Attention Network Dysfunction in Bulimia Nervosa - An fMRI Study.
OBJECTIVE
Recent evidence has suggested an increased rate of comorbid ADHD and subclinical attentional impairments in bulimia nervosa (BN) patients. However, little is known regarding the underlying neural mechanisms of attentional functions in BN.


METHODS
Twenty BN patients and twenty age- and weight-matched healthy controls (HC) were investigated using a modified version of the Attention Network Task (ANT) in an fMRI study. This design enabled an investigation of the neural mechanisms associated with the three attention networks involved in alerting, reorienting and executive attention.


RESULTS
The BN patients showed hyperactivation in parieto-occipital regions and reduced deactivation of default-mode-network (DMN) areas during alerting compared with HCs. Posterior cingulate activation during alerting correlated with the severity of eating-disorder symptoms within the patient group. Conversely, BN patients showed hypoactivation during reorienting and executive attention in anterior cingulate regions, the temporo-parietal junction (TPJ) and parahippocampus compared with HCs, which was negatively associated with global ADHD symptoms and impulsivity, respectively.


CONCLUSIONS
Our findings demonstrate altered brain mechanisms in BN associated with all three attentional networks. Failure to deactivate the DMN and increased parieto-occipital activation required for alerting might be associated with a constant preoccupation with food or body image-related thoughts. Hypoactivation of executive control networks and TPJ might increase the likelihood of inattentive and impulsive behaviors and poor emotion regulation. Thus, dysfunction in the attentional network in BN goes beyond an altered executive attentional domain and needs to be considered in the diagnosis and treatment of BN.
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany.|Department of Cognitive Neuroscience, Faculty of Psychology and Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands.
Jochen
J
Seitz
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany.
Manuel
M
Hueck
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany.
Brigitte
B
Dahmen
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany.|JARA-BRAIN, 52074 Aachen, Germany.
Martin
M
Schulte-Rüther
LWL Child and Adolescent Psychiatry, University Hospital Hamm, Ruhr-University Bochum, Hamm, Germany.|Psychiatric Outpatient Clinic, University Mainz, Mainz, Germany.
Tanja
T
Legenbauer
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany.
Beate
B
Herpertz-Dahlmann
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Aachen, Germany.
Kerstin
K
Konrad
D000293:Adolescent; D001288:Attention / Q000502:physiology*; D001519:Behavior; D001931:Brain Mapping; D052018:Bulimia Nervosa / Q000503:physiopathology*; D016022:Case-Control Studies; D003710:Demography; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging