Berner Laura A, Stefan Mihaela, Lee Seonjoo, Wang Zhishun, Terranova Kate, Attia Evelyn, Marsh Rachel
From the Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego (Berner); the Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Stefan, Lee, Wang, Terranova, Marsh); and the Eating Disorders Research Unit, Division of Clinical Therapeutics, Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Attia, Marsh).
J Psychiatry Neurosci. 2018 Jan 12;43(2):170070. doi: 10.1503/jpn.170070.
Frontostriatal and frontoparietal abnormalities likely contribute to deficits in control and attentional processes in individuals with bulimia nervosa and to the persistence of dysregulated eating across development. This study assessed these processes and cortical thickness in a large sample of adolescent girls and women with bulimia nervosa compared with healthy controls.
We collected anatomical MRI data from adolescent girls and women (ages 12-38 yr) with full or subthreshold bulimia nervosa and age-matched healthy controls who also completed the Conners Continuous Performance Test-II (CPT-II). Groups were compared on task performance and cortical thickness. Mediation analyses explored associations among cortical thickness, CPT-II variables, bulimia nervosa symptoms and age.
We included 60 girls and women with bulimia nervosa and 54 controls in the analyses. Compared with healthy participants, those with bulimia nervosa showed increased impulsivity and inattention on the CPT-II, along with reduced thickness of the right pars triangularis, right superior parietal and left dorsal posterior cingulate cortices. In the bulimia nervosa group, exploratory analyses revealed that binge eating frequency correlated inversely with cortical thickness of frontoparietal and insular regions and that reduced frontoparietal thickness mediated the association between age and increased symptom severity and inattention. Binge eating frequency also mediated the association between age and lower prefrontal cortical thickness.
These findings are applicable to only girls and women with bulimia nervosa, and our cross-sectional design precludes understanding of whether cortical thickness alterations precede or result from bulimia nervosa symptoms.
Structural abnormalities in the frontoparietal and posterior cingulate regions comprising circuits that support control and attentional processes should be investigated as potential contributors to the maintenance of bulimia nervosa and useful targets for novel interventions.
额纹状体和额顶叶异常可能导致神经性贪食症患者在控制和注意力过程方面出现缺陷，并导致整个发育过程中饮食失调的持续存在。本研究评估了大量神经性贪食症青少年女孩和女性与健康对照者在这些过程及皮质厚度方面的情况。
我们收集了年龄在12至38岁之间、患有完全型或阈下型神经性贪食症的青少年女孩和女性以及年龄匹配的健康对照者的解剖学MRI数据，这些对照者还完成了康纳斯连续操作测验第二版（CPT-II）。比较了两组在任务表现和皮质厚度方面的差异。中介分析探讨了皮质厚度、CPT-II变量、神经性贪食症症状和年龄之间的关联。
分析中纳入了60名患有神经性贪食症的女孩和女性以及54名对照者。与健康参与者相比，患有神经性贪食症的人在CPT-II上表现出更高的冲动性和注意力不集中，同时右侧三角部、右侧顶上叶和左侧背侧后扣带回皮质厚度减小。在神经性贪食症组中，探索性分析显示，暴饮暴食频率与额顶叶和岛叶区域的皮质厚度呈负相关，额顶叶厚度减小介导了年龄与症状严重程度增加及注意力不集中之间的关联。暴饮暴食频率还介导了年龄与前额叶皮质厚度降低之间的关联。
这些发现仅适用于患有神经性贪食症的女孩和女性，且我们的横断面设计无法确定皮质厚度改变是先于神经性贪食症症状出现还是由其导致。
额顶叶和后扣带回区域的结构异常构成了支持控制和注意力过程的神经回路，应将其作为神经性贪食症维持的潜在因素进行研究，并作为新型干预措施的有用靶点。
