Atypical social cognition processing in bulimia nervosa: an fMRI study of patients thinking of others' mental states

Rio Kamashita; Rikukage Setsu; Noriko Numata; Yasuko Koga; Michiko Nakazato; Koji Matsumoto; Hiroki Ando; Yoshitada Masuda; Sertap Maral; Eiji Shimizu; Yoshiyuki Hirano

doi:10.1186/s13030-023-00297-y

Atypical social cognition processing in bulimia nervosa: an fMRI study of patients thinking of others' mental states

Biopsychosoc Med. 2024 Feb 21;18(1):5. doi: 10.1186/s13030-023-00297-y.

Authors

Rio Kamashita^{1

2}, Rikukage Setsu^{3

4}, Noriko Numata^{1

2

3}, Yasuko Koga¹, Michiko Nakazato^{5

6}, Koji Matsumoto⁷, Hiroki Ando⁷, Yoshitada Masuda⁷, Sertap Maral^{2

3}, Eiji Shimizu^{1

2

3}, Yoshiyuki Hirano^{8

9}

Affiliations

¹ Research Center for Child Mental Development, Chiba University, Chiba, Japan.
² United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan.
³ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁴ Sato Hospital, Nanyo, Japan.
⁵ Department of Clinical Psychiatry, Chiba University Hospital, Chiba, Japan.
⁶ International University of Health and Welfare, Narita, Department of Psychiatry, Narita, Japan.
⁷ Department of Radiology, Chiba University Hospital, Chiba, Japan.
⁸ Research Center for Child Mental Development, Chiba University, Chiba, Japan. hirano@chiba-u.jp.
⁹ United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan. hirano@chiba-u.jp.

Abstract

Background: Feeding and eating disorders are severe mental disorders that gravely affect patients' lives. In particular, patients with anorexia nervosa (AN) or bulimia nervosa (BN) appear to have poor social cognition. Many studies have shown the relationship between poor social cognition and brain responses in AN. However, few studies have examined the relationship between social cognition and BN. Therefore, we examined which brain regions impact the ability for social cognition in patients with BN.

Methods: We used task-based functional magnetic resonance imaging (fMRI) to examine brain responses during a social cognition task and the Reading Mind in the Eyes Test (RMET). During the fMRI, 22 women with BN and 22 healthy women (HW) took the RMET. Participants also completed the eating disorder clinical measures Bulimic Investigatory Test, Edinburgh (BITE) and Eating Disorders Examination Questionnaire (EDE-Q), the Patient Health Questionnaire (PHQ-9) measure of depression; and the Generalized Anxiety Disorder (GAD-7) measure of anxiety.

Results: No difference was observed in the RMET scores between women with BN and HW. Both groups showed activation in brain regions specific to social cognition. During the task, no differences were shown between the groups in the BOLD signal (p < 0.05, familywise error corrected for multiple comparisons). However, there was a tendency of more robust activation in the right angular gyrus, ventral diencephalon, thalamus proper, temporal pole, and middle temporal gyrus in BN (p < 0.001, uncorrected for multiple comparisons). Moreover, HW showed a positive correlation between RMET scores and the activation of two regions: medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC); however, no significant correlation was observed in women with BN.

Conclusions: While activation in the mPFC and ACC positively correlated to the RMET scores in HW, no correlation was observed in BN patients. Therefore, women with BN might display modulated neural processing when thinking of others' mental states. Further examination is needed to investigate neural processing in BN patients to better understand their social cognition abilities.

Trial registration: UMIN, UMIN000010220. Registered 13 March 2013, https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000010220.

Keywords: Bulimia nervosa; Eating disorders; Social cognition; Task-based fMRI; Theory of mind.