Yu Xinyang, Robinson Lauren, Bobou Marina, Zhang Zuo, Banaschewski Tobias, Barker Gareth J, Bokde Arun L W, Flor Herta, Grigis Antoine, Garavan Hugh, Gowland Penny, Heinz Andreas, Brühl Rüdiger, Martinot Jean-Luc, Paillère Martinot Marie-Laure, Artiges Eric, Nees Frauke, Orfanos Dimitri Papadopoulos, Lemaître Hervé, Poustka Luise, Hohmann Sarah, Holz Nathalie, Bäuchl Christian, Smolka Michael N, Stringaris Argyris, Walter Henrik, Whelan Robert, Sinclair Julia, Schumann Gunter, Schmidt Ulrike, Desrivières Sylvane
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Department of Psychological Medicine, Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom; Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, United Kingdom.
Biol Psychiatry. 2025 Aug 1;98(3):237-248. doi: 10.1016/j.biopsych.2024.11.008. Epub 2024 Nov 23.
BACKGROUND: Neurobiological understanding of eating disorders (EDs) is limited. This study presents the first comparative multimodal magnetic resonance imaging assessments of anorexia nervosa and bulimia nervosa and uncovers neurobiological differences associated with these disorders. METHODS: This case-control study included 57 healthy female control participants and 130 female participants with EDs (bulimia nervosa and anorexia nervosa subtypes). Structural and functional magnetic resonance imaging assessed gray matter volume (GMV), cortical thickness, and task-based activities related to reward processing, socioemotional functioning, and response inhibition. Whole-brain group differences were correlated with ED psychopathology. RESULTS: Significant structural differences were observed in the ED group compared with healthy control participants, including reduced GMV in the left lateral orbitofrontal cortex and lower cortical thickness in the left rostral middle frontal gyrus and precuneus after adjusting for body mass index. Specific structural alterations were only evident in anorexia nervosa subgroups. GMV reductions in the orbitofrontal cortex were linked to impulsivity, while lower cortical thickness in the frontal gyrus correlated with cognitive restraint in eating, suggesting that these regions may play key roles in ED psychopathology. Functional magnetic resonance imaging also revealed notable differences. During reward anticipation, participants with EDs exhibited deactivations in the cerebellum and right superior frontal gyrus together with reduced activation in the left lingual gyrus. These functional changes were associated with heightened neuroticism. Mediation analyses suggested that starvation-related GMV reductions in EDs disrupt reward-related brain function, increase neuroticism, and reinforce cognitive restraint, likely contributing to the persistence of ED symptoms. CONCLUSIONS: These findings illuminate key neurobehavioral mechanisms that underlie EDs and point to potential brain-based targets for developing specialized treatment.
背景：对饮食失调（EDs）的神经生物学理解有限。本研究首次对神经性厌食症和神经性贪食症进行了比较性多模态磁共振成像评估，并揭示了与这些疾病相关的神经生物学差异。 方法：本病例对照研究纳入了57名健康女性对照参与者和130名患有饮食失调（神经性贪食症和神经性厌食症亚型）的女性参与者。结构和功能磁共振成像评估了灰质体积（GMV）、皮质厚度以及与奖励处理、社会情感功能和反应抑制相关的任务活动。全脑组间差异与饮食失调的精神病理学相关。 结果：与健康对照参与者相比，饮食失调组观察到显著的结构差异，包括在调整体重指数后，左侧眶额皮质的灰质体积减少，左侧额中回喙部和楔前叶的皮质厚度降低。特定的结构改变仅在神经性厌食症亚组中明显。眶额皮质的灰质体积减少与冲动性有关，而额回皮质厚度降低与饮食中的认知抑制有关，表明这些区域可能在饮食失调的精神病理学中起关键作用。功能磁共振成像也显示出显著差异。在奖励预期期间，饮食失调参与者在小脑和右侧额上回表现出失活，同时左侧舌回的激活减少。这些功能变化与神经质增加有关。中介分析表明，饮食失调中与饥饿相关的灰质体积减少会破坏与奖励相关的脑功能，增加神经质，并加强认知抑制，可能导致饮食失调症状的持续存在。 结论：这些发现阐明了饮食失调背后的关键神经行为机制，并指出了开发专门治疗方法的潜在脑靶点。
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