Functional disturbances within frontostriatal circuits across multiple childhood psychopathologies

Abstract

Objective: Neuroimaging studies of healthy individuals inform us about the normative maturation of the frontostriatal circuits that subserve self-regulatory control processes. Findings from these studies can be used as a reference frame against which to compare the aberrant development of these processes in individuals across a wide range of childhood psychopathologies.

Method: The authors reviewed extensive neuroimaging evidence for the presence of abnormalities in frontostriatal circuits in children and adults with Tourette's syndrome and obsessive-compulsive disorder (OCD) as well as a more limited number of imaging studies of adolescents and adults with anorexia nervosa or bulimia nervosa that, together, implicate dysregulation of frontostriatal control systems in the pathogenesis of these eating disorders.

Results: The presence of an impaired capacity for self-regulatory control that derives from abnormal development of frontostriatal circuits likely interacts in similar ways with normally occurring somatic sensations and motor urges, intrusive thoughts, sensations of hunger, and preoccupation with body shape and weight to contribute, respectively, to the development of the tics of Tourette's syndrome, the obsessions of OCD, the binge eating behaviors of bulimia, and the self-starvation of anorexia.

Conclusions: Analogous brain mechanisms in parallel frontostriatal circuits, or even in differing portions of the same frontostriatal circuit, may underlie the differing behavioral disturbances in these multiple disorders, although further research is needed to confirm this hypothesis.

Trial registration: ClinicalTrials.gov NCT00345943.

FIGURE 1. The Role of Dysregulated Frontostriatal Systems in Tourette’s Syndrome, OCD, Anorexia, and Bulimiaa

^a The top row of panel (a) represents urges, thoughts, and drives that are present in both healthy and patient populations. An impaired capacity for self-regulatory control interacts with these normal urges, thoughts, and drives to produce ego-dystonic symptoms or behaviors (middle row). Attempts to relieve the anxiety associated with these symptoms or to compensate for these behaviors produce further behavioral abnormalities (bottom row). Bulimia and anorexia-restricting subtype are on opposite ends of a continuum. Anorexia-binge/purge subtype is positioned within the middle of this continuum, since it shares features with both bulimia and anorexia-restricting subtype. Panel (b) illustrates an alternative conceptualization of anorexia-restricting subtype: preoccupation with body shape and weight interact with heightened, rather than impaired, self-regulatory control, producing starvation directly.