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Brain connectome modularity in weight-restored anorexia nervosa and body dysmorphic disorder

  • A. Zhang (a1), A. Leow (a1) (a2) (a3), L. Zhan (a4), J. GadElkarim (a1), T. Moody (a5), S. Khalsa (a5), M. Strober (a5) and J. D. Feusner (a5)...

Anorexia nervosa (AN) and body dysmorphic disorder (BDD) frequently co-occur, and have several overlapping phenomenological features. Little is known about their shared neurobiology. The aim of the study was to compare modular organization of brain structural connectivity.


We acquired diffusion-weighted magnetic resonance imaging data on unmedicated individuals with BDD (n = 29), weight-restored AN (n = 24) and healthy controls (HC) (n = 31). We constructed connectivity matrices using whole-brain white matter tractography, and compared modular structures across groups.


AN showed abnormal modularity involving frontal, basal ganglia and posterior cingulate nodes. There was a trend in BDD for similar abnormalities, but no significant differences compared with AN. In AN, poor insight correlated with longer path length in right caudal anterior cingulate and right posterior cingulate.


Abnormal network organization patterns in AN, partially shared with BDD, may have implications for understanding integration between reward and habit/ritual formation, as well as conflict monitoring/error detection.

Corresponding author
*Address for correspondence: A. Leow, M.D., Ph.D., Department of Psychiatry and Bioengineering, University of Illinois College of Medicine, Room 584, 1601 West Taylor Street, Chicago, IL 60612, USA. (Email:
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Agam, Y, Hamalainen, MS, Lee, AK, Dyckman, KA, Friedman, JS, Isom, M, Makris, N, Manoach, DS (2010). Multimodal neuroimaging dissociates hemodynamic and electrophysiological correlates of error processing. Proceedings of the National Academy of Sciences of the United States of America 108, 1755617561.
Alexander-Bloch, AF, Gogtay, N, Meunier, D, Birn, R, Clasen, L, Lalonde, F, Lenroot, R, Giedd, J, Bullmore, ET (2010). Disrupted modularity and local connectivity of brain functional networks in childhood-onset schizophrenia. Frontiers in Systems Neuroscience 4, 147.
Altman, SE, Shankman, SA (2009). What is the association between obsessive compulsive disorder and eating disorders? Clinical Psychology Review 29, 638646.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR , 4th edn. American Psychiatric Association: Washington, DC.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5 , 5th edn. American Psychiatric Publishing: Washington, DC.
Aron, AR (2011). From reactive to proactive and selective control: developing a richer model for stopping inappropriate responses. Biological Psychiatry 69, e55e68.
Balleine, BW, Delgado, MR, Hikosaka, O (2007). The role of the dorsal striatum in reward and decision-making. Journal of Neuroscience: the Official Journal of the Society for Neuroscience 27, 81618165.
Belloch, A, Roncero, M, Perpina, C (2012). Ego-syntonicity and ego-dystonicity associated with upsetting intrusive cognitions. Journal of Psychopathology and Behavioral Assessment 34, 94106.
Buhlmann, U, Glaesmer, H, Mewes, R, Fama, JM, Wilhelm, S, Brahler, E, Rief, W (2010). Updates on the prevalence of body dysmorphic disorder: a population-based survey. Psychiatry Research 178, 171175.
Bullmore, E, Sporns, O (2009). Complex brain networks: graph theoretical analysis of structural and functional systems. Nature Reviews Neuroscience 10, 186198.
Bullmore, ET, Bassett, DS (2011). Brain graphs: graphical models of the human brain connectome. Annual Review of Clinical Psychology 7, 113140.
Cooper, MJ, Todd, G, Woolrich, R, Somerville, K, Wells, A (2006). Assessing eating disorder thoughts and behaviors: the development and preliminary evaluation of two questionnaires. Cognitive Therapy and Research 30, 551570.
Cororve, MB, Gleaves, DH (2001). Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies. Clinical Psychology Review 21, 949970.
Cowdrey, FA, Park, RJ, Harmer, CJ, McCabe, C (2011). Increased neural processing of rewarding and aversive food stimuli in recovered anorexia nervosa. Biological Psychiatry 70, 736743.
Das, TK, Abeyasinghe, PM, Crone, JS, Sosnowski, A, Laureys, S, Owen, AM, Soddu, A (2014). Highlighting the structure–function relationship of the brain with the Ising model and graph theory. BioMed Research International 2014, 237898.
Eisen, JL, Phillips, KA, Baer, L, Beer, DA, Atala, KD, Rasmussen, SA (1998). The Brown Assessment of Beliefs Scale: reliability and validity. American Journal of Psychiatry 155, 102108.
Eisen, JL, Phillips, KA, Coles, ME, Rasmussen, SA (2004). Insight in obsessive compulsive disorder and body dysmorphic disorder. Comprehensive Psychiatry 45, 1015.
Fairburn, CG, Cooper, Z, O'Connor M (2008). Eating Disorder Examination (16.0D). In Cognitive Behavior Therapy and Eating Disorders (ed. Fairburn, C. G.). The Guilford Press: New York.
Frank, GK, Reynolds, JR, Shott, ME, Jappe, L, Yang, TT, Tregellas, JR, O'Reilly, RC (2012). Anorexia nervosa and obesity are associated with opposite brain reward response. Neuropsychopharmacology 37, 20312046.
Gadelkarim, JJ, Ajilore, O, Schonfeld, D, Zhan, L, Thompson, PM, Feusner, JD, Kumar, A, Altshuler, LL, Leow, AD (2014). Investigating brain community structure abnormalities in bipolar disorder using path length associated community estimation. Human Brain Mapping 35, 22532264.
Garcia-Soriano, G, Roncero, M, Perpina, C, Belloch, A (2014). Intrusive thoughts in obsessive–compulsive disorder and eating disorder patients: a differential analysis. European Eating Disorders Review 22, 191199.
Grant, JE, Kim, SW, Eckert, ED (2002). Body dysmorphic disorder in patients with anorexia nervosa: prevalence, clinical features, and delusionality of body image. International Journal of Eating Disorders 32, 291300.
Haber, SN, Knutson, B (2010). The reward circuit: linking primate anatomy and human imaging. Neuropsychopharmacology 35, 426.
Hamilton, M (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 5055.
Hartmann, AS, Thomas, JJ, Wilson, AC, Wilhelm, S (2013). Insight impairment in body image disorders: delusionality and overvalued ideas in anorexia nervosa versus body dysmorphic disorder. Psychiatry Research 210, 11291135.
Kollei, I, Brunhoeber, S, Rauh, E, de Zwaan, M, Martin, A (2012). Body image, emotions and thought control strategies in body dysmorphic disorder compared to eating disorders and healthy controls. Journal of Psychosomatic Research 72, 321327.
Koran, LM, Abujaoude, E, Large, MD, Serpe, RT (2008). The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectrums 13, 316322.
Leow, A, Ajilore, O, Zhan, L, Arienzo, D, GadElkarim, J, Zhang, A, Moody, T, Van Horn, J, Feusner, J, Kumar, A, Thompson, P, Altshuler, L (2012). Impaired inter-hemispheric integration in bipolar disorder revealed with brain network analyses. Biological Psychiatry 73, 183193.
Li, W, Lai, TM, Bohon, C, Loo, SK, McCurdy, D, Strober, M, Bookheimer, S, Feusner, J (2015 a). Anorexia nervosa and body dysmorphic disorder are associated with abnormalities in processing visual information. Psychological Medicine 45, 21112122.
Li, W, Lai, TM, Loo, SK, Strober, M, Mohammad-Rezazadeh, I, Khalsa, S, Feusner, J (2015 b). Aberrant early visual neural activity and brain–behavior relationships in anorexia nervosa and body dysmorphic disorder. Frontiers in Human Neuroscience 9, 301.
Liu, Y, Liang, M, Zhou, Y, He, Y, Hao, Y, Song, M, Yu, C, Liu, H, Liu, Z, Jiang, T (2008). Disrupted small-world networks in schizophrenia. Brain: a Journal of Neurology 131, 945961.
Lynall, ME, Bassett, DS, Kerwin, R, McKenna, PJ, Kitzbichler, M, Muller, U, Bullmore, E (2010). Functional connectivity and brain networks in schizophrenia. Journal of Neuroscience: the Official Journal of the Society for Neuroscience 30, 94779487.
Mancuso, SG, Knoesen, NP, Castle, DJ (2010). Delusional versus nondelusional body dysmorphic disorder. Comprehensive Psychiatry 51, 177182.
Menzies, L, Chamberlain, SR, Laird, AR, Thelen, SM, Sahakian, BJ, Bullmore, ET (2008). Integrating evidence from neuroimaging and neuropsychological studies of obsessive–compulsive disorder: the orbitofronto-striatal model revisited. Neuroscience and Biobehavioral Reviews 32, 525549.
Montgomery, SA, Åsberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382389.
Moody, TD, Sasaki, MA, Bohon, C, Strober, MA, Bookheimer, SY, Sheen, CL, Feusner, JD (2015). Functional connectivity for face processing in individuals with body dysmorphic disorder and anorexia nervosa. Psychological Medicine 45, 34913503.
Nambu, A, Tokuno, H, Takada, M (2002). Functional significance of the cortico-subthalamo-pallidal “hyperdirect” pathway. Neuroscience Research 43, 111117.
Newman, ME, Girvan, M (2004). Finding and evaluating community structure in networks. Physical Review E 69, 026113.
Oldfield, RC (1971). The assessment and analysis of handedness: the Edinburgh Inventory. Neuropsychologia 9, 97113.
Peng, ZW, Shi, F, Shi, CZ, Yang, Q, Chan, RCK, Shen, DG (2014). Disrupted cortical network as a vulnerability marker for obsessive–compulsive disorder. Brain Structure and Function 219, 18011812.
Perpina, C, Roncero, M, Belloch, A, Sanchez-Reales, S (2011). Eating-related intrusive thoughts inventory: exploring the dimensionality of eating disorder symptoms. Psychological Reports 109, 108126.
Phillipou, A, Rossell, SL, Castle, DJ (2014). The neurobiology of anorexia nervosa: a systematic review. Australian and New Zealand Journal of Psychiatry 48, 128152.
Phillips, KA, Atala, KD, Pope, HG Jr. (1995). Diagnostic instruments for body dysmorphic disorder. New research program and abstracts, American Psychiatric Association 148th Annual Meeting; Miami, p. 157.
Phillips, KA, Hollander, E, Rasmussen, SA, Aronowitz, BR, DeCaria, C, Goodman, WK (1997). A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale–Brown Obsessive–Compulsive Scale. Psychopharmacology Bulletin 33, 1722.
Phillips, KA, Kaye, WH (2007). The relationship of body dysmorphic disorder and eating disorders to obsessive–compulsive disorder. CNS Spectrums 12, 347358.
Rabe-Jablonska, JJ, Sobow T, M (2000). The links between body dysmorphic disorder and eating disorders. European Psychiatry 15, 302305.
Rief, W, Buhlmann, U, Wilhelm, S, Borkenhagen, A, Brahler, E (2006). The prevalence of body dysmorphic disorder: a population-based survey. Psychological Medicine 36, 877885.
Ruffolo, J, Phillips, K, Menard, W, Fay, C, Weisberg, R (2006). Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance. International Journal of Eating Disorders 39, 1119.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 2233; quiz 34–57.
Sporns, O (2010). Networks of the Brain. MIT Press: Cambridge, MA.
Steinglass, JE, Eisen, JL, Attia, E, Mayer, L, Walsh, BT (2007). Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa. Journal of Psychiatric Practice 13, 6571.
Swinbourne, JM, Touyz, SW (2007). The co-morbidity of eating disorders and anxiety disorders: a review. European Eating Disorders Review 15, 253274.
van den Heuvel, MP, Mandl, RC, Stam, CJ, Kahn, RS, Hulshoff Pol, H (2010). Aberrant frontal and temporal complex network structure in schizophrenia: a graph theoretical analysis. Journal of Neuroscience: the Official Journal of the Society for Neuroscience 30, 1591515926.
Vogt, B (2009). Regions and subregions of the cingulate gyrus. In Cingulate Neurobiology and Disease (ed. Vogt, B.), pp. 330. Oxford University Press: Oxford.
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