Effects of body image therapy in anorexia nervosa: An fMRI study

Beyond self-starvation, Anorexia Nervosa (AN) is characterised by body image disturbance including a misperception of one’s own body size and an extreme dissatisfaction with one’s own body (Vocks et al. 2008). Previous messages of the day have already highlighted an enhanced plasticity of the sense of self coming from the body in this clinical population (see Message of the day: 22nd of January). We have also talked about the recent developments in the potential treatments of AN by mean of the practice of Mindfulness (see Message of the day: 28th of January) and nasally inhaled Oxytocin (see Message of the day: 1st of February).

The problem: A functional magnetic resonance imaging (fMRI) study (Uher et al., 2005) showed for the first time that body image disturbance in AN might be associated with dysfunctional body-image-processing brain circuits. In particular, the extrastriate body area, a brain region that is located in the occipito-temporal visual cortex and is specialised in the perception of human bodies, have shown a lower activation in patients with AN compared to healthy controls. Authors suggested that this lower activation could potentially underlie the body image disturbance, including body size overestimation and negative evaluation of one’s own body (Uher et al., 2005).

The solution: Due to the central role of body image disturbances in AN, direct interventions aiming at an improvement of body image have been applied as one component in the treatment of eating disorders (Vocks et al., 2008). This intervention consists of full-body mirror exposure plus 10 weekly sessions of cognitive-behavioural body image therapy (BIT). Although it has been demonstrated that this intervention can reduce body size overestimation and body dissatisfaction in AN, it was not clear whether there could be any change in brain activation as a result of it. Vocks et al. (2010) showed an increase in activation in the extrastriate body area following BIT. These preliminary findings provides the first evidence that the dysfunctional body-image-processing brain circuits that seem to be associated with body image distortion, preoccupation with body weight and negative body-related emotions are modifiable by cognitive-behavioral interventions.

Uher, R., Murphya, T., Friedericha, H. C., Dalgleishb, T., Brammera, M. J., Giampietro, V., Phillips, M. L., Andrew, C. M., Ng, V. W., Williams, S. C. R., Campell, I. C & Treasure, J. (2005). Functional Neuroanatomy of Body Shape Perception in Healthy and Eating-Disordered Women. Biological Psychiatry, 58, 990-997
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Vocks, S., Wa¨chter, A., Wucherer, M. & Kosfelder, J. (2008). Look at Yourself: Can Body Image Therapy Affect the Cognitive and Emotional Response to Seeing Oneself in the Mirror in Eating Disorders?

European Eating Disorders Review, 16, 147–154

Vocksa, S., Buschb, M., Schultea, D., Grönermeyerb, D., Herpertzc, S. & Suchand, B. (2010). Effects of body image therapy on the activation of the extrastriate body area in anorexia nervosa: An fMRI study.

Psychiatry Research: Neuroimaging, 183, 114–118