title: Neuroendocrinology and brain imaging of reward in eating disorders: A possible key to the treatment of anorexia nervosa and bulimia nervosa.
abstract: Anorexia nervosa and bulimia nervosa are severe eating disorders whose etiopathogenesis is still unknown. Clinical features suggest that eating disorders may develop as reward-dependent syndromes, since eating less food is perceived as rewarding in anorexia nervosa while consumption of large amounts of food during binge episodes in bulimia nervosa aims at reducing the patient's negative emotional states. Therefore, brain reward mechanisms have been a major focus of research in the attempt to contribute to the comprehension of the pathophysiology of these disorders. Structural brain imaging data provided the evidence that brain reward circuits may be altered in patients with anorexia or bulimia nervosa. Similarly, functional brain imaging studies exploring the activation of brain reward circuits by food stimuli as well as by stimuli recognized to be potentially rewarding for eating disordered patients, such as body image cues or stimuli related to food deprivation and physical hyperactivity, showed several dysfunctions in ED patients. Moreover, very recently, it has been demonstrated that some of the biochemical homeostatic modulators of eating behavior are also implicated in the regulation of food-related and non-food-related reward, representing a possible link between the aberrant behaviors of ED subjects and their hypothesized deranged reward processes. In particular, changes in leptin and ghrelin occur in patients with anorexia or bulimia nervosa and have been suggested to represent not only homeostatic adaptations to an altered energy balance but to contribute also to the acquisition and/or maintenance of persistent starvation, binge eating and physical hyperactivity, which are potentially rewarding for ED patients. On the basis of such findings new pathogenetic models of EDs have been proposed, and these models may provide new theoretical basis for the development of innovative treatment strategies, either psychological and pharmacological, with the aim to improve the outcomes of so severe disabling disorders.
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: Alessio Maria
authors.initials: AM
authors.lastname: Monteleone
authors.affiliation: Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Castellini
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Volpe
authors.affiliation: Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
authors.forename: Valdo
authors.initials: V
authors.lastname: Ricca
authors.affiliation: Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lelli
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy; Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy. Electronic address: monteri@tin.it.
authors.forename: Palmiero
authors.initials: P
authors.lastname: Monteleone
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Maj
mesh_terms: D000818:Animals; D001921:Brain / Q000000981:diagnostic imaging*; D001068:Feeding and Eating Disorders / Q000000981:diagnostic imaging* / Q000378:metabolism*; D006801:Humans; D009452:Neuroendocrinology; D012201:Reward
keywords: Anorexia nervosa; Brain imaging; Bulimia nervosa; Eating disorders; Neuroendocrinology; Reward