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

Zuo Zhang, Lauren Robinson, Tianye Jia, Erin Quinlan, Nicole Tay, Congying Chu, Edward Barker, Tobias Banaschewski, Gareth Barker, Arun L.W. Bokde, Herta Flor, Antoine Grigis, Hugh Garavan, Penny Gowland, Andreas Heinz, Bernd Ittermann, Jean-Luc Martinot, Argyris Stringaris, Jani Penttilä, Betteke van NoortYvonne Grimmer, Marie-Laure Paillère Martinot, Corinna Isensee, Andreas Becker, Frauke Nees, Dimitri Papadopoulos Orfanos, Tomáš Paus, Luise Poustka, Sarah Hohmann, Juliane H. Fröhner, Michael N. Smolka, Henrik Walter, Robert Whelan, Gunter Schumann, Ulrike Schmidt, Sylvane Desrivieres

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)
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Background: Eating disorders are common in adolescence and are devastating and strongly comorbid with other psychiatric disorders. Yet little is known about their etiology, knowing which would aid in developing effective preventive measures. 

Methods: Longitudinal assessments of disordered eating behaviors (DEBs)—binge-eating, purging, and dieting—and comorbid psychopathology were measured in 1386 adolescents from the IMAGEN study. Development of DEBs and associated mental health problems was investigated by comparing participants who reported symptoms at ages 16 or 19 years, but not at age 14 years, with asymptomatic control participants. 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 and conduct disorder, predated their development. Alterations in frontostriatal brain areas also predated the development of DEBs and depressive symptoms. Specifically, development of binge-eating was predicted by higher gray 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 gray matter volumes in the orbitofrontal and anterior cingulate cortices mediated the relationship between attention-deficit/hyperactivity disorder and conduct disorder symptoms and future purging and depressive symptoms. 

Conclusions: These findings suggest that alterations in frontal brain circuits are part of the shared etiology among eating disorders, attention-deficit/hyperactivity disorder, conduct disorder, and depression and highlight the importance of a transdiagnostic approach to treating these conditions.

Original languageEnglish
Pages (from-to)1-10
JournalBiological psychiatry
Issue number0
Early online date10 Jun 2020
Publication statusE-pub ahead of print - 10 Jun 2020


  • Attention-deficit/hyperactivity disorder
  • Biomarkers
  • Conduct disorder
  • Depression
  • Eating disorders
  • Gray matter volume


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