Emotion brain alterations in anorexia nervosa: a candidate biological marker and implications for treatment

Abstract

267Background: Identification of the biological markers of anorexia nervosa (AN) is crucial for the development of new treatments. We aimed to determine whether AN is associated with disturbances in the nonconscious neural processing of innate signals of emotion and whether these disturbances persist after weight gain. Methods: In a retest design, 28 adolescent females with AN were tested at first admission to hospital and again after they had gained weight. Matched healthy control participants were tested at the same times. We assessed emotion-elicited event-related potentials (ERPs) during overt and covert presentation of emotion expressions, scores on an emotion-identification behavioural task, and symptom measures. We performed between and within group analyses. Results: Individuals with AN had a marked alteration in ERPs relative to healthy controls. Irrespective of the form of stimulus, early and late ERP components were significantly reduced in AN patients at baseline (when underweight) and on retest (after weight gain), especially in the temporo-occipital regions, suggesting a persistent disruption of the early automatic appraisal of salient emotional signals. Limitations: This study could have been improved with a longer standardized retest interval. Conclusion: There is likely a core, generic disturbance in AN in the early "automatic" neural processing of emotion irrespective of weight or nutritional status. New innovative emotion-based psychologic or pharmacologic treatments targeting these nonconscious processes may prove beneficial.

Electroencephalography in eating disorders

“…In fact, the observed reduced P300 response to negative emotional faces in patients with anorexia nervosa has been interpreted as possible evidence of decreased cognitive processing ability in respect of negative emotional faces, which could lead to social difficulties and, as a consequence, to the maintenance of eating disorders. 50 Some ERP findings are very consistent with previous neuroimaging results on patients with anorexia nervosa, reporting neural disturbances in response to stimuli that are relevant to the pathology (eg, stimuli like food exposure, different emotional situations, or body images) 51…”

A review of attention biases in women with eating disorders

“…These findings provide support for the “hypervigilance” component of evidence-based theoretical models on anxiety disorders and the neural theory that attention is in fact deployed implicitly. Similar results are found in the processing of food pictures regardless of caloric content in EDs (Blechert, Feige, Joos, Zeeck, & Tuschen-Caffier, 2011) whereas the inverse pattern (decreased responding particularly in the temporo-occipital regions) is found in adolescents with AN in response to facial expressions of emotion (e.g., disgust, fear, sadness) (Hatch et al, 2010). …”

Threat‐Detection and Attentional Bias to Threat in Women Recovered from Anorexia Nervosa: Neural Alterations in Extrastriate and Medial Prefrontal Cortices

“…Also, an electroencephalography study showed that early neural responses to emotional faces are reduced in both ill and recovered patients (Hatch et al, 2010), supporting the notion that early and automatic processing of emotional stimuli are altered in AN. Similar decreased early neural responses to emotional faces have also been noted in patients with social anxiety disorder (Mueller et al, 2009).…”