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Who is in charge? Cortical and subcortical circuits determining eating disorder behavior.

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The eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) are severe psychiatric disorders with high mortality. Our knowledge about the neurobiology of eating disorders is very limited, and the question remains whether alterations in brain structure or function in eating disorders are state related, ...

The eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) are severe psychiatric disorders with high mortality. Our knowledge about the neurobiology of eating disorders is very limited, and the question remains whether alterations in brain structure or function in eating disorders are state related, remnants of the illness or premorbid traits.
Past research has highlighted the importance of anxiety and anxious traits in general, and fears of fatness and weight as specific manifestations of the disorders. Those weight and shape related concerns commonly are triggered by the environment, but seem to be perpetuated by an overactive anxiety circuitry across frontal brain regions, the anterior cingulate and amygdala. More recent studies have found that the more subcortical brain reward pathways may have important effects in eating disorder pathophysiology and may distinguish eating disorder subgroups. I propose that structural and functional alterations in the insula and frontal cortex, including orbitofrontal and cingulate regions, areas that contribute to reward and anxiety processing, could predispose to developing an eating disorder and that adaptive changes in those circuits in response to malnutrition or repeated binge eating and purging could further promote illness behavior, hinder recovery and contribute to relapse.
How anxiety, cognition and reward pathways interact is poorly understood, and would be especially relevant for the understanding and study of eating disorders. I therefore propose this topic.


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