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Social Brain Function in Anorexia Nervosa: Illness, Recovery, and Identity

Thursday, March 23, 2017: 2:00 PM-3:30 PM
Del Fuego (Green Valley Ranch)

Background: Neuroimaging evidence of how differences in social perception are related to illness and recovery in anorexia nervosa is presented, with an experiential example of social behavior. Three neurocognitive constructs are characterized: identity, mentalization, and self-blame. Patient cases related to how each construct emerges during therapy provides real-world relevance.

Objectives: 1. Following this presentation, participants will understand how neuroimaging studies provide specific evidence for neurocognitive differences. 2. Following this presentation, participants will understand what an attributional bias is, and its relationship to brain function and disease-state in anorexia nervosa. 3. Following this presentation, participants will understand what mentalization is, and its relationship to sustained recovery from anorexia nervosa.

  1. Introduction: Biopsychosocial Model of Anorexia and Functional Neuroimaging (McAdams)

    1. An overview of the importance of considering biological, psychological, and social considerations in treatment is provided. An introduction to the use of functional MRI as a tool to identify neurocognitive differences that relate to all dimensions (bio, psycho, social) is provided

  2. Neurocognitive Evidence of Differences in Social Perception (McAdams)

    1. Social Identity task is described, as a method to capture, across many subjects, neural regions involved in self-perception.

    2. Physical Self-Perception as a State of Illness: Patients with anorexia nervosa have heightened activation of the visual cortex in response to self-images; this is normalized after sustained weight-recovery.

    3. Social Self-Perception Differences as a Trait of Disease: Patients both currently with and in long-term recovery from anorexia nervosa use medial prefrontal cortex to disagree with self-relevant attributes whereas healthy women use this area to agree with self-relevant attributes. This suggests a persistent problem that may contribute to the risk for the development of these illnesses.

    4. Social Self-Evaluation as a Recovery Marker: Patients that show sustained weight-recovery following treatment for anorexia nervosa utilize additional social cognitive regions when evaluating themselves, unlike both controls and women currently with anorexia nervosa. This suggests a possible neurocognitive change related to perspective-taking may be important for sustained weight recovery.

  3. Noticing Perspective-Taking and Mentalization in Group Therapy (Brown)

    1. Case One – an example of the use of group therapy focusing on differences related to perspective taking is provided.

    2. Case Two – journal assignments related to self-perspectives are reviewed

  4. Neurocognitive Evidence of Differences in Social Perception (McAdams/Brown)

    1. Neuroeconomic game –a simulated social game is created, with audience participation. Moments of positive and negative social interaction are identified.

    2. Group differences related to kindness perception and self-blame are discussed.

  5. Attributional Biases and Self-Blame in Therapy (Brown)

    1. Case Three – noticing the positive in individual therapy

    2. Case Four – identifying self-blame as a guiding construct in treatment

Anorexia nervosa is a severe mental illness that includes problems with self and other perception. Whole-brain neural activations in healthy women, women with anorexia nervosa, and women in long-term weight recovery following anorexia nervosa were compared using three functional magnetic resonance imaging tasks probing different aspects of social perception. The Faces task compared viewing oneself to a stranger. The Social Identity-V2 task involved consideration about oneself and others using socially descriptive adjectives. The Trust Game involved playing an interactive social game. Using these three games, we found that both recovered and ill women with anorexia nervosa showed differences in self-relevance and kindness perception. Only the women currently with disease showed differences related to perceiving negative social behavior and viewing themselves. Most importantly, the women in sustained recovery showed changes in the utilization of the brain during social self-evaluations, as well as cognitive differences related to self-blame. Case examples of therapeutic treatments incorporating themes of perspective-taking, developing a self-narrative, identifying the positive, and reducing self-blame are provided. The focus is on using explicit knowledge (the science) to motivate patients in completing the implicit work (therapy) required for successful, dimensional treatment of anorexia nervosa.
Primary Presenter:
Carrie McAdams, MD, PhD

Dr. McAdams is a clinician scientist, whose translational research program is focused on understanding brain function in eating disorders to improve clinical care. She published the first manuscript reporting differences in the neural circuitry in social perception in anorexia nervosa (McAdams and Krawcyzk, Psychiatry Research, 2011). Most recently, she has found neural changes in self and other perception that are related to illness and recovery in anorexia nervosa (McAdams et al., Human Brain Mapping, 2015; McAdams et al., Social Cognitive and Affective Neuroscience, 2016). Her career goal is to improve treatments for eating disorders by targeting these neural circuits.

Anna Brown, PsyD

Dr. Anna Brown is a licensed clinical psychologist and primary therapist for The Eating Disorders Program at Texas Health Presbyterian Hospital Dallas. Brown has had a specific interest in improving the treatment of eating disorders since college. She earned her doctorate in clinical psychology from The Chicago School of Professional Psychology and completed a postdoctoral fellowship in the treatment of eating disorders at the residential level of care. She enjoys providing individual therapy, group therapy, and family education and therapy for the eating disorders program and has a particular interest in the application of mindfulness in the recovery process.

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