Gray matter abnormalities have been found in anorexia nervosa (AN) in several brain regions. However, little is known about white matter abnormalities under the condition of AN. To comprehensively assess the microstructural integrity of white matter pathways in women with anorexia nervosa, we performed voxel-based Diffusion Tensor Imaging (DTI). 21 women with AN according to DSM-IV criteria (9 of them recovered) and 20 female age-matched healthy control subjects were enrolled in the study. The patients had a mean body mass index of 17.2 kg/m(2) (controls: 19.6 kg/m(2)). High resolution T1 images (MP-RAGE) and DTI were performed on a 3 T Siemens-scanner. Images were pre-processed and analyzed using a modified protocol for DTI in SPM2. Fractional anisotropy (FA) maps were compared using t-tests (p < 0.05, corrected). Compared with controls, AN patients showed bilateral reductions of FA maps in the posterior thalamic radiation which includes the optic radiation, and the left mediodorsal thalamus. Our study is limited by the small sample size and its cross-sectional design. A longitudinal design with the same individuals assessed when acutely ill and recovered is warranted for future studies. For the first time, the findings of our DTI study identified disturbances of associational and commissural fibers in the bilateral occipitotemporal white matter. The results help narrowing the prevailing biological models of AN by suggesting that body image distortion is related to microstructural alterations of white matter tracts connecting the extrastriate visual cortex with other brain regions involved in body perception.