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OBJECTIVES: Body image is a multidimensional construct crucial to the development and maintenance of anorexia nervosa (AN). Cognitive-emotional mechanisms shaping body image, particularly AN patients' tendency to ruminate, remain insufficiently understood. This study investigated body-focused rumination using a novel functional magnetic resonance imaging (fMRI) Rumination Induction task. METHODS: Patients (n = 18) and healthy controls (n = 19) completed baseline assessments of rumination, body appreciation, and clinical measures. During fMRI, participants engaged in a task with self- and body-focused prompts contrasted with a neutral condition. Emotional valence and intensity were assessed pre- and post-task, alongside task-specific self-report ratings of affective valence and rumination experience. Whole-brain activations were examined for the main contrast (rumination vs. neutral) and, exploratorily, for early versus late rumination phases. RESULTS: Compared to controls, patients showed reduced activation in default mode network (DMN) overlapping regions, encompassing perigenual cingulate cortex, lateral parietal and temporal regions, praecuneus, temporoparietal junction, and cerebellum. A decreased engagement of the ventrolateral prefrontal cortex-key frontoparietal network node-in AN during early versus late rumination phases is outlined. CONCLUSIONS: Reduced DMN hubs activation may reflect disrupted cognitive-affective, autobiographical, and social mentalization processes in AN, as elicited by self-centred cognitions. At the same time, decreased ventrolateral prefrontal activity may suggest diminished ability to initiate affective reappraisal of self-focused cognitions, limiting voluntary suppression of repetitive thoughts in early versus later rumination stages. Overall, these findings support a model in which body image distortions are sustained by maladaptive cognitive-emotional mechanisms, whose neuronal markers may be highlighted through rumination predisposition.
Giuliano et al. (Tue,) studied this question.