1;Acknowledgements;8 2;Contents;12 3;Abbreviations;16 4;List of figures;18 5;List of tables;20 6;Zusammenfassung;22 7;Abstract;26 8;1 Scientific background;29 8.1;1.1 Introduction;29 8.2;1.2 Anorexia nervosa;30 8.2.1;1.2.1 Medical issues and complications of the disease;34 8.2.2;1.2.2 Psychopharmacological treatment;34 8.2.3;1.2.3 Recovery;35 8.3;1.3 Psychological aspects of anorexia nervosa;36 8.3.1;1.3.1 Etiopathogenetic factors;36 8.3.2;1.3.2 Personality aspects;37 8.3.3;1.3.3 Stress and Coping;38 8.3.4;1.3.4 Self-injurious behavior, suicide and mortality;38 8.4;1.4 Neurobiological aspects of anorexia nervosa;40 8.4.1;1.4.1 Structural changes;41 8.4.2;1.4.2 Structural alteration of the hippocampus;43 8.4.3;1.4.3 Neurobiological aspects concerning taste processing;45 8.4.4;1.4.4 Brain activity as a response to body images;46 8.4.5;1.4.5 Cognitive processing of taste-related stimuli;47 8.4.6;1.4.6 Viewing images of food;49 8.4.7;1.4.7 Administration of taste stimuli;51 9;2 Method;57 9.1;2.1 Objectives;57 9.2;2.2 Participants;58 9.2.1;2.2.1 Inclusion and exclusion criteria;58 9.3;2.3 Test procedure;59 9.4;2.4 MRI design;65 9.4.1;2.4.1 Magnetic resonance measurement;65 9.4.2;2.4.2 Taste stimulation;66 9.5;2.5 Data analysis;69 9.5.1;2.5.1 Sociodemographic, medical and psychological data;69 9.5.2;2.5.2 Structural brain data;70 9.5.3;2.5.3 fMRI data;71 10;3 Results;73 10.1;3.1 Characteristics;73 10.1.1;3.1.1 General characteristics;73 10.1.2;3.1.2 Health behavior;74 10.1.3;3.1.3 Weight limit;75 10.1.4;3.1.4 Psychiatric disorders in relatives;75 10.1.5;3.1.5 Co-morbid disorders;75 10.1.6;3.1.6 Medical issues/complications;76 10.1.7;3.1.7 Treatment and medication;76 10.1.8;3.1.8 Subjective health;76 10.2;3.2 Psychological aspects of anorexia nervosa;77 10.2.1;3.2.1 Personality;77 10.2.2;3.2.2 Coping Strategies;78 10.3;3.3 Neurobiological aspects of anorexia nervosa;86 10.3.1;3.3.1 Structural changes in overall brain volume and volume of the various brain areas;86 10.3.2;3.3.2 Volume of the hippocampal sub-structures;89 10.3.3;3.3.3 Associations between the total hippocampal volume and other brain areas, stress, and coping;91 10.3.4;3.3.4 Brain activity in response to taste stimuli: whole brain analyses;93 10.3.5;3.3.5 Brain activity in response to the different taste stimuli in the regions of interest;95 10.3.6;3.3.6 Associations between the brain activity in response to a taste in general and psychological aspects;98 10.3.6.1;3.3.6.1 Association between the brain activity due to a taste in general and stress;98 10.3.6.2;3.3.6.2 Association between the brain activity due to a taste in general and anxiety ratings concerning the taste;100 10.3.6.3;3.3.6.3 Association between the brain activity due to a taste in general and pleasantness ratings concerning the taste;103 10.3.6.4;3.3.6.4 Association between brain activity due to a taste in general and depression;103 10.3.6.5;3.3.6.5 Association between the brain activity due to a taste in general and anxiety;106 10.3.6.6;3.3.6.6 Association between the brain activity due to a taste in general and obsession;108 10.3.6.7;3.3.6.7 Association between the brain activity due to a taste in general and obsessional control;111 10.3.6.8;3.3.6.8 Association between the brain activity due to a taste in general and the duration of the illness;111 11;4 Discussion;115 11.1;4.1 Psychological aspects of anorexia nervosa;115 11.1.1;4.1.1 Personality;117 11.1.2;4.1.2 Stress and coping;118 11.1.3;4.1.3 Body image;119 11.2;4.2 Neurobiological aspects of anorexia nervosa;120 11.2.1;4.2.1 Structural changes;120 11.2.2;4.2.2 Hippocampal changes and associations with psychological symptoms in AN patients;121 11.2.3;4.2.3 Brain activity as a response to a taste in general;124 11.2.4;4.2.4 Brain activity as a response to sucrose, umami, and citric acid in regions of interest;126 11.2.5;4.2.5 Associations between the brain activity as a response to a taste and psychological factors;128 11.3;4.3 A critical reflectio