Body image alterations in eating disorders patients: a systematic review of neuroimaging studies

Body image distortion (BID) is a core diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN) and purging disorder. Binge eating disorder (BED) may also presents this symptom, however, it isn't yet a criteria recognized by DSM-V. It's speculated whether there are neurobiological factors that may collaborate with EDs vulnerability and maintenance. We aimed to discuss, through a systematic review, BID's neurobiology through studies that used neuroimaging tools in patients with AN, BN, purging disorder and BED. Review was developed using guideline PRISMA recommendation, following 27-step checklist and four-phase flowchart. In May and August 2021, following databases were consulted: Lilacs, Scielo, Pepsic, APA/Psycnet, Pubmed, Scopus, Bireme, Cochrane. 1,532 articles were found and 2.02% were included in this research. Body image distortion seems associated with paralimbic structures (cingulate cortex and insula); default-mode network; parietal, temporal and occipital structures. Paralimbic structures and default-mode network were associated with a change regarding the subjective self (material self) and ego. It's also possible to infer that these patients present a perceptual error of judgment and excess of self reference and self-investment in themselves, whose attempt would be to resolve the perceptual error, reinforcing ED dysfunctional behaviors.