title: An FMRI study of self-regulatory control and conflict resolution in adolescents with bulimia nervosa.
abstract: OBJECTIVE
  The authors examined functional activity in the frontostriatal systems that mediate self-regulatory capacities and conflict resolution in adolescents with bulimia nervosa.
  
  
  METHODS
  Functional magnetic resonance imaging was used to compare blood-oxygen-level-dependent response in 18 female adolescents with bulimia nervosa and 18 healthy female age-matched subjects during performance on a Simon spatial incompatibility task. Bayesian analyses were used to compare the two groups on patterns of brain activation during correct responses to conflict stimuli and to explore the effects of antecedent stimulus context on group differences in self-regulation and conflict resolution.
  
  
  RESULTS
  Adolescents with and without bulimia nervosa performed similarly on the task. During correct responses in conflict trials, frontostriatal circuits-including the right inferolateral and dorsolateral prefrontal cortices and putamen-failed to activate to the same degree in adolescents with bulimia nervosa as in healthy comparison subjects. Instead, deactivation was seen in the left inferior frontal gyrus as well as a neural system encompassing the posterior cingulate cortex and superior frontal gyrus. Group differences in cortical and striatal regions were driven by the differential responses to stimuli preceded by conflict and nonconflict stimuli, respectively.
  
  
  CONCLUSIONS
  When engaging the self-regulatory control processes necessary to resolve conflict, adolescents with bulimia nervosa displayed abnormal patterns of activation in frontostriatal and default-mode systems. Their abnormal processing of the antecedent stimulus context conditioned their brain response to conflict differently from that of healthy comparison subjects, specifically in frontal regions. It is suspected that functional disturbances in frontal portions of frontostriatal systems may release feeding behaviors from regulatory control, thereby perpetuating the conflicting desires to consume fattening foods and avoid weight gain that characterize bulimia nervosa.
authors.affiliation: Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, USA. MarshR@childpsych.columbia.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Marsh
authors.forename: Guillermo
authors.initials: G
authors.lastname: Horga
authors.forename: Zhishun
authors.initials: Z
authors.lastname: Wang
authors.forename: Pengwei
authors.initials: P
authors.lastname: Wang
authors.forename: Kristin W
authors.initials: KW
authors.lastname: Klahr
authors.forename: Laura A
authors.initials: LA
authors.lastname: Berner
authors.forename: B Timothy
authors.initials: BT
authors.lastname: Walsh
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Peterson
mesh_terms: D000293:Adolescent; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D052018:Bulimia Nervosa / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008279:Magnetic Resonance Imaging; D017008:Negotiating / Q000523:psychology*; D009415:Nerve Net / Q000503:physiopathology; D059906:Neuroimaging; D011597:Psychomotor Performance / Q000502:physiology; D012927:Social Control, Informal