The Use of Magnetic Resonance Imaging (MRI) in Eating Disorders

  • Valentina CardiEmail author
  • Masashi Suda
  • Janet Treasure


Eating disorders (EDs) are characterized by abnormal eating behavior, as well as emotional, cognitive, and interpersonal difficulties. The aim of this chapter is to summarize findings from brain imaging studies on brain morphometry; responses to eating and shape cues, reward, self-regulation, and social cognition; and functional connectivity in EDs. Results show that people with EDs have abnormalities in brain structure, functional connectivity, neural activations to symptoms-related cues, and reward sensitivity, with differences between diagnoses. Overall, neuroimaging studies appear to be underpowered and used a variety of paradigms and stimuli, which makes it difficult to synthesize the results. The next phase of research will hopefully rectify these problems by focusing on refining and exploring some of the theoretical models that have been developed to explain the evolution and maintenance of the illness.


Anorexia Nervosa Functional Connectivity Anterior Cingulate Cortex Eating Disorder Bulimia Nervosa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Anterior cingulate cortex


Anorexia nervosa


Binge eating and purging


Binge eating disorder


Body mass index


Bulimia nervosa


Cerebrospinal fluid


Computed tomography


Dorsolateral PFC


Eating disorder


Eating Disorder Not Otherwise Specified




Gray matter


Healthy control








Not reported


Orbitofrontal cortex


Prefrontal cortex








Single-photon emission computed tomography


Selective serotonin reuptake inhibitor


Voxel-based morphometry


White matter


  1. Ashburner J, Friston KJ (2000) Voxel-based morphometry–the methods. Neuroimage 11:805–821PubMedCrossRefGoogle Scholar
  2. Ashworth F, Pringle A, Norbury R, Harmer CJ, Cowen PJ, Cooper MJ (2011) Neural response to angry and disgusted facial expressions in bulimia nervosa. Psychol Med 41:2375–2384PubMedCrossRefGoogle Scholar
  3. Beato Fernandez L, Rodriguez Cano T, Garcia Vilches I, Garcia Vicente A, Poblete Garcia V, Castrejon AS, Toro J (2009) Changes in regional cerebral blood flow after body image exposure in eating disorders. Psychiatry Res 171:129–137PubMedCrossRefGoogle Scholar
  4. Berthoud HR (2004) Neural control of appetite: cross-talk between homeostatic and non-homeostatic systems. Appetite 43:315–317PubMedCrossRefGoogle Scholar
  5. Berthoud HR, Morrison C (2008) The brain, appetite, and obesity. Annu Rev Psychol 59:55–92PubMedCrossRefGoogle Scholar
  6. Blasel S, Pilatus U, Magerkurth J, von Stauffenberg M, Vronski D, Mueller M, Woeckel L, Hattingen E (2012) Metabolic gray matter changes of adolescents with anorexia nervosa in combined MR proton and phosphorus spectroscopy. Neuroradiology 54:753–764PubMedCrossRefGoogle Scholar
  7. Boghi A, Sterpone S, Sales S, D’Agata F, Bradac GB, Zullo G, Munno D (2011) In vivo evidence of global and focal brain alterations in anorexia nervosa. Psychiatry Res 192:154–159PubMedCrossRefGoogle Scholar
  8. Bohon C, Stice E (2011) Reward abnormalities among women with full and subthreshold bulimia nervosa: a functional magnetic resonance imaging study. Int J Eat Disord 44:585–595PubMedCentralPubMedCrossRefGoogle Scholar
  9. Brooks SJ, Barker GJ, O’Daly OG, Brammer M, Williams SC, Benedict C, Schioth HB, Treasure J, Campbell IC (2011a) Restraint of appetite and reduced regional brain volumes in anorexia nervosa: a voxel-based morphometric study. BMC Psychiatry 11:179PubMedCentralPubMedCrossRefGoogle Scholar
  10. Brooks SJ, O’Daly OG, Uher R, Friederich HC, Giampietro V, Brammer M, Williams SC, Schioth HB, Treasure J, Campbell IC (2011b) Differential neural responses to food images in women with bulimia versus anorexia nervosa. PLoS One 6:e22259PubMedCentralPubMedCrossRefGoogle Scholar
  11. Burger K, Stice E (2011) Relation of dietary restraint scores to activation of reward-related brain regions in response to food intake, anticipated intake, and food pictures. Neuroimage 55:233–239PubMedCentralPubMedCrossRefGoogle Scholar
  12. Burger KS, Stice E (2012) Frequent ice cream consumption is associated with reduced striatal response to receipt of an ice cream-based milkshake. Am J Clin Nutr 95:810–817PubMedCentralPubMedCrossRefGoogle Scholar
  13. Castro Fornieles J, Bargallo N, Lazaro L, Andres S, Falcon C, Plana MT, Junque C (2007) Adolescent anorexia nervosa: cross-sectional and follow-up frontal gray matter disturbances detected with proton magnetic resonance spectroscopy. J Psychiatr Res 41:952–958PubMedCrossRefGoogle Scholar
  14. Castro Fornieles J, Bargallo N, Lazaro L, Andres S, Falcon C, Plana MT, Junque C (2009) A cross-sectional and follow-up voxel-based morphometric MRI study in adolescent anorexia nervosa. J Psychiatr Res 43:331–340PubMedCrossRefGoogle Scholar
  15. Connan F, Murphy F, Connor SE, Rich P, Murphy T, Bara Carill N, Landau S, Krljes S, Ng V, Williams S, Morris RG, Campbell IC, Treasure J (2006) Hippocampal volume and cognitive function in anorexia nervosa. Psychiatry Res 146:117–125PubMedCrossRefGoogle Scholar
  16. Cowdrey FA, Filippini N, Park RJ, Smith SM, McCabe C (2014) Increased resting state functional connectivity in the default mode network in recovered anorexia nervosa. Hum Brain Mapp 35(2):483–491. doi:  10.1002/hbm.22202
  17. de Araujo IE, Oliveira Maia AJ, Sotnikova TD, Gainetdinov RR, Caron MG, Nicolelis MA, Simon SA (2008) Food reward in the absence of taste receptor signaling. Neuron 57:930–941PubMedCrossRefGoogle Scholar
  18. Favaro A, Santonastaso P, Manara R, Bosello R, Bommarito G, Tenconi E, Di Salle F (2012) Disruption of visuospatial and somatosensory functional connectivity in anorexia nervosa. Biol Psychiatry. 72(10):864–870.Google Scholar
  19. Fladung AK, Gron G, Grammer K, Herrnberger B, Schilly E, Grasteit S, Wolf RC, Walter H, von Wietersheim J (2010) A neural signature of anorexia nervosa in the ventral striatal reward system. Am J Psychiatry 167:206–212PubMedCrossRefGoogle Scholar
  20. Frank G, Reynolds J, Shott M, O’Reilly R (2011) Altered temporal difference learning in bulimia nervosa. Biol Psychatry 70:728–735CrossRefGoogle Scholar
  21. Frank GK, Wagner A, Achenbach S, McConaha C, Skovira K, Aizenstein H, Carter CS, Kaye WH (2006) Altered brain activity in women recovered from bulimic-type eating disorders after a glucose challenge: a pilot study. Int J Eat Disord 39:76–79PubMedCrossRefGoogle Scholar
  22. Friederich HC, Brooks S, Uher R, Campbell IC, Giampietro V, Brammer M, Williams SC, Herzog W, Treasure J (2010) Neural correlates of body dissatisfaction in anorexia nervosa. Neuropsychologia 48:2878–2885PubMedCrossRefGoogle Scholar
  23. Gaudio S, Nocchi F, Franchin T, Genovese E, Cannata V, Longo D, Fariello G (2011) Gray matter decrease distribution in the early stages of anorexia nervosa restrictive type in adolescents. Psychiatry Res 191:24–30PubMedCrossRefGoogle Scholar
  24. Geliebter A, Ladell T, Logan M, Schneider T, Sharafi M, Hirsch J (2006) Responsivity to food stimuli in obese and lean binge eaters using functional MRI. Appetite 46:31–35PubMedCrossRefGoogle Scholar
  25. Giordano GD, Renzetti P, Parodi RC, Foppiani L, Zandrino F, Giordano G, Sardanelli F (2001) Volume measurement with magnetic resonance imaging of hippocampus-amygdala formation in patients with anorexia nervosa. J Endocrinol Invest 24:510–514PubMedCrossRefGoogle Scholar
  26. Gizewski ER, Rosenberger C, de Greiff A, Moll A, Senf W, Wanke I, Forsting M, Herpertz S (2010) Influence of satiety and subjective valence rating on cerebral activation patterns in response to visual stimulation with high-calorie stimuli among restrictive anorectic and control women. Neuropsychobiology 62:182–192PubMedCrossRefGoogle Scholar
  27. Gottfried JA, O’Doherty J, Dolan RJ (2003) Encoding predictive reward value in human amygdala and orbitofrontal cortex. Science 301:1104–1107PubMedCrossRefGoogle Scholar
  28. Joos A, Kloppel S, Hartmann A, Glauche V, Tuscher O, Perlov E, Saum B, Freyer T, Zeeck A, Tebartz van Elst L (2010) Voxel-based morphometry in eating disorders: correlation of psychopathology with grey matter volume. Psychiatry Res 182:146–151PubMedCrossRefGoogle Scholar
  29. Joos AA, Perlov E, Buchert M, Hartmann A, Saum B, Glauche V, Freyer T, Weber Fahr W, Zeeck A, Tebartz van Elst L (2011a) Magnetic resonance spectroscopy of the anterior cingulate cortex in eating disorders. Psychiatry Res 191:196–200PubMedCrossRefGoogle Scholar
  30. Joos AA, Saum B, van Elst LT, Perlov E, Glauche V, Hartmann A, Freyer T, Tuscher O, Zeeck A (2011b) Amygdala hyperreactivity in restrictive anorexia nervosa. Psychiatry Res 191:189–195PubMedCrossRefGoogle Scholar
  31. Katzman DK, Zipursky RB, Lambe EK, Mikulis DJ (1997) A longitudinal magnetic resonance imaging study of brain changes in adolescents with anorexia nervosa. Arch Pediatr Adolesc Med 151:793–797PubMedCrossRefGoogle Scholar
  32. Katzman DK, Christensen B, Young AR, Zipursky RB (2001) Starving the brain: structural abnormalities and cognitive impairment in adolescents with anorexia nervosa. Semin Clin Neuropsychiatry 6:146–152PubMedCrossRefGoogle Scholar
  33. Kelley AE (2004) Ventral striatal control of appetitive motivation: role in ingestive behavior and reward-related learning. Neurosci Biobehav Rev 27:765–776PubMedCrossRefGoogle Scholar
  34. Kim KR, Ku J, Lee JH, Lee H, Jung YC (2012) Functional and effective connectivity of anterior insula in anorexia nervosa and bulimia nervosa. Neurosci Lett 521:152–157PubMedCrossRefGoogle Scholar
  35. Kingston K, Szmukler G, Andrewes D, Tress B, Desmond P (1996) Neuropsychological and structural brain changes in anorexia nervosa before and after refeeding. Psychol Med 26:15–28PubMedCrossRefGoogle Scholar
  36. Kohn MR, Ashtari M, Golden NH, Schebendach J, Patel M, Jacobson MS, Shenker IR (1997) Structural brain changes and malnutrition in anorexia nervosa. Ann N Y Acad Sci 817:398–399PubMedCrossRefGoogle Scholar
  37. Lambe EK, Katzman DK, Mikulis DJ, Kennedy SH, Zipursky RB (1997) Cerebral gray matter volume deficits after weight recovery from anorexia nervosa. Arch Gen Psychiatry 54:537–542PubMedCrossRefGoogle Scholar
  38. Lowe MR, van Steenburgh J, Ochner C, Coletta M (2009) Neural correlates of individual differences related to appetite. Physiol Behav 97:561–571PubMedCrossRefGoogle Scholar
  39. Marsh R, Steinglass JE, Gerber AJ, Graziano O’Leary K, Wang Z, Murphy D, Walsh BT, Peterson BS (2009) Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa. Arch Gen Psychiatry 66:51–63PubMedCentralPubMedCrossRefGoogle Scholar
  40. McAdams CJ, Krawczyk DC (2011) Impaired neural processing of social attribution in anorexia nervosa. Psychiatry Res 194:54–63PubMedCrossRefGoogle Scholar
  41. McCormick LM, Keel PK, Brumm MC, Bowers W, Swayze V, Andersen A, Andreasen N (2008) Implications of starvation-induced change in right dorsal anterior cingulate volume in anorexia nervosa. Int J Eat Disord 41:602–610PubMedCentralPubMedCrossRefGoogle Scholar
  42. McKnight R, Boughton N (2009) A patient’s journey. Anorexia nervosa. BMJ 339:b3800PubMedCrossRefGoogle Scholar
  43. Miller EK, Cohen JD (2001) An integrative theory of prefrontal cortex function. Annu Rev Neurosci 24:167–202PubMedCrossRefGoogle Scholar
  44. Miyake Y, Okamoto Y, Onoda K, Kurosaki M, Shirao N, Okamoto Y, Yamawaki S (2010) Brain activation during the perception of distorted body images in eating disorders. Psychiatry Res 181:183–192PubMedCrossRefGoogle Scholar
  45. Miyake Y, Okamoto Y, Onoda K, Shirao N, Okamoto Y, Yamawaki S (2012) Brain activation during the perception of stressful word stimuli concerning interpersonal relationships in anorexia nervosa patients with high degrees of alexithymia in an fMRI paradigm. Psychiatry Res 201:113–119PubMedCrossRefGoogle Scholar
  46. Mohr HM, Zimmermann J, Roder C, Lenz C, Overbeck G, Grabhorn R (2010) Separating two components of body image in anorexia nervosa using fMRI. Psychol Med 40:1519–1529PubMedCrossRefGoogle Scholar
  47. Muhlau M, Gaser C, Ilg R, Conrad B, Leibl C, Cebulla MH, Backmund H, Gerlinghoff M, Lommer P, Schnebel A, Wohlschlager AM, Zimmer C, Nunnemann S (2007) Gray matter decrease of the anterior cingulate cortex in anorexia nervosa. Am J Psychiatry 164:1850–1857PubMedCrossRefGoogle Scholar
  48. Ochner CN, Green D, van Steenburgh J, Kounios J, Lowe MR (2009) Asymmetric prefrontal cortex activation in relation to markers of overeating in obese humans. Appetite 53:44–49PubMedCentralPubMedCrossRefGoogle Scholar
  49. Ohrmann P, Kersting A, Suslow T, Lalee Mentzel J, Donges US, Fiebich M, Arolt V, Heindel W, Pfleiderer B (2004) Proton magnetic resonance spectroscopy in anorexia nervosa: correlations with cognition. Neuroreport 15:549–553PubMedCrossRefGoogle Scholar
  50. Pietrini F, Castellini G, Ricca V, Polito C, Pupi A, Faravelli C (2011) Functional neuroimaging in anorexia nervosa: a clinical approach. Eur Psychiatry 26:176–182PubMedCrossRefGoogle Scholar
  51. Roberto CA, Mayer LE, Brickman AM, Barnes A, Muraskin J, Yeung LK, Steffener J, Sy M, Hirsch J, Stern Y, Walsh BT (2011) Brain tissue volume changes following weight gain in adults with anorexia nervosa. Int J Eat Disord 44:406–411PubMedCrossRefGoogle Scholar
  52. Rodriguez Cano T, Beato Fernandez L, Garcia Vilches I, Garcia Vicente A, Poblete Garcia V, Soriano Castrejon A (2009) Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: a longitudinal study. Eur Psychiatry 24:275–281PubMedCrossRefGoogle Scholar
  53. Sachdev P, Mondraty N, Wen W, Gulliford K (2008) Brains of anorexia nervosa patients process self-images differently from non-self-images: an fMRI study. Neuropsychologia 46:2161–2168PubMedCrossRefGoogle Scholar
  54. Santel S, Baving L, Krauel K, Munte TF, Rotte M (2006) Hunger and satiety in anorexia nervosa: fMRI during cognitive processing of food pictures. Brain Res 1114:138–148PubMedCrossRefGoogle Scholar
  55. Schafer A, Vaitl D, Schienle A (2010) Regional grey matter volume abnormalities in bulimia nervosa and binge-eating disorder. Neuroimage 50:639–643PubMedCrossRefGoogle Scholar
  56. Schienle A, Schafer A, Hermann A, Vaitl D (2009) Binge-eating disorder: reward sensitivity and brain activation to images of food. Biol Psychiatry 65:654–661PubMedCrossRefGoogle Scholar
  57. Small DM, Zatorre RJ, Dagher A, Evans AC, Jones-Gotman M (2001) Changes in brain activity related to eating chocolate: from pleasure to aversion. Brain 124:1720–1733PubMedCrossRefGoogle Scholar
  58. Stice E, Yokum S, Bohon C, Marti N, Smolen A (2010) Reward circuitry responsivity to food predicts future increases in body mass: moderating effects of DRD2 and DRD4. Neuroimage 50:1618–1625PubMedCentralPubMedCrossRefGoogle Scholar
  59. Stice E, Yokum S, Burger KS, Epstein LH, Small DM (2011) Youth at risk for obesity show greater activation of striatal and somatosensory regions to food. J Neurosci 23:4360–4366CrossRefGoogle Scholar
  60. Suchan B, Busch M, Schulte D, Gronemeyer D, Herpertz S, Vocks S (2010) Reduction of gray matter density in the extrastriate body area in women with anorexia nervosa. Behav Brain Res 206:63–67PubMedCrossRefGoogle Scholar
  61. Tiller JM, Sloane G, Schmidt U, Troop N, Power M, Treasure JL (1997) Social support in patients with anorexia nervosa and bulimia nervosa. Int J Eat Disord 21:31–38PubMedCrossRefGoogle Scholar
  62. Treasure J, Cardi V, Kan C (2011) Eating in eating disorders. Eur Eat Disord Rev 20:e42–e49PubMedCrossRefGoogle Scholar
  63. Uher R, Treasure J (2005) Brain lesions and eating disorders. J Neurol Neurosurg Psychiatry 76:852–857PubMedCentralPubMedCrossRefGoogle Scholar
  64. Uher R, Brammer MJ, Murphy T, Campbell IC, Ng VW, Williams SC, Treasure J (2003) Recovery and chronicity in anorexia nervosa: brain activity associated with differential outcomes. Biol Psychiatry 54:934–942PubMedCrossRefGoogle Scholar
  65. Uher R, Murphy T, Brammer MJ, Dalgleish T, Phillips ML, Ng VW, Andrew CM, Williams SC, Campbell IC, Treasure J (2004) Medial prefrontal cortex activity associated with symptom provocation in eating disorders. Am J Psychiatry 161:1238–1246PubMedCrossRefGoogle Scholar
  66. Uher R, Murphy T, Friederich HC, Dalgleish T, Brammer MJ, Giampietro V, Phillips ML, Andrew CM, Ng VW, Williams SC, Campbell IC, Treasure J (2005) Functional neuroanatomy of body shape perception in healthy and eating-disordered women. Biol Psychiatry 58:990–997PubMedCrossRefGoogle Scholar
  67. Van den Eynde F, Suda M, Broadbent H, Guillaume S, Van den Eynde M, Steiger H, Israel M, Berlim M, Giampietro V, Simmons A, Treasure J, Campbell I, Schmidt U (2012) Structural magnetic resonance imaging in eating disorders: a systematic review of voxel-based morphometry studies. Eur Eat Disord Rev 20:94–105PubMedCrossRefGoogle Scholar
  68. van Kuyck K, Gerard N, Van Laere K, Casteels C, Pieters G, Gabriels L, Nuttin B (2009) Towards a neurocircuitry in anorexia nervosa: evidence from functional neuroimaging studies. J Psychiatr Res 43:1133–1145PubMedCrossRefGoogle Scholar
  69. Vocks S, Busch M, Gronemeyer D, Schulte D, Herpertz S, Suchan B (2010) Neural correlates of viewing photographs of one’s own body and another woman’s body in anorexia and bulimia nervosa: an fMRI study. J Psychiatry Neurosci 35:163–176PubMedCentralPubMedCrossRefGoogle Scholar
  70. Vocks S, Herpertz S, Rosenberger C, Senf W, Gizewski ER (2011) Effects of gustatory stimulation on brain activity during hunger and satiety in females with restricting-type anorexia nervosa: an fMRI study. J Psychiatr Res 45:395–403PubMedCrossRefGoogle Scholar
  71. Wagner A, Ruf M, Braus DF, Schmidt MH (2003) Neuronal activity changes and body image distortion in anorexia nervosa. Neuroreport 14:2193–2197PubMedCrossRefGoogle Scholar
  72. Wagner A, Greer P, Bailer UF, Frank GK, Henry SE, Putnam K, Meltzer CC, Ziolko SK, Hoge J, McConaha C, Kaye WH (2006) Normal brain tissue volumes after long-term recovery in anorexia and bulimia nervosa. Biol Psychiatry 59:291–293PubMedCrossRefGoogle Scholar
  73. Wagner A, Aizenstein H, Venkatraman VK, Fudge J, May JC, Mazurkewicz L, Frank GK, Bailer UF, Fischer L, Nguyen V, Carter C, Putnam K, Kaye WH (2007) Altered reward processing in women recovered from anorexia nervosa. Am J Psychiatry 164:1842–1849PubMedCrossRefGoogle Scholar
  74. Wagner A, Aizenstein H, Mazurkewicz L, Fudge J, Frank GK, Putnam K, Bailer UF, Fischer L, Kaye WH (2008) Altered insula response to taste stimuli in individuals recovered from restricting-type anorexia nervosa. Neuropsychopharmacology 33:513–523PubMedCrossRefGoogle Scholar
  75. Wagner A, Aizenstein H, Venkatraman VK, Bischoff Grethe A, Fudge J, May JC, Frank GK, Bailer UF, Fischer L, Putnam K, Kaye WH (2010) Altered striatal response to reward in bulimia nervosa after recovery. Int J Eat Disord 43:289–294PubMedCrossRefGoogle Scholar
  76. Wang GJ, Volkow ND, Telang F, Jayne M, Ma J, Rao M, Zhu W, Wong CT, Pappas NR, Geliebter A, Fowler JS (2004) Exposure to appetitive food stimuli markedly activates the human brain. Neuroimage 21:1790–1797PubMedCrossRefGoogle Scholar
  77. Whitwell JL (2009) Voxel-based morphometry: an automated technique for assessing structural changes in the brain. J Neurosci 29:9661–9664PubMedCrossRefGoogle Scholar
  78. Zhu Y, Hu X, Wang J, Chen J, Guo Q, Li C, Enck P (2012) Processing of food, body and emotional stimuli in anorexia nervosa: a systematic review and meta-analysis of functional magnetic resonance imaging studies. Eur Eat Disord Rev 20(6):439–450. doi:  10.1002/erv.2197. 4 Sept 2012
  79. Zucker NL, Losh M, Bulik CM, LaBar KS, Piven J, Pelphrey KA (2007) Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychol Bull 133:976–1006PubMedCrossRefGoogle Scholar

Copyright information

© Springer Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Psychological MedicineInstitute of Psychiatry, King’s College LondonLondonUK

Personalised recommendations