Neuropsychological Aspects of Eating Disorders – A Focus on Diagnostic Criteria

  • Jennie C. Ahrén


The interest in neurological basis for behavior has increased lately. Neuro-imaging techniques have made observations of human behavior possible in ways that were not anticipated a few decades ago. Eating disorders (ED) are severe psychiatric disturbances with psychosomatic complications, mainly affecting young women. The main diagnoses are anorexia nervosa (self-starvation) and bulimia nervosa (binge-eating and compensatory actions). Eating pathology has been linked to both neurological abnormalities and disturbances in neurotransmitters and neuroendocrine systems. It is not clear, however, whether these malfunctions are due to the condition or if they stand as predisposing factors. The Minnesota postwar experiment studied effects of starvation in a group of healthy men and showed behavioral patterns similar to those in patients with ED. Neuropsychological studies on ED patients show that cognitive functioning is impaired. Executive functions, visuospatial abilities, and psychomotor speed seem to be the main areas affected. Different regions of the brain are connected to food intake and could be involved in eating pathology. Hypothalamus and the insular cortex have been suggested to be of importance in ED. Further, reduced hippocampal volume and reductions in both grey and white matter has been reported in ED. These alterations are likely to be connected to deficits in cognitive functions, but seem to be reversible after recovery. Studies show that activation of the brains network for fear is involved in food processing and body distortion, indicating the severity of symptoms. The importance of assessing neurological structures and functions underlying the pathological eating behavior and related symptoms is essential for an increased understanding of these disorders. New insights in the interplay between brain and behavior make it possible to develop new methods for treatment and prevention in ED.


Eating Disorder Anorexia Nervosa Eating Disorder Bulimia Nervosa Neuropsychological Deficit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Anorexia nervosa


Bulimia nervosa


Binge eating disorder


Cerebrospinal fluid


Eating disorders


Eating disorders not otherwise specified


Functional magnetic resonance imaging


  1. Agrawal S, Lask B. Pediatric Health. 2009;3:209–121.CrossRefGoogle Scholar
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV). Washington: American Psychiatric Association; 1994.Google Scholar
  3. Bayless JD, Kanz JE, Moser DJ, McDowell BD, Bowers WA, Andersen AD, Paulsen JS. Ann Clin Psychiatry. 2002;14:203–7.PubMedGoogle Scholar
  4. Beato-Fernandez L, Rodriguez-Cano T, Garcia-Vilches I, Garcia-Vicente A, Poblete-Garcia V, Castrejon AS, Toro J. Psychiatry Res. 2009;171:129–37.PubMedCrossRefGoogle Scholar
  5. Braun CMJ, Chouinard M-J. Neuropsychol Rev. 1992;3:171–212.PubMedCrossRefGoogle Scholar
  6. Bulik CM, Tozzi F, Anderson C, Mazzeo SE, Aggen S, Sullivan PF. Am J Psychiatry. 2003;160:366–8.PubMedCrossRefGoogle Scholar
  7. Connan F, Lightman SL, Landau S, Wheeler M, Treasure J. Physiol Behav. 2003;79:13–24.PubMedCrossRefGoogle Scholar
  8. Connan F, Murphy F, Connor SE, Rich P, Murphy T, Bara-Carill N, Landau S, Krljes S, Ng V, Williams S, Morris RG, Campbell IC, Treasure J. Psychiatry Res. 2006;146:117–25.PubMedCrossRefGoogle Scholar
  9. Duchesne M, Mattos P, Fontenelle LF, Veiga H, Rizo L, Appolinario JC. Rev Bras Psiquiatr. 2004;26:107–17.PubMedCrossRefGoogle Scholar
  10. Ellison Z, Foong J, Howard R, Bullmore E, Williams S, Treasure J. Lancet. 1998;352:1192.PubMedCrossRefGoogle Scholar
  11. Fairburn CG, Cooper Z, Doll HA, Welch SL. Arch Gen Psychiatry. 1999;56:468–74.PubMedCrossRefGoogle Scholar
  12. Favaro A, Ferrara S, Santonastaso P. Psychosom Med. 2003;65:701–8.PubMedCrossRefGoogle Scholar
  13. Gillberg IC, Gillberg C, Råstam M, Johansson, M. Compr Psychiatry. 1996;37:23–30.PubMedCrossRefGoogle Scholar
  14. Gillberg IC, Råstam M, Wentz E, Gillberg C. J Clin Exp Neuropsychol. 2007;29:170–8.PubMedCrossRefGoogle Scholar
  15. Giordano GD, Renzetti P, Parodi RC, Foppiani L, Zandrino F, Giordano G, Sardanelli F. J Endocrinol Invest. 2001;24:510–4.PubMedGoogle Scholar
  16. Hay PJ, Mond J, Buttner P, Darby A. PLoS ONE 2008;3 (2):e1541.PubMedCrossRefGoogle Scholar
  17. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. Biol Psychiatry. 2007;61:348–58.PubMedCrossRefGoogle Scholar
  18. Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS. Psychol Bull. 2004;130:19–65.PubMedCrossRefGoogle Scholar
  19. Kandel ER. The brain and behavior. In: Kandel ER, Schwartz JH, Jessell TM editors. Principles of neural science, 4th edition. New York: McGraw Hill; 2000. p. 5–18.Google Scholar
  20. Kaye W. Physiol Behav. 2008;94:121–35.PubMedCrossRefGoogle Scholar
  21. Kaye WH, Fudge JL, Paulus M. Nature Rev. 2009;10:573–84.CrossRefGoogle Scholar
  22. Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL. The biology of human starvation. Minneapolis: The University of Minnesota Press; 1950.Google Scholar
  23. Koh M, Wilkins E, Bernsteins I. Behav Neurosci. 2003;117:1416–22.PubMedCrossRefGoogle Scholar
  24. Koob GF, Le Moal M. Annu Rev Psychol. 2008;59:29–53.PubMedCrossRefGoogle Scholar
  25. Lauer CJ, Gorzewski B, Gerlinghoff M, Backmund H, Zihl J. J Psychiatr Res. 1999;33:129–38.PubMedCrossRefGoogle Scholar
  26. Lena SM, Fiocco AJ, Leyenaar JK. Neuropsychol Rev. 2004;14:99–113.PubMedCrossRefGoogle Scholar
  27. Lilenfeld LRR, Wonderlich S, Riso LP, Crosby R, Mitchell J. Clin Psychol Rev. 2006;26:299–320.PubMedCrossRefGoogle Scholar
  28. Lopez C, Tchanturia K, Stahl D, Treasure J. Psychol Med. 2008a;38:1393–404.PubMedCrossRefGoogle Scholar
  29. Lopez C, Roberts ME, Tchanturia K, Treasure, J. Eur Eat Disord Rev. 2008b;16:411–20.PubMedCrossRefGoogle Scholar
  30. Mathes WF, Brownley KA, Mo X, Bulik CM. Appetite. 2009;52:5445–53.Google Scholar
  31. McAnarney ER. J Adolesc Health. 2008;42:321–3.PubMedCrossRefGoogle Scholar
  32. Nunn K, Frampton I, Gordon I, Lask B. Eur Eat Disord Rev. 2008;16:355–60.PubMedCrossRefGoogle Scholar
  33. Pearce JMS. Eur Neurol. 2006;55:53–6.PubMedCrossRefGoogle Scholar
  34. Palmer B. Psychiatry. 2008;7:143–6.CrossRefGoogle Scholar
  35. Seeger G, Braus DF, Ruf M, Goldberger U, Schmidt MH. Neurosci Lett. 2002;326:25–8.PubMedCrossRefGoogle Scholar
  36. Schmidt U. Eur Child Adolesc Psychiatry. 2003;12:30–7.CrossRefGoogle Scholar
  37. Southgate L, Tchanturia K, Treasure J. J Psychiatr Res. 2008;160:221–7.CrossRefGoogle Scholar
  38. Swayze VW 2nd, Andersen AE, Andreasen NC, Arndt S, Sato Y, Ziebell S. Int J Eat Disord. 2003;33:33–44.Google Scholar
  39. Swinbourne JM, Touyz SW. Eur Eat Disord Rev. 2007;15:253–74.PubMedCrossRefGoogle Scholar
  40. Tchanturia K, Anderluh MB, Morris RG, Rabe-Hesketh S, Collier DA, Sanchez P, Treasure, J. J Int Neuropsychol Soc. 2004;10:513–20.PubMedCrossRefGoogle Scholar
  41. Tchanturia K, Campbell IC, Morris R, Treasure J. Int J Eat Disord. 2005;37:S72–6.PubMedCrossRefGoogle Scholar
  42. Treasure J. Medicine. 2008;36:430–5.CrossRefGoogle Scholar
  43. Uher R, Murphy T, Brammer MJ, Dalgleish T, Philips ML, Ng VW, Andrew CM, Williams SCR, Campbell IC, Treasure J. Am J Psychiatry. 2004;161:1238–46.PubMedCrossRefGoogle Scholar
  44. Uher R, Murphy T, Friederich H-C, Dalgleish T, Brammer MJ, Giampietro V, Philips ML, Andrew CM, Ng VW, Williams SCR, Campbell EC, Treasure J. Biol Psychiatr. 2005;58:990–7.CrossRefGoogle Scholar
  45. Uher R, Treasure J, Heining M, Brammer MJ, Campbell IC. Behav Brain Res. 2006;169:111–9.PubMedCrossRefGoogle Scholar
  46. Wade TD, Bergin JL, Tiggemann M, Bulik CM, Fairburn CG. Austr NZ J Psychiatry. 2006;40:121–8.CrossRefGoogle Scholar
  47. Wagner A, Greer P, Bailer UF, Frank GK, Henry SE, Putnam K, Meltzer CC, Ziolko SK., Hoge J, McConaha C, Kaye WH. Biol Psychiatry. 2006;59:291–3.PubMedCrossRefGoogle Scholar
  48. Wilsdon A, Wade TD. J Psychiatr Res. 2006;40:746–54.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Center for Health Equity Studies, CHESSKarolinska Institutet/Stockholm UniversityStockholmSweden

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