Brain activation during the perception of stressful word stimuli concerning interpersonal relationships in anorexia nervosa patients with high degrees of alexithymia in an fMRI paradigm.

Several studies have reported that anorexia nervosa (AN) patients have high levels of alexithymia. However, relatively little is known about the underlying neurobiological relationships between alexithymia and AN. We used functional magnetic resonance imaging to examine the brain responses in 30 AN patients and 20 healthy women during the processing of negative words concerning interpersonal relationships. We investigated the relationship between alexithymia levels and brain activation in AN. AN patients showed significant activation of the orbitofrontal cortex, dorsolateral prefrontal cortex and medial prefrontal cortex while processing negative words concerning interpersonal relationships, as compared to the processing of neutral words. Moreover, the subjective rating of unpleasantness with negative words and neural activities in the amygdala, posterior cingulate cortex (PCC) and anterior cingulate cortex (ACC) negatively correlated with the level of alexithymia in AN. Our neuroimaging results suggest that AN patients tend to cognitively process negative words concerning interpersonal relationships, resulting in activation of the prefrontal cortex. Lower activation of the amygdala, PCC and ACC in response to these words may contribute to the impairments of emotional processing that are hallmarks of alexithymia. Functional abnormalities associated with alexithymia may be involved in the emotional processing impairments in AN patients.

Neural processing of negative word stimuli concerning body image in patients with eating disorders: an fMRI study.

Eating disorders (EDs) are associated with abnormalities of body image perception. The aim of the present study was to investigate the functional abnormalities in brain systems during processing of negative words concerning body images in patients with EDs. Brain responses to negative words concerning body images (task condition) and neutral words (control condition) were measured using functional magnetic resonance imaging in 36 patients with EDs (12 with the restricting type anorexia nervosa; AN-R, 12 with the binging-purging type anorexia nervosa; AN-BP, and 12 with bulimia nervosa; BN) and 12 healthy young women. Participants were instructed to select the most negative word from each negative body-image word set and to select the most neutral word from each neutral word set. In the task relative to the control condition, the right amygdala was activated both in patients with AN-R and in patients with AN-BP. The left medial prefrontal cortex (mPFC) was activated both in patients with BN and in patients with AN-BP. It is suggested that these brain activations may be associated with abnormalities of body image perception. Amygdala activation may be involved in fearful emotional processing of negative words concerning body image and strong fears of gaining weight. One possible interpretation of the finding of mPFC activation is that it may reflect an attempt to regulate the emotion invoked by the stimuli. These abnormal brain functions may help provide better accounts of the psychopathological mechanisms underlying EDs.

Brain activation during the perception of distorted body images in eating disorders.

Eating disorder (ED) patients have severe disturbances in the perception of body shape and weight. The authors investigated brain activation patterns during the perception of distorted body images in various subtypes of ED. Participants comprised 33 patients with EDs (11 with restricting-type anorexia nervosa (AN-R), 11 with binging-purging type anorexia nervosa (AN-BP), 11 with bulimia nervosa (BN)) and 11 healthy women. Functional magnetic resonance imaging was used to examine cerebral response to morphed images of subjects' own bodies, as well as that of another woman. The amygdala was significantly activated in AN-R patients, AN-BP patients, and healthy women in response to their own fat-image, but this did not occur in BN patients. The prefrontal cortex (PFC) was significantly activated in AN-BP patients and healthy women, but not in AN-R and BN patients. Our results showed that the various EDs are different with respect to significant activation of the amygdala and PFC during the processing of participants' own fat-image. Brain activation pattern differences between the various EDs may underlie cognitive differences with respect to distorted body image, and therefore might reflect a general failure to represent and evaluate one's own body in a realistic fashion.

[Cognitive function in eating disorders and therapeutic approach].

We examined brain activation in the presence of eating disorders while processing unpleasant words concerning body images using functional magnetic resonance imaging (fMRI). Anorexia nervosa restricting type (AN-R) and anorexia nervosa binge-eating/ purging type (AN-BP) patients showed significant amygdala activation. Farther, AN-BP and bulimia nervosa (BN) patients showed significant medial prefrontal cortex activation. Next, we conducted short-term integrated group therapy for eating disorders. After treatment, depressive scores of POMS and emotional-oriented coping scores of CISS were significantly decreased, and EAT scores and self-esteem scores of RSES were significantly increased.

Neural correlates of alexithymia in response to emotional stimuli: a study of anorexia nervosa patients.

Individuals with alexithymia are typically unable to identify, understand, or describe their own emotions. Patients with anorexia nervosa (AN) have been shown to have high levels of alexithymia, and the latter trait may play an important role over the course of AN. However, relatively little is known about the underlying neurobiological relationships between alexithymia and AN. The aim of this study was to investigate the relationship between alexithymia level and brain activation in patients with AN. Thirty female patients participated in this study. Alexithymia was measured using the 20-item Toronto Alexithymia Scale. Functional magnetic resonance imaging was used to identify the brain regions that display abnormal hemodynamic activity while patients with AN were engaged in an emotional decision-making task. There was significant activation in the amygdala during the task, but not in the posterior and anterior cingulate cortices (PCC, ACC). However, PCC and ACC activation did vary as a function of alexithymia level. These results suggest that alexithymia in AN patients is associated with a deficit in the cognitive evaluation of negative emotions concerning body image. Alexithymia might play a crucial role in the emotional processing impairments that are often observed in AN patients, and this trait might ultimately help to better account for the psychopathological mechanism that underlies AN.

Distorted images of one's own body activates the prefrontal cortex and limbic/paralimbic system in young women: a functional magnetic resonance imaging study.

BACKGROUND: Our aim was to study the gender differences in brain activation upon viewing visual stimuli of distorted images of one's own body. METHODS: We performed functional magnetic resonance imaging on 11 healthy young men and 11 healthy young women using the "body image tasks" which consisted of fat, real, and thin shapes of the subject's own body. RESULTS: Comparison of the brain activation upon performing the fat-image task versus real-image task showed significant activation of the bilateral prefrontal cortex and left parahippocampal area including the amygdala in the women, and significant activation of the right occipital lobe including the primary and secondary visual cortices in the men. Comparison of brain activation upon performing the thin-image task versus real-image task showed significant activation of the left prefrontal cortex, left limbic area including the cingulate gyrus and paralimbic area including the insula in women, and significant activation of the occipital lobe including the left primary and secondary visual cortices in men. CONCLUSIONS: These results suggest that women tend to perceive distorted images of their own bodies by complex cognitive processing of emotion, whereas men tend to perceive distorted images of their own bodies by object visual processing and spatial visual processing.

Reduced activation of posterior cingulate cortex during imagery in subjects with high degrees of alexithymia: a functional magnetic resonance imaging study.

BACKGROUND: Although the brain areas involved in imagery have been reported, the neural bases of individual differences in imagery remain to be elucidated. People with high degrees of alexithymia (HDA) are known to have constricted imaginal capacities. The purpose of this study was to investigate neural correlates of imagery disturbance in subjects with HDA. METHODS: A functional magnetic resonance imaging (fMRI) study was undertaken in 10 subjects with HDA and 10 subjects with low degrees of alexithymia (LDA), who were selected according to their scores on the 20-item Toronto Alexithymia Scale (TAS-20). The two groups' regional cerebral activation was compared during various imagery conditions. In those conditions, the subjects imaged a past happy (PH) event, a past sad (PS) event, a past neutral (PN) event, a future happy (FH) event, a future sad (FS) event, and a future neutral (FN) event. The activation levels during these conditions were compared with those during a rest condition (REST). RESULTS: The t tests showed that the mean subjective ratings of both the vividness of the imagery and the intensity of emotion during the imagery were higher in the subjects with LDA than in those with HDA for the PS and FS imagery conditions. On the other hand, relative to the LDA group, the HDA group showed significantly less activation in the posterior cingulate cortex (PCC) during the PH and FH imagery conditions compared with REST and during the FH imagery condition compared with the FN imagery condition. CONCLUSION: The present results suggest an association between an HDA and reduced activation of the PCC during happy imagery. Given the function of this brain region, these results might be related to a dysfunction of episodic memory retrieval during happy imagery in subjects with HDA.

Gender differences in brain activity generated by unpleasant word stimuli concerning body image: an fMRI study.

BACKGROUND: We have previously reported that the temporomesial area, including the amygdala, is activated in women when processing unpleasant words concerning body image. AIMS: To detect gender differences in brain activation during processing of these words. METHOD: Functional magnetic resonance imaging was used to investigate 13 men and 13 women during an emotional decision task consisting of unpleasant words concerning body image and neutral words. RESULTS: The left medial prefrontal cortex and hippocampus were activated only among men, and the left amygdala was activated only among women during the task; activation in the apical prefrontal region was significantly greater in men than in women. CONCLUSIONS: Our data suggest that the prefrontal region is responsible for the gender differences in the processing of words concerning body image, and may also be responsible for gender differences in susceptibility to eating disorders.

Gender differences in brain activity toward unpleasant linguistic stimuli concerning interpersonal relationships: an fMRI study.

Women are more vulnerable to psychosocial stressors such as interpersonal conflicts than men, and are more susceptible to some psychiatric disorders. We hypothesized that there are differences in the brain activity of men and women while perceiving unpleasant linguistic stimuli concerning interpersonal relationships, and that they underlie the different sensitivity toward these stressful stimuli. We carried out a functional magnetic resonance imaging (fMRI) study on 13 young female adults and 13 young male adults who performed an emotional decision task including sets of unpleasant words concerning interpersonal relationships and sets of neutral words. In the women, the unpleasant words more significantly activated the bilateral caudate nuclei and left putamen than the neutral words. However, among the men, there was no difference in the level of activation of any brain area induced by the unpleasant or neutral word stimuli. Upon performing the task, there was a significant gender difference in brain activation. Moreover, among the female subjects, the activation in the bilateral caudate nuclei and left thalamus was negatively correlated with the average rating of pleasantness of the words concerning interpersonal conflicts by the subject. These results demonstrate gender differences in brain activity in processing unpleasant linguistic stimuli related to interpersonal conflicts. Our data suggest that the bilateral caudate nuclei and left putamen play an important role in the perception of words concerning interpersonal conflicts in women. The bilateral caudate nuclei and left thalamus may regulate a woman's sensitivity to unpleasant information about interpersonal difficulties.

Temporomesial activation in young females associated with unpleasant words concerning body image.

Previous behavioral studies suggest that people who have an abnormal eating behavior may perceive information concerning body image distortion more aversively than others. We performed a functional magnetic resonance imaging (fMRI) study on 15 young women, using an emotional decision task including unpleasant words concerning body image and neutral words. The left amygdala and right parahippocampal gyrus were activated by unpleasant words concerning body image relative to neutral words. In addition, activation of the right parahippocampal gyrus was negatively correlated with the severity of psychological and behavioral problems assessed by the Eating Disorder Inventory-2. This activation also positively correlated with the subjects' rating of pleasantness of words concerning body image. These results demonstrated that the temporomesial area plays an important role in the perception of unpleasant words concerning body image. In particular, it is suggested that the right parahippocampal gyrus may be associated with subjective sensitivity to unpleasant information concerning body image.