Disrupted Salience Network and Its Deteriorated Interaction With the Central Executive Network in Anorexia Nervosa: A Multicenter Study

Background: Anorexia nervosa (AN) has not yet been treated biologically. Resting-state functional magnetic resonance imaging has been used to identify neurological substrates for its development; however, this remains elusive owing to sample size restrictions. In this study, we aimed to understand the relationship between intrinsic networks and AN psychopathology based on the triple-network hypothesis using a large sample of data from multiple facilities. Methods: We used resting-state functional magnetic resonance imaging data collected across multiple sites from 111 female patients with AN and 131 healthy female control participants. Independent component analysis was applied to identify the default mode network (DMN), central executive network (CEN), and salience network (SN), and to assess functional connectivity (FC) within each network and between these networks. Results: The analysis revealed that patients with AN exhibited significantly reduced FC within both the SN and DMN compared with healthy control participants. Notably, decreased FC within the SN was correlated with the severity of eating disorder symptoms. Additionally, the analysis showed decreased connectivity between the SN and CEN. Conclusions: Within the framework of the triple-network model, our findings emphasize SN dysfunction as a central feature of AN psychopathology, accompanied by impaired coupling between the SN and CEN as well as reduced connectivity within the DMN. These findings highlight the critical role of disruptions in large-scale brain networks, particularly within the SN, which may underlie deficits in adaptive cognitive control among individuals with AN.