title: Structural and functional differences in the cingulate cortex relate to disease severity in anorexia nervosa.
abstract: BACKGROUND
  The dysfunction of specific brain areas might account for the distortion of body image in patients with anorexia nervosa. The present study was designed to reveal brain regions that are abnormal in structure and function in patients with this disorder. We hypothesized, based on brain areas of altered activity in patients with anorexia nervosa and regions involved in pain processing, an interrelation of structural aberrations in the frontoparietal-cingulate network and aberrant functional activation during thermal pain processing in patients with the disorder.
  
  
  METHODS
  We determined pain thresholds outside the MRI scanner in patients with anorexia nervosa and matched healthy controls. Thereafter, thermal pain stimuli were applied during fMRI imaging. Structural analyses with high-resolution structural T1-weighted volumes were performed using voxel-based morphometry and a surface-based approach.
  
  
  RESULTS
  Twenty-six patients and 26 controls participated in our study, and owing to technical difficulties, 15 participants in each group were included in our fMRI analysis. Structural analyses revealed significantly decreased grey matter volume and cortical thickness in the frontoparietal-cingulate network in patients with anorexia nervosa. We detected an increased blood oxygen level-dependent signal in patients during the painful 45 °C condition in the midcingulate and posterior cingulate cortex, which positively correlated with increased pain thresholds. Decreased grey matter and cortical thickness correlated negatively with pain thresholds, symptom severity and illness duration, but not with body mass index.
  
  
  CONCLUSIONS
  The lack of a specific quantification of body image distortion is a limitation of our study.
  
  
  CONCLUSIONS
  This study provides further evidence for confined structural and functional brain abnormalities in patients with anorexia nervosa in brain regions that are involved in perception and integration of bodily stimuli. The association of structural and functional deviations with thermal thresholds as well as with clinical characteristics might indicate a common neuronal origin.
authors.affiliation: Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
authors.forename: Karl-Jürgen
authors.initials: KJ
authors.lastname: Bär
authors.affiliation: Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
authors.forename: Feliberto
authors.initials: F
authors.lastname: de la Cruz
authors.affiliation: Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
authors.forename: Sandy
authors.initials: S
authors.lastname: Berger
authors.affiliation: Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
authors.forename: Carl C
authors.initials: CC
authors.lastname: Schultz
authors.affiliation: Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Wagner
mesh_terms: D000856:Anorexia Nervosa / Q000473:pathology* / Q000503:physiopathology*; D001931:Brain Mapping; D005260:Female; D066128:Gray Matter / Q000473:pathology / Q000503:physiopathology; D006179:Gyrus Cinguli / Q000473:pathology* / Q000503:physiopathology*; D006358:Hot Temperature; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D058748:Pain Perception / Q000502:physiology; D017288:Pain Threshold / Q000502:physiology; D010812:Physical Stimulation; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D055815:Young Adult
references.citation: Clin Psychol Rev. 2011 Feb;31(1):37-51
references.pmid: 21130935
references.citation: Neuroimage. 2010 Nov 15;53(3):1135-46
references.pmid: 20006715
references.citation: J Neurosci. 2011 Mar 2;31(9):3217-24
references.pmid: 21368033
references.citation: Psychiatry Res. 2011 Jun 30;192(3):154-9
references.pmid: 21546219
references.citation: J Neurosci. 2012 Jan 4;32(1):215-22
references.pmid: 22219283
references.citation: BMC Psychiatry. 2011;11:179
references.pmid: 22093442
references.citation: Eur Eat Disord Rev. 2012 Mar;20(2):94-105
references.pmid: 22052722
references.citation: Neurosci Biobehav Rev. 2012 Sep;36(8):1839-47
references.pmid: 22613629
references.citation: J Psychiatr Res. 2012 Nov;46(11):1449-55
references.pmid: 22868048
references.citation: PLoS One. 2012;7(9):e45081
references.pmid: 23028771
references.citation: Int J Eat Disord. 2013 Jan;46(1):23-33
references.pmid: 22836447
references.citation: Acta Psychiatr Scand. 2013 Apr;127(4):269-78
references.pmid: 22747702
references.citation: N Engl J Med. 2013 Apr 11;368(15):1388-97
references.pmid: 23574118
references.citation: J Neurosci. 2013 Jun 19;33(25):10503-11
references.pmid: 23785162
references.citation: Am J Psychiatry. 2013 Oct;170(10):1152-60
references.pmid: 23680873
references.citation: Soc Cogn Affect Neurosci. 2013 Oct;8(7):828-37
references.pmid: 22798398
references.citation: Soc Cogn Affect Neurosci. 2014 Jan;9(1):12-21
references.pmid: 22956668
references.citation: Hum Brain Mapp. 2014 Feb;35(2):483-91
references.pmid: 23033154
references.citation: J Psychiatry Neurosci. 2014 May;39(3):178-88
references.pmid: 24280181
references.citation: Am J Psychiatry. 2000 Mar;157(3):393-401
references.pmid: 10698815
references.citation: Proc Natl Acad Sci U S A. 2000 Sep 26;97(20):11050-5
references.pmid: 10984517
references.citation: Int J Eat Disord. 2001 May;29(4):417-28
references.pmid: 11285579
references.citation: Psychol Med. 2001 May;31(4):737-40
references.pmid: 11352375
references.citation: Psychiatry Res. 2001 Jul 1;107(1):45-50
references.pmid: 11472863
references.citation: J Clin Exp Neuropsychol. 2001 Aug;23(4):520-9
references.pmid: 11780950
references.citation: Neuroimage. 2002 May;16(1):158-68
references.pmid: 11969326
references.citation: Nat Rev Neurosci. 2002 Aug;3(8):655-66
references.pmid: 12154366
references.citation: Psychiatry Res. 2011 Jan 30;191(1):24-30
references.pmid: 21081268
references.citation: Psychol Med. 2010 Sep;40(9):1519-29
references.pmid: 19917143
references.citation: Biol Psychiatry. 2003 Nov 1;54(9):934-42
references.pmid: 14573322
references.citation: Eur J Neurosci. 2003 Dec;18(11):3134-44
references.pmid: 14656310
references.citation: Proc Natl Acad Sci U S A. 2004 Apr 27;101(17):6827-32
references.pmid: 15096584
references.citation: J Clin Exp Neuropsychol. 1992 Mar;14(2):347-52
references.pmid: 1572954
references.citation: Biol Psychiatry. 1995 Feb 1;37(3):161-9
references.pmid: 7727624
references.citation: Psychol Med. 1996 Jan;26(1):15-28
references.pmid: 8643754
references.citation: J Psychosom Res. 1996 Jul;41(1):65-70
references.pmid: 8887820
references.citation: Brain Res Brain Res Rev. 1996 Oct;22(3):229-44
references.pmid: 8957561
references.citation: J Psychiatr Res. 1999 Mar-Apr;33(2):129-38
references.pmid: 10221745
references.citation: Psychosom Med. 1962 Mar-Apr;24:187-94
references.pmid: 13873828
references.citation: Neuroimage. 2005 Apr 15;25(3):718-26
references.pmid: 15808973
references.citation: Pain. 2005 Sep;117(1-2):97-103
references.pmid: 16061323
references.citation: Psychiatry Res. 2005 Dec 30;140(3):251-8
references.pmid: 16288853
references.citation: J Am Acad Child Adolesc Psychiatry. 2006 Sep;45(9):1068-76
references.pmid: 16926614
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2006 Sep 30;30(7):1265-70
references.pmid: 16777310
references.citation: Biol Psychiatry. 2006 Feb 1;59(3):291-3
references.pmid: 16139807
references.citation: Brain Res. 2006 Oct 9;1114(1):138-48
references.pmid: 16919246
references.citation: Biol Psychiatry. 2007 Dec 1;62(11):1281-7
references.pmid: 17570347
references.citation: Am J Psychiatry. 2007 Dec;164(12):1850-7
references.pmid: 18056240
references.citation: Z Kinder Jugendpsychiatr Psychother. 2007 Nov;35(6):423-34
references.pmid: 18357972
references.citation: Eur Eat Disord Rev. 2008 Sep;16(5):355-60
references.pmid: 18711713
references.citation: Neuroimage. 2009 Jan 1;44(1):83-98
references.pmid: 18501637
references.citation: Nat Rev Neurosci. 2009 Jan;10(1):59-70
references.pmid: 19096369
references.citation: J Psychiatr Res. 2009 Sep;43(14):1133-45
references.pmid: 19442986
references.citation: Behav Brain Res. 2010 Jan 5;206(1):63-7
references.pmid: 19729041
references.citation: J Psychiatry Neurosci. 2010 May;35(3):163-76
references.pmid: 20420767
references.citation: Psychiatry Res. 2010 May 30;182(2):146-51
references.pmid: 20400273
references.citation: Neuropsychologia. 2010 Aug;48(10):2878-85
references.pmid: 20553738