Gorrell Sasha, Ramappa Sapna, Richson Brianne, Dougherty Elizabeth, Singh Simar, Lindstrom Kate, Day Maya, Rasmussen Emma, Anderson Lisa M
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.
Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.
Int J Eat Disord. 2025 Jun 9. doi: 10.1002/eat.24485.
OBJECTIVE: Etiological models of eating disorders (EDs) suggest there is considerable overlap between anxiety and EDs. In particular, shared clinical features across these psychiatric diagnoses suggest that common threat processes (i.e., changes in affect, cognition, and physiology, or behavior in response to a feared stimulus) underlie their maintenance. Compared to anxiety disorders, however, less is known about the neurobiological bases of threat that may give rise to and maintain ED symptoms, particularly among adolescents. Addressing this knowledge gap will aid in informing future research and interventional efforts. METHODS: We searched four online databases to review studies published through March 2025 comprising all potential types of assessment of biobehavioral activity associated with threat (e.g., neuroimaging, skin conductance) in clinical samples of adolescents with EDs. RESULTS: From 2546 articles identified, N = 19 studies met inclusion criteria. A majority of investigations employed functional neuroimaging to study adolescent girls with anorexia nervosa, compared with age-matched controls. We classified and synthesized evidence within categories of non-ED-specific threat (harm avoidance) or ED-specific threat (bodily- or food-related threat, or their combination). Most studies demonstrated altered ED-specific threat processing in adolescent girls with anorexia nervosa compared to controls, as well as associations between neural threat response and ED symptomology. The study focused on non-ED-specific threat found no noted differences in threat response in cases versus controls. DISCUSSION: Given the apparent relevance of threat processing in EDs, future inquiry is needed to resolve remaining questions and yield new insights with clinical relevance across transdiagnostic adolescent ED presentations.
目的:饮食失调(EDs)的病因模型表明,焦虑与饮食失调之间存在相当大的重叠。特别是,这些精神疾病诊断中共同的临床特征表明,共同的威胁过程(即情感、认知、生理或行为对恐惧刺激的反应变化)是其维持的基础。然而,与焦虑症相比,对于可能引发和维持饮食失调症状的威胁的神经生物学基础知之甚少,尤其是在青少年中。填补这一知识空白将有助于为未来的研究和干预工作提供信息。 方法:我们搜索了四个在线数据库,以回顾截至2025年3月发表的研究,这些研究包括对患有饮食失调的青少年临床样本中与威胁相关的生物行为活动的所有潜在类型评估(如神经影像学、皮肤电传导)。 结果:从识别出的2546篇文章中,有19项研究符合纳入标准。与年龄匹配的对照组相比,大多数研究采用功能神经影像学研究患有神经性厌食症的青少年女孩。我们将证据分类并综合为非饮食失调特异性威胁(回避伤害)或饮食失调特异性威胁(身体或食物相关威胁,或其组合)类别。与对照组相比,大多数研究表明患有神经性厌食症的青少年女孩在饮食失调特异性威胁处理方面存在改变,以及神经威胁反应与饮食失调症状之间的关联。关注非饮食失调特异性威胁的研究未发现病例与对照组在威胁反应上有显著差异。 讨论:鉴于威胁处理在饮食失调中明显具有相关性,未来需要进一步探究以解决剩余问题,并在跨诊断青少年饮食失调表现中产生具有临床相关性的新见解。
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