Institute of Living and Hartford Hospital, Hartford, CT, and Yale University, New Haven, CT.
Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, and the Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.
J Am Acad Child Adolesc Psychiatry. 2019 Feb;58(2):232-241. doi: 10.1016/j.jaac.2018.09.433. Epub 2018 Oct 29.
Bulimia nervosa (BN) is characterized by excessive attention to self and specifically to body shape and weight, but the ventral attention (VAN) and default mode (DMN) networks that support attentional and self-referential processes are understudied in BN. This study assessed whether altered functional connectivity within and between these networks contributes to such excessive concerns in adolescents with BN early the course of the disorder.
Resting-state functional magnetic resonance images were acquired from 33 adolescents with BN and 37 healthy control adolescents (12-21 years) group matched by age and body mass index. Region-of-interest analyses were performed to examine group differences in functional connectivity within and between the VAN and DMN. In addition associations of VAN-DMN connectivity with BN symptoms, body shape/weight concerns, and sustained attention were explored using the Continuous Performance Test (CPT).
Compared with control adolescents, those with BN showed significantly increased positive connectivity between the right ventral supramarginal gyrus and all DMN regions and between the right ventrolateral prefrontal cortex and the left lateral parietal cortex. Within-network connectivity did not differ between groups. VAN-DMN connectivity was associated with BN severity and body shape/weight concerns in the BN group. No significant group-by-CPT interactions on VAN-DMN connectivity were detected.
Increased positive VAN-DMN connectivity in adolescents with BN could reflect abnormal engagement of VAN-mediated attentional processes at rest, perhaps related to their excessive attention to self-referential thoughts about body shape/weight. Future studies should further investigate these circuits as targets for the development of early interventions aimed at decreasing excessive body shape/weight concerns.
神经性贪食症（BN）的特征是过度关注自身，尤其是体型和体重，但支持注意力和自我参照过程的腹侧注意（VAN）和默认模式（DMN）网络在 BN 中研究较少。本研究评估了这些网络内和网络间功能连接的改变是否导致 BN 青少年在疾病早期对这些过度关注。
对 33 名 BN 青少年和 37 名健康对照青少年（12-21 岁）进行静息态功能磁共振成像。通过感兴趣区分析，研究 VAN 和 DMN 内和网络间功能连接的组间差异。此外，还使用连续性能测试（CPT）探讨了 VAN-DMN 连接与 BN 症状、体型/体重担忧和持续注意力的相关性。
与对照组青少年相比，BN 组青少年右侧腹侧缘上回与所有 DMN 区域之间以及右侧腹外侧前额叶与左侧外侧顶叶之间的正连接显著增加。两组之间的网络内连接没有差异。在 BN 组中，VAN-DMN 连接与 BN 严重程度和体型/体重担忧相关。未检测到 VAN-DMN 连接的显著组间与 CPT 的相互作用。
BN 青少年中 VAN-DMN 连接的增加可能反映了 VAN 介导的注意力过程在静息状态下的异常参与，这可能与他们对体型/体重的自我参照思维的过度关注有关。未来的研究应该进一步研究这些回路，作为开发旨在减少过度体型/体重担忧的早期干预措施的目标。
