Cited by 124Eating Disorders and BehaviorsNutrition, Health and Food BehaviorRegulation of Appetite and Obesity

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Amygdala hyperreactivity in restrictive anorexia nervosa

Joos, Andreas A.B., Saum, Barbara, van Elst, Ludger Tebartz, Perlov, Evgeniy, Glauche, Volkmar, Hartmann, Armin, Freyer, Tobias, Tüscher, Oliver, Zeeck, Almut·2011·Psychiatry Research: Neuroimaging

DOI 10.1016/j.pscychresns.2010.11.008

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Abstract

Functional imaging studies had often investigated heterogeneous samples of anorexia nervosa (AN) patients with varying paradigms and methodologies that had resulted in divergent results. The present study aimed to examine these issues by studying a well-defined sample of restrictive AN patients with a disorder-specific paradigm which had been used previously. Subjects showed increased blood oxygen level dependent responses of the cingulate, frontal, insular and parietal cortices. Group comparisons demonstrated increased activity of the right amygdala in the sample of restrictive AN patients. Our results are in support of other recently published functional imaging studies and point to a pivotal role of the right amygdala in AN. Signals of the midcingulum were reduced in comparison to healthy controls. The constellation of increased activity of the amygdala and decreased activity of the cingulate cortex likely represents parts of a negative feedback loop of emotional processing. Disgust ratings correlated with the amygdala signal negatively, which points to the complex role of this structure within eating disorders.

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Horster, I., Nickel, K., Holovics, L., Schmidt, S., Endres, D., van Elst, L. T., Zeeck, A., Maier, S. J., & Joos, A. A. B. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00777 · Cited by 14
“Whole Brain Second Level Analysis Replicating the Original Study The resulting beta estimates for the two regressors were fed into a voxel-wise group-level random effects analyses using SPM’s ‘‘full factorial’’ model with the factors condition (food and nonfood) and group (AN, NP) (30).”
BackgroundMethodResultInfluentialSelf-citation
Anorexia nervosa, neuroimaging research, and the contextual salience of food cues: The food approach–avoidance conundrum
Murray, S. B., & Strigo, I. A. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22883 · Cited by 14
“In keeping, several studies report hyperactivity of the amygdala in response to food cues (Joos et al., 2011), whereas others have reported hypoactivity of the amygdala in response to food cues (Holsen et al.”
Provocation of Symmetry/Ordering Symptoms in Anorexia nervosa: A Functional Neuroimaging Study
Suda, M., Brooks, S. J., Giampietro, V., Uher, R., Mataix‐Cols, D., Brammer, M. J., Williams, S., Treasure, J. L., & Campbell, I. C. (2014) · PLoS ONE · doi:10.1371/journal.pone.0097998 · Cited by 13
“Two patients with AN were excluded from this study because of motion artefacts during fMRI scanning, therefore, a total of 20 patients with AN were included in the data analyses.”
ResultInfluential
Neurobiological signature of intimacy in anorexia nervosa
Maier, S. J., Spiegelberg, J., van Zutphen, L., Zeeck, A., van Elst, L. T., Hartmann, A., Holovics, L., Reinert, E., Sandholz, A., Lahmann, C., et al. (2019) · European Eating Disorders Review · doi:10.1002/erv.2663 · Cited by 13
Self-citation
Eating Disorder Neuroimaging Initiative (EDNI): a multicentre prospective cohort study protocol for elucidating the neural effects of cognitive–behavioural therapy for eating disorders
Hamatani, S., Hirano, Y., Sugawara, A., Isobe, M., Kodama, N., Yoshihara, K., Moriguchi, Y., Ando, T., Endo, Y., Takahashi, J., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-042685 · Cited by 13
Structural and functional brain correlates of altered taste processing in anorexia nervosa: A systematic review
Kot, E., Kucharska, K., Monteleone, A. M., & Monteleone, P. (2019) · European Eating Disorders Review · doi:10.1002/erv.2713 · Cited by 13
When do anorexic patients perceive their body as too fat? Aggravating and ameliorating factors
Kazén, M., Baumann, N., Twenhöfel, J. F., & Kühl, J. (2019) · PLoS ONE · doi:10.1371/journal.pone.0212612 · Cited by 14
Neural representations of anxiety in adolescents with anorexia nervosa: a multivariate approach
Seiger, R., Reggente, N., Majid, D. S. A., Ly, R., Tadayonnejad, R., Strober, M. A., & Feusner, J. D. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02581-5 · Cited by 11
“detected increases in the amygdala and reductions in the midcingulate cortex in those with AN compared to the healthy comparison group [20].”
Background
Neural Mechanisms in Eating Behaviors: A Pilot fMRI Study of Emotional Processing
Molina-Ruiz, R. M., García-Saiz, T., Looi, J. C., Virgili, E. V., Rincón, M., de Anta, L., López, H. T., Perera, J. L. C., & Díaz‐Marsá, M. (2020) · Psychiatry Investigation · doi:10.30773/pi.2019.0038 · Cited by 10
State or trait: the neurobiology of anorexia nervosa — contributions of a functional magnetic resonance imaging study
Göller, S., Nickel, K., Horster, I., Endres, D., Zeeck, A., Domschke, K., Lahmann, C., van Elst, L. T., Maier, S. J., & Joos, A. A. B. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00598-7 · Cited by 10
“The paradigm has already been employed previously in a study of AN with some REC participants [24, 43] and a study focusing on NP versus AN [44].”
MethodSelf-citation
Novel ketamine and zinc treatment for anorexia nervosa and the potential beneficial interactions with the gut microbiome
Elwyn, R., Mitchell, J., Kohn, M. R., Driver, C., Hay, P., Lagopoulos, J., & Hermens, D. F. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105122 · Cited by 10
Activity-Based Anorexia in Adolescent Female Rats Causes Changes in Brain Mitochondrial Dynamics
Bhasin, H., O’Brien, S. C., Cordner, Z. A., Aston, S. A., Tamashiro, K. L., & Moran, T. H. (2022) · Physiology & Behavior · doi:10.1016/j.physbeh.2022.114072 · Cited by 9
Increased early motivational response to food in adolescent anorexia nervosa revealed by magnetoencephalography
Frausto, H. R., Roesmann, K., Klinkenberg, I. A. G., Rehbein, M. A., Föcker, M., Romer, G., Junghoefer, M., & Wessing, I. (2021) · Psychological Medicine · doi:10.1017/s003329172100088x · Cited by 9
“…cognitive control (e.g. frontal cortex), and visual perception and attention (e.g. OCC) (Boehm et al., 2018; Brooks et al., 2011, 2012a; Foerde, Steinglass, Shohamy, & Walsh, 2015; Gordon et al., 2001; Joos et al., 2011; Kim, Ku, Lee, Lee, & Jung, 2012; Rothemund et al., 2011; Zhu et al., 2012).”
Increased anticipatory but decreased consummatory brain responses to food in sisters of anorexia nervosa patients
Horndasch, S., O'Keefe, S., Lamond, A., Brown, K., & McCabe, C. (2016) · BJPsych Open · doi:10.1192/bjpo.bp.115.002550 · Cited by 7
“…cue in the FH group, compared with the controls, might be due to increased disgust as amygdala activation has been found to correlate with disgust ratings in AN patients when confronted with food stimuli 37 and is known to be activated by aversive stimuli from multiple sensory modalities.”
Overcontrol in anorexia nervosa: Elevated prefrontal activity and amygdala connectivity in a working memory task with food distractors
Pauligk, S., Seidel, M., Ritschel, F., Geisler, D., Doose, A., Boehm, I., Hellerhoff, I., Ludwicki, F., Roessner, V., King, J. A., et al. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100544 · Cited by 6
Testing anxiety and reward processing in anorexia nervosa as predictors of longitudinal clinical outcomes
Derissen, M., Majid, D. S. A., Tadayonnejad, R., Seiger, R., Strober, M. A., & Feusner, J. D. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.09.004 · Cited by 7
Evaluation of visual food stimuli paradigms on healthy adolescents for future use in fMRI studies in anorexia nervosa
Dąbkowska-Mika, A., Steiger, R., Gander, M., Haid-Stecher, N., Fuchs, M., Sevecke, K., & Gizewski, E. R. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00761-8 · Cited by 5
From shared mechanisms to treatment gaps: a review of the comorbidity between eating disorders and PTSD
Ouyang, H., Wang, Y., & Chen, J. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01454-0 · Cited by 6
“Amygdala hyperactivation [53, 54] and hippocampal dysfunction [32, 55] may promote excessive CRH release, thereby contributing to persistent HPA axis dysregulation through shared neural circuits involved in stress and emotion regulation.”
Distinct Functional and Structural Cerebral Abnormalities in Eating Disorders in the Light of Diagnostic Classification Systems
Joos, A. A. B., Saum, B., Hartmann, A., Tüscher, O., van Elst, L. T., & Zeeck, A. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000337747 · Cited by 5
Self-citation
Neural Response to High and Low Energy Food Images in Anorexia Nervosa
Foroughi, N., Donnelly, B., Williams, M., Madden, S., Kohn, M. R., Clarke, S. P., Sachdev, P. S., Touyz, S. W., & Hay, P. (2021) · OBM Neurobiology · doi:10.21926/obm.neurobiol.2103107 · Cited by 5
“A further source of difference in the research findings is studies at varied stages of AN’s onset, recovery, and particular brain processes that may be implicated in adolescence [23].”
Background
A systematic review of the inter-individual differences in avoidance learningPreprint
Wong, A. H. K., Aslanidou, A., Malbec, M., Pittig, A., Wieser, M. J., & Andreatta, M. (2023) · doi:10.31234/osf.io/2xbwd · Cited by 5
What influences food choices in anorexia nervosa? Disentangling cognitive and emotional components of decision-making by translational research
Lodovico, L. D., Hamelin, H., Zorzi, L. D., du Montcel, C. T., Schéle, E., Stoltenborg, I., Adan, R. A. H., Dickson, S. L., Gorwood, P. A. P. M., Tolle, V., et al. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.104080 · Cited by 6
“In patients with anorexia nervosa, passive exposure to the visual food stimuli activates the attentional salience network that encompasses the amygdala, insula and anterior cingulate cortex (Young et al., 2020; Joos et al., 2011).”
Taste and olfactory status in a gourmand with a right amygdala lesion
Gallo, M., Gámiz, F., Pérez-Garcı́a, M., del Moral, R. G., & Rolls, E. T. (2013) · Neurocase · doi:10.1080/13554794.2013.791862 · Cited by 4
“Patients with anorexia nervosa show increased activity in the right amygdala to photographs depicting food and nonfood items, and the signal correlates negatively with disgust ratings (Joos et al., 2011).”
Background
Neural correlates of intimate picture stimuli in females
Maier, S. J., Spiegelberg, J., Jacob, G. A., van Zutphen, L., Zeeck, A., Hartmann, A., Tüscher, O., Holovics, L., van Elst, L. T., & Joos, A. A. B. (2018) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2018.01.003 · Cited by 4
Self-citation
Biopsychiatric Theories of Eating Disorders
Madden, S. (2015) · doi:10.1002/9781118574089.ch17 · Cited by 2
Exploring the neurofunctional impairments and cognitive biases concerning food and body related stimuli in anorexia nervosa: An integrated EEG and eye-tracking study protocol
Loizou, P., Παναγιώτου, Γ., Zanos, P., & Paraskevopoulos, E. (2024) · PLoS ONE · doi:10.1371/journal.pone.0299529 · Cited by 3
State of Mind Assessment in Relation to Adult Attachment and Text Analysis of Adult Attachment Interviews in a Sample of Patients with Anorexia Nervosa
Civilotti, C., Franceschinis, M., Gandino, G., Veglia, F., Anselmetti, S., Bertelli, S., D’Agostino, A., Redaelli, C. A., del Giudice, R., Giampaolo, R., et al. (2022) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe12120124 · Cited by 3
Post-Traumatic Eating Disorder
Schumann, R., Fasoli, V., & Mazzoni, C. (2021) · Springer eBooks · doi:10.1007/978-3-030-81174-7_7 · Cited by 2
What the Eye Sees, the Mind Rejects: Implicit Visual Processing of Food Images in Anorexia Nervosa
Dimakopoulou, M., Ciorli, T., Pyasik, M. M., Andriulli, C., Bevione, F., Martini, M., Daga, G. A., & Pia, L. (2025) · European Eating Disorders Review · doi:10.1002/erv.3210 · Cited by 3
No effect of very brief exposure to masked food pictures on fear of food in anorexia nervosa
Palmer, S., Gronemann, J., Mattler, U., Febry, H., Wünsch‐Leiteritz, W., Leiteritz, A., & Brockmeyer, T. (2021) · European Eating Disorders Review · doi:10.1002/erv.2835 · Cited by 2
“Second, presentation of food images can lead to changes in amygdala activation (Ellison et al., 1998; Holsen et al., 2012; Joos et al., 2011).”
Background
Impaired maturation of resting-state connectivity in anorexia nervosa from adolescence to adulthood: differential mechanisms of consummatory vs. anticipatory responses through a symptom provocation paradigm
Mendez-Torrijos, A., Selvakumar, M., Kreitz, S., Roesch, J., Dörfler, A., Paslakis, G., Krehbiel, J., Steins‐Loeber, S., Kratz, O., Horndasch, S., et al. (2024) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2024.1451691 · Cited by 1
Structural brain alterations in anorexia nervosa: a global brain volume and anatomical likelihood estimation (ALE) meta-analysis combined with a functional decoding approach
Keller, L., Lotter, L. D., Eickhoff, C. R., Eickhoff, S. B., Otten, K., Herpertz‐Dahlmann, B., & Seitz, J. (2026) · NeuroImage Clinical · doi:10.1016/j.nicl.2026.103950 · Cited by 2
“While some studies have observed sustained global and regional brain volume differences in recovered patients (e.g., Friederich et al., 2012; Joos et al., 2011a; Mühlau et al., 2007; Oliva et al., 2020; Roberto et al., 2011; Scaife et al., 2017), others have not (e.g., Bang et al., 2016; Cascino et…”
Belohnungssystem bei Essstörungen und Adipositas
Simon, J. J., & Friederich, H. (2015) · Springer eBooks · doi:10.1007/978-3-642-54573-3_24 · Cited by 1
Consistency of reward responses in neutral and anxious states in adolescent females with anorexia nervosa
Peel, H. J., Reggente, N., Strober, M., & Feusner, J. D. (2025) · NeuroImage Clinical · doi:10.1016/j.nicl.2025.103896 · Cited by 3
“2) Given the salience of personalized anxiety-inducing stimuli (Joos et al., 2011), and as we previously demonstrated multi-variate anxiety responses to be more consistent in AN than controls (Seiger et al., 2023), we hypothesized that this consistent/coordinated response to anxiety provocation in…”
A Protocol for Integrating Neuroscience Into Studies of Family-Based Treatment for Anorexia Nervosa: An Approach to Research and Potential Benefits for Clinical Care
Bohon, C., Weinbach, N., & Lock, J. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00919 · Cited by 2
“Food Image Task We utilize the same design as in prior literature examining neural response to food images in AN by presenting five blocks of highcalorie food images alternating with five blocks of non-food images (37).”
Method
Systematic Review of fMRI Studies with Visual Food Stimuli in Anorexia Nervosa
Dąbkowska-Mika, A., Steiger, R., Gander, M., Sevecke, K., & Gizewski, E. R. (2021) · Austin Journal of Nutrition & Metabolism · doi:10.26420/austinjnutrmetab.2021.1115 · Cited by 1
The Use of Magnetic Resonance Imaging (MRI) in Eating Disorders
Cardi, V., Suda, M., & Treasure, J. L. (2014) · Springer eBooks · doi:10.1007/978-3-642-54542-9_18
An Evolutionary Perspective on Anorexia Nervosa: Theoretical Explorations of Applications for Art Therapy
MacKenzie, A. R. (2011) · Spectrum Research Repository (Concordia University)
cZy to MożLiWe, żeby pSychoterApiA nie ZMieniAłA MóZGu?*
Bomba, J., Pilecki, M. W., & Gierowski, J. K. (2012)
Was steuert unsere (verhängnisvolle) Essensfreude?
Verchen, A. W. D. P. (2021) · Diabetes aktuell · doi:10.1055/a-1696-9234
“Neben diesem nahrungsbezogenen Automatismus kann aber auch eine generelle Neigung zu impulsiven Ver haltensweisen die emotionale Befindlichkeit beeinflus sen, die möglicherweise ihrerseits als interner Stimulus enthemmtes, das GBS bedienendes Essverhalten verur sacht [10, 11, 12] (▶Abb.”
BackgroundInfluential
Faculty Opinions recommendation of What can food-image tasks teach us about anorexia nervosa? A systematic review.
Frank, G. (2019) · Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature · doi:10.3410/f.734409463.793558785
Neurobiologia, temperamento y nuevos enfoques en el tratamiento de la Anorexia Nerviosa del adulto
Rueda, J. G., & Guarín, M. R. (2022) · Revista Mexicana de Trastornos Alimentarios/Mexican Journal of Eating Disorders · doi:10.22201/fesi.20071523e.2022.1.727

Authors: Joos, A. A. B., Saum, B., van Elst, L. T., Perlov, E., Glauche, V., Hartmann, A., Freyer, T., Tüscher, O., & Zeeck, A.
Affiliations: University of Freiburg (DE)
Corresponding author: Joos, Andreas A.B.
ORCID: Joos, Andreas A.B.
Perlov, Evgeniy
Glauche, Volkmar
Hartmann, Armin
Tüscher, Oliver
Zeeck, Almut
Venue: Psychiatry Research: Neuroimaging
Publisher: Elsevier BV
Published: 2011-03
Volume: 191
Issue: 3
Pages: 189-195
ISSN: 0925-4927 (ISSN-L)
DOI: 10.1016/j.pscychresns.2010.11.008
OpenAlex: W2126841876
Cited by: 124
References: 57
Citations by year: 2026: 5 · 2025: 10 · 2024: 8 · 2023: 9 · 2022: 10 · 2021: 12 · 2020: 5 · 2019: 9 · 2018: 9 · 2017: 3 · 2016: 8 · 2015: 6 · 2014: 6 · 2013: 9 · 2012: 12
FWCI: 10.35
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Psychiatry Research Neuroimaging (publishedVersion)
PubMed (publishedVersion)
Funders: Albert-Ludwigs-Universität Freiburg
Topics: Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
Keywords: anorexia nervosa, restrictive anorexia nervosa, right amygdala, midcingulate cortex, emotional processing, disgust, eating disorders, brain activity
MeSH terms: Adult, Amygdala, Anorexia Nervosa, Brain Mapping, Cerebral Cortex, Emotions, Female, Food, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Oxygen, Photic Stimulation, Young Adult

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Amygdala hyperreactivity in restrictive anorexia nervosa

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