Regional Cerebral Blood Flow Differences During High-Caloric Food Challenge in Patients with Anorexia Nervosa Versus Normal Controls • 9

Previous neuroimaging studies have employed symptom provocation paradigms to examine the functional neuroanatomic correlates of emotions or behaviors that characterize particular psychiatric disorders. This study was designed to determine areas of differential brain activity associated with the hallmark food aversion of anorexia nervosa (AN). We hypothesized that this feature of AN would be associated with dysfunction within the paralimbic system. The tracer, oxygen 15-labeled carbon dioxide, was used to make positron emission tomographic measurements of regional cerebral blood flow (rCBF). We compared 8 young women with AN to 8 medically/psychiatrically healthy female control subjects during both a neutral and provoked state. Presentation of standardized neutral, low-caloric food stimuli (apple, lettuce) was followed by viewing of provocative, high-caloric food stimuli (cake, bagel + cream cheese). Heart rate was monitored by pulse oximetry and subjects completed emotional state analog scales after each scan. Stereotactic transformation and statistical parametric mapping techniques were used to determine locations of significant activation; a statistical threshold of p=0.001 (z=3.09) was used for analysis of imaging data. Provocative food stimuli produced a significant desire to eat in controls (p=0.01), whereas in the AN group, identical stimuli produced significant disgust (p=0.008) and other negative emotions. A significant heart rate increase (p=0.023) was noted after exposure to provocative stimuli in AN subjects, but not in controls. Planned contrasts(rCBF for provoked vs. neutral conditions) demonstrated a significant decrease in rCBF within the left anterior temporal cortex in controls only. Within the AN group alone, significantly decreased rCBF was seen in the right somatosensory cortex in an area controlling sensory function of the mouth. These results implicate left anterior temporal cortex, a component of the paralimbic system, in the mediation of normal appetitive function and as an area that appears to be differentially activated in AN. Interestingly, subjects with AN had decreased activity in a brain region mediating oral sensation, accompanying their reported experience of high-caloric food aversion.

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Gordon, C., Emans, S., Grace, E. et al. Regional Cerebral Blood Flow Differences During High-Caloric Food Challenge in Patients with Anorexia Nervosa Versus Normal Controls • 9. Pediatr Res 43, 4 (1998). https://doi.org/10.1203/00006450-199804001-00030

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