Brain responses to body image stimuli but not food are altered in women with bulimia nervosa

BACKGROUND Research into the neural correlates of bulimia nervosa (BN) psychopathology remains limited. METHODS In this functional magnetic resonance imaging study, 21 BN patients and 23 healthy controls (HCs) completed two paradigms: (1) processing of visual food stimuli and (2) comparing their own appearance with that of slim women. Participants also rated food craving and anxiety levels. RESULTS Brain activation patterns in response to food cues did not differ between women with and without BN. However, when evaluating themselves against images of slim women, BN patients engaged the insula more and the fusiform gyrus less, compared to HCs, suggesting increased self-focus among women with BN whilst comparing themselves to a 'slim ideal'. In these BN patients, exposure to food and body image stimuli increased self-reported levels of anxiety, but not craving. CONCLUSIONS Our findings suggest that women with BN differ from HCs in the way they process body image, but not in the way they process food stimuli.