Remediating body image distortions in adolescents with anorexia nervosa using visual attention modulation

Overview

This study will test a novel visual attention intervention in adolescents with anorexia nervosa (AN) to reduce rigid, distorted body image perceptions that contribute to severe illness. Through this research, investigators aim to better understand the neurobiology of AN and evaluate whether modifying visual attentional biases can help “unlock” adolescents from their perceptual distortion box and improve symptoms.

Abstract

Persistent body image disturbance is a strong prognosticator of poor clinical outcomes in eating disorders, including relapse, which occurs in approximately 50% with standard treatments. Treatment strategies to correct body image distortion are underdeveloped, with efforts to-date not sufficiently informed by neurobiological mechanisms. Converging evidence implicates reduced engagement of the dorsal visual stream (DVS)—the neural substrate of holistic, global processing—in these distortions, rendering local details (e.g., perceived skin folds) disproportionately salient. Visual attention modulation that constrains eye movements has been shown in body dysmorphic disorder to enhance DVS connectivity responsible for global processing but has never been tested in eating disorders. We will (Aim 1) delineate relationships between DVS function during own-body viewing and global versus local visual perception in 50 weight-restored adolescent girls with AN and 50 age-matched healthy controls, and (Aim 2) evaluate whether repeated visual attention modulation can normalize DVS connectivity, improve global perception, and enhance appearance satisfaction in AN. Those with AN will be randomized to three sessions of attention modulation—maintaining gaze on a central crosshair—versus naturalistic viewing; eye-tracking will verify compliance. Participants will undergo pre- and post- functional magnetic resonance imaging (fMRI) while viewing personalized body photographs. Effective connectivity analyses will quantify directional influences among DVS nodes, while the body-inversion effect task will index global perception. We hypothesize that at baseline, weaker DVS connectivity will be associated with lower global perception. Further, we hypothesize that attention modulation specifically will increase DVS connectivity and global processing, with increases in connectivity associated with increases in global perception and improved appearance satisfaction. This will provide the first experimental test of a perception-focused intervention for AN, and mechanistic pilot data to propel a definitive clinical trial. By directly remediating distorted body perception, this work addresses a critical unmet need and may transform treatment trajectories in adolescent AN.

Broader Impact

This study can lead to a novel visual modulation strategy to address distorted visual perception. Effective remediation of perceptual distortions will meet an unmet treatment need for AN