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Conn K, Huang K, Gorrell S, Foldi CJ. A transdiagnostic and translational framework for delineating the neuronal mechanisms of compulsive exercise in anorexia nervosa. Int J Eat Disord 2024; 57:1406-1417. [PMID: 38174745 PMCID: PMC11222308 DOI: 10.1002/eat.24130] [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: 10/30/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE The development of novel treatments for anorexia nervosa (AN) requires a detailed understanding of the biological underpinnings of specific, commonly occurring symptoms, including compulsive exercise. There is considerable bio-behavioral overlap between AN and obsessive-compulsive disorder (OCD), therefore it is plausible that similar mechanisms underlie compulsive behavior in both populations. While the association between these conditions is widely acknowledged, defining the shared mechanisms for compulsive behavior in AN and OCD requires a novel approach. METHODS We present an argument that a better understanding of the neurobiological mechanisms that underpin compulsive exercise in AN can be achieved in two critical ways. First, by applying a framework of the neuronal control of OCD to exercise behavior in AN, and second, by taking better advantage of the activity-based anorexia (ABA) rodent model to directly test this framework in the context of feeding pathology. RESULTS A cross-disciplinary approach that spans preclinical, neuroimaging, and clinical research as well as compulsive neurocircuitry and behavior can advance our understanding of when, why, and how compulsive exercise develops in the context of AN and provide targets for novel treatment strategies. DISCUSSION In this article, we (i) link the expression of compulsive behavior in AN and OCD via a transition between goal-directed and habitual behavior, (ii) present disrupted cortico-striatal circuitry as a key substrate for the development of compulsive behavior in both conditions, and (iii) highlight the utility of the ABA rodent model to better understand the mechanisms of compulsive behavior relevant to AN. PUBLIC SIGNIFICANCE Individuals with AN who exercise compulsively are at risk of worse health outcomes and have poorer responses to standard treatments. However, when, why, and how compulsive exercise develops in AN remains inadequately understood. Identifying whether the neural circuitry underlying compulsive behavior in OCD also controls hyperactivity in the activity-based anorexia model will aid in the development of novel eating disorder treatment strategies for this high-risk population.
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Affiliation(s)
- K Conn
- Monash University, Department of Physiology, 26 Innovation Walk, 3800, Clayton, Australia
- Monash Biomedicine Discovery Institute, 23 Innovation Walk, 3800, Clayton, Australia
| | - K Huang
- Monash University, Department of Physiology, 26 Innovation Walk, 3800, Clayton, Australia
- Monash Biomedicine Discovery Institute, 23 Innovation Walk, 3800, Clayton, Australia
| | - S Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th street, San Francisco, CA 94143, USA
| | - CJ Foldi
- Monash University, Department of Physiology, 26 Innovation Walk, 3800, Clayton, Australia
- Monash Biomedicine Discovery Institute, 23 Innovation Walk, 3800, Clayton, Australia
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Song Y, Guo SH, Davies-Jenkins CW, Guarda A, Edden RA, Smith KR. Myo-inositol Levels in the Dorsal Anterior Cingulate Cortex Predicts Anxiety-to-Eat in Anorexia Nervosa. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.29.596476. [PMID: 38854088 PMCID: PMC11160692 DOI: 10.1101/2024.05.29.596476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Anorexia nervosa (AN) is a mental and behavioral health condition characterized by an intense fear of weight or fat gain, severe restriction of food intake resulting in low body weight, and distorted self-perception of body shape or weight. While substantial research has focused on general anxiety in AN, less is known about eating-related anxiety and its underlying neural mechanisms. Therefore, we sought to characterize anxiety-to-eat in AN and examine the neurometabolic profile within the dorsal anterior cingulate cortex (dACC), a brain region putatively involved in magnifying the threat response. Methods Women seeking inpatient treatment for AN and women of healthy weight without a lifetime history of an eating disorder (healthy controls; HC) completed a computer-based behavioral task assessing anxiety-to-eat in response to images of higher (HED) and lower (LED) energy density foods. Participants also underwent magnetic resonance spectroscopy of the dACC in a 3 Tesla scanner. Results The AN group reported greater anxiety to eat HED and LED foods relative to the HC group. Both groups reported greater anxiety to eat HED foods relative to LED foods. The neurometabolite myo-inositol (mI) was lower in the dACC in AN relative to HC, and mI levels negatively predicted anxiety to eat HED but not LED foods in the AN group only. mI levels in the dACC were independent of body weight, body mass, and general anxiety. Conclusions These findings provide critical new insight into the clinically challenging feature and underlying neural mechanisms of eating-related anxiety and indicate mI levels in the dACC could serve as a novel biomarker of illness severity that is independent of body weight to identify individuals vulnerable to disordered eating or eating pathology as well as a potential therapeutic target.
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Affiliation(s)
- Yulu Song
- The Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Sarah H. Guo
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Christopher W. Davies-Jenkins
- The Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Angela Guarda
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Richard A.E. Edden
- The Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Kimberly R. Smith
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD USA
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Lyall AE, Breithaupt L, Ji C, Haidar A, Kotler E, Becker KR, Plessow F, Slattery M, Thomas JJ, Holsen LM, Misra M, Eddy KT, Lawson EA. Lower region-specific gray matter volume in females with atypical anorexia nervosa and anorexia nervosa. Int J Eat Disord 2024; 57:951-966. [PMID: 38366701 PMCID: PMC11018478 DOI: 10.1002/eat.24168] [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: 09/29/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Few studies have focused on brain structure in atypical anorexia nervosa (atypical AN). This study investigates differences in gray matter volume (GMV) between females with anorexia nervosa (AN) and atypical AN, and healthy controls (HC). METHOD Structural magnetic resonance imaging data were acquired for 37 AN, 23 atypical AN, and 41 HC female participants. Freesurfer was used to extract GMV, cortical thickness, and surface area for six brain lobes and associated cortical regions of interest (ROI). Primary analyses employed linear mixed-effects models to compare group differences in lobar GMV, followed by secondary analyses on ROIs within significant lobes. We also explored relationships between cortical gray matter and both body mass index (BMI) and symptom severity. RESULTS Our primary analyses revealed significant lower GMV in frontal, temporal and parietal areas (FDR < .05) in AN and atypical AN when compared to HC. Lobar GMV comparisons were non-significant between atypical AN and AN. The parietal lobe exhibited the greatest proportion of affected cortical ROIs in both AN versus HC and atypical AN versus HC. BMI, but not symptom severity, was found to be associated with cortical GMV in the parietal, frontal, temporal, and cingulate lobes. No significant differences were observed in cortical thickness or surface area. DISCUSSION We observed lower GMV in frontal, temporal, and parietal areas, when compared to HC, but no differences between AN and atypical AN. This indicates potentially overlapping structural phenotypes between these disorders and evidence of brain changes among those who are not below the clinical underweight threshold. PUBLIC SIGNIFICANCE Despite individuals with atypical anorexia nervosa presenting above the clinical weight threshold, lower cortical gray matter volume was observed in partial, temporal, and frontal cortices, compared to healthy individuals. No significant differences were found in cortical gray matter volume between anorexia nervosa and atypical anorexia nervosa. This underscores the importance of continuing to assess and target weight gain in clinical care, even for those who are presenting above the low-weight clinical criteria.
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Affiliation(s)
- Amanda E. Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Lauren Breithaupt
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Chunni Ji
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
- Division of Women’s Health, Department of Medicine, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anastasia Haidar
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
| | - Elana Kotler
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
| | - Kendra R Becker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
| | - Jennifer J. Thomas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Laura M. Holsen
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
- Division of Women’s Health, Department of Medicine, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Harvard Medical School, MA
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Kamryn T. Eddy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
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Conceição ISR, Garcia-Burgos D, de Macêdo PFC, Nepomuceno CMM, Pereira EM, Cunha CDM, Ribeiro CDF, de Santana MLP. Habits and Persistent Food Restriction in Patients with Anorexia Nervosa: A Scoping Review. Behav Sci (Basel) 2023; 13:883. [PMID: 37998630 PMCID: PMC10669471 DOI: 10.3390/bs13110883] [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: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023] Open
Abstract
The aetiology of anorexia nervosa (AN) presents a puzzle for researchers. Recent research has sought to understand the behavioural and neural mechanisms of these patients' persistent choice of calorie restriction. This scoping review aims to map the literature on the contribution of habit-based learning to food restriction in AN. PRISMA-ScR guidelines were adopted. The search strategy was applied to seven databases and to grey literature. A total of 35 studies were included in this review. The results indicate that the habit-based learning model has gained substantial attention in current research, employing neuroimaging methods, scales, and behavioural techniques. Food choices were strongly associated with dorsal striatum activity, and habitual food restriction based on the self-report restriction index was associated with clinical impairment in people chronically ill with restricting AN. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and Regulating Emotions and Changing Habits (REaCH) have emerged as potential treatments. Future research should employ longitudinal studies to investigate the time required for habit-based learning and analyse how developmental status, such as adolescence, influences the role of habits in the progression and severity of diet-related illnesses. Ultimately, seeking effective strategies to modify persistent dietary restrictions controlled by habits remains essential.
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Affiliation(s)
- Ismara Santos Rocha Conceição
- Graduate Program in Food, Nutrition and Health, School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (I.S.R.C.); (P.F.C.d.M.)
| | - David Garcia-Burgos
- Department of Psychobiology, The “Federico Olóriz” Institute of Neurosciences, Biomedical Research Centre, University of Granada, 18071 Granada, Spain;
| | - Patrícia Fortes Cavalcanti de Macêdo
- Graduate Program in Food, Nutrition and Health, School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (I.S.R.C.); (P.F.C.d.M.)
| | | | | | - Carla de Magalhães Cunha
- School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (C.d.M.C.); (C.D.F.R.)
| | - Camila Duarte Ferreira Ribeiro
- School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (C.d.M.C.); (C.D.F.R.)
- Graduate Program in Food Science, Faculty of Pharmacy, Federal University of Bahia, Salvador 40170-115, Brazil
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Scherma M, Palmas MF, Pisanu A, Masia P, Dedoni S, Camoglio C, Fratta W, Carta AR, Fadda P. Induction of Activity-Regulated Cytoskeleton-Associated Protein and c-Fos Expression in an Animal Model of Anorexia Nervosa. Nutrients 2023; 15:3830. [PMID: 37686862 PMCID: PMC10490422 DOI: 10.3390/nu15173830] [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: 07/27/2023] [Revised: 08/19/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Anorexia nervosa (AN) is a complex eating disorder characterized by reduced caloric intake to achieve body-weight loss. Furthermore, over-exercise is commonly reported. In recent years, animal models of AN have provided evidence for neuroplasticity changes in specific brain areas of the mesocorticolimbic circuit, which controls a multitude of functions including reward, emotion, motivation, and cognition. The activity-regulated cytoskeleton-associated protein (Arc) is an immediate early gene that modulates several forms of synaptic plasticity and has been linked to neuropsychiatric illness. Since the role of Arc in AN has never been investigated, in this study we evaluated whether the anorexic-like phenotype reproduced by the activity-based anorexia (ABA) model may impact its expression in selected brain regions that belong to the mesocorticolimbic circuit (i.e., prefrontal cortex, nucleus accumbens, and hippocampus). The marker of neuronal activation c-Fos was also assessed. We found that the expression of both markers increased in all the analyzed brain areas of ABA rats in comparison to the control groups. Moreover, a negative correlation between the density of Arc-positive cells and body-weight loss was found. Together, our findings suggest the importance of Arc and neuroplasticity changes within the brain circuits involved in dysfunctional behaviors associated with AN.
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Affiliation(s)
- Maria Scherma
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy; (M.F.P.); (S.D.); (C.C.); (W.F.); (A.R.C.); (P.F.)
| | - Maria Francesca Palmas
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy; (M.F.P.); (S.D.); (C.C.); (W.F.); (A.R.C.); (P.F.)
| | - Augusta Pisanu
- Neuroscience Institute, Section of Cagliari, National Research Council (CNR), 09042 Cagliari, Italy;
| | - Paolo Masia
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy; (M.F.P.); (S.D.); (C.C.); (W.F.); (A.R.C.); (P.F.)
| | - Simona Dedoni
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy; (M.F.P.); (S.D.); (C.C.); (W.F.); (A.R.C.); (P.F.)
| | - Chiara Camoglio
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy; (M.F.P.); (S.D.); (C.C.); (W.F.); (A.R.C.); (P.F.)
| | - Walter Fratta
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy; (M.F.P.); (S.D.); (C.C.); (W.F.); (A.R.C.); (P.F.)
| | - Anna R. Carta
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy; (M.F.P.); (S.D.); (C.C.); (W.F.); (A.R.C.); (P.F.)
| | - Paola Fadda
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy; (M.F.P.); (S.D.); (C.C.); (W.F.); (A.R.C.); (P.F.)
- Neuroscience Institute, Section of Cagliari, National Research Council (CNR), 09042 Cagliari, Italy;
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