Normal Brain Tissue Volumes after Long-Term Recovery in Anorexia and Bulimia Nervosa

doi:10.1016/j.biopsych.2005.06.014

Biological Psychiatry

Volume 59, Issue 3, 1 February 2006, Pages 291-293

https://doi.org/10.1016/j.biopsych.2005.06.014 Get rights and content

Background

Individuals who are ill with anorexia (AN) and bulimia nervosa (BN) often have increased cerebrospinal fluid (CSF) volumes and decreased total gray and white matter volumes. It is unclear whether such disturbances persist after recovery from an eating disorder.

Methods

Magnetic resonance imaging was performed on 40 women who were long-term recovered (>1 year no binging, purging, or restricting behaviors, normal weight, and menstrual cycles, not on medication) from restricting or binge/purging type AN or BN and 31 healthy control women (CW). Voxel-based morphometry (VBM) was used for data analysis.

Results

Recovered AN and BN subgroups were similar to CW in terms of cerebrospinal fluid (CSF) volume as well as total or regional gray or white matter volume.

Conclusions

These findings suggest that structural brain abnormalities are reversible in individuals with eating disorders after long-term recovery.

Section snippets

Sample Collection

Forty recovered ED subjects were recruited, 14 meeting criteria for restricting type AN (RAN), 16 for binge-purging type AN (BAN) and 10 for BN. To be considered “recovered,” for the previous year subjects had to (1) maintain a weight above 85% of average body weight; (2) have regular menstrual cycles; (3) have not binged, purged, restricted food intake or exercised excessively; and (4) not used psychoactive medications. Thirty-one CW were recruited. They had no history of an ED or any

Results

Recovered subjects and CW were of similar age and body mass index (BMI) (Table 1). The average length of recovery ranged from 29.8 to 39.5 months. Groups had similar volumes for total (Table 2) GM, WM, and CSF as well as regional values (data not shown). There was a small but not significant decline of total GMV with age, while total WMV and total CSF volume showed a small but not significant increase in all recovered subjects (age/GMV: r = −.193, p = .232; age/ WMV: r = .167, p = .304; age vs.

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Cited by (137)

Brain Structure in Acutely Underweight and Partially Weight-Restored Individuals With Anorexia Nervosa: A Coordinated Analysis by the ENIGMA Eating Disorders Working Group
2022, Biological Psychiatry
The pattern of structural brain abnormalities in anorexia nervosa (AN) is still not well understood. While several studies report substantial deficits in gray matter volume and cortical thickness in acutely underweight patients, others find no differences, or even increases in patients compared with healthy control subjects. Recent weight regain before scanning may explain some of this heterogeneity. To clarify the extent, magnitude, and dependencies of gray matter changes in AN, we conducted a prospective, coordinated meta-analysis of multicenter neuroimaging data.
We analyzed T1-weighted structural magnetic resonance imaging scans assessed with standardized methods from 685 female patients with AN and 963 female healthy control subjects across 22 sites worldwide. In addition to a case-control comparison, we conducted a 3-group analysis comparing healthy control subjects with acutely underweight AN patients (n = 466) and partially weight-restored patients in treatment (n = 251).
In AN, reductions in cortical thickness, subcortical volumes, and, to a lesser extent, cortical surface area were sizable (Cohen’s d up to 0.95), widespread, and colocalized with hub regions. Highlighting the effects of undernutrition, these deficits were associated with lower body mass index in the AN sample and were less pronounced in partially weight-restored patients.
The effect sizes observed for cortical thickness deficits in acute AN are the largest of any psychiatric disorder investigated in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium to date. These results confirm the importance of considering weight loss and renutrition in biomedical research on AN and underscore the importance of treatment engagement to prevent potentially long-lasting structural brain changes in this population.
Dynamic Structural Brain Changes in Anorexia Nervosa: A Replication Study, Mega-analysis, and Virtual Histology Approach
2022, Journal of the American Academy of Child and Adolescent Psychiatry
Citation Excerpt :
Extending previous longitudinal findings,7 comparisons between acAN-TP2 and HC showed again that GM structure is already normalized after short-term/partial weight restoration. In fact, the velocity of changes in GM structure as a function of weight gain was much faster than previously assumed49,50 and at least one order of magnitude faster than common age-related effects (Figure S3, available online). This rapid normalization could not be attributed to an improvement in symptom severity or changes in hydration status.
Several, but not all, previous studies of brain structure in anorexia nervosa (AN) have reported reductions in gray matter volume and cortical thickness (CT) in acutely underweight patients, which seem to reverse upon weight gain. The biological mechanisms underlying these dynamic alterations remain unclear.
In this structural magnetic resonance imaging study, we first replicated and extended previous results in (1) a larger independent sample of 75 acutely underweight adolescent and young adult female patients with AN (acAN; n = 54 rescanned longitudinally after partial weight restoration), 34 weight-recovered individuals with a history of AN (recAN), and 139 healthy controls (HC); and 2) a greater combined sample compiled of both our previous samples and the present replication sample (120 acAN [90 rescanned longitudinally], 68 recAN, and 207 HC). Next, we applied a “virtual histology” approach to the combined data, investigating relations between interregional profiles of differences in CT and profiles of cell-specific gene expression. Finally, we used the ENIGMA toolbox to relate aforementioned CT profiles to normative structural and functional connectomics.
We confirmed sizeable and widespread reductions of CT as well as volumes (and, to a lesser extent, surface area) in acAN and rapid increases related to partial weight restoration. No differences were detected between either short- or long-term weight-recovered patients and HC. The virtual histology analysis identified associations between gene expression profiles of S1 pyramidal cells and oligodendrocytes and brain regions with more marked differences in CT, whereas the remaining regions were those with a greater expression of genes specific to CA1 pyramidal, astrocytes, microglia, and ependymal cells. Furthermore, the most affected regions were also more functionally and structurally connected.
The overall data pattern deviates from findings in other psychiatric disorders. Both virtual histology and connectomics analyses indicated that brain regions most affected in AN are also the most energetically demanding.
Striatal volumes as potential biomarkers in Eating Disorders: A pilot study
2022, Revista de Psiquiatria y Salud Mental
Differences in bulimic and impulsive behaviours in Eating Disorders (ED) have been associated with cortico-striatal circuit dysfunction at a neurobiological level. We sought to investigate neo-striatal volume as a biomarker in ED subgroups as well as the possible relationship with trauma history.
We studied 24 female patients: Anorexia Nervosa AN (n = 8), Bulimia Nervosa BN (n = 9), comorbid ED with borderline personality disorder (EDc; n = 7), and a group of Healthy Controls (n = 19). Binge eating behaviours and impulsivity scales were used to characterize our sample as well as Trauma Questionnaires and Magnetic resonance imaging (MRI) volumetric manual measurements of caudate and putamen nuclei (striatum).
Our preliminary results showed a significantly larger left putaminal volume in AN compared to the other three groups [C (p = 0.008), BN (p < .001) and EDc (p = .001)] and a smaller right putaminal volume in EDc compared to controls (p = .045) and AN (p = .039).
Some negative correlations were found between bilateral putaminal volumes and self-reported general and early traumatization scores.
This pilot study suggested that striatal volumes might differentiate AN from BN and EDc at a neurobiological level with implications for treatment strategies. Larger scale studies should be carried out that allow replication of these data.
Las diferencias en comportamientos bulímicos e impulsivos de los trastornos de la conducta alimentaria (TCA) se han relacionado, desde el punto de vista neurobiológico con una disfunción córtico-estriatal. El objetivo de este estudio fue investigar el volumen neo-estriatal como un biomarcador de los subgrupos de TCA, así como la posible relación con antecedentes traumáticos.
Se estudiaron 24 pacientes con diagnósticos de anorexia nerviosa (AN, n = 8); bulimia nerviosa (BN, n = 9); TCA comórbido con trastorno límite de la personalidad (TCAc; n = 7), y un grupo de controles sanos (n = 19). Se utilizaron escalas de impulsividad y comportamiento bulímico para caracterizar a la muestra, así como escalas de trauma y medidas volumétricas de trazado manual de los núcleos caudado y del putamen (estriado) de imágenes de resonancia magnética (RM).
Nuestros resultados preliminares mostraron un volumen del putamen izquierdo significativamente mayor en las pacientes con AN comparado con el resto de los grupos (C [p < 0,008], BN [p < 0,001] y TCAc [p < 0,001]) y un volumen del putamen derecho menor en el grupo TCAc comparado con los controles. Se encontraron algunas correlaciones negativas entre el volumen del putamen bilateral y algunas puntuaciones auto-referidas de escalas de trauma.
Este estudio piloto sugiere que los volúmenes estriatales podrían diferenciar las pacientes AN, BN y TCAc a un nivel neurobiológico, lo que puede tener implicaciones beneficiosas de cara a las estrategias de tratamiento. Sin embargo, serán necesarios estudios a mayor escala que permitan replicar estos datos.
End-Stage Anorexia Nervosa: When to Say “When”—A Literature Review of an Ethically Complicated Case
2020, Psychosomatics
Metacognition in individuals recovered from anorexia nervosa: a voxel-based morphometry study.
2020, Psychiatry Research - Neuroimaging
Recent evidence shows that individuals with Anorexia Nervosa (AN) can be characterized by dysfunctional metacognition as well as reductions of gray matter volumes (GMV) in prefrontal brain regions involved in cognitive processes. However, whether these differences are reversible or stable markers has yet to be understood. Thus, we aimed at characterizing metacognition and brain morphometry in individuals recovered from AN (rec-AN).
A combined psychometric-brain morphometry investigation on metacognitive functioning in rec-AN individuals was conducted. Fifteen healthy controls (HC) and fifteen rec-AN women underwent a psychometric assessment for metacognitive functioning and a high-resolution T1-weighted Magnetic Resonance Imaging measurement to assess global and regional brain volumes, using Voxel-Based Morphometry.
The two groups did not differ for metacognitive functioning and GMV, while regional GMV reductions were observed in rec-AN compared to HC in the left Inferior Frontal Gyrus (IFG). While changes in metacognitive abilities may not represent a stable trait of AN, regional GMV reductions in brain regions devoted to specific cognitive functions, such as inhibitory/top-down control processes, can act as a neurobiological fingerprint for such condition. These findings can represent a promising hint for future investigations on the maintaining factors of AN.
Alterations of brain structure and functions in anorexia nervosa
2019, Clinical Nutrition Experimental
The eating disorder anorexia nervosa develops mostly in adolescent girls and young women and has the highest mortality rate among psychiatric diseases. Symptoms are caloric food restriction, body weight loss or maintained very low body weight, body image disturbance and hyperactivity. Clinically, the disease is well characterized, but the underlying pathophysiology still remains to be better described. Already several decades ago, physicians and researchers began to investigate potential causes of the disease in the brain with advancing neuroimaging techniques yielding important insights. The purpose of this short review is to summarize the current knowledge on brain alterations in anorexia nervosa and to stimulate future research. By using MRI and fMRI scans, structural and functional changes can be detected. In MRI scans the most common finding is gray and white matter reduction correlating with the extent of malnourishment and mostly reversible with recovery. Most fMRI studies performed in patients with anorexia nervosa focused on food, taste, physical appearance and social cognition. Although very different in terms of the study protocol, the most common findings are increased activation of the amygdala and altered activation of the cingulate cortex. Further research is required in order to connect the different findings to further investigate the neurobiological differences between the subtypes of anorexia nervosa.

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Brief reportNormal Brain Tissue Volumes after Long-Term Recovery in Anorexia and Bulimia Nervosa

Background

Methods

Results

Conclusions

Section snippets

Sample Collection

Results

J Pediatr

Neuroimage

NeuroImage

Biol Psychiatry

Biol Psychiatry

J Pediatri

Psychiatry Res

Biol Psychiatry

Altered 5-HT2A receptor binding after recovery from bulimia-type anorexia nervosarelationships to harm avoidance and drive for thinness

Neuropsychopharmacology

Structural brain changes in patients with anorexia nervosa

Psychol Medicine

Users guide for the structured clinical interview for DSM-IV Axis I disorders- research version

Brief report
Normal Brain Tissue Volumes after Long-Term Recovery in Anorexia and Bulimia Nervosa

Altered 5-HT_2A receptor binding after recovery from bulimia-type anorexia nervosarelationships to harm avoidance and drive for thinness