Alexithymia in anorexia and bulimia: Ubiquitous and primary trait?

Background: Alexithymia is associated to Eating Disorders (ED) and relevant for their prognosis but it is uncertain if it is ubiquitous, primary, and necessary for ED outburst. Methods: 124 ED outpatients and 80 healthy controls were compared with the Toronto Alexithymia Scale, personality, and psychopathology measures. Alexithymia and the other features are compared between anorexia nervosa (AN), bulimia nervosa (BN) and control groups. Alexithymia-based clusters were explored and compared with controls. Alexithymia traits are correlated with the other features. Results: Difficulty in identifying feelings was ubiquitous in ED subjects. A Non-Alexithymic Cluster (NAC) and an Alexithymic Cluster (ALC) were found with no difference in AN/BN distribution. ALC displays disordered personality and high psychopathology. Self-directiveness and interoceptive awareness were independently related to alexithymia and to depressive feelings. These two features along with depressive features completely accounted for alexithymia variance. Conclusion: Even though the difficulty in identifying feelings is ubiquitous in ED subjects, Alexithymia may not represent a primary trait but a complex dysfunction consequent to co-occurring character immaturity, altered interoceptive awareness, and depressive traits

Reduced resting-state functional connectivity of the somatosensory cortex predicts psychopathological symptoms in women with bulimia nervosa.

Background: Alterations in the resting-state functional connectivity (rs-FC) of several brain networks have been demonstrated in eating disorders. However, very few studies are currently available on brain network dysfunctions in bulimia nervosa (BN). The somatosensory network is central in processing body-related stimuli and it may be altered in BN. The present study therefore aimed to investigate rs-FC in the somatosensory network in bulimic women. Methods: Sixteen medication-free women with BN (age = 23 ± 5 years) and 18 matched controls (age = 23 ± 3 years) underwent a functional magnetic resonance resting-state scan and assessment of eating disorder symptoms. Within-network and seed-based functional connectivity analyses were conducted to assess rs-FC within the somatosensory network and to other areas of the brain. Results: Bulimia nervosa patients showed a decreased rs-FC both within the somatosensory network (t = 9.0, df = 1, P = 0.005) and with posterior cingulate cortex and two visual areas (the right middle occipital gyrus and the right cuneus) (P = 0.05 corrected for multiple comparison). The rs-FC of the left paracentral lobule with the right middle occipital gyrus correlated with psychopathology measures like bulimia (r = −0.4; P = 0.02) and interoceptive awareness (r = −0.4; P = 0.01). Analyses were conducted using age, BMI (body mass index), and depressive symptoms as covariates. Conclusion: Our findings show a specific alteration of the rs-FC of the somatosensory cortex in BN patients, which correlates with eating disorder symptoms. The region in the right middle occipital gyrus is implicated in body processing and is known as extrastriate body area (EBA). The connectivity between the somatosensory cortex and the EBA might be related to dysfunctions in body image processing. The results should be considered preliminary due to the small sample size