Kaye Walter H, Wagner Angela, Fudge Julie L, Paulus Martin
Department of Psychiatry, University of California, San Diego, CA, USA.
Curr Top Behav Neurosci. 2011;6:37-57. doi: 10.1007/7854_2010_85.
This chapter reviews brain imaging findings in anorexia and bulimia nervosa which characterize brain circuitry that may contribute to the pathophysiology of eating disorders (EDs).
Recent imaging studies provide evidence of disturbed gustatory processing in EDs which involve the anterior insula as well as striatal regions. These results raise the possibility that individuals with anorexia nervosa have altered appetitive mechanism that may involve sensory, interoceptive, or reward processes. Furthermore, evidence of altered reward mechanisms is supported by studies that suggest that individuals with anorexia nervosa and bulimia nervosa share a trait toward similar anterior ventral striatal pathway dysregulation. This shared trait disturbance of the modulation of reward and emotionality may create a vulnerability for dysregulated appetitive behaviors. However, those with anorexia nervosa may be able to inhibit appetite and have extraordinary self-control because of exaggerated dorsal cognitive circuit function, whereas individuals with bulimia nervosa are vulnerable to overeating when they get hungry, because they have less ability to control their impulses.
Current therapeutic interventions have modest success. Better understanding of neurocircuits that may be related to altered appetite, mood, impulse control, and other symptoms underlying the pathophysiology of EDs might improve psychotherapeutic and drug treatment strategies.
本章回顾神经性厌食症和神经性贪食症的脑成像研究结果，这些结果描绘了可能导致饮食失调（EDs）病理生理学的脑回路特征。
近期的成像研究提供了证据，表明饮食失调中味觉处理存在紊乱，涉及脑岛前部以及纹状体区域。这些结果增加了这样一种可能性，即神经性厌食症患者的食欲机制发生了改变，这可能涉及感觉、内感受或奖赏过程。此外，奖赏机制改变的证据得到了一些研究的支持，这些研究表明神经性厌食症和神经性贪食症患者具有类似的前腹侧纹状体通路失调特征。这种奖赏和情绪调节的共同特征紊乱可能会导致食欲行为失调的易感性。然而，神经性厌食症患者可能能够抑制食欲并具有非凡的自我控制能力，因为其背侧认知回路功能亢进，而神经性贪食症患者在饥饿时容易暴饮暴食，因为他们控制冲动的能力较弱。
目前的治疗干预取得的成功有限。更好地理解可能与食欲改变、情绪、冲动控制以及饮食失调病理生理学基础的其他症状相关的神经回路，可能会改善心理治疗和药物治疗策略。
