Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are characterized by distorted perception of appearance, yet no studies have directly compared the neurobiology associated with body perception. We compared AN and BDD in brain activation and connectivity in relevant networks when viewing images of others’ bodies and tested their relationships with clinical symptoms and subjective appearance evaluations. We acquired fMRI data from 64 unmedicated females (20 weight-restored AN, 23 BDD, 21 controls) during a matching task using unaltered or spatial-frequency filtered photos of others’ bodies. Using general linear model and independent components analyses we compared brain activation and connectivity in visual, striatal, and parietal networks and performed univariate and partial least squares multivariate analyses to investigate relationships with clinical symptoms and appearance evaluations. AN and BDD showed partially overlapping patterns of hyperconnectivity in the dorsal visual network and hypoconnectivity in parietal network compared with controls. BDD, but not AN, demonstrated hypoactivity in dorsal visual and parietal networks compared to controls. Further, there were significant activity and connectivity differences between AN and BDD in both networks. In both groups, activity and/or connectivity were associated with symptom severity and appearance ratings of others’ bodies. Thus, AN and BDD demonstrate both distinct and partially-overlapping aberrant neural phenotypes involved in body processing and visually encoding global features. Nevertheless, in each disorder, aberrant activity and connectivity show relationships to clinically relevant symptoms and subjective perception. These results have implications for understanding distinct and shared pathophysiology underlying perceptual distortions of appearance and may inform future novel treatment strategies.
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We would like to thank Amy Yu for contributions to the figures. Results were presented in part at the 56th ACNP Annual Meeting, 2017.
National Institutes of Health, USA grant R01MH093535 (Feusner) & T32 GM08042 (Porterra).
The authors report no competing interests. The funding sources had no participation in conducting the study. The UCLA Institutional Review Board (IRB) approved the study.
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Teena D Moody declares that she has no conflict of interest. Francesca Morfini declares that she has no conflict of interest. Gigi Cheng declares that she has no conflict of interest. Courtney Sheen declares that she has no conflict of interest. Wesley Kerr declares that he has no conflict of interest. Michael Strober declares that he has no conflict of interest. Jamie Feusner declares that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The UCLA Institutional Review Board (IRB) approved the study.
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Moody, T.D., Morfini, F., Cheng, G. et al. Brain activation and connectivity in anorexia nervosa and body dysmorphic disorder when viewing bodies: relationships to clinical symptoms and perception of appearance. Brain Imaging and Behavior 15, 1235–1252 (2021). https://doi.org/10.1007/s11682-020-00323-5
- Spatial frequency
- Visual processing
- Brain connectivity
- Brain activation
- Independent components analysis
- Partial least squares