Common and Distinct Phenotypes of Body Dysmorphic Disorder and Anorexia Nervosa

描述（由申请人提供）：本研究的目的是使用一组功能性神经成像实验来表征与躯体变形障碍（BDD）和神经性厌食症（AN）相关的共享和独特脑回路。BDD和神经性厌食症AN是严重和致残的精神疾病，它们具有许多共同的临床特征，例如扭曲的身体形象和对自我价值的高估，但它们目前被分类为单独的诊断类别。尽管其发病率和死亡率显著，但很少有研究对这些疾病进行比较和对比，以了解共享和独特临床表型的潜在神经生物学。BDD和AN的一个重要的共同临床表型是外观的感知扭曲，这可能有助于扭曲的身体形象。有早期的证据表明，在BDD和AN的视觉感知和视觉空间处理的障碍相似，共同的表型，从临床和神经心理学测试证明。然而，人们对介导这些的潜在神经生物学过程知之甚少。一项针对BDD成年人的初步功能性磁共振成像（fMRI）研究表明，当观察他人面部时，负责高细节处理的左半球区域异常激活。最近的一项关于BDD的研究表明，当观察自己的面孔时，主要情绪处理区域没有异常。另一方面，AN的特征通常是早期的、儿童期发作的焦虑，以及对体重增加的极度恐惧。然而，没有研究专门研究AN的恐惧处理，也没有将其与BDD进行比较。这项研究的目的是确定BDD和AN中映射到特定大脑系统的视觉和情感处理的共同和不同的表型。这项研究将招募25名BDD受试者，25名体重恢复的AN受试者和25名健康对照者，年龄18-30岁。功能性磁共振成像（fMRI）将用于识别与视觉和情感处理相关的大脑系统中的关键异常。本研究在前人关于BDD的功能磁共振成像研究的基础上，结合我们的实验数据和前人关于AN患者细节加工异常的研究，采用不同类型的视觉图像（高、低和正常细节水平），探讨AN患者对他人面孔、身体和非面孔物体（房屋）的视觉加工。为了比较和对比情绪处理模式，本研究将使用恐惧的面部刺激来了解与情绪反应、调节和习惯化相关的常见或不同的大脑活动模式。. 公共卫生相关性：本研究将描述与这些严重和致残的身体意象障碍中的感知扭曲和情绪处理相关的脑回路，以建立其共同和独特的临床特征的神经基础。这将有助于基于对潜在大脑机制的理解而不仅仅是表面症状和行为来完善分类方案。这也将为未来开发新的治疗方法奠定基础，如感知再训练和情绪调节技术。

DESCRIPTION (provided by applicant): The purpose of this study is to characterize shared and unique brain circuits associated with Body Dysmorphic Disorder (BDD) and Anorexia Nervosa (AN) using a set of functional neuroimaging experiments. BDD and anorexia nervosa AN are severe and disabling psychiatric disorders that share many clinical features such as distorted body image and overvaluation of appearance for self-worth, yet they are currently classified in separate diagnostic categories. Despite their significant morbidity and mortality, very little research has been conducted to compare and contrast these disorders in order to understand the underlying neurobiology of shared and unique clinical phenotypes. An important shared clinical phenotype in BDD and AN is perceptual distortion of appearance, which may contribute to distorted body image. There is early evidence of similar, common phenotypes of disturbances in visual perception and visuospatial processing in BDD and AN, as evidenced clinically and from neuropsychological testing. However, little is known of the underlying neurobiological processes that mediate these. A preliminary functional magnetic resonance imaging (fMRI) study in adults with BDD demonstrated abnormal activation in left hemisphere regions responsible for high-detail processing when viewing others' faces. A more recent study in BDD demonstrated no abnormalities of primary emotional processing regions when viewing own-faces. AN, on the other hand, is often characterized by early, childhood-onset anxiety in addition to extreme fears of weight gain. However, no study has specifically examined fear processing in AN nor compared it to BDD. The goal of the proposed study is to define the common and distinct and phenotypes of visual and emotional processing in BDD and AN that map onto specific brain systems. This study will enroll 25 subjects with BDD, 25 with weight-restored AN, and 25 healthy controls, ages 18-30. Functional magnetic resonance imaging (fMRI) will be used to identify key abnormalities in brain systems associated with visual and emotional processing. Based on previous fMRI research in BDD, and our pilot data and previous studies suggesting abnormalities of detail-processing in AN, this study will investigate visual processing of others' faces, bodies, and non-face objects (houses) using different types of visual images that convey high, low, or normal level of detail. To compare and contrast patterns of emotional processing, this study will use fearful face stimuli to understand common or distinct brain activity patterns associated with emotional reactivity, regulation, and habituation. . PUBLIC HEALTH RELEVANCE: This study will characterize brain circuitry associated with perceptual distortions and emotional processing in these severe and disabling disorders of body image to establish the neural basis for their shared and distinct clinical features. This will assist in refining classification schemes based on an understanding of underlying brain mechanisms and not merely surface symptoms and behaviors. It will also lay the foundation for future development of novel therapeutics such as perceptual retraining and emotion regulation techniques.