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Medial prefrontal cortex activity is associated with symptom provocation in eating disorders
Uher, R., Murphy, T., Brammer, M.J., DALGLEISH, T., Phillips, M.L., Ng, V.W., Andrew, C.M., Williams, S.C.R., Campbell, I.C. & Treasure, J.
American Journal of Psychiatry, 161(7), 1238-1246
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Objective: Identification of neural correlates will contribute to the debate on the genesis and classification of eating disorders and will provide endophenotypes for genetic research. Method: 26 female patients with eating disorders (10 with bulimia nervosa, 16 with anorexia nervosa) and 19 female controls matched for age and education were presented with food and aversive emotional images while brain activity was being recorded by functional magnetic resonance. Results: Women with eating disorders identified the food stimuli as threatening and disgusting. In response to these stimuli, left medial orbitofrontal and anterior cingulate cortices were more activated whereas the lateral prefrontal cortex, the inferior parietal lobule and cerebellum were less active than in the comparison group. In bulimia nervosa, there was an additional decrease in lateral and apical prefrontal activity. The between-group differences in response to non-specific emotional stimuli were in the occipital cortex, parietal cortex and cerebellum. Conclusions: A medial prefrontal response to symptom provoking stimuli has been identified as a common feature of anorexia and bulimia nervosa, supporting the transdiagnostic concept in eating disorders at a neural level. The abnormal prefrontal reaction is associated with symptom-related material whereas the occipital and cerebellar differences are non-specific. It is proposed that an abnormal propensity to activate medial prefrontal circuits in response to inappropriate stimuli is common to eating, obsessive-compulsive and addictive disorders and may account for the compulsive features of behavior in these conditions.