Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder associated with food avoidance and malnutrition. In this study, we wanted to test whether we would find brain reward alterations in AN, compared with individuals with normal or increased body weight. We studied 21 underweight, restricting-type AN (age M 22.5, SD 5.8 years), 19 obese (age M 27.1, SD 6.7 years), and 23 healthy control women (age M 24.8, SD 5.6 years), using blood oxygen level-dependent functional magnetic resonance brain imaging together with a reward-conditioning task. This paradigm involves learning the association between conditioned visual stimuli and unconditioned taste stimuli, as well as the unexpected violation of those learned associations. The task has been associated with activation of brain dopamine reward circuits, and it allows the comparison of actual brain response with expected brain activation based on established neuronal models. A group-by-task condition analysis (family-wise-error-corrected P<0.05) indicated that the orbitofrontal cortex differentiated all three groups. The dopamine model reward-learning signal distinguished groups in the anteroventral striatum, insula, and prefrontal cortex (P<0.001, 25 voxel cluster threshold), with brain responses that were greater in the AN group, but lesser in the obese group, compared with controls. These results suggest that brain reward circuits are more responsive to food stimuli in AN, but less responsive in obese women. The mechanism for this association is uncertain, but these brain reward response patterns could be biomarkers for the respective weight state.
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Acknowledgements
We thank Dr O’Doherty for providing the fractal images used as CS in the study. We would like to thank all the individuals who participated in this study, as well as the staff at the Eating Disorders program at the Children's Hospital and the Eating Disorder Center Denver.
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The authors declare no conflict of interest. All authors contributed significantly to this manuscript. Dr Frank is on the scientific advisory board of the Eating Disorders Center of Denver. Dr O’Reilly has received funding through the NIH IBSC center Grant 1-P50-MH079485. A Davis Foundation Award of the Klarman Family Foundation Grants Program in Eating Disorders, and the NIMH Grant K23 MH080135-01A2 provided funding for all aspects of the study to Dr Frank. The following is a list of the funding sources for each of the contributing authors: Dr Frank: NIH 5K23MH080135-04; Dr Reynolds: NIH, MH 079485, P50/IBSC and NIH, R01-DA027748; Dr O’Reilly: iARPA, ICArUS MINDS, NIH IBSC center 1-P50-MH079485 and ONR N00014-10-1-0177 1/15/10-12/31/12; Dr Yang: NIH 5R01MH085734-02; Dr Tregellas: VA 1I01CX000459-01 and NIH 5R01DK089095-02; Ms Shott And Ms Jappe: not applicable.
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Frank, G., Reynolds, J., Shott, M. et al. Anorexia Nervosa and Obesity are Associated with Opposite Brain Reward Response. Neuropsychopharmacol 37, 2031–2046 (2012). https://doi.org/10.1038/npp.2012.51
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DOI: https://doi.org/10.1038/npp.2012.51
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