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Global Cortical Thinning in Acute Anorexia Nervosa Normalizes Following Long-Term Weight Restoration

  • Joseph A. King
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Daniel Geisler
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Franziska Ritschel
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Ilka Boehm
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Maria Seidel
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Benjamin Roschinski
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Laura Soltwedel
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Johannes Zwipp
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Gerit Pfuhl
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden

    Department of Psychology, University of Tromsø, Tromsø, Norway
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  • Michael Marxen
    Affiliations
    Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany
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  • Veit Roessner
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
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  • Stefan Ehrlich
    Correspondence
    Address correspondence to Stefan Ehrlich, M.D., University Hospital C. G. Carus, Department of Psychiatry, Technische Universität Dresden, Faculty of Medicine, Dresden, Department of Child and Adolescent Psychiatry, Fetscherstraße 74, CNY Building 120, Suite 100, Dreden 01307, Germany
    Affiliations
    Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden

    Massachusetts General Hospital/Massachusetts Institute of Technology /Harvard Medical School Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown

    Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Published:September 20, 2014DOI:https://doi.org/10.1016/j.biopsych.2014.09.005

      Abstract

      Background

      Anorexia nervosa (AN) is a serious eating disorder characterized by self-starvation, extreme weight loss, and alterations in brain structure. Structural magnetic resonance imaging studies have documented brain volume reductions in acute AN, but it is unclear whether they are 1) regionally specific, or 2) reversible following weight restoration. Here, we measured cortical thickness (CT) for the first time in AN.

      Methods

      Structural magnetic resonance imaging data were acquired from adolescent and young adult female patients with acute AN (n = 40), recovered patients following long-term weight restoration (n = 34), and an equal number of age-matched healthy control subjects. Group differences in CT were tested with well-validated procedures implemented in FreeSurfer. The mediating role of clinical variables including body mass index and drive for thinness were explored. For completeness, we also used FreeSurfer’s subcortical segmentation stream to test group differences in volumes of select gray matter regions of interest.

      Results

      Vertex-wise analyses revealed significant thinning of over 85% of the cortical surface in patients with acute AN and CT normalization in recovered patients following long-term weight restoration, although normal age-related trajectories were absent in the disorder. This pattern of results was largely mirrored in subcortical volumes. We also observed a strong negative correlation between CT and drive for thinness in extrastriate regions involved in body perception.

      Conclusions

      Structural brain anomalies in AN as expressed in CT and subcortical volume are primarily the consequence of malnutrition and unlikely to reflect premorbid trait markers or permanent scars, but longitudinal data are needed.

      Keywords

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