Abstract
Perceptually-based disturbances in body image, or body size distortions, have been posited to occur in anorexia nervosa (AN). Perception does not result from a simple flow of sensory information from periphery to cortex (“bottom-up” processing), but involves the selection of inputs most likely to be relevant in light of an individual’s experience and expectations (“top-down” processing). Most investigations of body size distortion in AN have used procedures likely to engage top-down processing, raising the possibility that attitudinal disturbances may play a role. To our knowledge, there have been no studies that assess the presence, in AN, of neurocognitive deficits associated with neurologically based disturbances in body schema. Such deficits, if found, could provide evidence of body image distortion unlikely to result from top-down processing. We tested 20 inpatients with AN on measures of proprioception, finger identification, right/left orientation, general cognition and eating disorders symptomatology, both before and after treatment. Matched normal controls were tested on the same measures over the same time intervals. Significant differences between the two groups occurred only prior to treatment, and only on those measures which involved executive, in addition to more body-schema-specific functions. This suggests that patients with AN do not have enduring deficits in the domain of body-schema, but may have subtle cognitive dysfunction, in the acute state, which is not specific to, but can interact with processing of body-schema-related information. This, in turn, suggests that their body image distortion may not be secondary to bottom-up perceptual disturbances.
Similar content being viewed by others
References
Bruch H.: Perceptual and conceptual disturbances in anorexia nervosa. Psychosom. Med., 24, 187–194, 1962.
Cash T.F., Deagle E.A. 3rd: The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta-analysis. Int. J. Eat. Disord., 22, 107–125, 1997.
Slade P., Brodie D.: Body-Image Distortion and Eating Disorder: A reconceptualization based on the recent literature. Eating Disord. Rev., 2, 32–46, 1994.
Smeets M.A.M.: The Rise and Fall of Body Size Estimation Research in Anorexia Nervosa: A review and reconceptualization. Eur. Eating Disord. Rev., 52, 75–95, 1997.
Williamson D.A.: Body image disturbances in eating disorders: A form of cognitive bias? Eating Disorders: the Journal of Treatment & Prevention, 4, 47–58, 1996.
Smeets M.A., Ingleby J.D., Hoek H.W., Panhuysen G.E.: Body size perception in anorexia nervosa: a signal detection approach. J. Psychosom. Res., 46, 465–477, 1999.
Gardner R.M., Bokenkamp E.D.: The role of sensory and nonsensory factors in body size estimations of eating disorders subjects. J. Clin. Psychol., 52, 3–15, 1996.
Thompson J.K., Penner L.A., Altabe M.N.: Procedures, problems, and progress in the assessment of body images. In: Cash T.F. (Ed.), Body images: Development, deviance, and change. New York, Guilford Press, 1990, pp. 21–48.
Thompson J.K., Spana R.E.: Visuospatial ability, accuracy of size estimation, and bulimic disturbance in a noneating-disordered college sample: A neuropsychological analysis. Percept. Mot. Skills, 73, 335–338, 1991.
Maxwell J.K., Tucker D.M., Townes B.D.: Asymmetric cognitive function in anorexia nervosa. Int. J. Neurosci, 24, 37–44, 1984.
Lautenbacher S., Roscher S., Strian F., Pirke K.M., Krieg J.C.: Theoretical and empirical considerations on the relation between ‘body image’, body scheme and somatosensation. J. Psychosom. Res., 37, 447–454, 1993.
Horne R.L., Van Vactor J.C., Emerson S.: Disturbed body image in patients with eating disorders. Am. J. Psychiatry, 148, 211–215, 1991.
Berry E.M., Fried S., Edelstein E.L.: Abnormal oral sensory perception in patients with a history of anorexia nervosa and the relationship between physiological and psychological improvement in this disease. Psychother. Psychosom., 63, 32–37, 1995.
Casper R.C., Halmi K.A., Goldberg S.C., Eckert E.D., Davis J.M.: Disturbances in body image estimation as related to other characteristics and outcome in anorexia nervosa. Br. J. Psychiatry, 134, 60–66, 1979.
Benton A., Sivan A.S.: Disturbances of the body schema. In: Heilman K.M. (Ed.), Clinical Neuropsychology. 3rd ed. New York, Oxford University Press, 1993, pp. 123–140.
Goldenberg G.: Disorders of Body Perception. In: Feinberg T.E., Farah M.J., (Eds), Behavioral Neurology and Neuropsychology. New York, McGraw-Hill, 1997, pp. 289–296.
Melzack R.: Phantom limbs and the concept of a neuromatrix. Trends Neurosci., 13, 88–92, 1990.
Feinberg T.E.: Anosognosia and Confa-bulation. In: Feinberg T.E., Farah M.J. (Eds.), Behavioral Neurology and Neuro-psychology. New York, McGraw-Hill, 1997, pp. 369–390.
Bisiach E., Perani D., Vallar G., Berti A.: Unilateral neglect: Personal and extra-personal. Neuropsychologia, 24, 759–767, 1986.
Trimble M.R.: Body image and the temporal lobes. Br. J. Psychiatry, 153 (Suppl 2), 12–14, 1988.
Yamadori A.: Body awareness and its disorders. In: Ito M. (Ed.),. Cognition, computation, and consciousness. Oxford, Oxford University Press, 1997, pp. 169–176.
Benton A.L., Sivan A.B., Hamsher K.D., Varney N.R., Spreen O.: Contributions to Neuropsychological Assessment: a clinical manual. New York, Oxford University Press, 1994.
APA: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, American Psychiatric Association, 1994.
Mazure C.M., Halmi K.A., Sunday S.R., Romano S.J., Einhorn A.M.: The Yale-Brown-Cornell Eating Disorder Scale: development, use, reliability and validity. J. Psychiatr. Res., 28, 425–445, 1994.
Cockrell J.R., Folstein M.F.: Mini-Mental State Examination (MMSE). Psychopharmacol. Bull., 24, 689–692, 1988.
Nelson A., Fogel B.S., Faust D.: Bedside cognitive screening instruments: A critical assessment. J. Nerv. Ment. Dis., 174, 73–83, 1986.
Green M.W., Rogers P.J.: Impairments in working memory associated with spontaneous dieting behaviour. Psychol. Med., 28, 1063–1070, 1998.
Avraham Y., Bonne O., Berry E.M.: Behavioral and neurochemical alterations caused by diet restriction: The effect of tyrosine administration in mice. Brain Res., 732, 133–144, 1996.
Patchell R.A., Fellows H.A., Humphries L.L.: Neurologic complications of anorexia nervosa. Acta Neurol. Scand., 89, 111–116, 1994.
Szmukler G.I., Andrewes D., Kingston K., Chen L., Stargatt R., Stanley R.: Neuropsy-chological impairment in anorexia nervosa: before and after refeeding. J. Clin. Exp. Neuropsychol., 14, 347–352, 1992.
de Zwaan M., Mitchell J.E.: Medical complications of anorexia nervosa and bulimia nervosa. In: Garfinkel P., Kaplan A.S. (Eds.), Medical issues and the eating disorders: The interface. New York, Brunner/Mazel, 1993, pp. 60–100.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Epstein, J., Wiseman, C.V., Sunday, S.R. et al. Neurocognitive evidence favors “top down” over “bottom up” mechanisms in the pathogenesis of body size distortions in anorexia nervosa. Eat Weight Disord 6, 140–147 (2001). https://doi.org/10.1007/BF03339763
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03339763