Alterations in brain structure in adults with anorexia nervosa and the impact of illness duration.
BACKGROUND
Brain structure alterations have been reported in anorexia nervosa, but findings have been inconsistent. This may be due to inadequate sample size, sample heterogeneity or differences in methodology.


METHODS
High resolution magnetic resonance images were acquired of 33 adult participants with anorexia nervosa and 33 healthy participants, the largest study sample to date, in order to assess whole-brain volume, ventricular cerebrospinal fluid, white matter and grey matter volume. Voxel-based morphometry was conducted to assess regional grey matter volume. Levels of depression, anxiety, obsessionality and eating disorder-related symptoms were measured and used to explore correlations with brain structure.


RESULTS
Participants with anorexia nervosa had smaller brain volumes as well as a global decrease in grey matter volume with ventricular enlargement. Voxel-based morphometry revealed a decrease in grey matter volume spanning across the cerebellum, temporal, frontal and occipital lobes. A correlation was found between grey matter volume loss and duration of illness in the cerebellum and mesencephalon. No correlations were found with clinical measures.


CONCLUSIONS
Findings are in accordance with several previous studies on brain structure and match functional studies that have assessed the symptomatology of anorexia nervosa, such as body image distortion and cognitive bias to food. The correlation with duration of illness supports the implication of cerebellar atrophy in the maintenance of low weight and disrupted eating behaviour and illustrates its role in the chronic phase of anorexia nervosa. The lack of other correlations suggests that these findings are not related to the presence of co-morbid disorders.
King's College London,Institute of Psychiatry, Department of Psychological Medicine, London,UK.
L
L
Fonville
King's College London,Institute of Psychiatry, Department of Neuroimaging, London,UK.
V
V
Giampietro
King's College London,Institute of Psychiatry, Department of Neuroimaging, London,UK.
S C R
SC
Williams
King's College London,Institute of Psychiatry, Department of Neuroimaging, London,UK.
A
A
Simmons
King's College London,Institute of Psychiatry, Department of Psychological Medicine, London,UK.
K
K
Tchanturia
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D002531:Cerebellum / Q000473:pathology; D002552:Cerebral Ventricles / Q000473:pathology; D005260:Female; D066128:Gray Matter / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult