Disruption of Visuospatial and Somatosensory Functional Connectivity in Anorexia Nervosa


      Although body image disturbance is considered one of the core characteristics of anorexia nervosa (AN), the exact nature of this complex feature is poorly understood. Task-related functional magnetic resonance imaging studies can only partially explore the multimodal complexity of body consciousness, which is a complex cognition underpinned by aspects of visual perception, proprioception, and touch. The aim of the present study was to explore the functional connectivity of networks involved in visuospatial and somatosensory processing in AN.


      Twenty-nine subjects with AN, 16 women who had recovered from it, and 26 healthy women underwent a resting-state functional magnetic resonance imaging scan and neuropsychological assessment of their visuospatial abilities using the Rey-Osterrieth Complex Figure Test.


      Both AN groups showed areas of decreased connectivity in the ventral visual network, a network involved in the “what?” pathway of visual perception. Even more interestingly, the AN group, but not the recovered AN group, displayed increased coactivation in the left parietal cortex, encompassing the somatosensory cortex, in an area implicated in long-term multimodal spatial memory and representation, even in the absence of visual information. A neuropsychological assessment of visuospatial abilities revealed that aspects of detail processing and global integration (central coherence) showed correlations with connectivity of this brain area in the AN group.


      Our findings show that AN is associated with double disruption of brain connectivity, which shows a specific association with visuospatial difficulties and may explain the failure of the integration process between visual and somatosensory perceptual information that might sustain body image disturbance.

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        • Favaro A.
        • Tenconi E.
        • Santonastaso P.
        Perinatal factors and the risk of developing anorexia and bulimia nervosa.
        Arch Gen Psychiatry. 2006; 63: 82-88
        • Favaro A.
        • Tenconi E.
        • Santonastaso P.
        The interaction between perinatal factor and childhood abuse in the risk of developing anorexia nervosa.
        Psychol Med. 2010; 40: 657-665
        • Hudson J.I.
        • Hiripi E.
        • Pope Jr, H.G.
        • Kessler R.C.
        The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.
        Biol Psychiatry. 2007; 61: 348-358
        • Kaye W.H.
        • Fudge J.L.
        • Paulus M.
        New insights into symptoms and neurocircuit function of anorexia nervosa.
        Nat Rev Neurosci. 2009; 10: 573-584
        • Berlucchi G.
        • Aglioti S.M.
        The body in the brain revisited.
        Exp Brain Res. 2010; 200: 25-35
        • Cash T.F.
        • Deagle E.A.
        The nature and extent of body image disturbances in anorexia nervosa and bulimia nervosa: A meta-analysis.
        Int J Eat Disord. 1997; 22: 107-124
        • Legrand D.
        Subjective and physical dimensions of bodily self-consciousness, and their dis-integration in anorexia nervosa.
        Neuropsychologia. 2010; 48: 726-737
        • van Kuyck K.
        • Gerard N.
        • Van Laere K.
        • Casteels C.
        • Pieters G.
        • Gabriels L.
        • Nuttin B.
        Towards a neurocircuitry in anorexia nervosa: Evidence from functional neuroimaging studies.
        J Psychiatr Res. 2009; 43: 1133-1145
        • Uher R.
        • Murphy T.
        • Friederich H.C.
        • Dalgleish T.
        • Brammer M.J.
        • Giampietro V.
        • et al.
        Functional neuroanatomy of body shape perception in healthy and eating-disordered women.
        Biol Psychiatry. 2005; 58: 990-997
        • Pietrini F.
        • Castellini G.
        • Ricca V.
        • Polito C.
        • Pupi A.
        • Faravelli C.
        Functional neuroimaging in anorexia nervosa: A clinical approach.
        Eur Psychiatry. 2011; 26: 176-182
        • Zucker N.L.
        • Losh M.
        • Bulik C.M.
        • LaBar K.S.
        • Piven J.
        • Pelphrey K.A.
        Anorexia nervosa and autism spectrum disorders: Guided investigation of social cognitive endophenotypes.
        Psychol Bull. 2007; 133: 976-1006
        • Tenconi E.
        • Santonastaso P.
        • Degortes D.
        • Bosello R.
        • Titton F.
        • Mapelli D.
        • Favaro A.
        Set-shifting abilities, central coherence, and handedness in anorexia nervosa patients, their unaffected siblings and healthy controls: Exploring putative endophenotypes.
        World J Biol Psychiatry. 2010; 11: 813-823
        • Lopez C.
        • Tchanturia K.
        • Stahl D.
        • Booth R.
        • Holliday J.
        • Treasure J.
        An examination of the concept of central coherence in women with anorexia nervosa.
        Int J Eat Disord. 2008; 41: 411-420
        • Nico D.
        • Daprati E.
        • Nighoghossian N.
        • Carrier E.
        • Duhamel J.R.
        • Sirigu A.
        The role of right parietal lobe in anorexia nervosa.
        Psychol Med. 2010; 40: 1531-1539
        • Harrison A.
        • Tchanturia K.
        • Treasure J.
        Measuring state trait properties of detail processing and global integration ability in eating disorders.
        World J Biol Psychiatry. 2011; 12: 462-472
        • Zhang D.
        • Raichle M.E.
        Disease and the brain's dark energy.
        Nat Rev Neurol. 2010; 6: 15-28
        • Esposito F.
        • Bertolino A.
        • Scarabino T.
        • Latorre V.
        • Blasi G.
        • Popolizio T.
        • et al.
        Independent component model of the default-mode brain function: Assessing the impact of active thinking.
        Brain Res Bull. 2006; 70: 263-269
        • Smith S.M.
        • Fox P.T.
        • Miller K.L.
        • Glahn D.C.
        • Fox P.M.
        • Mackay C.E.
        • et al.
        Correspondence of the brain's functional architecture during activation and rest.
        Proc Natl Acad Sci U S A. 2009; 106: 13040-13045
        • Fox M.D.
        • Greicius M.
        Clinical applications of resting state functional connectivity.
        Front Syst Neurosci. 2010; 4: 19
        • First M.B.
        • Spitzer R.L.
        • Gibbon M.
        • Williams J.B.W.
        Structured Clinical Interview for DSM-IV Axis I Disorders.
        Biometrics Research Department, New York1995
        • Derogatis L.R.
        • Lipman R.S.
        • Rickels K.
        • Uhlenhuth E.H.
        • Covi L.
        The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory.
        Behav Sci. 1974; 19: 1-15
        • Garner D.M.
        • Olmstead M.P.
        • Polivy J.
        Development and validation of a multidimensional Eating Disorder Inventory for anorexia nervosa and bulimia.
        Int J Eat Disord. 1983; 2: 15-35
        • Shafran R.
        • Lee M.
        • Payne E.
        • Fairburn C.G.
        An experimental analysis of body checking.
        Behav Res Ther. 2007; 45: 113-121
        • Colombo L.
        • Sartori G.
        • Brivio C.
        Stima del quoziente intellettivo tramite l'applicazione del Test di Intelligenza Breve [Estimation of intelligence quotient by means of the Brief Intelligence Test].
        Giornale di Psicologia. 2002; 3: 613-637
        • Oldfield R.C.
        The assessment and analysis of handedness: The Edinburgh inventory.
        Neuropsychologia. 1971; 9: 97-113
        • Osterrieth P.
        The test of copying a complex figure: A contribution to the study of perception and memory.
        Arch Psychol. 1944; 30: 206-356
        • Lezak M.D.
        • Howieson D.B.
        • Loring D.W.
        Neuropsychological Assessment.
        Oxford University Press, Oxford, UK2004
        • Van den Eynde F.
        • Suda M.
        • Broadbent H.
        • Guillaume S.
        • Van den Eynde M.
        • Steiger H.
        • et al.
        Structural magnetic resonance imaging in eating disorders: A systematic review of voxel-based morphometry studies.
        Eur Eat Disord Rev. 2012; 20: 94-105
        • Smith S.M.
        • Jenkinson M.
        • Woolrich M.W.
        • Beckmann C.F.
        • Behrens T.E.
        • Johansen-Berg H.
        • et al.
        Advances in functional and structural MR image analysis and implementations as FSL.
        Neuroimage. 2004; 23: 208-219
        • Oakes T.R.
        • Fox A.S.
        • Johnstone T.
        • Chung M.K.
        • Kalin N.
        • Davidson R.J.
        Integrating VBM into the general linear model with voxelwise anatomical covariates.
        Neuroimage. 2007; 34: 500-508
        • Filippini N.
        • Nickerson L.D.
        • Beckmann C.F.
        • Ebmeier K.P.
        • Frisoni G.B.
        • Matthews P.M.
        • et al.
        Age-related adaptations of brain function during a memory task are also present at rest.
        Neuroimage. 2012; 59: 3821-3828
        • Biswal B.B.
        • Mennes M.
        • Zuo X.N.
        • Gohel S.
        • Kelly C.
        • Smith S.M.
        • et al.
        Toward discovery science of human brain function.
        Proc Natl Acad Sci U S A. 2010; 107: 4734-4739
        • Beckmann C.F.
        • Smith S.M.
        Probabilistic independent component analysis for functional magnetic resonance imaging.
        IEEE Trans Med Imaging. 2004; 23: 137-152
        • Zuo X.N.
        • Kelly C.
        • Adelstein J.S.
        • Klein D.F.
        • Castellanos F.X.
        • Milham M.P.
        Reliable intrinsic connectivity networks: Test-retest evaluation using ICA and dual regression approach.
        Neuroimage. 2010; 49: 2163-2177
        • Smith S.M.
        • Nichols T.E.
        Threshold-free cluster enhancement: Addressing problems of smoothing, threshold dependence and localisation in cluster inference.
        Neuroimage. 2009; 44: 83-98
        • Kravitz D.J.
        • Saleem K.S.
        • Baker C.I.
        • Mishkin M.
        A new neural framework for visuospatial processing.
        Nat Rev Neurosci. 2011; 12: 217-230
        • Ferber S.
        • Humphrey G.K.
        • Vilis T.
        Segregation and persistence of form in the lateral occipital complex.
        Neuropsychologia. 2005; 43: 41-51
        • Peelen M.V.
        • Downing P.E.
        The neural basis of visual body perception.
        Nat Rev Neurosci. 2007; 8: 636-648
        • Blanke O.
        • Arzy S.
        The out-of-body experience: Disturbed self-processing at the temporo-parietal junction.
        Neuroscientist. 2005; 11: 16-24
        • Tanaka S.
        • Honda M.
        • Sadato N.
        Modality-specific cognitive function of medial and lateral human Brodmann area 6.
        J Neurosci. 2005; 25: 496-501
        • Ehrsson H.H.
        • Kito T.
        • Sadato N.
        • Passingham R.E.
        • Naito E.
        Neural substrate of body size: Illusory feeling of shrinking of the waist.
        PLoS Biol. 2005; 3: e412
        • Mahon B.Z.
        • Schwarzbach J.
        • Caramazza A.
        The representation of tools in left parietal cortex is independent of visual experience.
        Psychol Sci. 2010; 21: 764-771
        • Plaisted K.
        • Saksida L.
        • Alcantara J.
        • Weisblatt E.
        Towards an understanding of the mechanisms of weak central coherence effects: Experiments in visual configural learning and auditory perception.
        Philos Trans R Soc Lond B Biol Sci. 2003; 358: 375-386
        • Castro-Fornieles J.
        • Bargallo N.
        • Lazaro L.
        • Andres S.
        • Falcon C.
        • Plana M.T.
        • Junque C.
        A cross-sectional and follow-up voxel-based morphometric MRI study in adolescent anorexia nervosa.
        J Psychiatr Res. 2009; 43: 331-340
        • Probst M.
        • Vandereycken W.
        • Van Coppenolle H.
        • Pieters G.
        Body experience in eating disorders before and after treatment: A follow-up study.
        Eur Psychiatry. 1999; 14: 333-340
        • Vocks S.
        • Legenbauer T.
        • Wachter A.
        • Wucherer M.
        • Kosfelder J.
        What happens in the course of body exposure?.
        J Psychosom Res. 2007; 62: 231-239
        • Tchanturia K.
        • Davies H.
        • Lopez C.
        • Schmidt U.
        • Treasure J.
        • Wykes T.
        Neuropsychological task performance before and after cognitive remediation in anorexia nervosa: A pilot case-series.
        Psychol Med. 2008; 38: 1371-1373

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