Common and Distinct Phenotypes of Body Dysmorphic Disorder and Anorexia Nervosa

描述(由申请人提供)：这项研究的目的是通过一系列功能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)相关的共享和独特的大脑回路。BDD和神经性厌食症是严重和致残的精神疾病，具有许多共同的临床特征，如扭曲的身体形象和高估自我价值的外表，但目前它们被归类为不同的诊断类别。尽管它们的发病率和死亡率很高，但很少有人进行研究来比较和对比这些疾病，以了解共同和独特的临床表型的潜在神经生物学。BDD和AN的一个重要共同临床表型是外观的知觉扭曲，这可能是导致身体形象扭曲的原因之一。临床和神经心理测试证明，BDD和AN在视觉知觉和视觉空间处理方面有相似的、常见的表型障碍。然而，人们对调节这些过程的潜在神经生物学过程知之甚少。一项对患有BDD的成年人进行的初步功能磁共振成像(FMRI)研究显示，当看到其他人的脸时，负责高细节处理的左半球区域异常激活。BDD上最近的一项研究表明，当看自己的脸时，主要情绪处理区域没有异常。另一方面，除了对体重增加的极端恐惧外，AN的特征通常是儿童早期发作的焦虑。然而，还没有研究专门研究恐惧在AN中的处理，也没有将其与BDD进行比较。这项拟议研究的目标是确定BDD中视觉和情绪处理的共同和独特的表型，以及映射到特定大脑系统的表型。这项研究将招募25名患有BDD的受试者，25名体重恢复的AN患者，以及25名年龄在18-30岁的健康对照组。功能磁共振成像(FMRI)将用于识别与视觉和情绪处理相关的大脑系统的关键异常。基于BDD以前的功能磁共振研究，以及我们的试点数据和之前的研究表明细节处理的异常，本研究将使用传达高、低或正常细节水平的不同类型的视觉图像来研究其他人的面部、身体和非面部物体(房屋)的视觉加工。为了比较和对比情绪处理的模式，这项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共同或不同的大脑活动模式。。 公共卫生相关性：这项研究将描述与这些严重和致残的身体形象障碍相关的知觉扭曲和情绪处理相关的大脑电路，以建立它们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了解来完善分类方案，而不仅仅是表面症状和行为。这也将为未来新疗法的发展奠定基础，如知觉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.