Neurocircuitry of Temperament and Motivated Behavior in Adolescent Eating Disorders

项目总结/摘要 所有进食障碍（艾德）的共同点是进食动机的改变 ，从极端的食物 限制和减肥，暴饮暴食加上补偿策略，如自我诱导呕吐。 尽管传统上强调这些身体症状，但它们往往重叠，并且沿着显著的 诊断交叉（例如，从神经性厌食症到神经性贪食症），建议 目前的诊断标准没有很好地捕捉到的共同特征。这项新的提案旨在审查 如何基于RDoC的气质测量-行为激活/冲动，行为抑制，和努力 对照-确定可能反映艾德核心维度的青少年艾德患者的临床意义组 比DSM诊断更好，更符合脑功能和临床症状。这些 性情被认为在艾德行为中起作用，因为它们与改变的激励有关 处理，特别是在腹侧纹状体和纹状体，通过 评估预期和实际结果。例如，在其他方法障碍，如成瘾，高 冲动性与预期金钱奖励时纹状体活动减少有关， 回避障碍、焦虑和抑制与对奖励的反应增强有关 预期，9和减少纹状体结果反应。10我们测试了新的假设，过度和不足， 控制饮食行为反映了源于改变的评价的异常激励处理 预期和/或实际结果，以诱导补偿性消费（接近）或回避行为。 我们将招募150名目前患有艾德的女性和50名年龄在14-17岁的对照组，以研究如何 反映更大的抑制，冲动或努力控制的气质对应于1）临床症状 大脑对欲望和厌恶的预期和结果的反应（金钱胜利） 和损失）和疾病特异性（味觉）显著刺激，和3）通过收集一年的随访临床数据 随后，识别基于气质的亚型如何预测艾德症状变化（例如，临床预测）。 证明某些气质和个性特征与大脑反应直接相关 金钱和口味，而不仅仅是疾病特异性食物刺激，这与临床 症状，将提供更大的支持，为生物过程的贡献，潜在的激励 处理到艾德行为。我们还将探讨气质是否与白色物质有意义的联系 结构连接和静息状态功能连接以进一步表征脑行为 解决这些问题对于我们机械地理解青少年ED的关系至关重要。 饮食失调的神经基础，并将推动我们走向更有意义的表征和发展 更有针对性的干预和预防策略，而不是通过身体症状分型。

PROJECT SUMMARY/ABSTRACT Common to all eating disorders (ED) are alterations in the motivation to eat , ranging from extreme food restriction and weight loss, to binge eating coupled with compensatory strategies like self-induced vomiting. Despite the traditional emphasis on these physical symptoms, they often overlap, and, along with significant diagnostic crossover (e.g., from anorexia nervosa to bulimia nervosa) over the course of one's illness, suggest shared features that are not well captured by current diagnostic criteria. This novel proposal aims to examine how RDoC-based temperament measures – behavioral activation/impulsivity, behavioral inhibition, and effortful control – identify clinically meaningful groups of adolescent ED patients that may reflect core dimensions of ED better than DSM diagnosis and correspond more strongly to brain function and clinical symptoms. These temperaments are thought to play a role in ED behavior because they are linked to altered incentive processing, particularly in the ventral striatum and insula, which guides approach and avoidance motivation via evaluation of anticipated and actual outcomes. For example, in other approach disorders, like addiction, high impulsivity is associated with reduced striatal activity during monetary reward anticipation,8 whereas in avoidance disorders, anxiety and inhibition are linked with an increased insula response to reward anticipation,9 and decreased striatal outcome response.10 We test the novel hypothesis that over- and under- controlled eating behavior reflects aberrant incentive processing stemming from altered evaluation of anticipated and/or actual outcome to induce compensatory consumption (approach) or avoidance behaviors. We will recruit 150 females currently ill with an ED and 50 controls ages 14-17 to investigate how temperaments reflecting greater inhibition, impulsivity, or effortful control correspond to 1) clinical symptoms and 2) the brain's response to anticipation and outcome of appetitive and aversive generalized (monetary wins and losses) and disorder-specific (taste) salient stimuli, and 3) by collecting follow-up clinical data one year later, identify how temperament-based subtypes predict ED symptom change (e.g., clinical prediction). Demonstrating that certain temperament and personality characteristics are directly related to brain response to both money and taste, rather than only disorder-specific food stimuli, and that correspond to clinical symptoms, will provide greater support for the contribution of biological processes underlying incentive processing to ED behavior. We will also explore whether temperament is meaningfully related to white matter structural connectivity and resting state functional connectivity to further characterize brain-behavior relationships in adolescent ED. Resolving these questions is critical to our mechanistic understanding of the neural basis of disordered eating and will move us towards more meaningful characterization and development of more targeted intervention and prevention strategies than subtyping by physical symptoms.