Neural Links Between OCD and Anorexia

Shared and Unique Neural Links Between OCD and Anorexia: Investigating Biological Mechanisms of Phenotypic Expression

Individuals with anorexia nervosa (AN) have long been observed to demonstrate symptoms in common with obsessive-compulsive disorder (OCD), in particular, an obsessive fear of normal weight leading to dangerous food restriction, as well as many compulsive rituals about food. Both AN and OCD are seriously handicapping and often resistant to conventional therapies. Given that the two conditions often co-occur and are associated with still unknown genetic risk factors, the aim of this project is to identify their shared and distinct patterns of brain activity.

The investigators propose to use functional magnetic resonance imaging to compare brain response among adolescents with AN, OCD, and age-matched healthy individuals. Specifically, this study will investigate function of distinct brain circuits related to core aspects of these related disorders. The investigators use three tasks related to set shifting, global vs. local processing, and reward. Based on evidence of deficits in cognitive flexibility and ability to change behavior, the investigators hypothesize that adolescents with AN and with OCD will show hypoactivity of frontostriatal circuitry during cognitive tasks, and adolescents with AN will show hyperactivity in limbic regions in a reward task.

This study is the first to directly compare brain activation patterns using functional neuroimaging in AN and OCD. The goal is to determine how abnormal brain activity relates to symptom formation, what accounts for shared characteristics amongst these disorders, and whether deficits in specific circuitry underlie their unique defining features. The study of shared and unique elements of functional brain circuitry reflects a new, emerging approach to the classification of psychiatric illness, one based on identifying unique combinations of biological risk factors that link related conditions. This approach is widely believed to be a critical step forward in developing more brain-relevant targeted strategies for preventative interventions.

Study Overview

• Status: Completed
• Conditions: Anorexia Nervosa; Obsessive-compulsive Disorder
• Intervention / Treatment: Procedure: Functional Magnetic Resonance Imaging

• Study Type: Observational
• Enrollment (Actual): 64

Contacts and Locations

Study Locations

• United States
  • California
    • Stanford, California, United States, 94305
      • Stanford University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 19 years (Child, Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

Adolescent females ages 12-19 drawn from clinic and community populations. With diagnosis of anorexia nervosa or obsessive-compulsive disorder or no psychiatric diagnosis.

Description

Inclusion Criteria:

• female
• age 12-19
• anorexia nervosa diagnosis OR obsessive-compulsive diagnosis OR no psychiatric disorder

Exclusion Criteria:

• any contraindication for MRI (orthodontia, vascular stent, metallic ear tubes, metal implants, piercings, etc.)
• neurological disorder, psychiatric disorder, or any major sensory deficit not associated with eating disorders or OCD (blindness, head trauma, bipolar disorder, seizure disorder, etc.)
• pregnancy
• below 85% of ideal body weight

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
anorexia nervosa; Diagnosis of anorexia nervosa	Procedure: Functional Magnetic Resonance Imaging
obsessive-compulsive disorder; Diagnosis of obsessive-compulsive disorder	Procedure: Functional Magnetic Resonance Imaging
healthy control; No psychiatric diagnoses	Procedure: Functional Magnetic Resonance Imaging
sisters; Sisters of those enrolled with a diagnosis of anorexia nervosa	Procedure: Functional Magnetic Resonance Imaging

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Brain activity related to set shifting	Baseline
Brain activity related to global vs. local processing	Baseline
Brain activity related to reward	Baseline

Collaborators and Investigators

• Sponsor: Stanford University
• Investigators: Principal Investigator: Cara Bohon, PhD, Stanford University

Study record dates

Study Major Dates

• Study Start: January 1, 2013
• Primary Completion (Actual): April 1, 2017
• Study Completion (Actual): April 1, 2017

Study Registration Dates

• First Submitted: March 10, 2014
• First Submitted That Met QC Criteria: March 11, 2014
• First Posted (Estimate): March 12, 2014

Study Record Updates

• Last Update Posted (Actual): November 13, 2017
• Last Update Submitted That Met QC Criteria: November 8, 2017
• Last Verified: November 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Signs and Symptoms, Digestive; Feeding and Eating Disorders; Anxiety Disorders; Anorexia; Anorexia Nervosa; Obsessive-Compulsive Disorder
• Other Study ID Numbers: 18888