Brain responses to body image stimuli but not food are altered in women with bulimia nervosa

Abstract

BackgroundResearch into the neural correlates of bulimia nervosa (BN) psychopathology remains limited.MethodsIn this functional magnetic resonance imaging study, 21 BN patients and 23 healthy controls (HCs) completed two paradigms: 1) processing of visual food stimuli and 2) comparing their own appearance with that of slim women. Participants also rated food craving and anxiety levels.ResultsBrain activation patterns in response to food cues did not differ between women with and without BN. However, when evaluating themselves against images of slim women, BN patients engaged the insula more and the fusiform gyrus less, compared to HCs, suggesting increased self-focus among women with BN whilst comparing themselves to a ‘slim ideal’. In these BN patients, exposure to food and body image stimuli increased self-reported levels of anxiety, but not craving.ConclusionsOur findings suggest that women with BN differ from HCs in the way they process body image, but not in the way they process food stimuli.

The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples

“…As in the current study, when the raw scores on the SAAS of the participants are compared, other studies have found [29,30] that ED patients obtained a higher score than control community groups. Although, to our knowledge, no research has analysed the role of gender and age in the specific fear of judgment based on appearance (SAA) in adult or adolescent samples, the gender and age differences across adolescents found in this research converged with a large body of research indicating that in general terms body and overall appearance concerns, social fears and particularly negative evaluation fears, and social anxiety are more salient from mid-adolescence onwards and across female participants [26,27,32,34,37,47,62,69].…”

“…Employing a female adult sample of 60 outpatients with EDs, Claes et al [10] supported the one-factor model of the SAAS and found that its score was significantly positive in relation to mistrust of others, social detachment, emotional lability and desire to become thinner. Evidence that ED patients obtained higher SAAS scores than matched healthy controls exists as well [29,30].…”

“…Finally, prior studies have examined the differences in SAAS observed scores between EDs and healthy controls [29,30] without establishing and testing the measurement equivalence/invariance (ME/I) of the SAAS. This approach is problematic [41] because if one does not verify that the items of an instrument hold the same meaning and the underlying constructs are perceived similarly in all populations of interest prior to making comparisons across groups, one can never be sure that the reported differences are indicative of true group differences [45].…”

Altered intrinsic functional brain architecture in female patients with bulimia nervosa

“…45 The relevance of the sensorimotor and occipital regions to distorted body image has been emphasized in several previous studies. [9][10][11]14 For instance, reduced occipitotemporal responses during presentations of underweight or overweight human bodies were observed in patients with bulimia nervosa; 9 the lateral occipital activation was sensitive to stimuli of body size distortions in healthy people, whereas such a modulation was not observed in those with bulimia nervosa. 10 At rest, patients with bulimia nervosa showed abnormal iFC within the somatosensory network and between the paracentral lobule and 2 occipital regions.…”

“…We hypothesized that patients with bulimia nervosa would show abnormal topological properties in functional brain networks and that the functional disturbances would be apparent in the cortical and subcortical regions involved in reward and emotional processing, sensorimotor and visual perception, and interoception, based on potential relevance of these neural functions to bulimia nervosa. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] We also examined the behavioural/symptom correlates of these network properties.…”