Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa.
BACKGROUND
Disturbances in neural systems that mediate voluntary self-regulatory processes may contribute to bulimia nervosa (BN) by releasing feeding behaviors from regulatory control.


OBJECTIVE
To study the functional activity in neural circuits that subserve self-regulatory control in women with BN.


METHODS
We compared functional magnetic resonance imaging blood oxygenation level-dependent responses in patients with BN with healthy controls during performance of the Simon Spatial Incompatibility task.


METHODS
University research institute.


METHODS
Forty women: 20 patients with BN and 20 healthy control participants. Main Outcome Measure We used general linear modeling of Simon Spatial Incompatibility task-related activations to compare groups on their patterns of brain activation associated with the successful or unsuccessful engagement of self-regulatory control.


RESULTS
Patients with BN responded more impulsively and made more errors on the task than did healthy controls; patients with the most severe symptoms made the most errors. During correct responding on incongruent trials, patients failed to activate frontostriatal circuits to the same degree as healthy controls in the left inferolateral prefrontal cortex (Brodmann area [BA] 45), bilateral inferior frontal gyrus (BA 44), lenticular and caudate nuclei, and anterior cingulate cortex (BA 24/32). Patients activated the dorsal anterior cingulate cortex (BA 32) more when making errors than when responding correctly. In contrast, healthy participants activated the anterior cingulate cortex more during correct than incorrect responses, and they activated the striatum more when responding incorrectly, likely reflecting an automatic response tendency that, in the absence of concomitant anterior cingulate cortex activity, produced incorrect responses.


CONCLUSIONS
Self-regulatory processes are impaired in women with BN, likely because of their failure to engage frontostriatal circuits appropriately. These findings enhance our understanding of the pathogenesis of BN by pointing to functional abnormalities within a neural system that subserves self-regulatory control, which may contribute to binge eating and other impulsive behaviors in women with BN.
Marsh
Rachel
R
Department of Psychiatry, New York State Psychiatric Institute and the College of Physicians and Surgeons, Columbia University, New York, New York. marshr@childpsych.columbia.edu
Steinglass
Joanna E
JE
Gerber
Andrew J
AJ
Graziano O'Leary
Kara
K
Wang
Zhishun
Z
Murphy
David
D
Walsh
B Timothy
BT
Peterson
Bradley S
BS
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology*; D052018:Bulimia Nervosa / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D002421:Caudate Nucleus / Q000503:physiopathology; D003342:Corpus Striatum / Q000503:physiopathology; D004192:Discrimination, Psychological / Q000502:physiology; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007175:Impulsive Behavior / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D007389:Internal-External Control; D008279:Magnetic Resonance Imaging; D009415:Nerve Net / Q000503:physiopathology; D009949:Orientation / Q000502:physiology; D010100:Oxygen / Q000097:blood*; D010364:Pattern Recognition, Visual / Q000502:physiology; D017397:Prefrontal Cortex / Q000503:physiopathology; D011597:Psychomotor Performance / Q000502:physiology; D012016:Reference Values
D010100:Oxygen