Elsevier

Biological Psychiatry

Volume 70, Issue 8, 15 October 2011, Pages 736-743
Biological Psychiatry

Archival Report
Increased Neural Processing of Rewarding and Aversive Food Stimuli in Recovered Anorexia Nervosa

https://doi.org/10.1016/j.biopsych.2011.05.028Get rights and content

Background

Recent evidence has shown that individuals with acute anorexia nervosa and those recovered have aberrant physiological responses to rewarding stimuli. We hypothesized that women recovered from anorexia nervosa would show aberrant neural responses to both rewarding and aversive disorder-relevant stimuli.

Methods

Using functional magnetic resonance imaging (fMRI), the neural response to the sight and flavor of chocolate, and their combination, in 15 women recovered from restricting-type anorexia nervosa and 16 healthy control subjects matched for age and body mass index was investigated. The neural response to a control aversive condition, consisting of the sight of moldy strawberries and a corresponding unpleasant taste, was also measured. Participants simultaneously recorded subjective ratings of “pleasantness,” “intensity,” and “wanting.”

Results

Despite no differences between the groups in subjective ratings, individuals recovered from anorexia nervosa showed increased neural response to the pleasant chocolate taste in the ventral striatum and pleasant chocolate sight in the occipital cortex. The recovered participants also showed increased neural response to the aversive strawberry taste in the insula and putamen and to the aversive strawberry sight in the anterior cingulate cortex and caudate.

Conclusions

Individuals recovered from anorexia nervosa have increased neural responses to both rewarding and aversive food stimuli. These findings suggest that even after recovery, women with anorexia nervosa have increased salience attribution to food stimuli. These results aid our neurobiological understanding and support the view that the neural response to reward may constitute a neural biomarker for anorexia nervosa.

Section snippets

Participants

Fifteen women who had previously met DSM criteria (1) for anorexia nervosa and sixteen healthy control subjects were recruited for this study. Participants were recruited through advertisements. Ethical approval for the study was obtained from the University of Oxford and Outer West London Research Ethics Committee. Written informed consent was obtained for all participants.

All participants underwent a screening process that involved a brief e-mail screening and a face-to-face assessment using

Participant Characteristics

The two groups were matched for age, IQ, BMI, and chocolate eating/liking (Table 1). There were no differences between the control group and the recovered anorexia nervosa group in the measures of anhedonia (Snaith–Hamilton Pleasure Scale, Fawcett–Clarke Pleasure Scale), depression (Beck Depression Inventory), or anxiety (Trait Anxiety Inventory). However, the recovered group scored significantly higher on the EDE-Q (Table 1).

Ratings of Stimuli

Using a repeated-measures analysis of variance for the pleasantness,

Discussion

Our findings are the first to show that those recovered from anorexia nervosa have increased ventral striatal activity to the pleasant taste of chocolate compared with healthy control participants despite no difference in subjective experience. Furthermore, our results show that those recovered also have increased insula and caudate activity to the unpleasant conditions compared with healthy control subjects. This is consistent with recent research using food stimuli during acute anorexia

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