Brain Abnormalities May Explain Why Some Anorexics Don’t Respond To Treatment

brain wiring

Researchers have discovered abnormalities in areas of the brain associated with forming insight. According to the team led by the University of Illinois at Chicago and UCLA, these abnormalities could potentially explain why some people with anorexia nervosa seem to have difficulty recognizing their own dangerous disorder eating habits.

According to the study recently published in the journal Psychological Medicine, participants with anorexia who scored lowest on tests measuring their ability to form insight showed more connective abnormalities in brain regions linked to error detection and self-reflection compared to other participants. The study also found individuals with body dysmorphic disorder also showed some of these abnormalities.

While many people just think of anorexia as an eating disorder, it also often involves mental issues such as distorted body image, obsessive thoughts, and poor insight.

Past research has indicated that individuals with anorexia nervosa and who show particularly poor insight may not respond as well to treatment because they fail to realize their behavior and dangerously low weight may be damaging to their health.

“The brains of people with anorexia nervosa who have poor insight may not generate an ‘error message’ when told, for example, that they are putting themselves at serious risk for death by severe restricting,” said Dr. Alex Leow, associate professor of psychiatry and bioengineering in the UIC College of Medicine and corresponding author on the paper. “Thus, it is plausible that their brains literally don’t believe that they are severely underweight and their behavior is dangerous even when objective evidence suggests otherwise.”

The researchers observed abnormal brain connections in numerous brain regions of people with anorexia, including regions shown to be crucial for error detection, conflict monitoring, and self-reflection.

“Our results suggest that in order to have insight, you have to be able to see a conflict or error when your perceptions differ from those of others, or from reality,” Leow said.

“For example, in people with anorexia nervosa, that conflict might be, ‘I may actually be way too thin, even if I think I am still fat.’ Next, they need to be able to reflect on that conflict and what it means. If they can, this insight can lead to adaptive decisions, such as ‘Hey, I need to get help to change my behavior and get healthy,’ and then that person has a better chance of recovering.

“But without that insight, they are stuck.”

For the study, the researchers measured brain connectivity patterns in 25 weight-restored individuals with anorexia, 29 participants with body dysmorphic disorder, and 31 healthy control patients. The team then assessed the participants’ insight and delusionality using specialized questionnaires.

Every participant underwent structural magnetic resonance imaging and diffusion-weight imaging to evaluate their brain connectivity patterns.

According to the findings, participants with anorexia also showed poor connectivity in the caudal anterior cingulate and posterior cingulate which corresponded with lower scores on tests of insight. The team also observed abnormal, overlapping brain networks related to reward and compulsive behaviors in those with anorexia.

“This could relate to the observation that many anorexics experience a rewarding feeling from ‘successfully’ carrying out compulsive exercising, restricting, achieving specific weight goals,” said Leow. Participants with body dysmorphic disorder showed similar but weaker abnormalities in the same regions.

These findings lead the team of researchers to believe improving a person with anorexia’s ability to detect the difference between their perception of their self and reality may be crucial in helping them recover.

“We may be able to teach insight to these patients using different tools or techniques including virtual or augmented reality technologies,” Leow said

One way to do this may include “amplifying” the so-called error signals. Leow explained, “Many anorexic patients with poor insight are able to understand someone else’s severe restricting is very dangerous for that person, but they can’t see it for themselves even when they are doing exactly the same thing.”

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