Emotion processing in anorexia nervosa: what happens in the brain?

In many psychiatric disorders difficulties/ abnormalities in appraising
affective situations are linked to the maintenance of disorders and in relapse
after treatment. This is also the case in anorexia nervosa (AN), where growing
research shows poor emotion recognition and emotion regulation impairments in
AN patients. Moreover, the majority of AN patients report high levels of
negative emotions (e.g. anxiety), particularly in response to uncertain
situations and events. There is research suggesting that these emotion
processing difficulties may hinder treatment. Since treatment for AN is
suboptimal, and relapse rates are high, there is an urgent need for a better
understanding of the aetiology and pathophysiology of this illness. Neural
responses to processing ambiguous emotional stimuli are understudied but can
provide important information about the emotion problems found in AN patients.

The primary aims of this study are firstly to identify the brain regions
involved in the appraisal of ambiguous affective stimuli in anorexia nervosa
patients, and secondly to compare their responses with those of healthy control
participants. The second aims of this study are to firstly assess emotion
processing in AN patients, secondly, to assess the effects of ambiguous
affective stimuli on levels of (negative) emotions in AN patients, and thirdly,
to assess the association between measures of executive and cognitive function
and emotional and neural responses to ambiguous affective stimuli in AN
patients.

This is a case-control trial where AN patients and healthy control participants
are asked to complete a number of questionnaires and computer tasks and one
task in the scanner.

On the study day participants will have a (30-minute) MRI session during which
they will do two emotion processing tasks. This type of paradigm poses no risk.
Functional MRI is a commonly used technique which is considered to be safe.
Additionally, measurements will be done to assess relevant clinical
characteristics along with a computer task to assess cognitive functioning.
This task has been used in AN patients and is not considered to be a burden; it
is even perceived as amusing to do. In summary, the risk associated with
participation is assessed as low and the burden as minimal.