Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-01-27T17:07:52.311Z Has data issue: false hasContentIssue false
  • English
  • Français

Advances from neuroimaging studies in eating disorders

Published online by Cambridge University Press:  23 April 2015

Guido K. W. Frank
Guido K. W. Frank*
Affiliation:
Departments of Psychiatry and Neuroscience, University of Colorado Anschutz Medical Campus, Childrenʼs Hospital Colorado, Aurora, Colorado, USA
*
*Address for correspondence: Guido K. W. Frank, MD, Departments of Psychiatry and Neuroscience, University of Colorado Anschutz Medical Campus, Childrenʼs Hospital Colorado, Gary Pavilion A036/B-130, 13123 East 16th Avenue, Aurora, CO 80045, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Over the past decade, brain imaging has helped to better define eating disorder–related brain circuitry. Brain research on gray matter (GM) and white matter (WM) volumes had been inconsistent, possibly due to the effects of acute starvation, exercise, medication, and comorbidity, but newer studies have controlled for such effects. Those studies suggest larger left medial orbitofrontal gyrus rectus volume in ill adult and adolescent anorexia nervosa after recovery from anorexia nervosa, and in adult bulimia nervosa. The orbitofrontal cortex is important in terminating food intake, and altered function could contribute to self-starvation. The right insula, which processes taste but also interoception, was enlarged in ill adult and adolescent anorexia nervosa, as well as adults recovered from the illness. The fixed perception of being fat in anorexia nervosa could be related to altered insula function. A few studies investigated WM integrity, with the most consistent finding of reduced fornix integrity in anorexia and bulimia nervosa—a limbic pathway that is important in emotion but also food intake regulation. Functional brain imaging using basic sweet taste stimuli in eating disorders during the ill state or after recovery implicated repeatedly reward pathways, including insula and striatum. Brain imaging that targeted dopamine-related brain activity using taste-reward conditioning tasks suggested that this circuitry is hypersensitive in anorexia nervosa, but hyporesponsive in bulimia nervosa and obesity. Those results are in line with basic research and suggest adaptive reward system changes in the human brain in response to extremes of food intake—changes that could interfere with normalization of eating behavior.

Keywords

Anorexia nervosabulimia nervosaDTIeating disordersfMRIgray matterimagingVBMwhite matter
Type
Review Articles
Information
CNS Spectrums , Volume 20 , Special Issue 4: Pediatric Neuroimaging , August 2015 , pp. 391 - 400
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Kaye, WH, Wierenga, CE, Bailer, UF, Simmons, AN, Bischoff-Grethe, A. Nothing tastes as good as skinny feels: the neurobiology of anorexia nervosa. Trends Neurosci. 2013; 36(2): 110–120.Google Scholar
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
3. Shenton, ME, Turetsky, BI. Understanding Neuropsychiatric Disorders: Insights From Neuroimaging. Cambridge, UK: Cambridge University Press; 2011.Google Scholar
4. Jalbrzikowski, M, Jonas, R, Senturk, D, et al. Structural abnormalities in cortical volume, thickness, and surface area in 22q11.2 microdeletion syndrome: relationship with psychotic symptoms. Neuroimage Clin. 2013; 3: 405–415.Google Scholar
5. Filler, A. Magnetic resonance neurography and diffusion tensor imaging: origins, history, and clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5000-patient study group. Neurosurgery. 2009; 65(4 Suppl): A29–A43.CrossRefGoogle Scholar
6. Raichle, ME. Behind the scenes of functional brain imaging: a historical and physiological perspective. Proc Natl Acad Sci U S A. 1998; 95(3): 765–772.Google Scholar
7. Frank, GK, Bailer, UF, Henry, S, Wagner, A, Kaye, WH. Neuroimaging studies in eating disorders. CNS Spectr. 2004; 9(7): 539–548.CrossRefGoogle ScholarPubMed
8. Van den Eynde, F, Suda, M, Broadbent, H, et al. Structural magnetic resonance imaging in eating disorders: a systematic review of voxel-based morphometry studies. Eur Eat Disord Rev. 2012; 20(2): 94–105.Google Scholar
9. Boghi, A, Sterpone, S, Sales, S, et al. In vivo evidence of global and focal brain alterations in anorexia nervosa. Psychiatry Res. 2011; 192(3): 154–159.Google Scholar
10. Castro-Fornieles, J, Bargallo, N, Lazaro, L, et al. A cross-sectional and follow-up voxel-based morphometric MRI study in adolescent anorexia nervosa. J Psychiatr Res. 2009; 43(3): 331–340.Google Scholar
11. Connan, F, Murphy, F, Connor, SE, et al. Hippocampal volume and cognitive function in anorexia nervosa. Psychiatry Res. 2006; 146(2): 117–125.Google Scholar
12. Gaudio, S, Nocchi, F, Franchin, T, et al. Gray matter decrease distribution in the early stages of anorexia nervosa restrictive type in adolescents. Psychiatry Res. 2011; 191(1): 24–30.Google Scholar
13. Joos, A, Hartmann, A, Glauche, V, et al. Grey matter deficit in long-term recovered anorexia nervosa patients. Eur Eat Disord Rev. 2011; 19(1): 59–63.Google Scholar
14. Joos, A, Kloppel, S, Hartmann, A, et al. Voxel-based morphometry in eating disorders: correlation of psychopathology with grey matter volume. Psychiatry Res. 2010; 182(2): 146–151.Google Scholar
15. McCormick, LM, Keel, PK, Brumm, MC, et al. Implications of starvation-induced change in right dorsal anterior cingulate volume in anorexia nervosa. Int J Eat Disord. 2008; 41(7): 602–610.Google Scholar
16. Muhlau, M, Gaser, C, Ilg, R, et al. Gray matter decrease of the anterior cingulate cortex in anorexia nervosa. Am J Psychiatry. 2007; 164(12): 1850–1857.Google Scholar
17. Brooks, SJ, Barker, GJ, OʼDaly, OG, et al. Restraint of appetite and reduced regional brain volumes in anorexia nervosa: a voxel-based morphometric study. BMC Psychiatry. 2011; 11: 179.Google Scholar
18. Suchan, B, Busch, M, Schulte, D, Gronemeyer, D, Herpertz, S, Vocks, S. Reduction of gray matter density in the extrastriate body area in women with anorexia nervosa. Behav Brain Res. 2010; 206(1): 63–67.Google Scholar
19. Friederich, HC, Walther, S, Bendszus, M, et al. Grey matter abnormalities within cortico-limbic-striatal circuits in acute and weight-restored anorexia nervosa patients. Neuroimage. 2012; 59(2): 1106–1113.Google Scholar
20. King, JA, Geisler, D, Ritschel, F, et al. Global cortical thinning in acute anorexia nervosa normalizes following long-term weight restoration. Biol Psychiatry. 2015; 77(7): 624–632.Google Scholar
21. Roberto, CA, Mayer, LE, Brickman, AM, et al. Brain tissue volume changes following weight gain in adults with anorexia nervosa. Int J Eat Disord. 2011; 44(5): 406–411.Google Scholar
22. Wagner, A, Greer, P, Bailer, U, et al. Normal brain tissue volumes after long-term recovery in anorexia and bulimia nervosa. Biol Psychiatry. 2006; 59(3): 291–293.Google Scholar
23. Lazaro, L, Andres, S, Calvo, A, et al. Normal gray and white matter volume after weight restoration in adolescents with anorexia nervosa. Int J Eat Disord. 2013; 46(8): 841–848.Google Scholar
24. Fonville, L, Giampietro, V, Williams, SC, Simmons, A, Tchanturia, K. Alterations in brain structure in adults with anorexia nervosa and the impact of illness duration. Psychol Med. 2014; 44(9): 1965–1975.Google Scholar
25. Favaro, A, Tenconi, E, Degortes, D, Manara, R, Santonastaso, P. Effects of obstetric complications on volume and functional connectivity of striatum in anorexia nervosa patients. Int J Eat Disord. 2014; 47(7): 686–695.Google Scholar
26. Amianto, F, Caroppo, P, DʼAgata, F, et al. Brain volumetric abnormalities in patients with anorexia and bulimia nervosa: a voxel-based morphometry study. Psychiatry Res. 2013; 213(3): 210–216.Google Scholar
27. Schafer, A, Vaitl, D, Schienle, A. Regional grey matter volume abnormalities in bulimia nervosa and binge-eating disorder. Neuroimage. 2010; 50(2): 639–643.CrossRefGoogle ScholarPubMed
28. Marsh, R, Stefan, M, Bansal, R, Hao, X, Walsh, BT, Peterson, BS. Anatomical characteristics of the cerebral surface in bulimia nervosa. Biol Psychiatry. 2015; 77(7): 616–623.Google Scholar
29. Coutinho, J, Ramos, AF, Maia, L, et al. Volumetric alterations in the nucleus accumbens and caudate nucleus in bulimia nervosa: a structural magnetic resonance imaging study. Int J Eat Disord. 2015; 48(2): 206–214.CrossRefGoogle ScholarPubMed
30. Streitburger, DP, Moller, HE, Tittgemeyer, M, Hund-Georgiadis, M, Schroeter, ML, Mueller, K. Investigating structural brain changes of dehydration using voxel-based morphometry. PLoS One. 2012; 7(8): e44195.Google Scholar
31. Freund, W, Faust, S, Birklein, F, et al. Substantial and reversible brain gray matter reduction but no acute brain lesions in ultramarathon runners: experience from the TransEurope-FootRace Project. BMC Med. 2012; 10: 170.Google Scholar
32. Bomba, M, Riva, A, Veggo, F, et al. Impact of speed and magnitude of weight loss on the development of brain trophic changes in adolescents with anorexia nervosa: a case control study. Ital J Pediatr. 2013; 39: 14.Google Scholar
33. Frank, GK, Shott, ME, Hagman, JO, Mittal, VA. Alterations in brain structures related to taste reward circuitry in ill and recovered anorexia nervosa and in bulimia nervosa. Am J Psychiatry. 2013; 170(10): 1152–1160.Google Scholar
34. Frank, GK, Shott, ME, Hagman, JO, Yang, TT. Localized brain volume and white matter integrity alterations in adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry. 2013; 52(10): 1066–1075.Google Scholar
35. Shott, ME, Cornier, MA, Mittal, VA, et al. Orbitofrontal cortex volume and brain reward response in obesity. Int J Obes. (Lond.). 2015; 39(2): 214–221.Google Scholar
36. Rolls, ET. Functions of the orbitofrontal and pregenual cingulate cortex in taste, olfaction, appetite and emotion. Acta Physiol Hung. 2008; 95(2): 131–164.Google Scholar
37. Frank, GK, Reynolds, JR, Shott, ME, et al. Anorexia nervosa and obesity are associated with opposite brain reward response. Neuropsychopharmacology. 2012; 37(9): 2031–2046.Google Scholar
38. Plassmann, H, OʼDoherty, JP, Rangel, A. Appetitive and aversive goal values are encoded in the medial orbitofrontal cortex at the time of decision making. J Neurosci. 2010; 30(32): 10799–10808.Google Scholar
39. Frank, GK, Reynolds, JR, Shott, ME, OʼReilly, RC. Altered temporal difference learning in bulimia nervosa. Biol Psychiatry. 2011; 70(8): 728–735.Google Scholar
40. Craig, AD. How do you feel—now? The anterior insula and human awareness. Nat Rev Neurosci. 2009; 10(1): 59–70.Google Scholar
41. Wang, GJ, Tomasi, D, Backus, W, et al. Gastric distention activates satiety circuitry in the human brain. Neuroimage. 2008; 39(4): 1824–1831.Google Scholar
42. Tomasi, D, Wang, GJ, Wang, R, et al. Association of body mass and brain activation during gastric distention: implications for obesity. PLoS One. 2009; 4(8): e6847.Google Scholar
43. Devue, C, Collette, F, Balteau, E, et al. Here I am: the cortical correlates of visual self-recognition. Brain Res. 2007; 1143: 169–182.Google Scholar
44. Critchley, HD, Wiens, S, Rotshtein, P, Ohman, A, Dolan, RJ. Neural systems supporting interoceptive awareness. Nat Neurosci. 2004; 7(2): 189–195.Google Scholar
45. Konstantakopoulos, G, Varsou, E, Dikeos, D, et al. Delusionality of body image beliefs in eating disorders. Psychiatry Res. 2012; 200(2–3): 482–488.Google Scholar
46. Dukart, J, Bertolino, A. When structure affects function—the need for partial volume effect correction in functional and resting state magnetic resonance imaging studies. PLoS One. 2014; 9(12): e114227.Google Scholar
47. Dehaene, S, Changeux, JP. Reward-dependent learning in neuronal networks for planning and decision making. Prog Brain Res. 2000; 126: 217–229.Google Scholar
48. Le Bihan, D. Looking into the functional architecture of the brain with diffusion MRI. Nat Rev Neurosci. 2003; 4(6): 469–480.Google Scholar
49. Jiang, H, van Zijl, PC, Kim, J, Pearlson, GD, Mori, S. DtiStudio: resource program for diffusion tensor computation and fiber bundle tracking. Comput Methods Programs Biomed. 2006; 81(2): 106–116.Google Scholar
50. Kazlouski, D, Rollin, MD, Tregellas, J, et al. Altered fimbria-fornix white matter integrity in anorexia nervosa predicts harm avoidance. Psychiatry Res. 2011; 192(2): 109–116.CrossRefGoogle ScholarPubMed
51. Nagahara, Y, Nakamae, T, Nishizawa, S, et al. A tract-based spatial statistics study in anorexia nervosa: abnormality in the fornix and the cerebellum. Prog Neuropsychopharmacol Biol Psychiatry. 2014; 51: 72–77.Google Scholar
52. Via, E, Zalesky, A, Sanchez, I, et al. Disruption of brain white matter microstructure in women with anorexia nervosa. J Psychiatry Neurosci. 2014; 39(6): 367–375.Google Scholar
53. Frieling, H, Fischer, J, Wilhelm, J, et al. Microstructural abnormalities of the posterior thalamic radiation and the mediodorsal thalamic nuclei in females with anorexia nervosa—a voxel based diffusion tensor imaging (DTI) study. J Psychiatr Res. 2012; 46(9): 1237–1242.Google Scholar
54. Yau, WY, Bischoff-Grethe, A, Theilmann, RJ, et al. Alterations in white matter microstructure in women recovered from anorexia nervosa. Int J Eat Disord. 2013; 46(7): 701–708.Google Scholar
55. Mettler, LN, Shott, ME, Pryor, T, Yang, TT, Frank, GK. White matter integrity is reduced in bulimia nervosa. Int J Eat Disord. 2013; 46(3): 264–273.Google Scholar
56. Onoda, K, Ikeda, M, Sekine, H, Ogawa, H. Clinical study of central taste disorders and discussion of the central gustatory pathway. J Neurol. 2012; 259(2): 261–266.Google Scholar
57. Okun, MS, Mann, G, Foote, KD, et al. Deep brain stimulation in the internal capsule and nucleus accumbens region: responses observed during active and sham programming. J Neurol Neurosurg Psychiatry. 2007; 78(3): 310–314.Google Scholar
58. Salinas, JA, White, NM. Contributions of the hippocampus, amygdala, and dorsal striatum to the response elicited by reward reduction. Behav Neurosci. 1998; 112(4): 812–826.Google Scholar
59. Dalgleish, T. The emotional brain. Nat Rev Neurosci. 2004; 5(7): 583–589.Google Scholar
60. Osborne, B, Silverhart, T, Markgraf, C, Seggie, J. Effects of fornix transection and pituitary-adrenal modulation on extinction behavior. Behav Neurosci. 1987; 101(4): 504–512.CrossRefGoogle ScholarPubMed
61. Kringelbach, ML. Food for thought: hedonic experience beyond homeostasis in the human brain. Neuroscience. 2004; 126(4): 807–819.Google Scholar
62. Berridge, KC. Food reward: brain substrates of wanting and liking. Neurosci Biobehav Rev. 1996; 20(1): 1–25.Google Scholar
63. Kelley, AE, Schiltz, CA, Landry, CF. Neural systems recruited by drug- and food-related cues: studies of gene activation in corticolimbic regions. Physiol Behav. 2005; 86(1–2): 11–14.Google Scholar
64. Lak, A, Stauffer, WR, Schultz, W. Dopamine prediction error responses integrate subjective value from different reward dimensions. Proc Natl Acad Sci U S A. 2014; 111(6): 2343–2348.Google Scholar
65. Kringelbach, ML, Rolls, E. The functional neuroanatomy of the human orbitofrontal cortex: evidence from neuroimaging and neuropsychology. Prog Neurobiol. 2004; 72(5): 341–372.Google Scholar
66. Rolls, ET. Taste, olfactory and food texture reward processing in the brain and obesity. Int J Obes (Lond). 2011; 35(4): 550–561.Google Scholar
67. OʼReilly, RC. Biologically based computational models of high-level cognition. Science. 2006; 314(5796): 91–94.Google Scholar
68. Cowdrey, FA, Park, RJ, Harmer, CJ, McCabe, C. Increased neural processing of rewarding and aversive food stimuli in recovered anorexia nervosa. Biol Psychiatry. 2011; 70(8): 736–743.Google Scholar
69. Oberndorfer, TA, Frank, GK, Simmons, AN, et al. Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa. Am J Psychiatry. 2013; 170(10): 1143–1151.Google Scholar
70. Wagner, A, Aizenstein, H, Mazurkewicz, L, et al. Altered insula response to taste stimuli in individuals recovered from restricting-type anorexia nervosa. Neuropsychopharmacology. 2008; 33(3): 513–523.Google Scholar
71. Wagner, A, Aizenstein, H, Venkatraman, VK, et al. Altered striatal response to reward in bulimia nervosa after recovery. Int J Eat Disord. 2010; 43(4): 289–294.Google Scholar
72. Wagner, A, Aizenstein, H, Venkatraman, VK, et al. Altered reward processing in women recovered from anorexia nervosa. Am J Psychiatry. 2007; 164(12): 1842–1849.Google Scholar
73. Schultz, W, Dayan, P, Montague, PR. A neural substrate of prediction and reward. Science. 1997; 275(5306): 1593–1599.Google Scholar
74. Avena, NM, Rada, P, Hoebel, BG. Underweight rats have enhanced dopamine release and blunted acetylcholine response in the nucleus accumbens while bingeing on sucrose. Neuroscience. 2008; 156(4): 865–871.Google Scholar
75. Johnson, PM, Kenny, PJ. Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats. Nat Neurosci. 2010; 13(5): 635–641.Google Scholar
76. Maia, TV, Frank, MJ. From reinforcement learning models to psychiatric and neurological disorders. Nat Neurosci. 2011; 14(2): 154–162.Google Scholar
77. Frank, GK, Wagner, A, Achenbach, S, et al. Altered brain activity in women recovered from bulimic-type eating disorders after a glucose challenge: a pilot study. Int J Eat Disord. 2006; 39(1): 76–79.CrossRefGoogle ScholarPubMed
78. Radeloff, D, Willmann, K, Otto, L, et al. High-fat taste challenge reveals altered striatal response in women recovered from bulimia nervosa: a pilot study. World J Biol Psychiatry. 2014; 15(4): 307–316.Google Scholar
79. Bischoff-Grethe, A, McCurdy, D, Grenesko-Stevens, E, et al. Altered brain response to reward and punishment in adolescents with Anorexia nervosa. Psychiatry Res. 2013; 214(3): 331–340.Google Scholar
80. Jappe, LM, Frank, GK, Shott, ME, et al. Heightened sensitivity to reward and punishment in anorexia nervosa. Int J Eat Disord. 2011; 44(4): 317–324.Google Scholar
81. Vocks, S, Herpertz, S, Rosenberger, C, Senf, W, Gizewski, ER. Effects of gustatory stimulation on brain activity during hunger and satiety in females with restricting-type anorexia nervosa: an fMRI study. J Psychiatr Res. 2011; 45(3): 395–403.Google Scholar
82. Bohon, C, Stice, E. Negative affect and neural response to palatable food intake in bulimia nervosa. Appetite. 2012; 58(3): 964–970.Google Scholar
83. Heine, L, Soddu, A, Gomez, F, et al. Resting state networks and consciousness: alterations of multiple resting state network connectivity in physiological, pharmacological, and pathological consciousness states. Front Psychol. 2012; 3: 295.Google Scholar
84. Favaro, A, Santonastaso, P, Manara, R, et al. Disruption of visuospatial and somatosensory functional connectivity in anorexia nervosa. Biol Psychiatry. 2012; 72(10): 864–870.Google Scholar
85. Suchan, B, Bauser, DS, Busch, M, et al. Reduced connectivity between the left fusiform body area and the extrastriate body area in anorexia nervosa is associated with body image distortion. Behav Brain Res. 2013; 241: 80–85.Google Scholar
86. Cowdrey, FA, Filippini, N, Park, RJ, Smith, SM, McCabe, C. Increased resting state functional connectivity in the default mode network in recovered anorexia nervosa. Hum Brain Mapp. 2014; 35(2): 483–491.CrossRefGoogle ScholarPubMed
87. Kim, KR, Ku, J, Lee, JH, Lee, H, Jung, YC. Functional and effective connectivity of anterior insula in anorexia nervosa and bulimia nervosa. Neurosci Lett. 2012; 521(2): 152–157.Google Scholar
88. Amianto, F, DʼAgata, F, Lavagnino, L, et al. Intrinsic connectivity networks within cerebellum and beyond in eating disorders. Cerebellum. 2013; 12(5): 623–631.Google Scholar
89. Kullmann, S, Giel, KE, Teufel, M, Thiel, A, Zipfel, S, Preissl, H. Aberrant network integrity of the inferior frontal cortex in women with anorexia nervosa. Neuroimage Clinical. 2014; 4: 615–622.CrossRefGoogle ScholarPubMed
90. McFadden, KL, Tregellas, JR, Shott, ME, Frank, GK. Reduced salience and default mode network activity in women with anorexia nervosa. J Psychiatry Neurosci. 2014; 39(3): 178–188.Google Scholar
91. Bailer, UF, Frank, GK, Henry, SE, et al. Altered brain serotonin 5-HT1A receptor binding after recovery from anorexia nervosa measured by positron emission tomography and [carbonyl11C]WAY-100635. Arch Gen Psychiatry. 2005; 62(9): 1032–1041.CrossRefGoogle ScholarPubMed
92. Frank, G, Kaye, W, Meltzer, C, et al. Reduced 5-HT2A receptor binding after recovery from anorexia nervosa. Biol Psychiatry. 2002; 52(9): 896–906.Google Scholar
93. Bailer, UF, Frank, GK, Price, JC, et al. Interaction between serotonin transporter and dopamine D2/D3 receptor radioligand measures is associated with harm avoidant symptoms in anorexia and bulimia nervosa. Psychiatry Res. 2013; 211(2): 160–168.Google Scholar
94. Tauscher, J, Pirker, W, Willeit, M, et al. [123I] beta-CIT and single photon emission computed tomography reveal reduced brain serotonin transporter availability in bulimia nervosa. Biol Psychiatry. 2001; 49(4): 326–332.Google Scholar
95. Tiihonen, J, Keski-Rahkonen, A, Lopponen, M, et al. Brain serotonin 1A receptor binding in bulimia nervosa. Biol Psychiatry. 2004; 55(8): 871–873.Google Scholar
96. Bailer, UF, Bloss, CS, Frank, GK, et al. 5-HT(1)A receptor binding is increased after recovery from bulimia nervosa compared to control women and is associated with behavioral inhibition in both groups. Int J Eat Disord. 2011; 44(6): 477–487.Google Scholar
97. Frank, GK, Bailer, UF, Henry, SE, et al. Increased dopamine D2/D3 receptor binding after recovery from anorexia nervosa measured by positron emission tomography and [11c]raclopride. Biol Psychiatry. 2005; 58(11): 908–912.Google Scholar
98. Wang, G, Volkow, N, Thanos, P, Fowler, JS. Similarity between obesity and drug addiction as assessed by neurofunctional imaging: a concept review. J Addict Dis. 2004; 23(3): 39–53.Google Scholar
99. Broft, A, Shingleton, R, Kaufman, J, et al. Striatal dopamine in bulimia nervosa: a PET imaging study. Int J Eat Disord. 2012; 45(5): 648–656.CrossRefGoogle ScholarPubMed
100. Frank, GK. Advances in the diagnosis of anorexia nervosa and bulimia nervosa using brain imaging. Expert Opin Med Diagn. 2012; 6(3): 235–244.Google Scholar