Wonderlich Joseph A, Bershad Mariya, Steinglass Joanna E
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
Neuropsychiatr Dis Treat. 2021 Jun 21;17:2053-2062. doi: 10.2147/NDT.S282554. eCollection 2021.
Studies using functional magnetic resonance imaging (fMRI) have contributed to our understanding of possible neural abnormalities among individuals with eating disorders. Many of these studies have focused on three domains: 1) cognitive control, 2) reward processing, and 3) affective processing. This review attempts to summarize the recent fMRI findings across these domains among the most well-characterized eating disorders: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Though the literature is a bit murky, a few major themes have emerged. Cognitive control systems are affected among individuals across eating disorder diagnoses, but effects seem least pronounced in AN. Specifically, individuals with all eating disorders appear to show decreased prefrontal activation during cognitive control, but there is less evidence in AN linking decreased prefrontal activation with behavior. There is some evidence that the reinforcing value of food is reduced in AN, but individuals with BN and BED show hyperactivation to rewarding food-related stimuli, suggesting the reinforcing value of food may be enhanced. However, more complex reward processing paradigms show that individuals with BN and BED exhibit hypoactivation to reward anticipation and provide mixed results with regards to reward receipt. There are fewer neuroimaging findings related to affective processing, yet behavioral findings suggest affective processing is important in understanding eating disorders. Though the extant literature is complicated, these studies represent a foundation from which to build and provide insight into potential neurobiological mechanisms that may contribute to the pathophysiology of eating disorders.
使用功能磁共振成像（fMRI）的研究有助于我们理解饮食失调个体可能存在的神经异常。这些研究大多集中在三个领域：1）认知控制，2）奖赏处理，3）情感处理。本综述试图总结在特征最明确的饮食失调症——神经性厌食症（AN）、神经性贪食症（BN）和暴饮暴食症（BED）中，这些领域最近的fMRI研究结果。尽管文献有些模糊，但已出现了一些主要主题。在所有饮食失调诊断个体中，认知控制系统均受影响，但在神经性厌食症中这种影响似乎最不明显。具体而言，所有饮食失调症患者在认知控制过程中前额叶激活均降低，但在神经性厌食症中，将前额叶激活降低与行为联系起来的证据较少。有证据表明，在神经性厌食症中食物的强化价值降低，但神经性贪食症和暴饮暴食症患者对与食物相关的奖赏刺激表现出过度激活，这表明食物的强化价值可能增强。然而，更复杂的奖赏处理范式表明，神经性贪食症和暴饮暴食症患者在奖赏预期方面表现出激活不足，并且在奖赏接收方面结果不一。与情感处理相关的神经影像学研究结果较少，但行为学研究结果表明，情感处理在理解饮食失调症方面很重要。尽管现有文献复杂，但这些研究为进一步研究奠定了基础，并为可能导致饮食失调症病理生理学的潜在神经生物学机制提供了见解。
