Neuroanatomical correlates of state of mind with respect to attachment in patients with anorexia nervosa

Objective: Anorexia Nervosa (AN) is a multi-factorial disorder (sociological, psychological and biological), but we can use two important tools to better understand its psychopathology: attachment theory and modern neuroimaging techniques. In this study, we looked for the anatomical and functional correlates of the attachment system in both young woman with AN and healthy controls. Methods: We enrolled 18 participants - 10 AN and 8 controls. The Adult Attachment Interview (AAI) was administered to all participants in the study to assess their state of mind with respect to attachment. All participants also underwent a MRI scan (T1 weighted high resolution anatomical images and BOLD resting state fMRI). We analyzed MRI data using Voxel Based Morphometry and voxel-wise resting state measures (standard deviation and amplitude of low-frequency fluctuations of the timecourse). Results: In our study, secure attachment was more common in controls than in AN patients. Some subscales of AAI were found to be significantly different between the groups: pressure to achieve exerted by the mother was bigger in AN than in controls while the scores in both Coherence of Mind (CoM) and Coherence of Transcript (CoT) scales were significantly lower. CoM and CoT positively correlated with the volume of GM in a network of brain areas comprising the temporal poles, both amygdalae, the midbrain, the thalamus and the anterior and middle sections of cingulate cortex. The love received by the mother (LM) correlated with a network largely overlapping with CoM/CoT, while anger anticorrelated with parts of the same network (for instance, the precuneus and part of the limbic system). Higher passivity correlated with lower GM volumes in a network comprising mostly mesial areas such as the precuneus. Conclusions: It seems therefore that the experience of love during childhood and the feeling of anger towards the caregivers expressed during the interview have opposite effects on brain areas: while the experience of love seems to be a protective factor, anger is correlated with lower GM volume. We conclude that non-secure attachment is a core feature of anorexia nervosa both at psychopathological and neurobiological levels.