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Frisone F, Brizzi G, Sansoni M, Di Natale AF, Pizzoli SFM, Stanghellini G, Riva G. Autobiographical Memory in Feeding and Eating Disorders: A Systematic Review. Psychopathology 2024:1-25. [PMID: 39378858 DOI: 10.1159/000540901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 07/08/2024] [Indexed: 10/10/2024]
Abstract
INTRODUCTION Prominent eating disorders (EDs) theories identify a critical relationship between body and self. One of the ways to study this relationship is through autobiographical memories (AMs). The present review aimed to evaluate the studies that investigated AM in patients with EDs. METHODS A search of PubMed, ScienceDirect, and Scopus databases was performed to identify relevant articles. Of the 57,113 studies found, 25,016 were not duplicated. After screening, 27 articles were included. RESULTS The studies had some methodological flaws: none of the articles was a randomized control trial and the sample sizes were small. Nevertheless, important evidence emerged because all studies showed that patients with EDs have impaired AM function. This is because the way patients with EDs remember and define themselves is through an allocentric perspective associated with the gazes of others whose role has an impact on AM, body shape, and self. CONCLUSION To our knowledge, this is the first systematic review to examine AM in patients with EDs. Future research is needed in EDs to expand knowledge about the relationship between the body and the self.
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Affiliation(s)
- Fabio Frisone
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giulia Brizzi
- Applied Technology for Neuro-Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Maria Sansoni
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Anna Flavia Di Natale
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Centro de Estudios de Fenomenologia y Psiquiatrías, Diego Portales University, Santiago, Chile
| | - Giuseppe Riva
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy
- Applied Technology for Neuro-Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Noon R, Pathan T. A Systematic Review to Explore a Neuropsychological Profile that Predates Anorexia Nervosa. Arch Clin Neuropsychol 2024:acae072. [PMID: 39244212 DOI: 10.1093/arclin/acae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 07/11/2024] [Accepted: 08/23/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVE Research demonstrates reduced cognitive flexibility and weak central coherence during acute illness and following recovery from anorexia nervosa (AN). This systematic review investigated if these impairments are present in first-degree relatives of individuals with AN, representing a possible neuropsychological risk profile. METHODS A systematic review of electronic databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search ended on July 14, 2023. Established search terms and inclusion criteria identified relevant research. Risk of bias was assessed using the Critical Appraisal Skills Program. The review was registered with Prospero international prospective register of systematic reviews (No. CRD42023401268). Study selection, descriptive data, critical appraisal, and risk of bias are presented in tables and figures. RESULTS The search yielded 10 studies. The included studies conducted neuropsychological assessments of discordant AN relatives and lifetime longitudinal study participants. Most studies found cognitive flexibility and central coherence to be significantly reduced in participants with AN and their relatives compared with controls. One study found decision making to be significantly impaired in AN participants and relatives. Effect sizes were moderate to large. DISCUSSION Reduced cognitive flexibility and weak central coherence appear to be endophenotypes of AN. Further research is required with relatives concordant for AN to establish whether these biomarkers co-segregate with AN within families. These findings suggest a possibility of developing screeners to identify individuals at risk of AN allowing for early intervention.
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Affiliation(s)
- Rachel Noon
- Division of Medicine, Eating Disorders and Clinical Nutrition, UCL, London, UK
| | - Tayeem Pathan
- Division of Medicine, MRCPsych Honorary Clinical Lecturer, Consultant Psychiatrist in Eating Disorders, Surrey and Borders Partnership NHS Foundation Trust, UCL, London, UK
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Portingale J, Krug I, Butler D. Enfacement illusions: Filling a knowledge gap in eating disorder risk assessment, prevention, and intervention? Int J Eat Disord 2024; 57:1805-1810. [PMID: 38837437 DOI: 10.1002/eat.24230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
Body image disturbance (BID) is central to eating disorders (EDs), yet the role of self-face perception has received limited empirical attention despite rising sociocultural pressures emphasizing facial appearance through technologies such as social media. Emerging evidence suggests impairments in self-face recognition accuracy and distorted perceptions of facial appearance among individuals with EDs. Enfacement illusions, involving the experimental induction of perceived ownership over another's face, offer a novel paradigm to comprehensively investigate the perceptual multisensory integration processes underlying self-face perception disturbances in ED populations. Such an approach may hold promise for elucidating core pathological mechanisms contributing to BID and ED psychopathology. We discuss how rigorous investigation of self-face perception through the enfacement illusion paradigm represents an innovative direction of research and/or clinical application that may advance etiological models of EDs and possibly inform interventions targeting the potentially multidimensional nature of body and facial image disturbances characterizing EDs. PUBLIC SIGNIFICANCE STATEMENT: Body image disturbance is central to eating disorders (EDs), yet, the role of face-related disturbances remains critically under-investigated. After summarizing findings on face-related disturbances in EDs we propose how enfacement illusions (i.e., the experimental induction of ownership over another's face) may elucidate self-face perception disturbances in EDs, and their underlying mechanisms. Enfacement illusions may also offer an intervention to potentially address multifaceted face and body image disturbances characterizing EDs.
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Affiliation(s)
- Jade Portingale
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Isabel Krug
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - David Butler
- Faculty of Psychology and Counselling, The Cairnmillar Institute, Melbourne, Australia
- Department of Psychology, Counselling and Therapy, LaTrobe University, Melbourne, Australia
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Mas-Cuesta L, Baltruschat S, Cándido A, Catena A. Brain signatures of catastrophic events: Emotion, salience, and cognitive control. Psychophysiology 2024:e14674. [PMID: 39169571 DOI: 10.1111/psyp.14674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/10/2024] [Accepted: 08/08/2024] [Indexed: 08/23/2024]
Abstract
Anticipatory brain activity makes it possible to predict the occurrence of expected situations. However, events such as traffic accidents are statistically unpredictable and can generate catastrophic consequences. This study investigates the brain activity and effective connectivity associated with anticipating and processing such unexpected, unavoidable accidents. We asked 161 participants to ride a motorcycle simulator while recording their electroencephalographic activity. Of these, 90 participants experienced at least one accident while driving. We conducted both within-subjects and between-subjects comparisons. During the pre-accident period, the right inferior parietal lobe (IPL), left anterior cingulate cortex (ACC), and right insula showed higher activity in the accident condition. In the post-accident period, the bilateral orbitofrontal cortex, right IPL, bilateral ACC, and middle and superior frontal gyrus also showed increased activity in the accident condition. We observed greater effective connectivity within the nodes of the limbic network (LN) and between the nodes of the attentional networks in the pre-accident period. In the post-accident period, we also observed greater effective connectivity between networks, from the ventral attention network (VAN) to the somatomotor network and from nodes in the visual network, VAN, and default mode network to nodes in the frontoparietal network, LN, and attentional networks. This suggests that activating salience-related processes and emotional processing allows the anticipation of accidents. Once an accident has occurred, integration and valuation of the new information takes place, and control processes are initiated to adapt behavior to the new demands of the environment.
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Affiliation(s)
- Laura Mas-Cuesta
- Mind, Brain and Behavior Research Center, University of Granada, Campus de Cartuja s/n, Granada, Spain
| | - Sabina Baltruschat
- Mind, Brain and Behavior Research Center, University of Granada, Campus de Cartuja s/n, Granada, Spain
| | - Antonio Cándido
- Mind, Brain and Behavior Research Center, University of Granada, Campus de Cartuja s/n, Granada, Spain
| | - Andrés Catena
- School of Psychology, University of Granada, Campus de Cartuja s/n, Granada, Spain
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Qiu H, Shi M, Zhong Z, Hu H, Sang H, Zhou M, Feng Z. Causal Relationship between Aging and Anorexia Nervosa: A White-Matter-Microstructure-Mediated Mendelian Randomization Analysis. Biomedicines 2024; 12:1874. [PMID: 39200338 PMCID: PMC11351342 DOI: 10.3390/biomedicines12081874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
This study employed a two-step Mendelian randomization analysis to explore the causal relationship between telomere length, as a marker of aging, and anorexia nervosa and to evaluate the mediating role of changes in the white matter microstructure across different brain regions. We selected genetic variants associated with 675 diffusion magnetic resonance imaging phenotypes representing changes in brain white matter. F-statistics confirmed the validity of the instruments, ensuring robust causal inference. Sensitivity analyses, including heterogeneity tests, horizontal pleiotropy tests, and leave-one-out tests, validated the results. The results show that telomere length is significantly negatively correlated with anorexia nervosa in a unidirectional manner (p = 0.017). Additionally, changes in specific white matter structures, such as the internal capsule, corona radiata, posterior thalamic radiation, left cingulate gyrus, left longitudinal fasciculus, and left forceps minor (p < 0.05), were identified as mediators. These findings enhance our understanding of the neural mechanisms, underlying the exacerbation of anorexia nervosa with aging; emphasize the role of brain functional networks in disease progression; and provide potential biological targets for future therapeutic interventions.
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Affiliation(s)
- Haoyuan Qiu
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (H.Q.); (M.S.); (Z.Z.); (H.H.)
| | - Miao Shi
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (H.Q.); (M.S.); (Z.Z.); (H.H.)
| | - Zicheng Zhong
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (H.Q.); (M.S.); (Z.Z.); (H.H.)
| | - Haoran Hu
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (H.Q.); (M.S.); (Z.Z.); (H.H.)
| | - Hunini Sang
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China;
| | - Meijuan Zhou
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Zhijun Feng
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
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Toenders YJ, Dorsman H, van der Cruijsen R, Crone EA. Developing body estimation in adolescence is associated with neural regions that support self-concept. Soc Cogn Affect Neurosci 2024; 19:nsae042. [PMID: 38902015 PMCID: PMC11223914 DOI: 10.1093/scan/nsae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/10/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
Both self-concept, the evaluation of who you are, and the physical body undergo changes throughout adolescence. These two processes might affect the development of body image, a complex construct that comprises one's thoughts, feelings, and perception of one's body. This study aims to better understand the development of body image in relation to self-concept development and its neural correlates. Adolescents (aged 11-24) from the longitudinal Leiden Self-Concept study were followed for three consecutive years (NT1 = 160, NT2 = 151, and NT3 = 144). Their body image was measured using a figure rating scale and body dissatisfaction questionnaire. Body estimation was calculated based on figure ratings relative to their actual body mass index (BMI). Additionally, participants evaluated their physical appearance traits in an functional magnetic resonance imaging (fMRI) task. Results revealed that body estimation and body dissatisfaction increased with age. Heightened inferior parietal lobe (IPL) activation during physical self-evaluation was associated with lower body estimation, meaning that the neural network involved in thinking about one's physical traits is more active for individuals who perceive themselves as larger than they are. IPL activity showed continued development during adolescence, suggesting an interaction between neural development and body perception. These findings highlight the complex interplay between affective, perceptual, and biological factors in shaping body image.
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Affiliation(s)
- Yara J Toenders
- Developmental and Educational Psychology, Leiden University, Leiden 2333AK, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden 2333AK, The Netherlands
- Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam 3062PA, The Netherlands
| | - Hannah Dorsman
- Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam 3062PA, The Netherlands
| | | | - Eveline A Crone
- Developmental and Educational Psychology, Leiden University, Leiden 2333AK, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden 2333AK, The Netherlands
- Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam 3062PA, The Netherlands
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Chastan N, Achamrah N, Etard O, Nathou C, Piquet M, Guillaume S, Attal J, Gillibert A, Dechelotte P, Guillin O, Welter M. Effects of repetitive transcranial magnetic stimulation of the right inferior parietal lobe on the body image perception in anorexia nervosa: A pilot randomized controlled study. Brain Behav 2024; 14:e3617. [PMID: 38970216 PMCID: PMC11226536 DOI: 10.1002/brb3.3617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/07/2024] [Accepted: 06/15/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION Restrictive anorexia nervosa (AN) is associated with distorted perception of body shape, previously linked to hypoactivity and reduced excitability of the right inferior parietal lobe (rIPL). Here, we investigated the impact of high-frequency repetitive transcranial magnetic stimulation (HF rTMS) of the rIPL on body shape perception in patients with AN. METHODS Seventeen patients with AN (median [Q1_Q3] age, 35 [27_39] years; disease duration, 12 [6_18] years) were randomly assigned to receive real or sham HF (10 Hz) rTMS of the rIPL over a period of 2 weeks, comprising 10 sessions. The primary outcome measure was the Body Shape Questionnaire (BSQ). Secondary outcomes included eating disorder symptoms, body mass index, mood, anxiety, and safety. Data collection were done at baseline, post-rTMS, and at 2 weeks and 3 months post-rTMS. RESULTS Following both real and sham rTMS of the rIPL, no significant differences were observed in body shape perception or other parameters. Both real and sham rTMS interventions were deemed safe and well tolerated. Notably, serious adverse events were associated with the underlying eating and mood disorders, resulting in hospitalization for undernutrition (five patients) or suicidal attempts (two patients). CONCLUSION This pilot study does not support the use of rTMS of the rIPL as an effective method for improving body shape perception in individuals with the restrictive form of AN. Further research is warranted to comprehensively explore both the clinical and neurophysiological effects of HF rTMS in this population.
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Affiliation(s)
- Nathalie Chastan
- Department of NeurophysiologyNormandie University, UNIROUEN, Rouen University HospitalRouenFrance
| | - Najate Achamrah
- Department of NutritionNormandie University, UNIROUEN, INSERM UMR1073, Rouen University HospitalRouenFrance
| | - Olivier Etard
- Department of NeurophysiologyNormandie University, UNICAEN, INSERM, COMETE, CYCERON, CHU CaenCaenFrance
| | - Clément Nathou
- Department of NeurophysiologyNormandie University, UNICAEN, INSERM, COMETE, CYCERON, CHU CaenCaenFrance
- Department of PsychiatryCHU CaenCaenFrance
| | | | - Sébastien Guillaume
- Department of Emergency Psychiatry and Acute CareLapeyronie Hospital, CHU Montpellier, Institute of Functional Genomics, University of Montpellier, CNRS, INSERMMontpellierFrance
| | - Jérôme Attal
- Department of Emergency Psychiatry and Acute CareLapeyronie Hospital, CHU Montpellier, Institute of Functional Genomics, University of Montpellier, CNRS, INSERMMontpellierFrance
| | | | - Pierre Dechelotte
- Department of NutritionNormandie University, UNIROUEN, INSERM UMR1073, Rouen University HospitalRouenFrance
| | - Olivier Guillin
- Department of PsychiatryNormandie University, UNIROUEN, Rouen University HospitalRouenFrance
| | - Marie‐Laure Welter
- Department of NeurophysiologyNormandie University, UNIROUEN, Rouen University HospitalRouenFrance
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Parma C, Doria F, Zulueta A, Boscarino M, Giani L, Lunetta C, Parati EA, Picozzi M, Sattin D. Does Body Memory Exist? A Review of Models, Approaches and Recent Findings Useful for Neurorehabilitation. Brain Sci 2024; 14:542. [PMID: 38928542 PMCID: PMC11201876 DOI: 10.3390/brainsci14060542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Over the past twenty years, scientific research on body representations has grown significantly, with Body Memory (BM) emerging as a prominent area of interest in neurorehabilitation. Compared to other body representations, BM stands out as one of the most obscure due to the multifaceted nature of the concept of "memory" itself, which includes various aspects (such as implicit vs. explicit, conscious vs. unconscious). The concept of body memory originates from the field of phenomenology and has been developed by research groups studying embodied cognition. In this narrative review, we aim to present compelling evidence from recent studies that explore various definitions and explanatory models of BM. Additionally, we will provide a comprehensive overview of the empirical settings used to examine BM. The results can be categorized into two main areas: (i) how the body influences our memories, and (ii) how memories, in their broadest sense, could generate and/or influence metarepresentations-the ability to reflect on or make inferences about one's own cognitive representations or those of others. We present studies that emphasize the significance of BM in experimental settings involving patients with neurological and psychiatric disorders, ultimately analyzing these findings from an ontogenic perspective.
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Affiliation(s)
- Chiara Parma
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (C.P.); (F.D.)
- PhD. Program, Medicina Clinica e Sperimentale e Medical Humanities, Insubria University, 21100 Varese, Italy
| | - Federica Doria
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (C.P.); (F.D.)
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Labion, Via Camaldoli 64, 20138 Milan, Italy;
| | - Marilisa Boscarino
- Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy; (M.B.); (L.G.); (E.A.P.)
| | - Luca Giani
- Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy; (M.B.); (L.G.); (E.A.P.)
| | - Christian Lunetta
- Amyotrophic Lateral Sclerosis Unit, Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy;
| | - Eugenio Agostino Parati
- Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy; (M.B.); (L.G.); (E.A.P.)
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Davide Sattin
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (C.P.); (F.D.)
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Feusner JD, Nowacka A, Ly R, Luders E, Kurth F. Corpus callosum morphology and relationships to illness phenotypes in individuals with anorexia nervosa. Sci Rep 2024; 14:11112. [PMID: 38750237 PMCID: PMC11096409 DOI: 10.1038/s41598-024-61841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
Anorexia nervosa is an often-severe psychiatric illness characterized by significantly low body weight, fear of gaining weight, and distorted body image. Multiple neuroimaging studies have shown abnormalities in cortical morphology, mostly associated with the starvation state. Investigations of white matter, while more limited in number, have suggested global and regional volume reductions, as well as abnormal diffusivity in multiple regions including the corpus callosum. Yet, no study has specifically examined thickness of the corpus callosum, a large white matter tract instrumental in the inter-hemispheric integration of sensory, motor, and cognitive information. We analyzed MRI data from 48 adolescents and adults with anorexia nervosa and 50 healthy controls, all girls/women, to compare corpus callosum thickness and examined relationships with body mass index (BMI), illness duration, and eating disorder symptoms (controlling for BMI). There were no significant group differences in corpus callosum thickness. In the anorexia nervosa group, severity of body shape concerns was significantly, positively correlated with callosal thickness in the rostrum, genu, rostral body, isthmus, and splenium. In addition, there were significant positive correlations between eating disorder-related obsessions and compulsions and thickness of the anterior midbody, rostral body, and splenium. There were no significant associations between callosal thickness and BMI or illness duration. In sum, those with AN with worse concerns about bodily appearance and worse eating disorder-related obsessive thought patterns and compulsive behaviours have regionally thicker corpus callosum, independent of current weight status. These findings provide important neurobiological links to key, specific eating disorder behavioural phenotypes.
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Affiliation(s)
- Jamie D Feusner
- Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Department of Women's and Children's Health, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden.
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Alicja Nowacka
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Ronald Ly
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Eileen Luders
- School of Psychology, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Laboratory of Neuro Imaging, School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Florian Kurth
- School of Psychology, University of Auckland, Auckland, New Zealand
- Departments of Neuroradiology and Radiology, Jena University Hospital, Jena, Germany
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10
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Reilly EE, Brown TA, Frank GKW. Perceptual Dysfunction in Eating Disorders. Curr Top Behav Neurosci 2024. [PMID: 38730196 DOI: 10.1007/7854_2024_470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Eating disorders (EDs) are characterized by abnormal responses to food and weight-related stimuli and are associated with significant distress, impairment, and poor outcomes. Because many of the cardinal symptoms of EDs involve disturbances in perception of one's body or abnormal affective or cognitive reactions to food intake and how that affects one's size, there has been longstanding interest in characterizing alterations in sensory perception among differing ED diagnostic groups. Within the current review, we aimed to critically assess the existing research on exteroceptive and interoceptive perception and how sensory perception may influence ED behavior. Overall, existing research is most consistent regarding alterations in taste, visual, tactile, and gastric-specific interoceptive processing in EDs, with emerging work indicating elevated respiratory and cardiovascular sensitivity. However, this work is far from conclusive, with most studies unable to speak to the precise etiology of observed perceptual differences in these domains and disentangle these effects from affective and cognitive processes observed within EDs. Further, existing knowledge regarding perceptual disturbances in EDs is limited by heterogeneity in methodology, lack of multimodal assessment protocols, and inconsistent attention to different ED diagnoses. We propose several new avenues for improving neurobiology-informed research on sensory processing to generate actionable knowledge that can inform the development of innovative interventions for these serious disorders.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, USA
| | - Tiffany A Brown
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - Guido K W Frank
- Department of Psychiatry, University of California, San Diego, CA, USA.
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Hamamoto Y, Oba K, Ishibashi R, Ding Y, Nouchi R, Sugiura M. Reduced body-image disturbance by body-image interventions is associated with neural-response changes in visual and social processing regions: a preliminary study. Front Psychiatry 2024; 15:1337776. [PMID: 38510808 PMCID: PMC10951070 DOI: 10.3389/fpsyt.2024.1337776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Body-image disturbance is a major factor in the development of eating disorders, especially among young women. There are two main components: perceptual disturbance, characterized by a discrepancy between perceived and actual body size, and affective disturbance, characterized by a discrepancy between perceived and ideal body size. Interventions targeting body-image disturbance ask individuals to describe their own body without using negative expressions when either viewing it in a mirror or imagining it. Despite the importance of reducing body-image disturbance, its neural mechanisms remain unclear. Here we investigated the changes in neural responses before and after an intervention. We hypothesized that neural responses correlated with the degree of body-image disturbance would also be related to its reduction, i.e., a reduction in perceptual and affective disturbances would be related to changes in attentional and socio-cognitive processing, respectively. Methods Twenty-eight young adult women without known psychiatric disorders underwent a single 40-min intervention. Participants completed tasks before and after the intervention, in which they estimated their perceived and ideal body sizes using distorted silhouette images to measure body-image disturbance. We analyzed the behavioral and neural responses of participants during the tasks. Results The intervention did not significantly reduce body-image disturbance. Analysis of individual differences showed distinct changes in neural responses for each type of disturbance. A decrease in perceptual disturbance was associated with bodily visuospatial processing: increased activation in the left superior parietal lobule, bilateral occipital gyri, and right cuneus. Reduced affective disturbance was associated with socio-cognitive processing; decreased activation in the right temporoparietal junction, and increased functional connectivity between the left extrastriate body area and the right precuneus. Discussion We identified distinct neural mechanisms (bodily visuospatial and socio-cognitive processing) associated with the reduction in each component of body-image disturbance. Our results imply that different neural mechanisms are related to reduced perceptual disturbance and the expression thereof, whereas similar neural mechanisms are related to the reduction and expression of affective disturbance. Considering the small sample size of this study, our results should be regarded as preliminary.
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Affiliation(s)
- Yumi Hamamoto
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kentaro Oba
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Ryo Ishibashi
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yi Ding
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
- School of Medicine, Tohoku University, Sendai, Japan
| | - Rui Nouchi
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Motoaki Sugiura
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
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12
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Xia R, Liu Y, Liu B, Kou M, Zhao L, Zhang P, Wang Q. Effects of perspective taking on attention bias to body-related information among junior high school students with body image disturbance. Acta Psychol (Amst) 2024; 243:104131. [PMID: 38219429 DOI: 10.1016/j.actpsy.2024.104131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/27/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024] Open
Abstract
Using lexical judgment tasks, the present study explored whether perspective taking affected attention bias to body-related information among junior high school students with body image disturbance. Experiment 1 examined the junior high school students' attention bias to body schema-related words; the results showed the body image disturbance group responded significantly more quickly to negative body schema-related words than positive words, whereas the control group did not show a significant difference between positive and negative words. In Experiment 2, participants were asked to judge whether the positive or negative body schema-related words were suitable to describe themselves, when adopting their own perspective or that of another person. The results showed that reaction times to negative words were significantly shorter than to positive words when adopting a self-perspective. When taking another's perspective, there was no significant difference of reaction time between positive and negative words. This result demonstrated that perspective taking reduced attention bias to negative body schema-related information among junior high school students with body image disturbance. The present research suggests that guiding adolescents to view themselves from different perspectives can help them form a more accurate and objective body image.
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Affiliation(s)
- Ruixue Xia
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; Key Laboratory of Behavioral and Mental Health of Gansu Province, Lanzhou 730070, China.
| | - Yang Liu
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; Key Laboratory of Behavioral and Mental Health of Gansu Province, Lanzhou 730070, China
| | - Binghua Liu
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; Key Laboratory of Behavioral and Mental Health of Gansu Province, Lanzhou 730070, China; School of Education and Arts, Lanzhou Modern Vocational College, Lanzhou 730070, China
| | - Mingjiao Kou
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; Key Laboratory of Behavioral and Mental Health of Gansu Province, Lanzhou 730070, China; Shenzhen Fuhe Psychological Education Consulting Co., Ltd, Shenzhen 518105, China
| | - Liyun Zhao
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; Key Laboratory of Behavioral and Mental Health of Gansu Province, Lanzhou 730070, China
| | - Peiying Zhang
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; Key Laboratory of Behavioral and Mental Health of Gansu Province, Lanzhou 730070, China
| | - Qin Wang
- School of Psychology, Northwest Normal University, Lanzhou 730070, China; Key Laboratory of Behavioral and Mental Health of Gansu Province, Lanzhou 730070, China
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13
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Brizzi G, Sansoni M, Di Lernia D, Frisone F, Tuena C, Riva G. The multisensory mind: a systematic review of multisensory integration processing in Anorexia and Bulimia Nervosa. J Eat Disord 2023; 11:204. [PMID: 37974266 PMCID: PMC10655389 DOI: 10.1186/s40337-023-00930-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023] Open
Abstract
Individuals with Anorexia Nervosa and Bulimia Nervosa present alterations in the way they experience their bodies. Body experience results from a multisensory integration process in which information from different sensory domains and spatial reference frames is combined into a coherent percept. Given the critical role of the body in the onset and maintenance of both Anorexia Nervosa and Bulimia Nervosa, we conducted a systematic review to examine multisensory integration abilities of individuals affected by these two conditions and investigate whether they exhibit impairments in crossmodal integration. We searched for studies evaluating crossmodal integration in individuals with a current diagnosis of Anorexia Nervosa and Bulimia Nervosa as compared to healthy individuals from both behavioral and neurobiological perspectives. A search of PubMed, PsycINFO, and Web of Sciences databases was performed to extract relevant articles. Of the 2348 studies retrieved, 911 were unique articles. After the screening, 13 articles were included. Studies revealed multisensory integration abnormalities in patients affected by Anorexia Nervosa; only one included individuals with Bulimia Nervosa and observed less severe impairments compared to healthy controls. Overall, results seemed to support the presence of multisensory deficits in Anorexia Nervosa, especially when integrating interoceptive and exteroceptive information. We proposed the Predictive Coding framework for understanding our findings and suggested future lines of investigation.
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Affiliation(s)
- Giulia Brizzi
- Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149, Milan, Italy.
| | - Maria Sansoni
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
| | - Daniele Di Lernia
- Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149, Milan, Italy
| | - Fabio Frisone
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149, Milan, Italy
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20121, Milan, Italy
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14
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Murray SB, Diaz-Fong JP, Duval CJ, Balkchyan AA, Nagata JM, Lee DJ, Ganson KT, Toga AW, Siegel SJ, Jann K. Sex differences in regional gray matter density in pre-adolescent binge eating disorder: a voxel-based morphometry study. Psychol Med 2023; 53:6077-6089. [PMID: 36305572 DOI: 10.1017/s0033291722003269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with broad medical and psychiatric morbidity, and obesity. While BED may be characterized by altered cortical morphometry, no evidence to date examined possible sex-differences in regional gray matter characteristics among those with BED. This is especially important to consider in children, where BED symptoms often emerge coincident with rapid gray matter maturation. METHODS Pre-adolescent, 9-10-year old boys (N = 38) and girls (N = 33) with BED were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development Study. We investigated sex differences in gray matter density (GMD) via voxel-based morphometry. Control sex differences were also assessed in age and body mass index and developmentally matched control children (boys N = 36; girls N = 38). Among children with BED, we additionally assessed the association between dorsolateral prefrontal (dlPFC) GMD and parent-reported behavioral approach and inhibition tendencies. RESULTS Girls with BED uniquely demonstrate diffuse clusters of greater GMD (p < 0.05, Threshold Free Cluster Enhancement corrected) in the (i) left dlPFC (p = 0.003), (ii) bilateral dmPFC (p = 0.004), (iii) bilateral primary motor and somatosensory cortex (p = 0.0003) and (iv) bilateral precuneus (p = 0.007). Brain-behavioral associations suggest a unique negative correlation between GMD in the left dlPFC and behavioral approach tendencies among girls with BED. CONCLUSIONS Early-onset BED may be characterized by regional sex differences in terms of its underlying gray matter morphometry.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Joel P Diaz-Fong
- Department of Psychiatry & Behavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA, USA
| | - Christina J Duval
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Ane A Balkchyan
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Darrin J Lee
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
- USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Arthur W Toga
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Steven J Siegel
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Kay Jann
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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15
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Wronski ML, Hohnemann C, Bernardoni F, Bahnsen K, Doose A, Arold D, Borucki K, Holsen LM, Lawson EA, Plessow F, Weidner K, Roessner V, Diestel S, King JA, Seidel M, Ehrlich S. Explicating the role of amygdala substructure alterations in the link between hypoleptinemia and rumination in anorexia nervosa. Acta Psychiatr Scand 2023; 148:368-381. [PMID: 37688292 DOI: 10.1111/acps.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The amygdaloid complex plays a pivotal role in emotion processing and has been associated with rumination transdiagnostically. In anorexia nervosa (AN), we previously observed differential reductions of amygdala nuclei volumes (rostral-medial cluster substantially affected) and, in another study, elevated food-/weight-related rumination. Both amygdala volumes and rumination frequency correlated with characteristically suppressed leptin levels in AN. Thus, we hypothesized that amygdala nuclei alterations might be associated with AN-related rumination and potentially mediate the leptin-rumination relationship in AN. METHODS Rumination (food-/weight-related) was assessed using ecological momentary assessment for a 14-day period. We employed frequentist and Bayesian linear mixed effects models in females with AN (n = 51, 12-29 years, majority admitted to inpatient treatment) and age-matched healthy females (n = 51) to investigate associations between rostral-medial amygdala nuclei volume alterations (accessory basal, cortical, medial nuclei, corticoamygdaloid transitions) and rumination. We analyzed mediation effects using multi-level structural equation models. RESULTS Reduced right accessory basal and cortical nuclei volumes predicted more frequent weight-related rumination in AN; both nuclei fully mediated the effect of leptin on weight-related rumination. In contrast, we found robust evidence for the absence of amygdala nuclei volume effects on rumination in healthy females. CONCLUSION This study provides first evidence for the relevance of specific amygdala substructure reductions regarding cognitive symptom severity in AN and points toward novel mechanistic insight into the relationship between hypoleptinemia and rumination, which might involve the amygdaloid complex. Our findings in AN may have important clinical value with respect to understanding the beneficial neuropsychiatric effects of leptin (treatment) in AN and potentially other psychiatric conditions such as depression.
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Affiliation(s)
- Marie-Louis Wronski
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charlotte Hohnemann
- Schumpeter School of Business and Economics, Faculty of Economy, University of Wuppertal, Wuppertal, Germany
| | - Fabio Bernardoni
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Klaas Bahnsen
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Arne Doose
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dominic Arold
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Borucki
- Department of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Laura M Holsen
- Division of Women's Health, Department of Medicine/Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Franziska Plessow
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Diestel
- Schumpeter School of Business and Economics, Faculty of Economy, University of Wuppertal, Wuppertal, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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16
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Mitchell JS, Anijärv TE, Levenstein JL, Hermens DF, Lagopoulos J. Excitatory and inhibitory neurometabolites in anorexia nervosa: A systematic review of proton magnetic resonance spectroscopy studies. Neurosci Biobehav Rev 2023; 152:105279. [PMID: 37307945 DOI: 10.1016/j.neubiorev.2023.105279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023]
Abstract
The dysregulation of excitatory and inhibitory neurotransmission is considered a pathological marker of Anorexia Nervosa (AN), however, no systematic evaluation of the proton Magnetic Resonance Spectroscopy (1H-MRS) literature has been conducted to date. Accordingly, we conducted a systematic review of neurometabolite differences between individuals with AN and healthy controls (HC). A comprehensive database search (until June 2023) identified seven studies meeting inclusion criteria. Samples included adolescents and adults with similar mean age (AN: 22.20 HC: 22.60), and female percentages (AN: 98%; HC: 94%). The review found a considerable need for improving study design and the reporting of MRS sequence parameters and analysis. Reduced glutamate concentrations in the ACC and OCC, and reduced Glx concentrations in the ACC were reported by one and two studies, respectively. Lastly, only one study to date has quantified GABA concentrations, with no significant differences found. In conclusion, there is currently insufficient evidence of excitatory and inhibitory neurometabolites changes in AN. As the 1H-MRS literature in AN increases, the key questions herein proposed must be revisited.
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Affiliation(s)
- Jules S Mitchell
- Thompson Institute, University of Sunshine Coast, 12 Innovation Parkway, Birtinya, 4575 Sunshine Coast, Queensland, Australia.
| | - Toomas E Anijärv
- Thompson Institute, University of Sunshine Coast, 12 Innovation Parkway, Birtinya, 4575 Sunshine Coast, Queensland, Australia
| | - Jacob L Levenstein
- Thompson Institute, University of Sunshine Coast, 12 Innovation Parkway, Birtinya, 4575 Sunshine Coast, Queensland, Australia
| | - Daniel F Hermens
- Thompson Institute, University of Sunshine Coast, 12 Innovation Parkway, Birtinya, 4575 Sunshine Coast, Queensland, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of Sunshine Coast, 12 Innovation Parkway, Birtinya, 4575 Sunshine Coast, Queensland, Australia
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17
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Chen X, Dong D, Zhou F, Gao X, Liu Y, Wang J, Qin J, Tian Y, Xiao M, Xu X, Li W, Qiu J, Feng T, He Q, Lei X, Chen H. Connectome-based prediction of eating disorder-associated symptomatology. Psychol Med 2023; 53:5786-5799. [PMID: 36177890 DOI: 10.1017/s0033291722003026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite increasing knowledge on the neuroimaging patterns of eating disorder (ED) symptoms in non-clinical populations, studies using whole-brain machine learning to identify connectome-based neuromarkers of ED symptomatology are absent. This study examined the association of connectivity within and between large-scale functional networks with specific symptomatic behaviors and cognitions using connectome-based predictive modeling (CPM). METHODS CPM with ten-fold cross-validation was carried out to probe functional networks that were predictive of ED-associated symptomatology, including body image concerns, binge eating, and compensatory behaviors, within the discovery sample of 660 participants. The predictive ability of the identified networks was validated using an independent sample of 821 participants. RESULTS The connectivity predictive of body image concerns was identified within and between networks implicated in cognitive control (frontoparietal and medial frontal), reward sensitivity (subcortical), and visual perception (visual). Crucially, the set of connections in the positive network related to body image concerns identified in one sample was generalized to predict body image concerns in an independent sample, suggesting the replicability of this effect. CONCLUSIONS These findings point to the feasibility of using the functional connectome to predict ED symptomatology in the general population and provide the first evidence that functional interplay among distributed networks predicts body shape/weight concerns.
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Affiliation(s)
- Ximei Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Debo Dong
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Feng Zhou
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Xiao Gao
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Yong Liu
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Junjie Wang
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Jingmin Qin
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Yun Tian
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Mingyue Xiao
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Xiaofei Xu
- School of Computing Technologies, RMIT University, Melbourne, Australia
| | - Wei Li
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
- Southwest University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality at Beijing Normal University, Chongqing, China
| | - Tingyong Feng
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
- Research Center of Psychology and Social Development, Faculty of Psychology, Southwest University, Chongqing, China
| | - Qinghua He
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
- Southwest University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality at Beijing Normal University, Chongqing, China
| | - Xu Lei
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
- Research Center of Psychology and Social Development, Faculty of Psychology, Southwest University, Chongqing, China
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18
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Ambrosecchia M, Ardizzi M, Russo EC, Ditaranto F, Speciale M, Vinai P, Todisco P, Maestro S, Gallese V. Bodily self-recognition and body size overestimation in restrictive anorexia nervosa: implicit and explicit mechanisms. Front Psychol 2023; 14:1197319. [PMID: 37519354 PMCID: PMC10380935 DOI: 10.3389/fpsyg.2023.1197319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
It is widely known that among others, a pervasive symptom characterizing anorexia nervosa (AN) concerns body image overestimation, which largely contributes to the onset and maintenance of eating disorders. In the present study, we investigated the nature of the body image distortion by recording accuracy and reaction times in both a group of healthy controls and AN patients during two validated tasks requiring an implicit or explicit recognition of self/other hand stimuli, in which the perceived size of the stimuli was manipulated. Our results showed that (1) the perceived size of hand stimuli modulated both the implicit and explicit processing of body parts in both groups; (2) the implicit self-advantage emerged in both groups, but the bodily self, at an explicit level (perceptual, psycho-affective, cognitive) together with the integration and the distinction between self and other, was altered only in restrictive anorexia patients. Although further investigations will be necessary, these findings shed new light on the relationship between the different layers of self-experience and bodily self-disorders.
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Affiliation(s)
- Marianna Ambrosecchia
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Martina Ardizzi
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elisa Caterina Russo
- Eating Disorders Unit, Casa di Cura, “Villa Margherita”, Arcugnano, Vicenza, Italy
| | - Francesca Ditaranto
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Stella Maris, Pisa, Italy
| | | | | | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura, “Villa Margherita”, Arcugnano, Vicenza, Italy
| | - Sandra Maestro
- Comunità ad alta Intensità di Cura per Minori con DNA “Gli Orti di Ada”, Calambrone, Italy
| | - Vittorio Gallese
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Italian Academy for Advanced Studies in America, Columbia University, New York, NY, United States
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19
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Lo Buono V, Corallo F, Bonanno L, Quartarone A, De Cola MC. Body Image and Emotional Status in Patients with Acquired Brain Injury. J Clin Med 2023; 12:4070. [PMID: 37373763 DOI: 10.3390/jcm12124070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Emotional experiences can lead to a real or distorted self-representation. After brain damage, altered self-perception of one's own body image is frequent. This study evaluates the relationship of mood disorders and lesion sites on body image in a cohort of ABI patients. A total of 46 patients (26 men, 20 women) without severe physical impairments were found eligible for this study. Patients underwent Beck's Depression Inventory and the Hamilton Rating Scale for Anxiety to assess mood disorders, whereas the Body Image Scale and Human Figure Drawing were used to evaluate body dissatisfaction and implicit body image. The Montreal Cognitive Assessment was used to assess patients' cognitive condition. We found a moderate correlation between depression and body image (r = 0.48), as well as between anxiety and body image (r = 0.52), and the regression model also reported the right lesion site as a predictive variable for body image score. In addition, the regression model built by Human Figure Drawing scores showed anxiety, cognitive functioning, and a marital status of single to be significant predictors. The study confirmed that participants with acquired brain injury have deficits in body representation associated with mood disorders, regardless of the side of the lesions. A neuropsychological intervention could be useful for these patients to improve their cognitive performance and learn to manage emotional dysfunction in order to increase their self-perception of body image and improve their quality of life.
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Affiliation(s)
| | | | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
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20
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Yu X, Desrivières S. Altered anticipatory brain responses in eating disorders: A neuroimaging meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2023; 31:363-376. [PMID: 36639902 PMCID: PMC10947459 DOI: 10.1002/erv.2967] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/24/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Functional neuroimaging studies have found differential neural activation patterns during anticipation-related paradigms in participants with eating disorders (EDs) compared to controls. However, publications reported conflicting results on the directionality and location of the abnormal activations. There is an urgent need to integrate our existing knowledge of anticipation, both rewarding and aversive, to elucidate these differences. METHOD We conducted an activation likelihood estimation (ALE) meta-analysis to quantitatively review functional neuroimaging studies that evaluated differences between brain correlates of anticipation in participants with and without disordered eating. PubMed, Web of Sciences, PsycINFO, Medline and EMBASE were searched for studies published up to November 2022. Exploratory sub-analyses to check for differences between reward and non-reward anticipation among all anticipation paradigms. RESULTS Twenty-one references met the inclusion criteria for meta-analysis. The meta-analysis across anticipation all tasks identified a significant hyperactivation cluster in the right putamen in participants with disordered eating (n = 17 experiments) and a significant hypoactivation cluster in the left inferior parietal lobule (n = 13 experiments), in participants with disordered eating compared to controls. CONCLUSIONS These findings and sub-analyses of reward- and non-reward-related cues suggest potential pathophysiological mechanisms underlying anticipatory responses to rewarding and aversive cues in ED.
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Affiliation(s)
- Xinyang Yu
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Sylvane Desrivières
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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21
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Hamamoto Y, Suzuki S, Motoki K, Oba K, Kawashima R, Sugiura M. Neural mechanisms of perceptual and affective body-image disturbance during own-body and ideal-body estimation. Behav Brain Res 2023; 444:114349. [PMID: 36801426 DOI: 10.1016/j.bbr.2023.114349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/04/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
Body-image disturbance is a core feature of eating disorders and can predict their development in healthy individuals. There are two components of body-image disturbance: perceptual disturbance (associated with overestimation of body size) and affective disturbance (associated with body dissatisfaction). Previous behavioral studies have hypothesized that attention to particular body parts and negative body-related emotions resulting from social pressure are associated with the respective degrees of perceptual and affective disturbance; however, the neural representations that underlie this hypothesis have not been elucidated. Thus, this study investigated the brain regions and connectivity associated with the degree of body-image disturbance. Specifically, we examined the brain activations associated with participants' estimation of the width of their actual and ideal bodies; we sought to determine which brain regions and functional connectivity from body-related visual processing regions were correlated with the degree of each component of body-image disturbance. The degree of perceptual disturbance was positively correlated with excessive width-dependent brain activations in the left anterior cingulate cortex when estimating one's body size; it was positively correlated with the functional connectivity between the left extrastriate body area and left anterior insula. The degree of affective disturbance was positively correlated with excessive width-dependent brain activation in the right temporoparietal junction and negatively correlated with functional connectivity between the left extrastriate body area and right precuneus when estimating one's ideal body size. These results support the hypothesis that perceptual disturbance is associated with attentional processing, whereas affective disturbance is associated with social processing.
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Affiliation(s)
- Yumi Hamamoto
- School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan.
| | - Shinsuke Suzuki
- Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Frontier Research Institute for Interdisciplinary Science, Tohoku University, 6-3 Aramaki aza Aoba, Aoba-ku, Sendai 980-8578, Japan; Centre for Brain, Minds and Markets, Department of Finance, Faculty of Business and Economics, The University of Melbourne, 198 Berkeley St, Carlton, VIC 3053, Australia; Center for the Promotion of Social Data Science Education and Research, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo 186-8601, Japan
| | - Kosuke Motoki
- Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan; Department of Management, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kentaro Oba
- Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Ryuta Kawashima
- Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Motoaki Sugiura
- Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai 980-8572, Japan
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22
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Raoul L, Grosbras MH. Relating different Dimensions of Bodily Experiences: Review and proposition of an integrative model relying on phenomenology, predictive brain and neuroscience of the self. Neurosci Biobehav Rev 2023; 148:105141. [PMID: 36965863 DOI: 10.1016/j.neubiorev.2023.105141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
How we mentally experience our body has been studied in a variety research domains. Each of these domains focuses in its own ways on different aspects of the body, namely the neurophysiological, perceptual, affective or social components, and proposes different conceptual taxonomies. It is therefore difficult to find one's way through this vast literature and to grasp the relationships between the different dimensions of bodily experiences. In this narrative review, we summarize the existing research directions and present their limits. We propose an integrative framework, grounded in studies on phenomenal consciousness, self-consciousness and bodily self-consciousness, that can provide a common basis for evaluating findings on different dimensions of bodily experiences. We review the putative mechanisms, relying on predictive processes, and neural substrates that support this model. We discuss how this model enables a conceptual assessment of the interrelationships between multiple dimensions of bodily experiences and potentiate interdisciplinary approaches.
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Affiliation(s)
- Lisa Raoul
- Aix Marseille Univ, CNRS, LNC, Laboratoire de Neurosciences Cognitives, Marseille, France.
| | - Marie-Hélène Grosbras
- Aix Marseille Univ, CNRS, LNC, Laboratoire de Neurosciences Cognitives, Marseille, France.
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23
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Navas-León S, Morales Márquez L, Sánchez-Martín M, Crucianelli L, Bianchi-Berthouze N, Borda-Mas M, Tajadura-Jiménez A. Exploring multisensory integration of non-naturalistic sounds on body perception in young females with eating disorders symptomatology: a study protocol. J Eat Disord 2023; 11:28. [PMID: 36849992 PMCID: PMC9969697 DOI: 10.1186/s40337-023-00749-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Bodily illusions can be used to investigate the experience of being in a body by manipulating the underlying processes of multisensory integration. Research suggests that people with eating disorders (EDs) may have impairments in visual, interoceptive, proprioceptive, and tactile bodily perception. Furthermore, people with EDs also show abnormalities in integrating multisensory visuo-tactile and visual-auditory signals related to the body, which may contribute to the development of body image disturbances. Visuo-auditory integration abnormalities have been observed also in people with subthreshold ED symptomatology. However, it remains unclear whether these impairments are specific to bodily signals or if they extend to any auditory signals. METHODS We will recruit 50 participants (aged 18-24; females assigned at birth) with ED symptomatology (subthreshold group) and 50 control participants. The Eating Disorder Examination Questionnaire will be administered to screen for ED symptomatology and divide the sample into two groups accordingly (control and subthreshold group using a clinical cut-off score of 2.8). The strength of both illusions will be measured implicitly with estimations of body part position and size, and explicitly with self-report questionnaires. As a secondary aim, regression analysis will be run to test the predictive role of susceptibility for both illusions on interoceptive body awareness (measured by the Multidimensional Assessment of Interoceptive Awareness Scale) and sensory-processing sensitivity (measured by the Highly Sensitive Person Scale). DISCUSSION Our study may contribute to our understanding of the mechanisms underlying body image disturbances. The results may pave the way for novel clinical interventions targeting early symptoms prior to the development of the disorder in young females.
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Affiliation(s)
- Sergio Navas-León
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Spain
| | | | | | | | | | | | - Ana Tajadura-Jiménez
- UCL Interaction Centre, University College London, London, UK. .,i_mBODY lab, DEI Interactive Systems Group, Department of Computer Science and Engineering, Universidad Carlos III de Madrid, Madrid, Spain.
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24
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Kosuge M, Honma M, Masaoka Y, Kosuge S, Nakayama M, Kamijo S, Shikama Y, Izumizaki M. Respiratory rhythm affects recalibration of body ownership. Sci Rep 2023; 13:920. [PMID: 36650347 PMCID: PMC9844178 DOI: 10.1038/s41598-023-28158-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Change in body perception requires recalibration of various sensory inputs. However, it is less known how information other than sensations relates to the recalibration of body perception. Here, we focused on the relationship between respiration and cognition and investigated whether respiratory rhythms are related to the recalibration of hand perception. We built a visual feedback environment, in which a mannequin hand moved in conjunction with its own respiratory rhythm, and participants performed an experiment under conditions in congruency/incongruency for spatial and temporal factors. The temporal and spatial congruency between own respiratory rhythm and the mannequin hand markedly facilitated the phenomenon of hand ownership sense transfer to the mannequin hand, while incongruency had little effect on the change in hand ownership. The finding suggests that an internal model in the brain allows respiratory rhythms to be involved in the adaptation of the body's neural representations.
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Affiliation(s)
- Miku Kosuge
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Motoyasu Honma
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan.
| | - Yuri Masaoka
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Shota Kosuge
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | | | - Shotaro Kamijo
- Department of Pharmacology, Toxicology and Therapeutics, Division of Physiology, Showa University School of Pharmacy, Tokyo, Japan
| | - Yusuke Shikama
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Masahiko Izumizaki
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
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25
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Abstract
Anorexia nervosa is a disorder associated with serious adverse health outcomes, for which there is currently considerable treatment ineffectiveness. Characterised by restrictive eating behaviours, distorted body image perceptions and excessive physical activity, there is growing recognition anorexia nervosa is associated with underlying dysfunction in excitatory and inhibitory neurometabolite metabolism and signalling. This narrative review critically explores the role of N-methyl-D-aspartate receptor-mediated excitatory and inhibitory neurometabolite dysfunction in anorexia nervosa and its associated biomarkers. The existing magnetic resonance spectroscopy literature in anorexia nervosa is reviewed and we outline the brain region-specific neurometabolite changes that have been reported and their connection to anorexia nervosa psychopathology. Considering the proposed role of dysfunctional neurotransmission in anorexia nervosa, the potential utility of zinc supplementation and sub-anaesthetic doses of ketamine in normalising this is discussed with reference to previous research in anorexia nervosa and other neuropsychiatric conditions. The rationale for future research to investigate the combined use of low-dose ketamine and zinc supplementation to potentially extend the therapeutic benefits in anorexia nervosa is subsequently explored and promising biological markers for assessing and potentially predicting treatment response are outlined.
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26
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Garcia-Gil M, Ceccarini MR, Stoppini F, Cataldi S, Mazzeschi C, Delvecchio E, Albi E, Gizzi G. Brain and gut microbiota disorders in the psychopathology of anorexia nervosa. Transl Neurosci 2022; 13:516-526. [PMID: 36660007 PMCID: PMC9824428 DOI: 10.1515/tnsci-2022-0267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/08/2023] Open
Abstract
Studies of pathophysiological mechanisms involved in eating disorders (EDs) have intensified over the past several years, revealing their unprecedented and unanticipated complexity. Results from many articles highlight critical aspects in each member of ED family. Notably, anorexia nervosa (AN) is a disorder due to undefined etiology, frequently associated with symptoms of depression, anxiety, obsessive-compulsiveness, accompanied by endocrine alterations, altered immune response, increased inflammation, and dysbiosis of the gut microbiota. Hence, an advanced knowledge of how and why a multisystem involvement exists is of paramount importance to understand the pathogenetic mechanisms of AN. In this review, we describe the change in the brain structure/function focusing on hypothalamic endocrine disorders and the disequilibrium of gut microbiota in AN that might be responsible for the psychopathological complication.
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Affiliation(s)
- Mercedes Garcia-Gil
- Department of Biology, University of Pisa, 56127, Pisa, Italy,Department of Biology, Interdepartmental Research Center Nutrafood “Nutraceuticals and Food for Health”, University of Pisa, 56127 Pisa, Italy,Department of Biology, CISUP, Center for Instrument Sharing of the University of Pisa, 56127 Pisa, Italy
| | | | - Fabrizio Stoppini
- Department of Pharmaceutical Science, University of Perugia, 06126 Perugia, Italy
| | - Samuela Cataldi
- Department of Pharmaceutical Science, University of Perugia, 06126 Perugia, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy
| | - Elisa Delvecchio
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy
| | - Elisabetta Albi
- Department of Pharmaceutical Science, University of Perugia, 06126 Perugia, Italy
| | - Giulia Gizzi
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy
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27
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Daprati E, Nico D. Vulnerability factors and neuropsychiatric disorders: What could be learned from individual variability in cognitive functions. Front Psychol 2022; 13:1019030. [PMID: 36619098 PMCID: PMC9815448 DOI: 10.3389/fpsyg.2022.1019030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elena Daprati
- Dipartimento di Medicina dei Sistemi and CBMS, Università di Roma Tor Vergata, Rome, Italy,*Correspondence: Elena Daprati ✉
| | - Daniele Nico
- Dipartimento di Psicologia, Università di Roma La Sapienza, Rome, Italy
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28
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Mottarlini F, Rizzi B, Targa G, Fumagalli F, Caffino L. Long-lasting BDNF signaling alterations in the amygdala of adolescent female rats exposed to the activity-based anorexia model. Front Behav Neurosci 2022; 16:1087075. [PMID: 36570702 PMCID: PMC9772010 DOI: 10.3389/fnbeh.2022.1087075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction: Anorexia nervosa (AN) is a severe psychiatric disorder characterized by a pathological fear of gaining weight, excessive physical exercise, and emotional instability. Since the amygdala is a key region for emotion processing and BDNF has been shown to play a critical role in this process, we hypothesized that alteration in the amygdalar BDNF system might underline vulnerability traits typical of AN patients. Methods: To this end, adolescent female rats have been exposed to the Activity-Based Anorexia (ABA) protocol, characterized by the combination of caloric restriction and intense physical exercise. Results: The induction of the anorexic phenotype caused hyperactivity and body weight loss in ABA animals. These changes were paralleled by amygdalar hyperactivation, as measured by the up-regulation of cfos mRNA levels. In the acute phase of the pathology, we observed reduced Bdnf exon IX, exon IV, and exon VI gene expression, while mBDNF protein levels were enhanced, an increase that was, instead, uncoupled from its downstream signaling as the phosphorylation of TrkB, Akt, and S6 in ABA rats were reduced. Despite the body weight recovery observed 7 days later, the BDNF-mediated signaling was still downregulated at this time point. Discussion: Our findings indicate that the BDNF system is downregulated in the amygdala of adolescent female rats under these experimental conditions, which mimic the anorexic phenotype in humans, pointing to such dysregulation as a potential contributor to the altered emotional processing observed in AN patients. In addition, since the modulation of BDNF levels is observed in other psychiatric conditions, the persistent AN-induced changes of the BDNF system in the amygdala might contribute to explaining the onset of comorbid psychiatric disorders that persist in patients even beyond recovery from AN.
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29
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Chen X, Li W, Qin J, Gao X, Liu Y, Song S, Huang Y, Chen H. Gray matter volume and functional connectivity underlying binge eating in healthy children. Eat Weight Disord 2022; 27:3469-3478. [PMID: 36223059 DOI: 10.1007/s40519-022-01483-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/14/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE As a maladaptive disordered eating behavior, binge eating (BE) onset has been reported in children as young as eight years old and is linked with a range of negative psychological consequences. However, previous neuroimaging research of BE has mainly focused on adults in clinical conditions, and little is known about the potential neurostructural and neurofunctional bases of BE in healthy children. METHODS In this study, we examined these issues in 76 primary school students (mean age = 9.86 years) using voxel-based morphometry and resting-state functional connectivity (rsFC) approaches. RESULTS After controlling for age, sex, and total intracranial volume/head motion, we observed that higher levels of BE were correlated with greater gray matter volumes (GMV) in the left fusiform and right insula and weaker rsFC between the right insula and following three regions: right orbital frontal cortex, left cingulate gyrus, and left superior frontal gyrus. No significant associations were observed between BE and regional white matter volume. Significant sex differences were found only in the relationship between BE and GMV in the left fusiform. Furthermore, the GMV- and rsFC-based predictive models (a machine-learning method) achieved significant correlations between the actual and predicted BE values, demonstrating the robustness of our findings. CONCLUSION The present study provides novel evidence for the brain structural and functional substrates of children's BE, and further reveals that the weakened communication between core regions associated with negative affectivity, reward responsivity, and executive function is strongly related to dysregulated eating. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Ximei Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, No. 2, Tiansheng Road, Beibei District, Chongqing, 400715, China
| | - Wei Li
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, No. 2, Tiansheng Road, Beibei District, Chongqing, 400715, China
| | - Jingmin Qin
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, No. 2, Tiansheng Road, Beibei District, Chongqing, 400715, China
| | - Xiao Gao
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, No. 2, Tiansheng Road, Beibei District, Chongqing, 400715, China
| | - Yong Liu
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, No. 2, Tiansheng Road, Beibei District, Chongqing, 400715, China
| | - Shiqing Song
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, No. 2, Tiansheng Road, Beibei District, Chongqing, 400715, China
| | - Yufei Huang
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, No. 2, Tiansheng Road, Beibei District, Chongqing, 400715, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, No. 2, Tiansheng Road, Beibei District, Chongqing, 400715, China.
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30
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Malighetti C, Sansoni M, Gaudio S, Matamala-Gomez M, Di Lernia D, Serino S, Riva G. From Virtual Reality to Regenerative Virtual Therapy: Some Insights from a Systematic Review Exploring Inner Body Perception in Anorexia and Bulimia Nervosa. J Clin Med 2022; 11:jcm11237134. [PMID: 36498708 PMCID: PMC9737310 DOI: 10.3390/jcm11237134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
Despite advances in our understanding of the behavioral and molecular factors that underlie the onset and maintenance of Eating Disorders (EDs), it is still necessary to optimize treatment strategies and establish their efficacy. In this context, over the past 25 years, Virtual Reality (VR) has provided creative treatments for a variety of ED symptoms, including body dissatisfaction, craving, and negative emotions. Recently, different researchers suggested that EDs may reflect a broader impairment in multisensory body integration, and a particular VR technique-VR body swapping-has been used to repair it, but with limited clinical results. In this paper, we use the results of a systematic review employing PRISMA guidelines that explore inner body perception in EDs (21 studies included), with the ultimate goal to analyze the features of multisensory impairment associated with this clinical condition and provide possible solutions. Deficits in interoception, proprioception, and vestibular signals were observed across Anorexia and Bulimia Nervosa, suggesting that: (a) alteration of inner body perception might be a crucial feature of EDs, even if further research is needed and; (b) VR, to be effective with these patients, has to simulate/modify both the external and the internal body. Following this outcome, we introduce a new therapeutic approach-Regenerative Virtual Therapy-that integrates VR with different technologies and clinical strategies to regenerate a faulty bodily experience by stimulating the multisensory brain mechanisms and promoting self-regenerative processes within the brain itself.
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Affiliation(s)
- Clelia Malighetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Maria Sansoni
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
- Correspondence: ; Tel.: +39-02-72-343-863
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Husargatan 3, 75237 Uppsala, Sweden
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy
| | - Marta Matamala-Gomez
- Department of Psychology, Mind and Behavior Technological Center, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
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31
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Tajadura-Jiménez A, Crucianelli L, Zheng R, Cheng C, Ley-Flores J, Borda-Más M, Bianchi-Berthouze N, Fotopoulou A. Body weight distortions in an auditory-driven body illusion in subclinical and clinical eating disorders. Sci Rep 2022; 12:20031. [PMID: 36414765 PMCID: PMC9681758 DOI: 10.1038/s41598-022-24452-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
Previous studies suggest a stronger influence of visual signals on body image in individuals with eating disorders (EDs) than healthy controls; however, the influence of other exteroceptive sensory signals remains unclear. Here we used an illusion relying on auditory (exteroceptive) signals to manipulate body size/weight perceptions and investigated whether the mechanisms integrating sensory signals into body image are altered in subclinical and clinical EDs. Participants' footstep sounds were altered to seem produced by lighter or heavier bodies. Across two experiments, we tested healthy women assigned to three groups based on self-reported Symptomatology of EDs (SED), and women with Anorexia Nervosa (AN), and used self-report, body-visualization, and behavioural (gait) measures. As with visual bodily illusions, we predicted stronger influence of auditory signals, leading to an enhanced body-weight illusion, in people with High-SED and AN. Unexpectedly, High-SED and AN participants displayed a gait typical of heavier bodies and a widest/heaviest visualized body in the 'light' footsteps condition. In contrast, Low-SED participants showed these patterns in the 'heavy' footsteps condition. Self-reports did not show group differences. The results of this pilot study suggest disturbances in the sensory integration mechanisms, rather than purely visually-driven body distortions, in subclinical/clinical EDs, opening opportunities for the development of novel diagnostic/therapeutic tools.
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Affiliation(s)
- Ana Tajadura-Jiménez
- DEI Interactive Systems Group, Department of Computer Science and Engineering, Universidad Carlos III de, Av. de La Universidad, 30, 28911, Madrid, Leganés, Spain.
- UCL Interaction Centre (UCLIC), University College London, London, UK.
| | - Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rebecca Zheng
- UCL Interaction Centre (UCLIC), University College London, London, UK
| | - Chloe Cheng
- UCL Interaction Centre (UCLIC), University College London, London, UK
| | - Judith Ley-Flores
- DEI Interactive Systems Group, Department of Computer Science and Engineering, Universidad Carlos III de, Av. de La Universidad, 30, 28911, Madrid, Leganés, Spain
| | - Mercedes Borda-Más
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Sevilla, Seville, Spain
| | | | - Aikaterini Fotopoulou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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32
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Gizzi G, Cataldi S, Mazzeschi C, Delvecchio E, Ceccarini MR, Codini M, Albi E. Hypercholesterolemia in Cancer and in Anorexia Nervosa: A Hypothesis for a Crosstalk. Int J Mol Sci 2022; 23:ijms23137466. [PMID: 35806470 PMCID: PMC9267523 DOI: 10.3390/ijms23137466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
The relationship between cholesterol and cancer has been widely demonstrated. Clinical studies have shown changes in blood cholesterol levels in cancer patients. In parallel, basic research studies have shown that cholesterol is involved in the mechanisms of onset and progression of the disease. On the other hand, anorexic patients have high cholesterol levels and a high susceptibility to cancer. In this review, we first present a brief background on the relations among nutrition, eating disorders and cancer. Using several notable examples, we then illustrate the changes in cholesterol in cancer and in anorexia nervosa, providing evidence for their important relationship. Finally, we show a new possible link between cholesterol disorder in cancer and in anorexia nervosa.
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Affiliation(s)
- Giulia Gizzi
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy; (G.G.); (C.M.); (E.D.)
| | - Samuela Cataldi
- Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy; (S.C.); (M.R.C.); (M.C.)
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy; (G.G.); (C.M.); (E.D.)
| | - Elisa Delvecchio
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy; (G.G.); (C.M.); (E.D.)
| | - Maria Rachele Ceccarini
- Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy; (S.C.); (M.R.C.); (M.C.)
| | - Michela Codini
- Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy; (S.C.); (M.R.C.); (M.C.)
| | - Elisabetta Albi
- Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy; (S.C.); (M.R.C.); (M.C.)
- Correspondence: ; Tel./Fax: +39-0755857940
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Chen X, Xiao M, Qin J, Bian Z, Qiu J, Feng T, He Q, Lei X, Chen H. Association between high levels of body-esteem and increased degree of midcingulate cortex global connectivity: A resting-state fMRI study. Psychophysiology 2022; 59:e14072. [PMID: 35460526 DOI: 10.1111/psyp.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/09/2021] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
Multiple neuroimaging studies have examined the neural underpinnings of body image disturbances in patients with eating disorders. However, key brain regions related to body image, such as body-esteem (BE), among healthy individuals are understudied. Given the extremely crucial role of BE in eating behaviors and physical and mental health, the current study conducted data-driven analysis and characterized the neurobiological correlates of BE with the network properties of the resting brain using the voxel-wise degree centrality (DC) measures of resting-state functional magnetic resonance imaging (rs-fMRI) data and seed-based resting-state functional connectivity (RSFC). A total of 694 healthy young adults (females = 474, mean age = 18.38 years, range = 17-22) underwent rs-fMRI, and completed the Body-Esteem Scale for Adolescents and Adults, the Eating Disorder Diagnosis Scale, and the Restraint Scale. After correcting for differences in age, gender, body mass index, and head motion, whole-brain correlation analyses revealed that a high level of BE was associated with increased DC within the right midcingulate cortex (MCC) and subsequent high levels of MCC-based RSFC strengths. Furthermore, MCC connectivity patterns related to BE were inversely associated with disordered eating behaviors. These findings suggest that adaptive cognitive and emotional regulation (i.e., self-evaluation and emotion based on body image) may explain the potential relationship between MCC connectivity patterns and BE to a certain extent. As such, future studies should investigate these interesting possibilities.
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Affiliation(s)
- Ximei Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Mingyue Xiao
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Jingmin Qin
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Ziming Bian
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China.,Southwest University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal University, Chongqing, China
| | - Tingyong Feng
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China.,Research Center of Psychology and Social Development, Faculty of Psychology, Southwest University, Chongqing, China
| | - Qinghua He
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China.,Southwest University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal University, Chongqing, China.,Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China
| | - Xu Lei
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China.,Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
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Hamamoto Y, Suzuki S, Sugiura M. Two components of body-image disturbance are differentially associated with distinct eating disorder characteristics in healthy young women. PLoS One 2022; 17:e0262513. [PMID: 35020770 PMCID: PMC8754315 DOI: 10.1371/journal.pone.0262513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Body-image disturbance comprises two components. The first is perceptual in nature, and is measured by a discrepancy between one’s actual body and perceived self-image (“perceived–actual discrepancy”). The other component is affective, and is measured by a discrepancy between one’s perceived self-image and ideal body image (“perceived–ideal discrepancy”). The present study evaluated the relationships between body-image disturbance and characteristics of eating disorders such as symptoms and related personality traits. In a psychophysiological experiment, female university students (mean ± SD age = 21.0 ± 1.38 years) were presented with silhouette images of their own bodies that were distorted in terms of width. The participants were asked whether each silhouette image was more overweight than their actual or ideal body images. Eating-disorder characteristics were assessed using six factors from the Japanese version of the Eating Disorder Inventory 2 (EDI2). We found that perceived–actual discrepancies correlated with negative self-evaluation (i.e., factor 3 of the EDI2), whereas perceived–ideal discrepancies correlated with dissatisfaction with one’s own body (i.e., factor 2 of EDI2). These results imply that distinct psychological mechanisms underlie the two components of body-image disturbance.
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Affiliation(s)
- Yumi Hamamoto
- School of Medicine, Tohoku University, Sendai-shi, Miyagi, Japan
- Institute of Development, Aging and Cancer, Tohoku University, Sendai-shi, Miyagi, Japan
- * E-mail: ,
| | - Shinsuke Suzuki
- Institute of Development, Aging and Cancer, Tohoku University, Sendai-shi, Miyagi, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai-shi, Miyagi, Japan
- Brain, Minds and Markets Laboratory, Department of Finance, The University of Melbourne, Carlton Victoria, Australia
| | - Motoaki Sugiura
- Institute of Development, Aging and Cancer, Tohoku University, Sendai-shi, Miyagi, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai-shi, Miyagi, Japan
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Kot E, Grzegorzewski P, Kostecka B, Kucharska K. Self-disgust and disgust sensitivity are increased in anorexia nervosa inpatients, but only self-disgust mediates between comorbid and core psychopathology. EUROPEAN EATING DISORDERS REVIEW 2021; 29:879-892. [PMID: 34655142 DOI: 10.1002/erv.2862] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The possible role of abnormal disgust processing in the development and course of anorexia nervosa (AN) has been emphasized in theoretical models and research. However, disgust toward external stimuli and self-disgust have not yet been investigated together in a clinical sample of AN patients. Therefore, the purpose of the study was to measure these constructs and examine their role in shaping eating pathology in AN patients and healthy controls (HCs), considering comorbid depressive and anxiety psychopathology. The study also aimed at testing the possible mediational roles of both disgust types in the associations between comorbid psychopathology and eating disorders (EDs) characteristics. METHOD Altogether, 63 inpatients with AN and 57 HCs partook in the study. Participants completed the Eating Disorder Inventory-3, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Disgust Scale-Revised and Self-Disgust Scale. RESULTS AN patients manifested higher self-disgust and disgust sensitivity than HCs. In addition, self-disgust predicted the severity of EDs characteristics and mediated the links of depressive symptoms and trait anxiety with EDs characteristics in both groups. DISCUSSION Our findings imply the putative role of self-disgust in the development of EDs psychopathology in HCs and in its maintenance in AN patients.
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Affiliation(s)
- Emilia Kot
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Grzegorzewski
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
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Myrvang AD, Vangberg TR, Linnman C, Stedal K, Rø Ø, Endestad T, Rosenvinge JH, Aslaksen PM. Altered functional connectivity in adolescent anorexia nervosa is related to age and cortical thickness. BMC Psychiatry 2021; 21:490. [PMID: 34615497 PMCID: PMC8496064 DOI: 10.1186/s12888-021-03497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Functional networks develop throughout adolescence when anorexia nervosa (AN) normally debuts. In AN, cerebral structural alterations are found in most brain regions and may be related to the observed functional brain changes. Few studies have investigated the functional networks of the brain in adolescent AN patients.. The aim of this explorative study was to investigate multiple functional networks in adolescent AN patients compared to healthy age-matched controls (HC) and the relationship with age, eating disorder symptoms and structural alterations. METHODS Included were 29 female inpatients with restrictive AN, and 27 HC. All participants were between the ages of 12 to 18 years. Independent component analysis (ICA) identified 21 functional networks that were analyzed with multivariate and univariate analyses of components and group affiliation (AN vs HC). Age, age × group interaction and AN symptoms were included as covariates. Follow-up correlational analyses of selected components and structural measures (cortical thickness and subcortical volume) were carried out. RESULTS Decreased functional connectivity (FC) in AN patients was found in one cortical network, involving mainly the precuneus, and identified as a default mode network (DMN). Cortical thickness in the precuneus was significantly correlated with functional connectivity in this network. Significant group differences were also found in two subcortical networks involving mainly the hippocampus and the amygdala respectively, and a significant interaction effect of age and group was found in both these networks. There were no significant associations between FC and the clinical measures used in the study. CONCLUSION The findings from the present study may imply that functional alterations are related to structural alterations in selected regions and that the restricted food intake in AN patients disrupt normal age-related development of functional networks involving the amygdala and hippocampus.
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Affiliation(s)
- Anna D. Myrvang
- grid.10919.300000000122595234Department of Psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Huginbakken 32, N-9037 Tromsø, Norway
| | - Torgil R. Vangberg
- grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540PET Center, University Hospital of North Norway, Tromsø, Norway
| | - Clas Linnman
- grid.416228.b0000 0004 0451 8771Spaulding Rehabilitation Hospital, Boston, USA
| | - Kristin Stedal
- grid.55325.340000 0004 0389 8485Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- grid.55325.340000 0004 0389 8485Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Tor Endestad
- grid.5510.10000 0004 1936 8921Department of psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway ,Helgelandssykehuset, Mosjøen, Norway
| | - Jan H. Rosenvinge
- grid.10919.300000000122595234Department of Psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Huginbakken 32, N-9037 Tromsø, Norway
| | - Per M. Aslaksen
- grid.10919.300000000122595234Department of Psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Huginbakken 32, N-9037 Tromsø, Norway ,grid.412244.50000 0004 4689 5540Regional Center for Eating Disorders, University Hospital of North Norway, Tromsø, Norway
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Wayda-Zalewska M, Kostecka B, Kucharska K. Body Image in Borderline Personality Disorder: A Systematic Review of the Emerging Empirical Literature. J Clin Med 2021; 10:jcm10184264. [PMID: 34575375 PMCID: PMC8470847 DOI: 10.3390/jcm10184264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
As an element of distorted self-image, body image disturbances may be relevant to borderline personality disorder (BPD). Therefore, this systematic review aims to critically discuss and summarize empirical findings in this matter. Based on the available theoretical models, three body image components were identified: (a) perception, (b) affect and cognition, and (c) general body dissatisfaction. We conducted a systematic search of the empirical literature published in English in the MEDLINE, PsycINFO, and Scopus databases until June 2021 using a priori eligibility criteria (BPD; BPD symptoms or features in nonclinical groups; quasipsychotic or psychotic symptoms were not considered). We included k = 10 records meeting the criteria. Compared with other analyzed groups, individuals diagnosed with BPD obtained higher scores in the three components of body image disturbances. The issue of body image in BPD is relatively understudied, although current research findings clearly indicate disturbances in all of the abovementioned body image components in individuals with BPD or significant relationships of these components with BPD traits or symptoms both in clinical and nonclinical samples. Eventually, possible practical implications and future research directions are also discussed.
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Affiliation(s)
- Magdalena Wayda-Zalewska
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (M.W.-Z.); (K.K.)
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, 03-242 Warsaw, Poland
- Correspondence:
| | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (M.W.-Z.); (K.K.)
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Dunne JP, Shindul-Rothschild J, White L, Lee CS, Wolfe BE. Mindfulness in persons with anorexia nervosa and the relationships between eating disorder symptomology, anxiety and pain. Eat Disord 2021; 29:497-508. [PMID: 31791198 DOI: 10.1080/10640266.2019.1688009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Mindfulness is useful for some psychiatric illnesses, but limited research exists among persons with anorexia nervosa (AN). This study aimed to determine the relationship between mindfulness, eating disorder symptomology and indicators of health in women with AN (n = 59) entering residential treatment. Participants completed a self-administered survey, including the Cognitive Affective Mindfulness Scale and other measures. Additional data from medical records were collected. Greater mindfulness was associated with less eating disorder symptoms (p = .049). This relationship was most profound in individuals with AN, including restrictive and binge-purge subtypes compared to individuals with atypical AN (interaction p-value = 0.044). Greater mindfulness was significantly associated with less shape (p = .023) and weight concern (p = .047). Expectedly, anxiety was inversely associated with eating disorder symptoms (p = .001). Greater pain was associated with less eating disorder symptoms (p = .024). Overall, mindfulness may be a protective factor against some eating disorder symptomology.
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Affiliation(s)
- Julie P Dunne
- W. F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Cambridge Eating Disorder Center, Cambridge, Massachusetts, USA
| | | | - Laura White
- W. F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Christopher S Lee
- W. F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Barbara E Wolfe
- College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA
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Cortical thickness 20 years after diagnosis of anorexia nervosa during adolescence. Eur Arch Psychiatry Clin Neurosci 2021; 271:1133-1139. [PMID: 30847623 DOI: 10.1007/s00406-019-00992-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of the present study is to evaluate cortical thickness (CT) abnormalities using FreeSurfer in adult subjects who had an onset of anorexia nervosa during their adolescence some 20 years previously, and to compare them with control subjects. METHODS Fifty-four participants, including 26 women who were diagnosed and treated for AN during adolescence some 20 years previously and 28 healthy women of similar age and geographical area were assessed using structured interviews and MRI scans. Prior AN subjects were divided into two groups depending on their current eating disorder status (recovered or not recovered from any eating disorder). In all subjects, CT was measured using FreeSurfer. RESULTS A significantly lower CT was observed in the eating disorder group than in the control group in the right post-central gyrus and the lateral occipital cortex. The recovered eating disorder group only had lower CT in the post-central gyrus. Within all subjects with prior AN, no correlations were found between lower CT in these areas and clinical variables. DISCUSSION CT is reduced some 20 years after diagnosis of AN especially in the parietal and precentral areas, even in subjects without any current ED diagnosis.
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Regnaud A, Boto J, Klauser A, Lövblad KO, Vargas MI, Lazeyras F. Metabolic changes in the cingulate gyrus, precuneus, and white matter in anorexia nervosa using multivoxel MR spectroscopy. J Neuroimaging 2021; 31:1099-1110. [PMID: 34463008 PMCID: PMC9292420 DOI: 10.1111/jon.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 07/11/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose This study aimed to highlight anorexia nervosa‐related metabolic changes in different brain regions with different gray and white matter contents. Methods In a prospective study, 25 anorexic patients with mean body mass index (BMI) of 14.79 kg/m2 (range 10.04–20.58) were compared with 15 healthy controls with mean BMI of 21.08 kg/m2 (range 18.36–27.34). Two‐dimensional magnetic resonance spectroscopic imaging was acquired in the axial plane above the corpus callosum, including frontal, precentral, postcentral, cingular, and parietal regions, as well as the precuneus, each voxel containing gray and white matter. Results In the anorexic group, a significant increase of choline/creatine was observed in all brain regions except the precuneus: frontal (p = 0.009), cingulate (p = 0.001), precentral (p = 0.001), postcentral (p = 0.001), and parietal (p = 0.002); and in white and gray matter (p< 0.001). Macromolecules09/creatine was decreased in the following regions: frontal (p = 0.003), cingulate (p< 0.001), precentral (p = 0.004), and precuneus (p = 0.007), and in white and gray matter (p< 0.05). We observed significantly lower values of N‐acetyl aspartate/creatine in the frontal (p < 0.001) and precentral (p< 0.001) regions and in voxels containing more than 50% white matter (p = 0.001); and significantly lower values of myo‐inositol/creatine in the precentral (p = 0.006), postcentral (p< 0.001), and precuneus (p = 0.006) regions. Conclusions We observed an increase in choline/creatine in anorexics, possibly reflecting increased cell turnover; a decrease in macromolecules, which was particularly low in the cingulate and precuneus the former being known to be altered in eating disorders; and a decrease in N‐acetyl aspartate/creatine considered as a marker of neuronal density and function.
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Affiliation(s)
- Alice Regnaud
- Division of Neuroradiology, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - José Boto
- Division of Neuroradiology, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - Antoine Klauser
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.,Center for Biomedical Imaging (CIBM), University of Geneva, Geneva, Switzerland
| | - Karl-Olof Lövblad
- Division of Neuroradiology, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - François Lazeyras
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.,Center for Biomedical Imaging (CIBM), University of Geneva, Geneva, Switzerland
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Dalton B, Maloney E, Rennalls SJ, Bartholdy S, Kekic M, McClelland J, Campbell IC, Schmidt U, O'Daly OG. A pilot study exploring the effect of repetitive transcranial magnetic stimulation (rTMS) treatment on cerebral blood flow and its relation to clinical outcomes in severe enduring anorexia nervosa. J Eat Disord 2021; 9:84. [PMID: 34243816 PMCID: PMC8268186 DOI: 10.1186/s40337-021-00420-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment option for people with severe enduring anorexia nervosa (SE-AN), but associated neurobiological changes are poorly understood. This study investigated the effect of rTMS treatment on regional cerebral blood flow (CBF) and whether any observed changes in CBF are associated with changes in clinical outcomes in people with SE-AN. METHODS As part of a randomised sham-controlled feasibility trial of 20 sessions of high-frequency rTMS to the left dorsolateral prefrontal cortex, 26 of 34 trial participants completed arterial spin labelling (ASL) functional magnetic resonance imaging (fMRI) to quantify regional and global resting state CBF before (pre-randomisation baseline) and after real or sham treatment (1-month post-randomisation). A group of healthy females (n = 30) were recruited for baseline comparison. Clinical outcomes, including BMI, and depression and anxiety symptoms, were assessed at baseline, 1-, 4-, and 18-months post-randomisation. RESULTS No group differences in regional CBF were identified between the SE-AN and healthy comparison participants. A significant treatment-by-time interaction in a medial temporal lobe cluster with the maximal peak in the right amygdala was identified, reflecting a greater reduction in amygdala CBF following real rTMS compared to sham. Participants with the greatest rTMS-related reduction in amygdala CBF (i.e., between baseline and 1-month post-randomisation) showed the greatest sustained weight gain at 18-months post-randomisation. Higher baseline CBF in the insula predicted greater weight gain between baseline and 1-month post-randomisation and between baseline and 4-months post-randomisation. CONCLUSIONS This exploratory pilot study identified rTMS treatment related changes in CBF in adults with SE-AN and these were associated with changes in weight. Our preliminary findings also suggest that CBF (as measured by ASL fMRI) may be a marker of rTMS treatment response in this patient group. Future rTMS studies in AN should employ longitudinal neuroimaging to further explore the neurobiological changes related to rTMS treatment. TRIAL REGISTRATION ISRCTN14329415 , registered 23rd July 2015.
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Affiliation(s)
- Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Erica Maloney
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samantha J Rennalls
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Kekic
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica McClelland
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Owen G O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Song W, Qian W, Wang W, Yu S, Lin GN. Mendelian randomization studies of brain MRI yield insights into the pathogenesis of neuropsychiatric disorders. BMC Genomics 2021; 22:342. [PMID: 34078268 PMCID: PMC8171058 DOI: 10.1186/s12864-021-07661-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Observational studies have identified various associations between neuroimaging alterations and neuropsychiatric disorders. However, whether such associations could truly reflect causal relations remains still unknown. RESULTS Here, we leveraged genome-wide association studies (GWAS) summary statistics for (1) 11 psychiatric disorders (sample sizes varied from n = 9,725 to 1,331,010); (2) 110 diffusion tensor imaging (DTI) measurement (sample size n = 17,706); (3) 101 region-of-interest (ROI) volumes, and investigate the causal relationship between brain structures and neuropsychiatric disorders by two-sample Mendelian randomization. Among all DTI-Disorder combinations, we observed a significant causal association between the superior longitudinal fasciculus (SLF) and the risk of Anorexia nervosa (AN) (Odds Ratio [OR] = 0.62, 95 % confidence interval: 0.50 ~ 0.76, P = 6.4 × 10- 6). Similar significant associations were also observed between the body of the corpus callosum (fractional anisotropy) and Alzheimer's disease (OR = 1.07, 95 % CI: 1.03 ~ 1.11, P = 4.1 × 10- 5). By combining all observations, we found that the overall p-value for DTI - Disorder associations was significantly elevated compared to the null distribution (Kolmogorov-Smirnov P = 0.009, inflation factor λ = 1.37), especially for DTI - Bipolar disorder (BP) (λ = 2.64) and DTI - AN (λ = 1.82). In contrast, for ROI-Disorder combinations, we only found a significant association between the brain region of pars triangularis and Schizophrenia (OR = 0.48, 95 % CI: 0.34 ~ 0.69, P = 5.9 × 10- 5) and no overall p-value elevation for ROI-Disorder analysis compared to the null expectation. CONCLUSIONS As a whole, we show that SLF degeneration may be a risk factor for AN, while DTI variations could be causally related to some neuropsychiatric disorders, such as BP and AN. Also, the white matter structure might have a larger impact on neuropsychiatric disorders than subregion volumes.
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Affiliation(s)
- Weichen Song
- Shanghai Mental Health Center, School of Biomedical Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China
| | - Wei Qian
- Shanghai Mental Health Center, School of Biomedical Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China
| | - Weidi Wang
- Shanghai Mental Health Center, School of Biomedical Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, 200030, Shanghai, China
| | - Shunying Yu
- Shanghai Mental Health Center, School of Biomedical Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, 200030, Shanghai, China
| | - Guan Ning Lin
- Shanghai Mental Health Center, School of Biomedical Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China.
- Shanghai Key Laboratory of Psychotic Disorders, 200030, Shanghai, China.
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Chen X, Gao X, Qin J, Wang C, Xiao M, Tian Y, Luo YJ, Qiu J, Feng T, He Q, Lei X, Chen H. Resting-state functional network connectivity underlying eating disorder symptoms in healthy young adults. NEUROIMAGE-CLINICAL 2021; 30:102671. [PMID: 33892431 PMCID: PMC8082688 DOI: 10.1016/j.nicl.2021.102671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/25/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
This study examined the resting-state functional network connectivity underlying eating disorder symptoms in a large sample of healthy young adults (n = 693). Individuals with higher levels of eating disorder symptoms displayed weaker intra-network connectivity of the executive control network and basal ganglia network, as well as weaker inter-network connectivity in the three examined networks (i.e., the executive control network, basal ganglia network, and default mode network). The findings suggest that these neural circuits may play a key role in symptoms of disordered eating in healthy adults. They further reveal that the less efficient information exchange within and between intrinsic networks associated with self-referential thinking, inhibitory control, and reward sensitivity are strongly related to eating disorder symptoms.
Previous neuroimaging research of eating disorders such as anorexia nervosa and bulimia nervosa has mainly focused on clinical patients, indicating the crucial role of intrinsic connectivity networks involved in aberrant behavioral control (i.e., executive control network), reward reactivity (i.e., basal ganglia network), and excessive self-focused and body-focused ruminations (i.e., default mode network) in the onset and maintenance of eating disturbances. However, examinations of large-scale resting-state networks that support the role of cognitive control, reward sensitivity, and self-directed thinking in disordered eating have rarely involved non-clinical samples from the general population. This study, involving a total of 693 healthy young adults (68.69% females; mean age, 18.37 years), investigated these issues by using pre-defined functional regions of interest from the executive control network, basal ganglia network, default mode network, and a seed-based region of interest-to-region of interest approach. After statistically controlling for differences in age, sex, body mass index, and head motion, we observed significant associations of higher levels of eating disorder symptoms, especially bulimia-type eating (i.e., binge eating and a combination of binge eating and compensatory behaviors, such as purging via self-induced vomiting or laxative use, and compulsive exercise), with weaker intra-network and inter-network functional synchrony. These results remained significant after excluding underweight, overweight, and obese participants. These findings suggest that these neural circuits may play a key role in the symptoms of disordered eating in healthy adults. They further reveal that the less efficient information exchange within and between intrinsic networks associated with self-referential thinking, inhibitory control, and reward sensitivity are strongly related to eating disorder symptoms.
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Affiliation(s)
- Ximei Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Xiao Gao
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Jingmin Qin
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Chuan Wang
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Mingyue Xiao
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Yun Tian
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China; Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
| | - Yi-Jun Luo
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China; Southwest University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality at Beijing Normal University, Chongqing, China
| | - Tingyong Feng
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China; Research Center of Psychology and Social Development, Faculty of Psychology, Southwest University, Chongqing, China
| | - Qinghua He
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China; Southwest University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality at Beijing Normal University, Chongqing, China
| | - Xu Lei
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China; Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China; Research Center of Psychology and Social Development, Faculty of Psychology, Southwest University, Chongqing, China.
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The song of Anorexia Nervosa: a specific evoked potential response to musical stimuli in affected participants. Eat Weight Disord 2021; 26:807-816. [PMID: 32372322 DOI: 10.1007/s40519-020-00898-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Research applying electroencephalography (EEG) to Anorexia Nervosa (AN) is still limited, even though in other psychiatric disorders EEG has permitted to find out the hallmarks of the disorder. The aim of the study was to explore whether EEG basal activity and reactivity to musical stimulation differ in participants with AN as compared to healthy subjects (HS). METHODS Twenty female participants (respectively 10 with AN and 10 healthy controls) were administered a battery of psychometric tests and underwent EEG under three different conditions: (1) at baseline; (2) after a generic music stimulation; and (3) after a favorite musical stimulation. RESULTS In participants with AN, basal EEG showed the higher absolute amplitude of cortical slow waves (theta) in the parieto-occipital and temporal derivations, with a deficit in the beta band. In AN, there was a higher N100 latency and a reduced P300 latency compared to HS. While the N100 and P300 latencies were sensitive to the musical stimulus in HS, there was no difference after music stimulation in AN. CONCLUSION These data suggest that AN is accompanied by a state of brain hyperarousal with abnormal reactivity to environmental stimuli, similar to the state of HS after musical stimulation. If confirmed, this finding may have treatment implications. LEVEL OF EVIDENCE III, Evidence obtained from well-designed cohort or case-control analytic studies.
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Differential effects of minified and magnified mirror visual feedback on the underlying misperception of hand size. Atten Percept Psychophys 2021; 83:2281-2290. [PMID: 33754299 PMCID: PMC8213598 DOI: 10.3758/s13414-021-02262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 11/08/2022]
Abstract
Perception of the size of body parts, for instance the hand, has been shown to be distorted in healthy participants, with over- and underestimations of width and length, respectively. Illusory manipulations of body shape and size have highlighted the flexibility of the body representation and have also been found to update immediate perceptions of body size and surrounding objects. Here, we examined whether underlying misperceptions of hand width and length can be modified through exposure to illusory changes in hand size using a mirror visual feedback (MVF) paradigm. While questionnaire responses indicated subjective susceptibility to both magnified and minified manipulations, objective hand size estimates only showed significant differences following exposure to minifying mirrors. These variations might reflect differences in the way that stored representations are accessed or updated in response to size manipulations. Secondly, the findings further reinforce differences between subjective and objective outcomes of illusions on subsequent body perception.
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Recovery-Associated Resting-State Activity and Connectivity Alterations in Anorexia Nervosa. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:1023-1033. [PMID: 33766777 DOI: 10.1016/j.bpsc.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies provided controversial insight on the impact of starvation, disease status, and underlying gray matter volume (GMV) changes on resting-state functional magnetic resonance imaging alterations in anorexia nervosa (AN). Here, we adapt a combined longitudinal and cross-sectional approach to disentangle the effects of these factors on resting-state alterations in AN. METHODS Overall, 87 female subjects were included in the study: adolescent patients with acute AN scanned at inpatient admission (n = 22, mean age 15.3 years) and at discharge (n = 21), patients who recovered from AN (n = 21, mean age 22.3 years), and two groups of healthy age-matched control subjects (both n = 22, mean age 16.0 and 22.5 years, respectively). Whole-brain measures of resting-state activity and functional connectivity were computed (network-based statistics, global correlation, integrated local correlation, and fractional amplitude of low-frequency fluctuations) to assess resting-state functional magnetic resonance imaging alterations over the course of AN treatment before and after controlling for underlying GMV. RESULTS Patients with acute AN displayed strong and widespread prefrontal, sensorimotor, parietal, temporal, precuneal, and insular reductions of resting-state connectivity and activity. All alterations were independent of GMV and were largely normalized in short-term recovered AN and absent in long-term recovered patients. CONCLUSIONS Resting-state functional magnetic resonance imaging alterations in AN constitute acute and GMV-independent, presumably starvation-related, phenomena. The majority of alterations found here normalized over the course of recovery without evidence for possible preexisting trait- or remaining "scar" effects.
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Brown TA, Shott ME, Frank GKW. Body size overestimation in anorexia nervosa: Contributions of cognitive, affective, tactile and visual information. Psychiatry Res 2021; 297:113705. [PMID: 33472094 DOI: 10.1016/j.psychres.2021.113705] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
Body image disturbance (BID) in anorexia nervosa (AN) is poorly understood and the individual contribution of perceptual, cognitive, and affective components remains unclear. This study compared females with AN and matched healthy controls (HC) on a perceptual size estimation task. Participants (AN n=19 M[SD] age=16.97[2.24], HC n=19, age=15.77[2.17]) were blindfolded and estimated the size of neutral objects, safe foods, unsafe foods, and parts of their bodies (hips, waist, knees, ankle) over three blocks using: 1) no sensory information (baseline), 2) tactile information, and 3) added visual information. There were no significant differences between AN and HC on neutral and safe or unsafe food objects. Participants with AN were significantly more likely to overestimate their body size across blocks compared to HC. Both groups made fewer errors on unsafe foods and body parts when using tactile or visual information compared to baseline. Exploratory analyses revealed significant correlations between body size overestimation and drive for thinness and body dissatisfaction in the AN group, with body dissatisfaction being the most robust. Results suggest that both deficits in tactile and visual perception and affective factors play a role in BID for young women with AN.
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Affiliation(s)
- Tiffany A Brown
- University of California, UCSD Eating Disorder Center for Treatment and Research, 4510 Executive Dr., Suite 315, San Diego, CA 92121, United States
| | - Megan E Shott
- University of California, UCSD Eating Disorder Center for Treatment and Research, 4510 Executive Dr., Suite 315, San Diego, CA 92121, United States
| | - Guido K W Frank
- University of California, UCSD Eating Disorder Center for Treatment and Research, 4510 Executive Dr., Suite 315, San Diego, CA 92121, United States.
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Artoni P, Chierici ML, Arnone F, Cigarini C, De Bernardis E, Galeazzi GM, Minneci DG, Scita F, Turrini G, De Bernardis M, Pingani L. Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case-control efficacy study. Eat Weight Disord 2021; 26:499-514. [PMID: 32124409 DOI: 10.1007/s40519-020-00875-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder. OBJECTIVE We looked for an additional treatment effect on a protocol for ED inpatients to evaluate the efficacy of BPT. We performed the study through statistical analysis of admission and discharge scores. METHODS We conducted a case-control study in a hospital ward specialized in eating disorders. Two groups were identified: the control group (TAU; N = 91) and the experimental group (TAU + BPT; N = 91). The experimental group performed BTP activities in addition to the treatment at usual. All patients in both groups had an eating disorder diagnosis (AN, BN, BED and EDNOS/OSFED). Sampling occurred on a time basis and not by randomization. Moreover, all patients admitted in the ED hospital ward in the time frame considered (from end-2009 to mid-2017) were included in the study. BPT activities were introduced in mid-2013 and three psychometric instruments upon entry and discharge were used: Symptom Check List-90 (SCL-90) to measure the general psychopathological state; the Eating Disorder Inventory-3 (EDI-3) to estimate the incidence of personality traits strongly correlated to eating disorders; the body uneasiness test (BUT) to measure the body uneasiness. We performed a pre/post analysis for both groups; we studied the additional effect of the treatment through deltas analysis of the three questionnaires (Δ = assessment at discharge - assessment at the entrance). Data were analyzed using the Student T and the Wilcoxon rank-sum test. RESULTS The pre/post analysis showed statistically significant improvement in both conditions (TAU and TAU + BPT) in the general psychopathological state (SCL-90) and in the incidence of personality traits (EDI-3). Improvements in body uneasiness (BUT) were observed only in the experimental group (TAU + BPT). Furthermore, the analysis of the deltas shows more significant improvements in TAU + BPT compared to TAU in all the variables considered. CONCLUSION We found an additional effect of the BPT on TAU. The usual ED protocol added with BPT activities showed significantly better clinical results. We have interpreted these results in light of recent developments in the neuroscientific field of body image. LEVEL OF EVIDENCE Level II: controlled trial without randomization.
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Affiliation(s)
- P Artoni
- Maria Luigia Hospital, Monticelli Terme, Italy.
| | | | - F Arnone
- Maria Luigia Hospital, Monticelli Terme, Italy
| | - C Cigarini
- Maria Luigia Hospital, Monticelli Terme, Italy
| | | | - G M Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - D G Minneci
- Maria Luigia Hospital, Monticelli Terme, Italy
| | - F Scita
- Maria Luigia Hospital, Monticelli Terme, Italy
| | - G Turrini
- Maria Luigia Hospital, Monticelli Terme, Italy
| | | | - L Pingani
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
- Department of Health Professions, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Mental Health, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Kappou K, Ntougia M, Kourtesi A, Panagouli E, Vlachopapadopoulou E, Michalacos S, Gonidakis F, Mastorakos G, Psaltopoulou T, Tsolia M, Bacopoulou F, Sergentanis TN, Tsitsika A. Neuroimaging Findings in Adolescents and Young Adults with Anorexia Nervosa: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:137. [PMID: 33673193 PMCID: PMC7918703 DOI: 10.3390/children8020137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious, multifactorial mental disorder affecting predominantly young females. This systematic review examines neuroimaging findings in adolescents and young adults up to 24 years old, in order to explore alterations associated with disease pathophysiology. METHODS Eligible studies on structural and functional brain neuroimaging were sought systematically in PubMed, CENTRAL and EMBASE databases up to 5 October 2020. RESULTS Thirty-three studies were included, investigating a total of 587 patients with a current diagnosis of AN and 663 healthy controls (HC). Global and regional grey matter (GM) volume reduction as well as white matter (WM) microstructure alterations were detected. The mainly affected regions were the prefrontal, parietal and temporal cortex, hippocampus, amygdala, insula, thalamus and cerebellum as well as various WM tracts such as corona radiata and superior longitudinal fasciculus (SLF). Regarding functional imaging, alterations were pointed out in large-scale brain networks, such as default mode network (DMN), executive control network (ECN) and salience network (SN). Most findings appear to reverse after weight restoration. Specific limitations of neuroimaging studies in still developing individuals are also discussed. CONCLUSIONS Structural and functional alterations are present in the early course of the disease, most of them being partially or totally reversible. Nonetheless, neuroimaging findings have been open to many biological interpretations. Thus, more studies are needed to clarify their clinical significance.
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Affiliation(s)
- Kalliopi Kappou
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Myrto Ntougia
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Aikaterini Kourtesi
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Eleni Panagouli
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Elpis Vlachopapadopoulou
- Department of Endocrinology-Growth and Development, “P. & A. Kyriakou” Children’s Hospital, 115 27 Athens, Greece; (E.V.); (S.M.)
| | - Stefanos Michalacos
- Department of Endocrinology-Growth and Development, “P. & A. Kyriakou” Children’s Hospital, 115 27 Athens, Greece; (E.V.); (S.M.)
| | - Fragiskos Gonidakis
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 115 28 Athens, Greece;
| | - Georgios Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece;
| | - Theodora Psaltopoulou
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Maria Tsolia
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Theodoros N. Sergentanis
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Artemis Tsitsika
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
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de la Cruz F, Schumann A, Suttkus S, Helbing N, Zopf R, Bär KJ. Cortical thinning and associated connectivity changes in patients with anorexia nervosa. Transl Psychiatry 2021; 11:95. [PMID: 33542197 PMCID: PMC7862305 DOI: 10.1038/s41398-021-01237-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023] Open
Abstract
Structural brain abnormalities are a consistent finding in anorexia nervosa (AN) and proposed as a state biomarker of the disorder. Yet little is known about how regional structural changes affect intrinsic resting-state functional brain connectivity (rsFC). Using a cross-sectional, multimodal imaging approach, we investigated the association between regional cortical thickness abnormalities and rsFC in AN. Twenty-two acute AN patients and twenty-six age- and gender-matched healthy controls underwent a resting-state functional magnetic resonance imaging scan and cognitive tests. We performed group comparisons of whole-brain cortical thickness, seed-based rsFC, and network-based statistical (NBS) analyses. AN patients showed cortical thinning in the precuneus and inferior parietal lobules, regions involved in visuospatial memory and imagery. Cortical thickness in the precuneus correlated with nutritional state and cognitive functions in AN, strengthening the evidence for a critical role of this region in the disorder. Cortical thinning was accompanied by functional connectivity reductions in major brain networks, namely default mode, sensorimotor and visual networks. Similar to the seed-based approach, the NBS analysis revealed a single network of reduced functional connectivity in patients, comprising mainly sensorimotor- occipital regions. Our findings provide evidence that structural and functional brain abnormalities in AN are confined to specific regions and networks involved in visuospatial and somatosensory processing. We show that structural changes of the precuneus are linked to nutritional and functional states in AN, and future longitudinal research should assess how precuneus changes might be related to the evolution of the disorder.
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Affiliation(s)
- Feliberto de la Cruz
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Andy Schumann
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Stefanie Suttkus
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Nadin Helbing
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Regine Zopf
- Department of Cognitive Science, Perception in Action Research Centre, Faculty of Medical, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Karl-Jürgen Bär
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany.
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