The role of body image and self‐perception in anorexia nervosa: the neuroimaging perspective

Abstract

Anorexia nervosa is a severe psychiatric illness characterized by intense fear of gaining weight, relentless pursuit of thinness, deep concerns about food and a pervasive disturbance of body image. Functional magnetic resonance imaging tries to shed light on the neurobiological underpinnings of anorexia nervosa. This review aims to evaluate the empirical neuroimaging literature about self-perception in anorexia nervosa. This narrative review summarizes a number of task-based and resting-state functional magnetic resonance imaging studies in anorexia nervosa about body image and self-perception. The articles listed in references were searched using electronic databases (PubMed and Google Scholar) from 1990 to February 2016 using specific key words. All studies were reviewed with regard to their quality and eligibility for the review. Differences in brain activity were observed using body image perception and body size estimation tasks showing significant modifications in activity of specific brain areas (extrastriate body area, fusiform body area, inferior parietal lobule). Recent studies highlighted the role of emotions and self-perception in anorexia nervosa and their neural substrate involving resting-state networks and particularly frontal and posterior midline cortical structures within default mode network and insula. These findings open new horizons to understand the neural substrate of anorexia nervosa.

A resting‐state fMRI study of obese females between pre‐ and postprandial states before and after bariatric surgery

“…In terms of the functionality of these areas, the insula specifically has been implicated in a variety of experiments involving obesity (as shown via meta‐analysis) (Brooks et al ., ), as well as in eating disorders such as anorexia nervosa (Frank et al ., , ) and bulimia nervosa, where insular size differences distinguished the two diseases (Frank et al ., ). Furthermore, the insula is suggested to be involved in self‐referential processing within eating disorders (Esposito et al ., ) and obesity (Dietrich et al ., ). Likewise, the putamen is often implicated along with the insula in many of these same studies for both eating disorders (Boehm et al ., ) and obesity (Dietrich et al ., ).…”

Neurobiology of Anorexia Nervosa: Serotonin Dysfunctions Link Self-Starvation with Body Image Disturbances through an Impaired Body Memory

“…The affective and cognitive components of body image distortion are widely accepted and related both to socio-cultural issues (van den Berg et al, 2002; Tylka, 2011; Swami, 2015)—internalization of an ideal body figure (Fitzsimmons-Craft et al, 2016), social body comparison (Andrew et al, 2016), and self-objectification (Dakanalis et al, 2016a)—and/or to brain dysfunctions (Sato et al, 2013; Suchan et al, 2015; Esposito et al, 2016)—alterations of the prefrontal cortex, the insula and the amygdala (Dakanalis et al, 2016b). …”

Marked Body Shape Concerns in Female Patients Suffering from Eating Disorders: Relevance of a Clinical Sub-Group

“…It is a part of body representation, involved in conscious body-related perception and cognition. ED are usually associated with disturbances of self-perception and body size estimation [ 4 ]. Having distorted oversized body image leads the patients with an ED to body dissatisfaction, resulting in negative thoughts and feelings about their own body, and reinforces the fear of gaining weight or becoming fat.…”