Increased Functional Connectivity Between Ventral Attention and Default Mode Networks in Adolescents With Bulimia Nervosa

doi:10.1016/j.jaac.2018.09.433

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 58, Issue 2, February 2019, Pages 232-241

This work was presented at the 64th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Washington, DC, October 23–28, 2017, and the Annual Meeting of the Society of Biological Psychiatry, New York, NY, May 10–12, 2018.

https://doi.org/10.1016/j.jaac.2018.09.433 Get rights and content

Objective

Bulimia nervosa (BN) is characterized by excessive attention to self and specifically to body shape and weight, but the ventral attention (VAN) and default mode (DMN) networks that support attentional and self-referential processes are understudied in BN. This study assessed whether altered functional connectivity within and between these networks contributes to such excessive concerns in adolescents with BN early the course of the disorder.

Method

Resting-state functional magnetic resonance images were acquired from 33 adolescents with BN and 37 healthy control adolescents (12–21 years) group matched by age and body mass index. Region-of-interest analyses were performed to examine group differences in functional connectivity within and between the VAN and DMN. In addition associations of VAN-DMN connectivity with BN symptoms, body shape/weight concerns, and sustained attention were explored using the Continuous Performance Test (CPT).

Results

Compared with control adolescents, those with BN showed significantly increased positive connectivity between the right ventral supramarginal gyrus and all DMN regions and between the right ventrolateral prefrontal cortex and the left lateral parietal cortex. Within-network connectivity did not differ between groups. VAN-DMN connectivity was associated with BN severity and body shape/weight concerns in the BN group. No significant group-by-CPT interactions on VAN-DMN connectivity were detected.

Conclusion

Increased positive VAN-DMN connectivity in adolescents with BN could reflect abnormal engagement of VAN-mediated attentional processes at rest, perhaps related to their excessive attention to self-referential thoughts about body shape/weight. Future studies should further investigate these circuits as targets for the development of early interventions aimed at decreasing excessive body shape/weight concerns.

Section snippets

Participants

Adolescent girls with BN (n = 33) and HCs (n = 37) group matched for age, body mass index, race, and ethnicity were recruited for study participation. Demographic and clinical characteristics of the samples are listed in Table 1. Formal BN and comorbid psychiatric diagnoses in all participants were made using the Structured Clinical Interview for DSM Disorders⁴⁰ for adolescents at least 18 years old and the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and

Participants

R-fMRI scans were acquired from 33 adolescent girls with BN (14–21 years) and 37 HCs matched by age and body mass index (12–21 years; Table 1). The groups did not differ significantly in age, body mass index, or IQ. All participants with BN met DSM-5 criteria for BN. Seven participants with BN also met DSM-5 criteria for MDD, 1 for generalized anxiety disorder, 1 for social anxiety disorder, 1 for MDD and dysthymia, and 1 for MDD and specific phobia. Seven participants with BN were on

Discussion

We investigated functional connectivity across attentional and self-referential circuits in adolescents with BN to identify circuit-based abnormalities that might underlie the development of distorted cognitions about body shape and weight. Increased positive VAN-DMN connectivity was associated with the frequency of their binge-eating and purging behaviors and their body shape/weight concerns. Although adolescents with BN performed worse on the CPT, no significant group-by-CPT interactions on

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: This work was supported by National Institute of Mental Health (NIMH) grant R01MH090062 to Dr. Marsh, National Institutes of Health/National Institute on Aging grant K01AG051348 to Dr. Lee, a Postdoctoral Fellowship from the Fonds de Recherche du Québec–Santé to Dr. Cyr, and an NIMH T32 Postdoctoral Fellowship for Translational Research in Child Psychiatry at Columbia University to Dr. Domakonda. This work also was supported in part by an American Academy of Child and Adolescent Psychiatry Pilot Research Award for Child Psychiatry Residents and Junior Faculty to Dr. Domakonda.

: Dr. Lee served as the statistical expert for this research.

: Disclosure: Dr. Domakonda has received research support from Hartford Healthcare. Dr. Lee has received research support from the NIMH. Dr. Marsh has received research support from NIMH, the National Institute of Environmental Health Sciences, the NVLD Project, the Columbia University Magnetic Resonance Research Center, and the Promise Project at Columbia University. Drs. He and Cyr report no biomedical financial interests or potential conflicts of interest.

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New researchIncreased Functional Connectivity Between Ventral Attention and Default Mode Networks in Adolescents With Bulimia Nervosa

Objective

Method

Results

Conclusion

Section snippets

Participants

Participants

Discussion

Psychiatry Res

Appetite

Neuron

J Am Acad Child Adolesc Psychiatry

Magn Reson Imaging

Neuroimage

Biol Psychiatry

Psychiatry Res Neuroimaging

Biol Psychiatry

Neurosci Biobehav Rev

Psychiatry Res Neuroimaging

Neurosci Lett

Psychiatry Res Neuroimaging

J Am Acad Child Adolesc Psychiatry

Neuroimage

Neuroimage

Neuroimage

Neuropsychologia

Neuroimage

Psychiatry Res Neuroimaging

Neuroimage

Biol Psychol

Magn Reson Imaging

J Am Acad Child Adolesc Psychiatry

Appetite

The cognitive-behavioral model of bulimia nervosa: a direct evaluation

Int J Eat Disord

Attentional bias in eating disorders

Int J Eat Disord

Selective visual attention during mirror exposure in anorexia and bulimia nervosa

PLoS One

A cognitive behavioural approach to the treatment of bulimia

Psychol Med

The investigation of schematic content and processing in eating disorders

Cogn Ther Res

The cognitive-behavioral model of bulimia nervosa: a direct evaluation

Int J Eat Disord

Selective information processing in bulimia nervosa

Int J Eat Disord

Bias for the (un)attractive self: on the role of attention in causing body (dis)satisfaction

Health Psychol

Processing biases in eating disorders: the impact of temporal factors

Int J Eat Disord

New research
Increased Functional Connectivity Between Ventral Attention and Default Mode Networks in Adolescents With Bulimia Nervosa