McAdams Carrie J, Smith Whitney
University of Texas at Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, USA.
University of Texas at Southwestern Medical Center, Dallas, TX, USA.
Neurosci Neuroecon. 2015;4:35-49. doi: 10.2147/NAN.S76699. Epub 2015 Sep 1.
Eating disorders are complex and serious psychiatric illnesses whose etiology includes psychological, biological, and social factors. Treatment of eating disorders is challenging as there are few evidence-based treatments and limited understanding of the mechanisms that result in sustained recovery. In the last 20 years, we have begun to identify neural pathways that are altered in eating disorders. Consideration of how these pathways may contribute to an eating disorder can provide an understanding of expected responses to treatments. Eating disorder behaviors include restrictive eating, compulsive overeating, and purging behaviors after eating. Eating disorders are associated with changes in many neural systems. In this targeted review, we focus on three cognitive processes associated with neurocircuitry differences in subjects with eating disorders such as reward, decision-making, and social behavior. We briefly examine how each of these systems function in healthy people, using Neurosynth meta-analysis to identify key regions commonly implicated in these circuits. We review the evidence for disruptions of these regions and systems in eating disorders. Finally, we describe psychiatric and psychological treatments that are likely to function by impacting these regions.
饮食失调是复杂且严重的精神疾病,其病因包括心理、生物和社会因素。饮食失调的治疗具有挑战性,因为基于证据的治疗方法很少,而且对导致持续康复的机制了解有限。在过去20年里,我们已经开始确定饮食失调中发生改变的神经通路。考虑这些通路如何导致饮食失调,有助于理解对治疗的预期反应。饮食失调行为包括节食、强迫性暴饮暴食以及进食后的清除行为。饮食失调与许多神经系统的变化有关。在这篇有针对性的综述中,我们聚焦于与饮食失调患者神经回路差异相关的三个认知过程,即奖赏、决策和社会行为。我们简要研究这些系统在健康人群中的功能,使用Neurosynth元分析来确定这些回路中通常涉及的关键区域。我们综述饮食失调中这些区域和系统受到破坏的证据。最后,我们描述可能通过影响这些区域起作用的精神和心理治疗方法。