 | DSM-IV | 21.5 (2.8) 27.3 (1.4) | Interrogate gustatory neurocircuitry involving the anterior insula and related regions that modulate sensory-interoceptive-reward signals in response to palatable foods | AN-REC compared to controls had diminished response to tastes of sucrose in the anterior insula | |
Taste (cont.) | High-fat cream stimulus, water and non-caloric viscous stimulus | Radeloff et al., 2014 [52] | AN-REC = 15 BN-REC = 14 HC = 18 | DSM-IV | 21.0 (2.4) 25.2 (4.0) | To compare responses to a high-fat cream stimulus, water, and a non-caloric viscous stimulus in AN-REC and BN-REC and HC | The BN group showed increased activation in the anterior ventral striatum, however there were no differences in this region between the AN and HC group. |
Pain | Heat pain thresholds, and thermal painful stimuli | Bär et al., 2013 [15] | AN-R = 19 HC = 19 Male/female: 3/16 | DSM-IV | 16.9 (1.2) 22.6 (5.3) | Test the hypothesis that altered processing of pain in the insula might account for reduced perception of pain | Reduced activity in the insula, cerebellum and pons |
Thermal pain stimulation | Bär et al., 2015 [16] | AN = 26 HC = 26 Male/female: 3/23 | DSM-IV | 17.0 (1.5) 22.9 (5.0) | Investigate neural correlates of body perception deficit | Increased activation in the right Brodmann area 23/31, left dorsal posterior and midcingulate cortex | |
Painful heat stimuli | Strigo et al., 2013 [60] | AN-REC = 12 HC = 10 | DSM-IV | 21.9 (1.7) 29.7 (6.8) | Assess neural substrates of pain anticipation and processing | Greater activation in right anterior insula, dorsolateral prefrontal cortex and cingulate during pain anticipation. Greater activation in dorsolateral prefrontal cortex and decreased activation in the posterior insula during painful stimulation | |
Social cognition | Short videos of moving shapes | McAdams & Krawczyk, 2011 [62] | AN-REC = 17 HC = 17 | DSM-IV | 23.4 (4.2) 26.2 (7.0) | Examine neural correlates relating to thinking about social relationships | Reduced activation in the right temporoparietal junction |
Multiround trust game | McAdams et al., 2015 [63] | AN = 23 AN-REC = 19 HC = 21 | DSM-IV | AN: 18.0 (1.5) 26.3 (8.1) AN-REC: 22.8 (2.7) 29.6 (8.3) | Compare neural responses in a social relationship | Diminished response in the precuneus and angular gyrus to benevolence (improved relationship) in both ill and recovered patients. In response to malevolence (deteriorating relationship), differed in the fusiform gyrus in ill patients only). | |
Theory of mind task | Schulte-Rüther et al., 2012 [61] | AN = 19 HC = 21 | DSM-IV | 15.3 (1.5) 15.7 (1.5) | Identify neural mechanisms behind theory of mind deficits in AN | Reduced activation in the middle anterior temporal cortex and the medial prefrontal cortex. Increased activation in the medial prefrontal cortex | |
Compulsivity | Cue-reactivity | Rothemund et al., 2011 [65] | AN = 12 HC = 12 | NA | 13.6 (1.2) 24.0 (6.1) | Investigate compulsivity | Increased activation in caudate and precuneus |
Symmetry/order images e.g. uneven/chaotic/messy environments | Suda et al., 2014 [66] | AN = 22 HC = 24 | DSM-IV | 15.3 (1.1) 26.8 (8.0) | Examine brain activation in women with AN and HC during the provocation of symmetry/ordering-related anxiety | Reduced activation in the right parietal lobe (incl.precuneus) and the right prefrontal cortex in response to provocation. Inversely correlated with severity of symmetry/ordering symptoms | |
Self-identity | Identity appraisal tasks | McAdams & Krawczyk, 2014 [67] | AN-REC = 18 HC = 18 | DSM-IV | 19.8 (1.6) 26.1 (6.8) | Test the hypothesis that AN-REC show altered neural response while thinking about their identity | Reduced activity in the precuneus, dorsal anterior cingulate, middle frontal gyrus |