Longitudinal changes in neural responses to fearful faces in adolescents with anorexia nervosa – A fMRI study

Objective

Although proven neuronal changes are correlated with anorexia nervosa (AN), where these changes occur and how they change during the course of this disease are often unclear; this is especially true regarding emotion processing, e.g., of anxiety, despite a growing body of literature on its importance for the pathophysiology and clinical course of patients with AN.

Methods

Twenty-two female adolescent patients with AN were scanned during acute starvation and after short-term weight recovery and were compared to 27 healthy controls. A well-established face-matching paradigm involving individuals with different emotions was used during fMRI.

Results

Patients with AN selectively showed significantly increasing neural activation in the somatomotor cortex when viewing fearful faces following short-term weight recovery. No differences were found compared to healthy controls or for neutral, angry or surprised faces. Neural activation in response to fearful faces during acute starvation was associated with lower BMI-SDS and greater illness burden.

Conclusion

Higher somatomotor activity could represent anxiety-induced preparations for motor reactions (e.g., fight or flight) that are more pronounced in more affected patients. These results align with recent models of AN that increasingly incorporate anxiety into the pathophysiological and prognostic model of AN and help elucidate its underlying neurological mechanisms.