Neural activations are related to body-shape, anxiety, and outcomes in adolescent anorexia nervosa

https://doi.org/10.1016/j.jpsychires.2016.12.005Get rights and content

Highlights

  • Adolescents evaluated the relevance of social adjectives using fMRI.

  • Adolescents recovered from anorexia nervosa were compared to healthy adolescents.

  • Medial prefrontal cortex engagement was related to anxiety in both groups.

  • Body shape concern correlated with frontal brain activity in anorexia nervosa.

  • Altered social neural function contributes to clinical pathology in anorexia nervosa.

Abstract

Anorexia nervosa (AN) is an illness that frequently begins during adolescence and involves weight loss. Two groups of adolescent girls (AN-A, weight-recovered following AN) and (HC-A, healthy comparison) completed a functional magnetic resonance imaging task involving social evaluations, allowing comparison of neural activations during self-evaluations, friend-evaluations, and perspective-taking self-evaluations. Although the two groups were not different in their whole-brain activations, anxiety and body shape concerns were correlated with neural activity in a priori regions of interest. A cluster in medial prefrontal cortex and the dorsal anterior cingulate correlated with the body shape questionnaire; subjects with more body shape concerns used this area less during self than friend evaluations. A cluster in medial prefrontal cortex and the cingulate also correlated with anxiety such that more anxiety was associated with engagement when disagreeing rather than agreeing with social terms during self-evaluations. This data suggests that differences in the utilization of frontal brain regions during social evaluations may contribute to both anxiety and body shape concerns in adolescents with AN. Clinical follow-up was obtained, allowing exploration of whether brain function early in course of disease relates to illness trajectory. The adolescents successful in recovery used the posterior cingulate and precuneus more for friend than self evaluations than the adolescents that remained ill, suggesting that neural differences related to social evaluations may provide clinical predictive value. Utilization of both MPFC and the precuneus during social and self evaluations may be a key biological component for achieving sustained weight-recovery in adolescents with AN.

Introduction

Anorexia nervosa (AN) involves altered perceptions about one's body shape and weight and an inability to maintain one's body weight, and typically begins in adolescence or young adulthood (Nagl et al., 2016). Differences in self-identity have been proposed as a core feature of this illness (Fairchild and Cooper, 2010, Stein and Corte, 2007), and neurobiological differences in midline cortical structures associated with self-perception have been observed repeatedly in adult women with eating disorders when thinking about themselves and others (McAdams et al., 2015, McAdams et al., 2016, McAdams and Krawczyk, 2014). However, whether neural differences in self-perception also contribute to AN in adolescents has not been established. Additionally, the relationships between the neural differences in self-perception and specific clinical symptoms in AN is unknown.

Here, we consider these clinical questions by comparing the neural activations during self and other evaluations in adolescent girls with AN (AN-A) and healthy adolescent girls (HC-A) using the same functional magnetic resonance imaging (MRI) task we recently examined in adults with and recovered from AN (McAdams et al., 2016). This imaging task, the Social Identity-V2 task, involves reading and evaluating statements presented with different perspectives. Neurodevelopmental differences in the ability to consider oneself and others have been observed in adolescents compared to adults (Pfeifer et al., 2013, Pfeifer et al., 2007, Pfeifer et al., 2009); here we considered whether AN affects neural activations during perspective-taking and mentalization in adolescents.

We hypothesized that eating disorder (ED) clinical symptoms in adolescence would be related to neural activations in regions that differed in adults with AN because many adolescents with AN go on to be adults with AN. Thus, we also explored whether clinical outcomes following treatment of AN in adolescents could be related to neural activations, by collecting clinical follow-up from the AN-A subjects for a year after the scan, and dividing into recovered (AN-AR) and ill (AN-AI) groups based on the course of the disease. We then assessed whether any of the task-related neural activations, obtained soon after treatment, differed based on clinical outcome.

Section snippets

Participants

Subjects provided written informed consent to participate, approved by the UT Southwestern Institutional Review Board. A total of 42 adolescent girls (13–19 years) participated: 18 healthy comparison (HC-A) recruited from the community and 24 recently treated for AN (AN-A) recruited from both treatment centers and the community. All AN-A subjects met DSM- IV criteria, excluding amenorrhea, within prior year but were weight recovered at the scan to minimize the possibility of effects due to

Clinical and behavioral measures

The two groups did not differ in age, BMI at the time of the scan, or intelligence quotient (Table 1). They differed in all clinical measures, with the AN-A group showing higher levels of depression and anxiety, as well as cognitions related to body shape and eating behaviors. Five of the AN-A group had the binge-purge subtype of AN; the rest had the restricting subtype. Twenty of the AN-A group and none of the HC-A group were taking psychotropic medications at the time of the scan.

Response (

Discussion

We compared neural activations using a self-evaluation task in nutritionally rehabilitated adolescents recently treated for AN to healthy adolescents without any pre-existing psychiatric illnesses. Using direct, whole-brain comparisons, these groups did not show any neural differences. Using an ROI analysis based on regions associated with AN in the same task in adult women, we found that clinical symptoms correlated with activations of MPFC. Specifically, activation of the MPFC-dACC cluster

Conflict of interest

The authors report no conflicts of interest.

Acknowledgments

Funding was provided by the Children’s Medical Center Foundation, the Brain and Behavior Foundation (2012 NARSAD), the Hogg Foundation for Mental Health (JRG-311), and the National Institute of Mental Health (K23 MH093684, R25 MH101078). The content is solely the responsibility of the authors and does not represent the official views of the funding agencies. We thank all subjects that have participated, as well as Jarrette Moore for her work as a research coordinator at Children’s Medical

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