EXECUTIVE PERSONALITY TRAITS AND EATING BEHAVIOR

Eating disorders, such as anorexia, bulimia, and binge eating disorder, commonly involve a dysregulation of behavior (e.g., a lack or excess of inhibition and impulsive eating patterns) that is suggestive of prefrontal dysfunction. Functional neuro-imaging studies show that prefrontal-subcortical systems play a role in eating behavior and appetite in healthy individuals, and that people with eating disorders have altered activity in these systems. Eating behavior is often disturbed by illnesses and injuries that impinge upon prefrontal-subcortical systems. This study examined relationships between executive functioning and eating behavior in healthy individuals using validated behavioral rating scales (Frontal Systems Behavior Scale and Eating Inventory). Correlations demonstrated that increased dysexecutive traits were associated with disinhibited eating and greater food cravings. There was also a positive association with cognitive restraint of eating, suggesting that increased compensatory behaviors follow disinhibited eating. These psychometric findings reinforce those of other methodologies, supporting a role for prefrontal systems in eating     

THE ROLE OF PREFRONTAL SYSTEMS IN SEXUAL BEHAVIOR

Research from a variety of methodologies is demonstrating a role for neuroanatomical structures in different aspects of sexual behavior. This article reviews the particular contribution of prefrontal-subcortical systems to sexual behavior, including regions of prefrontal cortex (i.e., dorsolateral, medial, and orbitofrontal cortex), and associated subcortical structures (i.e., basal ganglia and thalamus). Findings are integrated from functional neuroimaging and clinical studies in humans, as well as animal studies, which convergently illustrate the role of different prefrontal systems. In addition to providing a clearer understanding of normal sexual behavior, appreciation of prefrontal systems in sexual behavior has implications for disorders of sexual behavior. Consistent with their role in other forms of cognition, emotion, and behavior, prefrontal systems serve in an executive capacity to regulate sexual behavior.     

The role of prefrontal systems in sexual behavior

Research from a variety of methodologies is demonstrating a role for neuroanatomical structures in different aspects of sexual behavior. This article reviews the particular contribution of prefrontal-subcortical systems to sexual behavior, including regions of prefrontal cortex (i.e., dorsolateral, medial, and orbitofrontal cortex), and associated subcortical structures (i.e., basal ganglia and thalamus). Findings are integrated from functional neuroimaging and clinical studies in humans, as well as animal studies, which convergently illustrate the role of different prefrontal systems. In addition to providing a clearer understanding of normal sexual behavior, appreciation of prefrontal systems in sexual behavior has implications for disorders of sexual behavior. Consistent with their role in other forms of cognition, emotion, and behavior, prefrontal systems serve in an executive capacity to regulate sexual behavior.     

Symptoms of eating disorders in patients with obsessive-compulsive disorder

OBJECTIVE: This study was designed to explore potential overlap of the symptoms of obsessive-compulsive disorder and eating disorders. METHOD: The authors administered a structured, self-rating scale, the Eating Disorder Inventory, to 59 outpatients at an obsessive-compulsive disorder clinic and to 60 sex-matched normal volunteers. The Eating Disorder Inventory has been previously validated as a reliable measure of the specific cognitive and behavioral dimensions of the psychopathology typical of patients with eating disorders. The scores of the patients with obsessive-compulsive disorder and of the healthy comparison subjects were compared with those of 32 female inpatients with anorexia nervosa (N = 10) or bulimia nervosa (N = 22) who had also been given the inventory. RESULTS: The patients with obsessive-compulsive disorder scored significantly higher than the healthy comparison subjects on all eight subscales of the Eating Disorder Inventory: drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness, and maturity fears. Relative to the healthy subjects, male patients with obsessive-compulsive disorder had more symptoms than female patients with obsessive-compulsive disorder. The scores of the female patients with obsessive-compulsive disorder were midway between those of the 32 female patients with eating disorders and those of the 35 female normal subjects. CONCLUSIONS: These results suggest that patients with obsessive-compulsive disorder display significantly more disturbed eating attitudes and behavior than healthy comparison subjects and that they share some of the psychopathological eating attitudes and behavior that are common to patients with eating disorders.     

Neurobehavioral correlates of impulsivity: evidence of prefrontal involvement

Impulsivity is associated with the functioning of prefrontal-subcortical circuits particularly, the orbitofrontal circuit, which is shown in neuro-imaging studies of neurological and psychological disorders. Objective behavioral measures, such as go/no-go, antisaccades, and delayed alternation, have demonstrated sensitivity to prefrontal function. This study examined the relationship between orbitofrontal-sensitive measures and impulsivity in healthy adults, as measured by the Barratt Impulsiveness Scale-11 (BIS). Go/no-go and antisaccades correlated positively and delayed alternations correlated negatively with BIS subscales, even after controlling for demographic influences. The results add to the validity of the BIS and support a role for prefrontal cortex in impulse control.     

NEUROBEHAVIORAL CORRELATES OF IMPULSIVITY: EVIDENCE OF PREFRONTAL INVOLVEMENT

Impulsivity is associated with the functioning of prefrontal-subcortical circuits particularly, the orbitofrontal circuit, which is shown in neuro-imaging studies of neurological and psychological disorders. Objective behavioral measures, such as go/no-go, antisaccades, and delayed alternation, have demonstrated sensitivity to prefrontal function. This study examined the relationship between orbitofrontal-sensitive measures and impulsivity in healthy adults, as measured by the Barratt Impulsiveness Scale-11 (BIS). Go/no-go and antisaccades correlated positively and delayed alternations correlated negatively with BIS subscales, even after controlling for demographic influences. The results add to the validity of the BIS and support a role for prefrontal cortex in impulse control     

Stories I Tell My Patients

Excessive diet soda intake is common in eating disorders. The present study examined factors contributing to excessive intake in a sample of individuals with lifetime eating disorders based on proposed DSM-5 criteria (n?=?240) and non-eating disorder controls (n?=?157). Individuals with eating disorders, particularly bulimia nervosa, consumed more diet soda than controls. Eating disorder symptoms that reflect increased appetitive drive or increased weight concerns were associated with increased diet soda intake. Increased weight concerns were associated with increased diet soda intake when levels of appetitive drive were high, but not when they were low. Results highlight the importance of monitoring diet soda intake in individuals with eating disorders and may have implications for the maintenance of dysregulated taste reward processing in bulimia nervosa.     

Electrogastrography abnormality in eating disorders

Eating disorders are common psychiatric disorders in young women. The aim of the present study was to evaluate the gastric electrical activity of patients with eating disorders and its relation to their symptoms. The electrogastrography (EGG) was performed before and after a water load test for outpatients with eating disorders (n = 36; 14 anorexia nervosa, 14 bulimia nervosa, eight eating disorder not otherwise specified) and healthy women (n = 19). A structured interview (Eating Disorder Examination) was used to assess clinical symptoms. The percentage of normal gastric myoelectrical power was significantly smaller in the eating disorder patients (44.5% vs 74.2%; P < 0.05), while the percentage of bradygastric power was significantly greater, both before and after the water load test compared with the control subjects (30.4% vs 10.4%; P < 0.05). In addition, moderate correlation was found between the duration of illness and the percentage of bradygastria (P < 0.05). In conclusion, it is suggested that longstanding abnormal eating in patients with eating disorders may induce disturbances to gastric motor function, resulting in their abnormal, eating-related behavior, and form a symptomatic vicious circle. The EGG may be a promising method for determining the pathophysiology of eating disorders and for developing effective therapeutic approaches.     

Emotional Eating among Individuals with Concurrent Eating and Substance Use Disorders

Emotional eating occurs frequently in individuals with eating disorders and is an overlooked factor within addictions research. The present study identified the relationship between emotional eating, substance use, and eating disorders, and assessed the usefulness of the Emotional Eating Scale (EES) for individuals with concurrent eating disorders (ED) and substance use disorders (SUD). One hundred and ninety three individuals seeking specialized substance use and eating disorder treatment were administered substance use, mental health, and eating disorders measures. Results suggested that emotional eating predicted the ability to resist using drugs in high risk situations and the tendency to be over-absorbed in face of stressful situations. The EES is useful for assessing emotional eating among individuals with concurrent ED and SUD, although it would be improved by the inclusion of more items of positive affect. Emotional eating within populations with concurrent ED and SUD is worthy of further investigation.     

Evolutionary mismatch,neural reward circuits,and pathological gambling

Evolutionary mismatch theory has been applied to disorders of self-regulation such as maladaptive eating patterns and drug abuse. Modern gambling represents a refinement of the elements of risk and chance, which draw upon the faculties of judgment and novelty-seeking. A set of neuroanatomical structures, including prefrontal-subcortical systems and associated limbic structures, have been implicated in the processing of reward and punishment, including gambling-related situations. Neurobiological systems guiding choice and behavior have evolved to maximize chances for survival under hunter-gatherer conditions, and modern gambling represents an abrupt departure from these circumstances, sometimes resulting in pathological gambling.     

Medial prefrontal cortex activity associated with symptom provocation in eating disorders

OBJECTIVE: The authors sought to identify neural correlates of eating disorders in order to contribute to the debate on the genesis and classification of eating disorders and provide endophenotypes for genetic research. METHOD: Twenty-six female patients with eating disorders (10 with bulimia nervosa, 16 with anorexia nervosa) and 19 healthy female comparison subjects matched for age and education were presented with food and aversive emotional images while brain activity was recorded with functional magnetic resonance imaging. RESULTS: Women with eating disorders identified the food stimuli as threatening and disgusting. In response to these stimuli, the women with eating disorders had greater activation in the left medial orbitofrontal and anterior cingulate cortices and less activation in the lateral prefrontal cortex, inferior parietal lobule, and cerebellum, relative to the comparison group. In addition, women with bulimia nervosa had less activation in the lateral and apical prefrontal cortex, relative to the comparison group. Between-group differences in response to nonspecific emotional stimuli were found in the occipital cortex, parietal cortex, and cerebellum. CONCLUSIONS: A medial prefrontal response to symptom-provoking stimuli was identified as a common feature of anorexia and bulimia nervosa. This finding supports a conceptualization of eating disorders as being transdiagnostic at the neural level. The abnormal prefrontal reaction is associated with symptom-related material, whereas the occipital and cerebellar differences are nonspecific. An abnormal propensity to activate medial prefrontal circuits in response to inappropriate stimuli is common to eating, obsessive-compulsive, and addictive disorders and may account for the compulsive features of behavior in these conditions.     

Development and preliminary validation of a Finnish version of the Eating Disorder Examination Questionnaire (EDE-Q)

Background: Eating behaviour can be viewed as a continuum, ranging from extremely restrictive to extremely disinhibited eating. Valid and reliable instruments are needed to ensure detection of individuals with risk for eating disorders (ED). Self-report methods are the most feasible, cost, and time efficient. One of the most widely used self-reports is the Eating Disorder Examination Questionnaire (EDE-Q).

Aim: The aim of this study was to develop a Finnish version of the EDE-Q version 6.0 and to assess its psychometric properties in adolescents, adults, and ED patients.

Methods: The present study utilized data from three different samples: adolescents (n?=?242), adults (n?=?133), and ED patients (n?=?52). The patient group comprised different EDs, but individual ED diagnoses were not studied separately. Data was collected January 2014 through June 2015.

Results: The Finnish version of the EDE-Q showed acceptable-to-excellent internal consistency on all sub-scales in all three samples and discriminated patients from healthy individuals. Female participants generally scored higher than male and sex differences were more pronounced among the younger age group.

Conclusions: The Finnish version of the EDE-Q can, based on this study, be regarded as reliable, valid, and functional. Further studies are needed to evaluate the population norms and to test the validity in individual ED diagnoses.     

EVOLUTIONARY MISMATCH,NEURAL REWARD CIRCUITS,AND PATHOLOGICAL GAMBLING

Evolutionary mismatch theory has been applied to disorders of self-regulation such as maladaptive eating patterns and drug abuse. Modern gambling represents a refinement of the elements of risk and chance, which draw upon the faculties of judgment and novelty-seeking. A set of neuroanatomical structures, including prefrontal-subcortical systems and associated limbic structures, have been implicated in the processing of reward and punishment, including gambling-related situations. Neurobiological systems guiding choice and behavior have evolved to maximize chances for survival under hunter-gatherer conditions, and modern gambling represents an abrupt departure from these circumstances, sometimes resulting in pathological gambling.     

Functional neuroanatomy of body shape perception in healthy and eating-disordered women.

BACKGROUND: Abnormalities in perception and evaluation of body shape are a hallmark of eating disorders. METHODS: Brain responses to line drawings of underweight, normal weight, and overweight female bodies were measured with functional magnetic resonance imaging in 9 women with bulimia nervosa, 13 with anorexia nervosa, and 18 healthy women. Participants rated the stimuli for fear and disgust. RESULTS: In the three groups, the lateral fusiform gyrus, inferior parietal cortex, and lateral prefrontal cortex were activated in response to body shapes compared with the control condition (drawings of houses). The responses in the lateral fusiform gyrus and in the parietal cortex were less strong in patients with eating disorders compared with healthy control subjects. Patients with eating disorders rated the body shapes in all weight categories as more aversive than did healthy women. In the group with eating disorders, the aversion ratings correlated positively with activity in the right medial apical prefrontal cortex. CONCLUSIONS: Processing of female body shapes engages a distributed neural network, parts of which are underactive in women with eating disorders. The considerable variability in subjective emotional reaction to body shapes in patients with eating disorders is associated with differential activity in the prefrontal cortex.     

The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality

Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N = 966,141, 51.3% male). Eating disorders diagnoses (AN, broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years–22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults.     

Night eating patterns of individuals with eating disorders: Implications for conceptualizing the night eating syndrome

The prevalence, correlates, and symptom coherence of night eating syndrome (NES) in individuals seeking inpatient treatment for eating disorders were assessed. Inpatients (n = 68; M age = 29.8 years; % female = 94.1; % diagnosed with anorexia nervosa [AN] = 47.1; % diagnosed with bulimia nervosa [BN] = 47.1) were interviewed with the Night Eating Syndrome History and Inventory. Additionally, medical charts were reviewed and participants completed measures of eating behavior and quality of life. NES was diagnosed in 25% of patients; significantly more patients diagnosed with BN meet criteria for NES compared to those diagnosed with AN. In general, patients with NES did not differ from patients without NES on eating behaviors, attitudes, or quality of life; symptoms of NES frequently co-occurred. This study supports previous research finding that night eating behavior is common in individuals diagnosed with eating disorders.     

Association between the insulin-like growth factor 2 gene (IGF2) and scores on the Eating Attitudes Test in nonclinical subjects: a family-based study

OBJECTIVE: An interesting candidate gene for eating disorders is the gene for insulin-like growth factor 2 (IGF2). Located on chromosome 11p15.5, IGF2 is a member of the insulin family of polypeptide growth factors that is involved in development and growth. Consistent with its profile of metabolic actions, an association has been reported between a single nucleotide polymorphism (SNP) in the 3' untranslated region of the IGF2 gene (ApaI) and body mass index. This investigation extended these studies and investigated the psychological and behavioral implications of this hormone's impact on metabolism and body composition. METHOD: The authors tested nonclinical subjects from 376 families for three IGF2 SNPs and for eating disorders, as reflected in scores on the 26-item Eating Attitudes Test, a self-report questionnaire widely used as a screening instrument. RESULTS: A highly significant association was observed between the IGF2 ApaI G allele and scores on the Eating Attitudes Test overall and each of its subscales (bulimia, dieting, and oral control). Additionally, a significant association was observed between this polymorphism and body mass index. CONCLUSIONS: The current finding that the IGF2 ApaI G polymorphism, which predisposes to weight gain, may also contribute to the pathology of eating disorders is intriguing. Neurotransmitter modulation of appetitive behavior is the focus of most hypotheses regarding the etiology of severe eating disorders. The current results to some measure challenge this view, and inborn metabolic tendencies to weight gain in some women may trigger constant dieting, which in predisposed individuals eventually leads to severe eating disorders.     

Eating-related anxiety in individuals with eating disorders

Although previous research has supported the importance of anxiety as an etiological and maintenance factor for eating disorders, the specific mechanisms are not well understood. The role of anxiety in the context of eating behavior is especially unclear. The purpose of this study was to identify anxiety-eliciting eating situations and anxiety management strategies patients use to mitigate anxiety experienced in the context of eating as determined by diagnostic groups and symptom patterns. Fifty-three eating disorder outpatients were administered the Eating and Anxiety Questionnaire (EAQ) and the Eating Disorder Diagnostic Scale. Ratings indicated significant anxiety in most eating situations, whereas management strategies were more limited yet regularly employed. Factor analysis of the EAQ revealed a 6-factor solution for anxiety management strategies and a 4-factor solution for anxiety-eliciting situations. These results indicate patients with eating disorders report high levels of anxiety associated with eating behaviors but utilize limited yet consistent anxiety management strategies. Effective intervention strategies for managing eating-related anxiety should be incorporated into treatment and may need to be specified for different diagnostic subgroups.     

Dissociation in eating disorders: relationship between dissociative experiences and binge-eating episodes

Objective

Several findings support the hypothesis that there is a relationship between dissociation and eating disorders (EDs). The aims of this study were as follows: (1) to assess whether ED patients show a higher level of dissociation than healthy control (HC) individuals or psychiatric control patients with anxiety and mood disorders and (2) to investigate the effects of dissociation on ED symptoms, specifically binge eating behavior.

Method

Fifty-four ED patients, 56 anxiety and mood disorders control patients, and 39 HC individuals completed the Eating Disorder Examination Questionnaire and the Dissociation Questionnaire. Each participant was asked about the number of binge eating episodes he or she had experienced in the past 4 weeks.

Results

The ED patients had higher levels of dissociation than both the psychiatric control group and the HC group. In the ED group, the number of binge episodes was related to the level of dissociation.

Discussion

Dissociative experiences are relevant in EDs, and binge eating is related to dissociation. In patients affected by the core psychopathologic beliefs of EDs (overevaluation of shape and weight), dissociation may allow an individual to initiate binging behavior, thus decreasing self-awareness and negative emotional states, without having to deal with the long-term consequences of their actions.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.