Development of disordered eating behaviors and comorbid depressive symptoms in adolescence: neural and psychopathological predictors

Abstract Background Eating disorders are common in adolescence, devastating and strongly comorbid with other psychiatric disorders. Yet, little is known about their etiology to develop effective preventive measures. Methods Longitudinal assessments of disordered eating behaviors (DEBs; binge-eating, purging and dieting) and comorbid psychopathology were measured in 1,386 adolescents from the IMAGEN study. Development of DEBs and associated mental health problems were investigated by comparing participants who reported symptoms at ages 16 or 19, but not at age 14 to asymptomatic controls. Voxel-based morphometry and psychopathological differences at age 14 were investigated to identify risk factors for the development of DEBs and associated mental health problems. Results DEBs and depressive symptoms developed together. Emotional and behavioral problems, including symptoms of attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD), predated their development. Alterations in fronto-striatal brain areas also predated the development of DEBs and depressive symptoms. Specifically, development of binge-eating was predicted by higher grey matter volumes in the right putamen/globus pallidus at age 14. Conversely, development of purging and depressive symptoms was predicted by lower volumes in the medial orbitofrontal, dorsomedial and dorsolateral prefrontal cortices. Lower grey matter volumes in the orbitofrontal and anterior cingulate cortices mediated the relationship between ADHD and CD symptoms and future purging and depressive symptoms. Conclusions These findings suggest that alterations in frontal brain circuits are part of the shared etiology between eating disorders, ADHD, CD and depression and highlight the importance of a transdiagnostic approach to treating these conditions.