Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, Aachen, Germany.
Clinic for Obstetrics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Eur Eat Disord Rev. 2022 Sep;30(5):486-500. doi: 10.1002/erv.2911. Epub 2022 Jun 14.
Theory of mind (ToM) is important for social interactions and typical development and has been found to be impaired in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Hypoactivation in frontotemporal brain regions seems to be the underlying neural mechanism in AN while whole-brain analyses in BN are lacking.
We used the well-validated social recognition task fMRI paradigm to assess ToM in a total of 72 female adolescents (16 BN, 18 AN and 38 matched healthy controls [HC]).
Compared to HC , patients with BN showed hyperactivity during ToM-activity in the right frontal pole, middle temporal gyrus and left temporal pole and differed fundamentally from hypoactivation in these regions observed in patients with AN before and after short-term weight rehabilitation. Interaction and overlap analyses confirmed that similar regions were affected in opposite directions in both diseases. Hyperactivations in BN in the right middle temporal gyrus and right frontal pole were associated with clinical BN-severity markers binging and purging frequency.
The hyperactivation in BN suggest different underlying neural mechanisms for ToM compared to AN. Hyperactivity might correspond to a different but also ineffective cognitive style in patients with BN when approaching social interactions. These important transdiagnostic differences are relevant for future brain-targeted therapeutic approaches.
心理理论（ToM）对于社交互动和典型发展很重要，并且已经发现厌食症（AN）和贪食症（BN）患者的心理理论受损。额叶和颞叶脑区的低激活似乎是 AN 的潜在神经机制，而 BN 的全脑分析则缺乏。
我们使用经过充分验证的社会认知任务 fMRI 范式，共评估了 72 名女性青少年（16 名 BN、18 名 AN 和 38 名匹配的健康对照组[HC]）的心理理论。
与 HC 相比，BN 患者在心理理论活动期间表现出右侧额极、中颞叶和左侧颞极的过度活跃，与 AN 患者在短期体重康复前后观察到的这些区域的低激活有根本区别。交互和重叠分析证实，两种疾病的相似区域以相反的方向受到影响。BN 中的右侧中颞叶和右侧额极的过度活跃与 BN 临床严重程度标志物暴食和清肠频率相关。
与 AN 相比，BN 的过度活跃表明心理理论的潜在神经机制不同。过度活跃可能对应于 BN 患者在处理社交互动时的一种不同但同样无效的认知方式。这些重要的跨诊断差异对未来针对大脑的治疗方法具有重要意义。
