A functional magnetic resonance imaging investigation of body image in adolescent girls with anorexia nervosa

Anorexia Nervosa (AN) is a psychiatric disorder characterized by restriction of food intake despite very low body weight and body image disturbance. We aimed to clarify body image disorder in this study by using functional magnetic resonance imaging (fMRI). The sample has consisted of twelve adolescent girls diagnosed with AN, nine girls with major depression, and ten girls without any psychiatric diagnosis. In addition to the psychiatric diagnosis interview before fMRI, all participants were given questionnaires about eating disorder, body image disorder, depression, anxiety, and obsessive symptoms. The participants were photographed for the task in standard clothes, and their original images were prepared to obtain overweight and underweight images. We applied a block-design task in fMRI and after imaging, the participants scored the images for resemblance, satisfaction, and anxiety levels. We observed wider activations in the occipitotemporal regions for overweight images in all three groups compared to other images. However, no difference was found between the groups. The frontal cortex and insula activations in the depression and healthy control groups for underweight images compared to original images were not seen in the AN group, but there were activations in the parietal cortex in the AN group. In depression group, we observed that midline limbic structures such as the cingulate cortex and basal ganglia were activated. Correlations were found between brain activations and self-report scores. As a result, AN patients evaluated their underweight compared to original images both subjectively and neurobiologically different from other groups. For all participants, the activation levels were greater for their overweight images. In conclusion, the biases AN patients had when evaluating their images may be related to aberrant cognitive and emotional evaluation processes of body image.