Additional file 1: of Applying neurobiology to the treatment of adults with anorexia nervosa

Behavioral Agreement. (PDF 660 kb

Altered BOLD Response during Inhibitory and Error Processing in Adolescents with Anorexia Nervosa

<div><p>Background</p><p>Individuals with anorexia nervosa (AN) are often cognitively rigid and behaviorally over-controlled. We previously showed that adult females recovered from AN relative to healthy comparison females had less prefrontal activation during an inhibition task, which suggested a functional brain correlate of altered inhibitory processing in individuals recovered from AN. However, the degree to which these functional brain alterations are related to disease state and whether error processing is altered in AN individuals is unknown.</p><p>Methodology/Principal Findings</p><p>In the current study, ill adolescent AN females (n = 11) and matched healthy comparison adolescents (CA) with no history of an eating disorder (n = 12) performed a validated stop signal task (SST) during functional magnetic resonance imaging (fMRI) to explore differences in error and inhibitory processing. The groups did not differ on sociodemographic variables or on SST performance. During inhibitory processing, a significant group x difficulty (hard, easy) interaction was detected in the right dorsal anterior cingulate cortex (ACC), right middle frontal gyrus (MFG), and left posterior cingulate cortex (PCC), which was characterized by less activation in AN compared to CA participants during hard trials. During error processing, a significant group x accuracy (successful inhibit, failed inhibit) interaction in bilateral MFG and right PCC was observed, which was characterized by less activation in AN compared to CA participants during error (i.e., failed inhibit) trials.</p><p>Conclusion/Significance</p><p>Consistent with our prior findings in recovered AN, ill AN adolescents, relative to CA, showed less inhibition-related activation within the dorsal ACC, MFG and PCC as inhibitory demand increased. In addition, ill AN adolescents, relative to CA, also showed reduced activation to errors in the bilateral MFG and left PCC. These findings suggest that altered prefrontal and cingulate activation during inhibitory and error processing may represent a behavioral characteristic in AN that is independent of the state of recovery.</p></div

Mean reaction time (MRT) in milliseconds for post-error slowing (trials following a failed inhibition trial) for errors that occurred on easy stop trials and hard stop trials.

<p>As represented by the uppercase letters on the barplot, the MRT for post-error slowing was significantly faster [F(1,21)  = 4.6, p = 0.04, g = 0.9] for AN (689.0±135.3 ms) than CA (800.7±133.1 ms). Error bars represent the standard error for each group. AN: ill adolescents with anorexia nervosa, restricting-type; CA: healthy comparison adolescents.</p

Voxelwise analysis of variance reporting significant clusters for an interaction of group x inhibition accuracy.

<p>Note: BA: Brodmann Area; B: bilateral; L: left; R: right.</p

Behavioral accuracy performance on the stop signal task.

<p>The percent of inhibition errors (failed inhibits) for easy stop trials vs. hard stop trails for each group. No group or group x trial type differences were revealed for accuracy of performance. Bars with different letters (A vs. B) are significantly different from one another: participants made significantly more errors during the hard stop trials than during the easy stop trials [F(1,21)  =  264,6, p<0.001, g = 6.5]. Error bars represent the standard error for each group. AN: ill adolescents with anorexia nervosa, restricting-type; CA: healthy comparison adolescents.</p

Voxelwise analysis of variance reporting significant clusters for an interaction of group x difficulty.

<p>Note: BA: Brodmann Area; B: bilateral; L: left; R: right.</p

Analysis of variance results within regions of interest demonstrating an interaction of group by inhibition accuracy (successful inhibit, failed inhibit).

<p>Note: Failed inhibition are trials in which participants failed to inhibit motor response when an auditory stop cue was presented, whereas successful inhibition are trials in which the participant correctly inhibited a motor response when the auditory stop cue was presented. BA: Brodmann Area; CA: healthy comparison adolescents; L: left; R: right; AN: adolescents ill with anorexia nervosa, restricting-type.</p

Analysis of variance results within regions of interest demonstrating an interaction of group (CA, AN) by difficulty (easy, hard).

<p>Note: BA: Brodmann Area; CA: healthy comparison adolescents; L: left; R: right; AN: adolescents ill with anorexia nervosa, restricting-type.</p