Self and other body perception in anorexia nervosa: The role of posterior DMN nodes

<p><b>Objectives:</b> Body image distortion is a core symptom of anorexia nervosa (AN), which involves alterations in self- (and other’s) evaluative processes arising during body perception. At a neural level, self-related information is thought to rely on areas of the so-called default mode network (DMN), which, additionally, shows prominent synchronised activity at rest.</p> <p><b>Methods:</b> Twenty female patients with AN and 20 matched healthy controls were scanned using magnetic resonance imaging when: (a) viewing video clips of their own body and another's body; (b) at rest. Between-group differences within the DMN during task performance were evaluated and further explored for task-related and resting-state-related functional connectivity alterations.</p> <p><b>Results:</b> AN patients showed a hyperactivation of the dorsal posterior cingulate cortex during their own-body processing but a response failure to another’s body processing at the precuneus and ventral PCC. Increased task-related connectivity was found between dPCC–dorsal anterior cingulate cortex and precuneus–mid-temporal cortex. Further, AN patients showed decreased resting-state connectivity between the dPCC and the angular gyrus.</p> <p><b>Conclusions:</b> The PCC and the precuneus are suggested as key components of a network supporting self–other-evaluative processes implicated in body distortion, while the existence of DMN alterations at rest might reflect a sustained, task-independent breakdown within this network in AN.</p

Diagram of the Social Judgment Task used in the fMRI session.

<p>Participants received social feedback based on the willingness to be met by other participants. Each facial stimulus (represented in by ovals instead of the originally presented faces) was presented for a total of 8 second-blocks, with an overlapping feedback symbol during the last 6 seconds. Acceptance, rejection or no-feedback (control condition) was indicated by a happy, sad, or neutral draw of a face. Originally presented images were contained in a preexisting face database: Martinez AM, Benavente R. The AR Face Database CVC Tech. Report #24 [Internet]. 1998. Available: <a href="http://www2.ece.ohio-state.edu/~aleix/ARdatabase.html" target="_blank">http://www2.ece.ohio-state.edu/~aleix/ARdatabase.html</a>.</p

Within and between-group brain activations during acceptance and rejection feedback.

<p>Brain hyperactivations (i.e. contrast acceptance/rejection>control condition) are depicted in yellow and deactivations (i.e. contrast acceptance/rejectionAN patients and for the comparison AN patients>controls. Color bars represents T value, only for between-group comparisons. Images are displayed in neurological convention (left is left).</p

Associations between EDI-2 scores and brain activity in AN patients during rejection feedback.

<p>Color bars represents T value. Images are displayed in neurological convention (left is left). Scatter plots represent Pearson's correlations between EDI-2 scores and the extracted mean eigenvalues in each one of the significant clusters. A results table is included, showing peak coordinates of each cluster and their corresponding statistics.</p

Interactions between Sensitivity to Reward and brain activations during the acceptance condition.

<p>Color bars represents T value. Images are displayed in neurological convention (left is left). Scatter plots represent Pearson's correlations between sensitivity to reward scores and the extracted mean eigenvalues in each relevant cluster: A. Dorsolateral prefrontal cortex. B. Left orbitofrontal-anterior insula cortex. C. Right orbitofrontal-anterior insula cortex. D. Dorsomedial prefrontal cortex. A results table is included, showing peak coordinates of each cluster and their corresponding statistics. (): Two outliers were detected based on the Tukey’s Outlier Filter. Although depicted in the figure, they were removed from correlation analyses.</p

Demographic and clinical description of the subjects included in the sample.

<p>BMI: Body mass index. EDI-2: Eating Disorders Inventory-2. LSAS: Liebowitz Social Anxiety Scale. HDRS: Hamilton Depression Rating Scale. HARS: Hamilton Anxiety Rating Scale.</p><p>* Patients received at least one week of supervised meals and hydration before the MRI, and were scanned in the afternoon, 2–4 hours after lunch.</p><p>Demographic and clinical description of the subjects included in the sample.</p

Table_1_Validation of the Spanish Version of the Yale Food Addiction Scale 2.0 (YFAS 2.0) and Clinical Correlates in a Sample of Eating Disorder, Gambling Disorder, and Healthy Control Participants.docx

<p>Aims: Due to the increasing evidence of shared vulnerabilities between addictive behaviors and excessive food intake, the concept of food addiction in specific clinical populations has become a topic of scientific interest. The aim of this study was to validate the Yale Food Addiction Scale (YFAS) 2.0 in a Spanish sample. We also sought to explore food addiction and its clinical correlates in eating disorder (ED) and gambling disorder (GD) patients.</p><p>Methods: The sample included 301 clinical cases (135 ED and 166 GD), diagnosed according to DSM-5 criteria, and 152 healthy controls (HC) recruited from the general population.</p><p>Results: Food addiction was more prevalent in patients with ED, than in patients with GD and HC (77.8, 7.8, and 3.3%, respectively). Food addiction severity was associated with higher BMI, psychopathology and specific personality traits, such as higher harm avoidance, and lower self-directedness. The psychometrical properties of the Spanish version of the YFAS 2.0 were excellent with good convergent validity. Moreover, it obtained good accuracy in discriminating between diagnostic subtypes.</p><p>Conclusions: Our results provide empirical support for the use of the Spanish YFAS 2.0 as a reliable and valid tool to assess food addiction among several clinical populations (namely ED and GD). The prevalence of food addiction is heterogeneous between disorders. Common risk factors such as high levels of psychopathology and low self-directedness appear to be present in individuals with food addiction.</p

Table_2_Validation of the Spanish Version of the Yale Food Addiction Scale 2.0 (YFAS 2.0) and Clinical Correlates in a Sample of Eating Disorder, Gambling Disorder, and Healthy Control Participants.docx

<p>Aims: Due to the increasing evidence of shared vulnerabilities between addictive behaviors and excessive food intake, the concept of food addiction in specific clinical populations has become a topic of scientific interest. The aim of this study was to validate the Yale Food Addiction Scale (YFAS) 2.0 in a Spanish sample. We also sought to explore food addiction and its clinical correlates in eating disorder (ED) and gambling disorder (GD) patients.</p><p>Methods: The sample included 301 clinical cases (135 ED and 166 GD), diagnosed according to DSM-5 criteria, and 152 healthy controls (HC) recruited from the general population.</p><p>Results: Food addiction was more prevalent in patients with ED, than in patients with GD and HC (77.8, 7.8, and 3.3%, respectively). Food addiction severity was associated with higher BMI, psychopathology and specific personality traits, such as higher harm avoidance, and lower self-directedness. The psychometrical properties of the Spanish version of the YFAS 2.0 were excellent with good convergent validity. Moreover, it obtained good accuracy in discriminating between diagnostic subtypes.</p><p>Conclusions: Our results provide empirical support for the use of the Spanish YFAS 2.0 as a reliable and valid tool to assess food addiction among several clinical populations (namely ED and GD). The prevalence of food addiction is heterogeneous between disorders. Common risk factors such as high levels of psychopathology and low self-directedness appear to be present in individuals with food addiction.</p

Clinical comparisons between anorexia nervosa subtypes and healthy controls.

<p>MD: mean difference. <i>d</i>: Cohen’s-<i>d</i> measuring effect size for mean difference.</p><p>*Significant mean difference (pairwise comparison, contrast) (.05 level).</p><p>^†Moderate (|<i>d</i>|≥0.50) to large (|<i>d</i>|≥0.80) effect size.</p><p>---Measure not available for the HC group.</p><p>AN-R: anorexia nervosa restricting subtype. AN-BP: anorexia nervosa binge/purging subtype. BMI: body mass index. BMR: basal metabolic rate. ED: eating disorder. FFM: fat-free mass. FM: fat-mass. HC: healthy controls. MM: muscular mass. TBW: total body water.</p><p>Clinical comparisons between anorexia nervosa subtypes and healthy controls.</p

Changes in body composition for AN patients.

<p>*Significant mean difference (pairwise comparison, contrast) (.05 level).</p><p>^†Moderate (|<i>d</i>|≥0.50) to large (|<i>d</i>|≥0.80) effect size.</p><p>^RPre-post (at the start and at the end of treatment) comparison for AN- restricting.</p><p>^PPre-post comparison for AN-binge/purging.</p><p>AN-R: anorexia nervosa restricting subtype. AN-BP: anorexia nervosa binge/purging subtype. BMI: body mass index. BMR: basal metabolic rate. FFM: fat-free mass. FM: fat mass. MM: muscular mass. TBW: total body water.</p><p>Changes in body composition for AN patients.</p