Neural correlates of eating disorders: translational potential

Figures & data

Table 1 Functional MRI studies of reward in eating disorders

Author	Participants	Stimuli	Neural differences
Food-based studies of reward pathways in ED
Wagner et al^Citation48	recAN 16 HC 16	Pseudorandom boluses of either sucrose or water.	Insula hypoactivation in AN after sucrose infusion.
Schienle et al^Citation58	BED 17 BN 14 HC-N 19 HC-O 17	Shown food items, disgust items, and neutral objects. Only compare food-disgust images.	Food pictures associate with increased activation of OFC, ACC, and insula in all groups. BED patients have highest OFC responses to food. BN had greater ACC activation, and insula activation to food. No difference in groups with disgust images or neutral images.
Brooks et al^Citation54*	AN 18 BN 8 HC 24	Shown images of food vs objects.	BN – HC: less bilateral STG/insula activity for food than HC. BN – AN: more caudate, insula, superior temporal.
Brooks et al^Citation51*	AN 18 HC 24	Shown images of food vs objects.	AN – HC: more visual and prefrontal activations to food.
Cowdrey et al^Citation49	recAN 15 HC 16	Viewing, tasting, rating both positive and negative flavors and images.	AN – HC: elevated activations in ventral striatum (positive taste), occipital (positive image), insula/putamen (negative taste), and ACC and caudate (negative image).
Frank et al^Citation56*	BN 20 HC 23	Boluses of sucrose, no solution, and artificial saliva administered with visual stimuli, examined responses to expected vs unexpected pairing.	BN showed reduced brain response compared to HC for unexpected receipt and omission of taste stimuli in insula, ventral putamen, amygdala, and OFC.
Bohon and Stice^Citation57*	BN 13 HC 13	view and sometimes receive taste of milkshake or water. Mood rating before scan.	BN: increased activation of putamen, caudate, pallidum when anticipating milkshake when sad.
Oberndorfer et al^Citation50*	recAN 14 recBN 14 HC 14	Pseudorandom boluses of sucrose and sucralose.	AN – HC: reduced R ant insula to sucrose. BN – HC: increased R ant insula to sucrose.
Weygandt et al^Citation59	BED 17 BN 14 HC-N 19 HC-O 17	Shown food items, disgust items, and neutral objects. Compare food to neutral objects.	Pattern recognition techniques identify insula as selective for food and differences in ventral striatum, insula, and OFC with diagnostic relevance.
Holsen et al^Citation52	AN 12 recAN 10 HC 11	Viewing high and low-caloric food images as well as objects shown before and after standardized meal.	AN and recAN: less hypothalamus, insula, and amygdala activity for high calorie food images before meal. AN: less insula response to food post-meal; less hippocampus and OFC pre-meal than controls.
Monetary-based studies of reward pathways in ED
Wagner et al^Citation60,*	recAN 13 HC 13	Guessing game paradigm with rewards based on accuracy of guesses.	recAN with more caudate activation during task than HC. recAN do not differentiate winning and losing in the dorsal caudate and anterior ventral striatum like the HC.
wagner et al^Citation61*	recBN 10 HC 10	Guessing game paradigm with rewards based on accuracy of guesses.	recBN do not differentiate winning and losing in the dorsal caudate and anterior ventral striatum like the HC.
Bischoff-Grethe et al^Citation62,*	rec teenAN 10 teenHC 12	Guessing game paradigm with rewards based on accuracy of guesses.	teenAN with more posterior executive and striatal activations in responses to losses than HC. Both teen groups with more limbic and striatal responses to wins vs losses.
Balodis et al^Citation63	BED 19 HC-N 19 HC-O 19	Monetary incentive delay task with an anticipation period and a receipt period for wins and losses.	HC-O relative to HC-N with increased ventral striatal and vmPFC activity during anticipation. HC-O relative to BED with increased ventral striatal activity during anticipation. No differences BED and HC in ventral striatum.
Wierenga et al^Citation140	recAN 23 HC 17	Delayed discounting task both when hungry and satiated.	HC show increased ventral striatum, caudate, and anterior cingulate activation for immediate monetary reward when hungry and increased insula and vlPFC when satiated. recAN showed no differences related to hunger status.

Note: *Similar tasks presented adjacent to these studies.

Abbreviations: ACC, anterior cingulate cortex; AN, anorexia nervosa; BED, binge-eating disorder; BN, bulimia nervosa; ED, eating disorder; HC, healthy controls; HC-N, healthy controls normal weight; HC-O, healthy controls obese; MRI, magnetic resonance imaging; OFC, orbitofrontal cortex; recAN, recovered anorexia nervosa; recBN, recovered bulimia nervosa; STG, superior temporal gyrus; vlPFC, ventrolateral prefrontal cortex; vmPFC, ventromedial prefrontal cortex; rec teenAN, recovered teenagers with anorexia nervosa; teenHC, teenagers healthy control; R ant, right anterior.

Table 2 Functional MRI studies of decision-making in eating disorders

Author	Participants	Stimuli	Neural differences
Marsh et al^Citation87,*	BN 20 HC 20	Simon spatial incompatibility task to assess self-regulation/impulsivity.	BN: less activation of ILPFC, inferior frontal gyri, ACC, putamen, caudate. More dACC activation during errors in BN.
Marsh et al^Citation88,*	teenBN 18 teenHC 18	Simon spatial incompatibility task to assess self-regulation and conflict resolution.	BN: less activity in frontostriatal circuit during correct trials·including left inferior frontal gyrus· posterior cingulate· and superior frontal gyrus.
Marsh et al^Citation90.*	BN 34 HC 34	Structural analysis of brain surfaces in subjects from above two studies using Simon Spatial Incompatibility.	Reduced gray matter in frontal and temporal regions in BN. Further· reduction of inferior frontal gyri correlated with symptom severity measures in BN.
Lock et al^Citation91	AN-BP/BN 13 AN-R 14 HC 13	Go/No-Go paradigm comparing correct-No-Go with correct Go.	AN-BP/BN group has more activity in bilateral precentral gyrus·ACC, and middle and superior temporal gyri than HC; also more hypothalamus and DLPFC than AN-R and HC.
Decker et al^Citation80	AN-R 13 AN-BP 10 HC 23	Delayed discounting task before and after weight restoration of patients.	When underweight, AN with less striatum and dACC. When weight-restored, AN with increase striatum, dACC, PFC, parietal HC opposite effect with repetition of task.
Kullmann et al^Citation92	AN 12 HC-Athlete 12 HC 14	Go/No-Go paradigm to examine response inhibition using food/nonfood images and people active/rest.	Food/nonfood: hypoactive right putamen in AN. Active/rest: AN group with increased PFC response inhibition; somatosensory cortex correlates with exercise commitment.

Note: *Similar tasks presented adjacent to these studies.

Abbreviations: ACC, anterior cingulate cortex; AN, anorexia nervosa; AN-BP, binge–purge anorexia nervosa; AN-R, restricting anorexia nervosa; BED, binge-eating disorder; BN, bulimia nervosa; dACC, dorsal anterior cingulate cortex; DLPFC, dorsolateral prefrontal cortex; HC, healthy controls; ILPFC, inferiolateral prefrontal cortex; MRI, magnetic resonance imaging; PFC, prefrontal cortex; recBN, recovered bulimia nervosa; recAN, recovered anorexia nervosa; teenHC, teenagers healthy control; teenBN, teenagers with bulimia nervosa; R ant, right anterior.

Table 3 Functional MRI studies of social behavior in eating disorders

Author	Participants	Stimuli	Neural differences
Ashworth et al^Citation105	BN 12 HC 16	Shown angry and disgusted faces as well as simple shapes.	BN with decreased precuneus activations for both anger and disgust. Also decreased right amygdala activation for anger.
McAdams and Krawczyk^Citation100*	recAN 17 HC 17	Social attribution task: subjects compare movements of shapes using both biological (social: friends?) and nonbiological (physical: same weight?) movements.	AN group with less activation of many social cognition regions, including rTPJ in biological movements. No significant differences between AN and HC in activations related to nonbiological condition.
Schulte-Ruther et al^Citation102*	teenAN19 teenHC 20	Similar task as above. Scanned before treatment and at discharge. 12-month clinical follow-up to assess recovery.	AN group with less activation of mPFC and temporal cortex relative to HC. Hypoactivation of mPFC at initial treatment associated with failure to maintain weight in follow-up.
McAdams and Krawczyk^Citation101*	BN 17 AN 18 HC 18	Same tasks as McAdams^Citation100 and 2014^111; Social attribution, social identity, and physical identity tasks.	BN subjects with differences intermediate of the AN and HC subjects: significant differences in all regions relative to HC and save the cingulate cluster from the physical identity task.
McAdams and Krawczyk^Citation111*	recAN 18 HC 18	Identity appraisal statements with social or physical descriptors.	HC with more activity in cingulate for physical descriptors of self and precuneus for social descriptors of self relative to AN. Largest differences in dACC with HC engaging for third person view of self but AN engaging for first person view of self in social task.
Pringle et al^Citation107	BN 1 1 HC 16	Presented negative social and eating disorder adjectives and asked to rate self-relevance of words.	BN with less activity in precuneus, occipital area, putamen, and amygdala.
Cowdrey et al^Citation103*	recAN 16 HC 16	Shown happy and fearful faces; decided sex.	No differences in groups.
Fonville et al^Citation104*	AN 31 HC 35	Shown images of neutral, happy, and very happy faces in an fMRi scanner; decided sex.	AN with increased right fusiform gyrus for all expressions.
Miyake et al^Citation108	AN 30 HC 20	Asked to select most negative word (social adjectives) or neutral word.	Alexithymia negatively correlated with activation of PCC and ACC. AN with increased frontal activations for negative words.
Suda et al^Citation109	AN 20 HC 15	Viewed images of normal weight individuals in body checking behavior or a neutral body action.	AN showed less activation of both mPFC and right fusiform gyrus when compared to HC for body checking compared to neutral actions.

Note: *Similar tasks presented adjacent to these studies.

Abbreviations: ACC, anterior cingulate cortex; AN, anorexia nervosa; AN-BP, binge–purge anorexia nervosa; AN-R, restricting anorexia nervosa; BN, bulimia nervosa; cing, cingulate; dACC, dorsal anterior cingulate cortex; fMRI, functional MRI; HC, healthy controls; MRI, magnetic resonance imaging; mPFC, medial prefrontal cortex; PCC, posterior cingulate cortex; recBN, recovered bulimia nervosa; recAN, recovered anorexia nervosa; rTPJ, right temporal parietal junction; teenAN, teenagers with anorexia nervosa; teenHC, teenagers healthy control.

Figure 1 Neurosynth meta-analyses were conducted for the terms “reward,” first column; “decision,” second column, and “social,” third column. These maps provide a visual representation of the subcortical and cortical structures engaged in studies utilizing the keywords. Each map can be examined at http://www.neurosynth.org/analyses/terms/reward; http://www.neurosynth.org/analyses/terms/decision; and http://www.neurosynth.org/analyses/terms/social.

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