Differential motivational responses to food and pleasurable cues in anorexia and bulimia nervosa: a startle reflex paradigm

BACKGROUND: Abnormal perceptions of food and shape underpin the cognitive behavioural model of eating disorders (EDs). The aim of this study was to investigate motivational processing of disorder-specific and standard emotional cues in anorexia (AN) and bulimia nervosa (BN) using startle eyeblink modulation (SEM). SEM was used because it is sensitive to motivational states of approach (appetitive response) and withdrawal (aversive response), which are independent of conscious intentional control. METHOD: Acoustically elicited SEM and subjective anxiety ratings were measured in 30 female patients with an ED (n=15 AN, n=15 BN) and 30 female control subjects while they viewed ED-relevant stimuli (food, female bodies) and standardized emotional pictures. RESULTS: BN subjects showed an appetitive response (startle inhibition) to food relative to neutral cues that differed significantly from AN subjects. By contrast, self-reports indicated significantly increased anxiety related to food cues across both ED groups. To female body picture (relative to neutral) cues, no significant between-group differences were found for SEM. ED subjects unexpectedly showed an aversive response (startle potentiation) to positive cues, in contrast to controls, who showed the established startle attenuation. CONCLUSIONS: These preliminary results suggest that BN patients demonstrated an exaggerated appetitive response to food but not to standardized positive cues, whereas SEM in AN patients points to a generalized failure to activate the appetitive motivational system. Differences in motivational salience to food cues are in line with distinctions between AN and BN in eating behaviour and food consumption and support differential treatment requirements.     

Deprivation selectively modulates brain potentials to food pictures

Event-related brain potentials (ERPs) were used to examine whether the processing of food pictures is selectively modulated by changes in the motivational state of the observer. Sixteen healthy male volunteers were tested twice 1 week apart, either after 24 hr of food deprivation or after normal food intake. ERPs were measured while participants viewed appetitive food pictures as well as standard emotional and neutral control pictures. Results show that the ERPs to food pictures in a hungry, rather than satiated, state were associated with enlarged positive potentials over posterior sensor sites in a time window of 170-310 ms poststimulus. Minimum-norm analysis suggests the enhanced processing of food cues primarily in occipito-temporo-parietal regions. In contrast, processing of standard emotional and neutral pictures was not modulated by food deprivation. Considered from the perspective of motivated attention, the selective change of food cue processing may reflect a state-dependent change in stimulus salience.     

Acoustic startle reactivity while processing reward‐related food cues during food deprivation: Evidence from women in different menstrual cycle phases and men

Previous research has shown that food deprivation enhances the acoustic startle reflex when it is elicited during presentation of visual food cues. Frustrative nonreward may explain this effect, since visual food cues are also rated to be more appetitive and arousing during food deprivation. However, the impact of menstrual cycle and sex on this effect remains unclear, and it is also not known whether this effect is influenced by hunger and motivation to eat. According to a within‐study design, 20 healthy women in different menstrual cycle phases and 14 healthy men participated twice, in normal and food‐deprived conditions. After 18 h of food deprivation, acoustic startle was attenuated by appetitive nonfood foreground pictures, but enhanced by presentation of food pictures. No differences between menstrual cycle phases and sexes appeared. The effect correlated with hunger changes, suggesting that motivational factors play a role.     

Binge eating and eating attitudes among Nazi concentration camp survivors

BACKGROUND: Prisoners in Nazi concentration camps lived through extreme situations that included starvation. We test our hypothesis that there is a greater lifetime presence of binge eating among survivors from concentration camps than in a control group. METHODS: The subjects were 51 political prisoners who survived Nazi concentration camps and 47 ex-partisans of similar age and sex. A clinical interview investigated the lifetime occurrence of binge eating. The Eating Attitudes Test was also administered. RESULTS: The mean reported loss of weight among survivors was 27-3 kg. Thirty-three per cent of them and 4% of the ex-partisans reported going on eating binges at some time in their lives (P < 0.0007). There was no significant difference in the Eating Attitudes Test scores of survivors and ex-partisans, but, among survivors, the Bulimia subscale significantly discriminated subjects who reported current binge eating. CONCLUSIONS: Our study confirms that subjects who have survived a period of extreme food deprivation are more likely to develop binge eating behaviour.     

Affective engagement for facial expressions and emotional scenes: the influence of social anxiety

Pictures of emotional facial expressions or natural scenes are often used as cues in emotion research. We examined the extent to which these different stimuli engage emotion and attention, and whether the presence of social anxiety symptoms influences responding to facial cues. Sixty participants reporting high or low social anxiety viewed pictures of angry, neutral, and happy faces, as well as violent, neutral, and erotic scenes, while skin conductance and event-related potentials were recorded. Acoustic startle probes were presented throughout picture viewing, and blink magnitude, probe P3 and reaction time to the startle probe also were measured. Results indicated that viewing emotional scenes prompted strong reactions in autonomic, central, and reflex measures, whereas pictures of faces were generally weak elicitors of measurable emotional response. However, higher social anxiety was associated with modest electrodermal changes when viewing angry faces and mild startle potentiation when viewing either angry or smiling faces, compared to neutral. Taken together, pictures of facial expressions do not strongly engage fundamental affective reactions, but these cues appeared to be effective in distinguishing between high and low social anxiety participants, supporting their use in anxiety research.     

Postauricular reflexes elicited by soft acoustic clicks and loud noise probes: Reliability,prepulse facilitation,and sensitivity to picture contents

The startle blink reflex is facilitated during early picture viewing, then inhibited by attention during pleasant and aversive pictures compared to neutral pictures, and finally potentiated during aversive pictures specifically. However, it is unclear whether the postauricular reflex, which is elicited by the same loud acoustic probe as the startle blink reflex but enhanced by appetitive instead of defensive emotion, has the same pattern and time course of emotional modulation. We examined this issue in a sample of 90 undergraduates using serially presented soft acoustic clicks that elicited postauricular (but not startle blink) reflexes in addition to standard startle probes. Postauricular reflexes elicited by both clicks and probes correlated during food and nurturant contents, during which they were potentiated compared to neutral pictures, suggesting clicks effectively elicit emotionally modulated postauricular reflexes. The postauricular reflex was initially facilitated during the first 500 ms of picture processing but was larger during pleasant than neutral pictures throughout picture processing, with larger effect sizes during the latter half of picture processing. Across reflexes and eliciting stimuli, measures of emotional modulation had higher coefficient alphas than magnitudes during specific picture contents within each valence, indicating that only emotional modulation measures assess higher‐order appetitive or defensive processing.     

Temporal stability of the emotion-modulated startle response

In the present study, we examined the stability of one measure of emotion, the emotion-modulated acoustic startle response, in an undergraduate sample. Using the acoustic startle paradigm on two different occasions, we measured stability of affective modulation of the startle response during and following the presentation of pictures selected to be of positive, negative, or neutral emotional valence. The two assessments were separated by 4 weeks. Two groups of subjects were compared: one group that viewed the same pictures at each assessment and a second group that viewed different pictures at the second assessment. We found that viewing different pictures at two assessments separated by 4 weeks yielded moderate stability of the emotion modulation of startle magnitude, whereas subjects who viewed the same pictures at both assessments showed poor stability. Furthermore, this difference was due to the stability of responses to high versus low arousal pictures, not to differences in valence.     

Association between alcohol-cue modulated startle reactions and drinking behaviour in alcohol dependent patients — results of the PREDICT study

Previous research on alcohol dependent patients has shown that variations in eyeblink startle response can be used as an indicator of their emotional responses to alcohol-related stimuli. Postulating that reactions on substance associated stimuli are controlled by either a negative or a positive affective processing system, we expect that abstinent alcoholics react differently (within-group) in the emotional evaluation of alcohol cues. Furthermore, we assumed the startle response to covary with medication response to acamprosate and naltrexone.We measured 74 detoxified inpatients' acoustic startle responses while they were being presented with alcohol-related images as well as affectively negative, neutral, and positive pictures before they were randomized to pharmacotherapy.Group-mean startle peak amplitudes were lowest for alcohol-related cues. The relative startle response (alcohol cues set in relation to the other stimulus categories) did not correlate with craving for alcohol (OCDS) or alcohol cue induced self-ratings of arousal, valence and craving. Patients with a lower percentage of abstinent days in the 90 days prior to the last drinking day showed a lower (“more appetitive”) startle response to alcohol cues. A survival analysis using the time to first heavy drinking day as the survival criterion revealed a significant interaction between alcohol-cue startle responses and medication type.The results indicate that the psycho-physiological measure of emotional evaluation of alcohol cues includes unconscious processing not reflected by conscious self-ratings. Furthermore, our result of a differential medication effect may encourage further studies to use biological characteristics to stratify patients as a step towards individualized treatment for alcohol dependence.     

Emotional response in patients with frontal brain damage: effects of affective valence and information content

The authors investigated the role of the frontal lobes in the emotional response in 19 patients with brain damage and 23 control subjects. They studied the modulation of the startle blink reflex by affective pictures, and other autonomic responses. Patients showed a dissociation between the startle reflex and the affective valence ratings of the pictures, as a result of a low inhibition of the startle reflex by pleasant pictures. Pictures elicited lower skin conductance responses (SCRs) in patients than in controls, whereas the groups did not differ in the SCRs prompted by less significant acoustic stimuli. The findings point to the frontal lobe as a structure involved in the emotional response and in the physiological emotional arousal related to the complexity of the stimuli.     

Affective reactions to acoustic stimuli

Emotional reactions to naturally occurring sounds (e.g., screams, erotica, bombs, etc.) were investigated in two studies. In Experiment 1, subjects rated the pleasure and arousal elicited when listening to each of 60 sounds, followed by an incidental free recall task. The shape of the two-dimensional affective space defined by the mean ratings for each sound was similar to that previously obtained for pictures, and, like memory for pictures, free recall was highest for emotionally arousing stimuli. In Experiment 2, autonomic and facial electromyographic (EMG) activity were recorded while a new group of subjects listened to the same set of sounds; the startle reflex was measured using visual probes. Listening to unpleasant sounds resulted in larger startle reflexes, more corrugator EMG activity, and larger heart rate deceleration compared with listening to pleasant sounds. Electrodermal reactions were larger for emotionally arousing than for neutral materials. Taken together, the data suggest that acoustic cues activate the appetitive and defensive motivational circuits underlying emotional expression in ways similar to pictures.     

Temporal course of emotional startle modulation in schizophrenia patients.

The temporal course of startle reflex modulation to emotional pictures was investigated in 49 relatively asymptomatic schizophrenia outpatients and 46 normal controls. Participants viewed pleasant, neutral and unpleasant pictures, which were presented for 6 s and acoustic startle probes were delivered at five different times after picture onset. Replicating previous findings schizophrenia patients showed the same affective modulation of the startle reflex as healthy controls when probes were presented later during the picture-viewing period (3800 ms). For the early probe times (300 and 800 ms), affective pictures proved to be the effective prepulse stimuli resulting in a clear Prepulse inhibition (PPI) effect in both groups. In contrast to previous findings, the PPI of startle response was not stronger during processing emotional stimuli relative to neutral stimuli. For control subjects, blink reflexes were larger for unpleasant pictures compared with neutral and pleasant pictures, representing an early activation of motivational systems. Schizophrenia patients on the other hand, did not show this early affective modulation of the acoustic startle reflex.     

Startle potentiation in aversive anticipation: evidence for state but not trait effects

The present study was undertaken to determine whether aversiveness contributes to startle potentiation in anticipation of affective pictures above and beyond the effects of emotional arousal. Further, participants high in trait anxious apprehension, which is characterized by worry about the future, were expected to show especially pronounced anticipatory startle responses. Startle blink reflex was measured during warning stimuli that predicted the valence of ensuing aversive/unpleasant, pleasant, or neutral pictures. Startle magnitude was larger in anticipation of aversive than of pleasant pictures and smallest in anticipation of neutral pictures. Enhanced startle potentiation was not found in anxious apprehension subjects. These data suggest that the aversive nature of stimuli contribute to the potentiation of startle above and beyond the effects of emotional arousal, which may be a universal phenomenon not modulated by individual differences.     

Emotional modulation of the post-auricular reflex

A large literature now exists on emotional modulation of the startle blink reflex. The current study examined affective modulation of the post-auricular reflex, which can be measured in relation to the same noise probe used to evoke the startle reflex. We recorded the post-auricular reflex during viewing of pictures that varied systematically in emotional valence, content, and intensity. A significant linear valence modulation effect was found, with pleasant pictures potentiating and aversive pictures inhibiting the post-auricular reflex in comparison with neutral pictures. This modulatory effect did not vary as a function of picture content, but it was most robust for highly intense emotional pictures. Implications for the assessment of basic emotional action tendencies are discussed.     

Electrocortical processing of food and emotional pictures in anorexia nervosa and bulimia nervosa

Objective To compare the electrocortical processing of food pictures in participants with anorexia nervosa (n = 21), bulimia nervosa (n = 22), and healthy controls (HCs) (n = 32) by measuring the early posterior negativity, an event-related potential that reflects stimulus salience and selective attention. Methods We exposed these three groups to a rapid stream of high- and low-calorie food pictures, as well as standard emotional and neutral pictures. Results Event-related potentials in the time range of 220 milliseconds to 310 milliseconds on posterior electrodes differed between groups: patients with eating disorders showed facilitated processing of both high- and low-calorie food pictures relative to neutral pictures, whereas HC participants did so only for the high-calorie pictures. Subjective palatability of the pictures was rated highest by patients with anorexia nervosa, followed by the HC and bulimia nervosa groups. Conclusions Patients with eating disorders show a generalized attentional bias for food images, regardless of caloric value. This might explain the persistent preoccupation with food in these individuals.     

Food exposure in patients with bulimia nervosa.

BACKGROUND: The aim of the study was to investigate psychological and physiological responses of bulimic patients to the repeated presentation of food cues. METHOD: On 2 subsequent days, 48 bulimic women (DSM-IV) were confronted with high- or low-caloric food for 20 min. A control group (n = 24) was exposed to high-caloric food once. Blood sugar levels were manipulated with a glucose load. RESULTS: High-caloric food only elicited increases in urge to binge, subjective and physiological stress in the first session. During the second session, reported urge to binge and subjective stress was significantly lower. Bulimic patients confronted with high-caloric food showed higher subjective and physiological stress in the first session compared to bulimic patients confronted with low-caloric food. In the second session, they reported more subjective stress and urge to binge, compared to the low-caloric group. Blood sugar levels did not affect psychological and physiological responses. DISCUSSION: The results are discussed in terms of the conditioning model of binge eating model, habituation models and implications for exposure therapy.     

Cognitive restraint and sensitivity to cues for hunger and satiety

The present study provides experimental evidence for the effects of cognitive restraint on sensitivity to internal and external cues of hunger. The design involved four experimental conditions. In each condition the subjects were given either a high calorie or a low calorie early morning drink, and either correctly or incorrectly told its calorie content. The subjects, 10 restrained and 10 nonrestrained normal weight women, then rated their subjective hunger and satiety responses and had a test meal. All subjects reported lower sensations of hunger and higher sensations of fullness after the high calorie drink than the low calorie drink, indicating sensitivity to internal cues. However, the restrained eaters' ratings of hunger were also influenced by the believed content of the drink, indicating sensitivity to external cues. The implications of the results are analysed in terms of current theories of restrained eating and their relevance to further research into pathological eating regulation is discussed.     

Binge Eating Scale: Further Assessment of Validity and Reliability1

Validity of the Binge Eating Scale (BES), used to measure binge eating severity in overweight binge eaters, was examined using food records. A sample of 56 nonpurge binge eating women completed the BES and 28-day food records. Self-identified binges were classified as subjective when less than 1,000 calories were consumed and as objective when 1,000 calories or more were consumed. Binge severity was measured by total number of binge calories, binge episodes, and binge days over 28 days. BES scores had significant, moderate associations between subjective and objective binge eating severity. In contrast, BES scores were not related to total caloric intake. The BES was unable to distinguish between subjective and objective binge eating, which is essential for diagnostic purposes.     

Addressing the specificity of affective startle modulation: fear versus disgust.

Previous research is equivocal regarding whether startle reflex eyeblink is specifically sensitive to the emotion of fear, or is more generally influenced by the valence dimension of emotion. Thirty-five undergraduate participants (17 male) viewed 60 pictures from five affective categories (pleasant, neutral, fear, disgust-blood, and disgust-other). Bilateral eyeblink EMG responses to acoustic startle probes were assessed during 2/3 of picture presentations, and 1/3 of intertrial intervals. Left corrugator and levator EMG responses to no-startle pictures were also examined. Supporting an emotional valence model of affective startle modulation, the startle potentiation effect was not specific to fear materials. In fact, women, but not men, had larger startles during disgust compared with fear pictures. Both corrugator and levator EMG responses were greater to disgust than fear stimuli. These findings limit the generalizability of corrugator as an index of all negative emotions and extend evidence for the specificity of levator to disgust.     

Effect of eating rate on binge size in Bulimia Nervosa

Bulimia Nervosa (BN) is an eating disorder characterized by recurrent episodes of binge eating. During binge eating episodes, patients often describe the rapid consumption of food, and laboratory studies have shown that during binges patients with BN eat faster than normal controls (NC), but the hypothesis that a rapid rate of eating contributes to the excessive intake of binge meals has not yet been experimentally tested. The aim of this study was to assess the effect of eating rate on binge size in BN, in order to determine whether binge size is mediated, in part, by rate of eating. Thirteen BN and 14 NC subjects were asked to binge eat a yogurt shake that was served at a fast rate (140 g/min) on one occasion and at a slow rate (70 g/min) on another. NC subjects consumed 169 g more when eating at the fast rate than when eating at the slow rate. In contrast, consumption rates failed to influence binge size in patients with BN (fast: 1205 g; slow: 1195 g). Consequently, there was a significant group by rate interaction. As expected, patients with BN consumed more overall than NC subjects (1200 g vs. 740 g). When instructed to binge in the eating laboratory, patients with BN ate equally large amounts of food at a slow rate as at a fast rate. NC subjects ate less at a slow rate. These findings indicate that in a structured laboratory meal paradigm binge size is not affected by rate of eating.     

The assessment of bulimic symptoms and personality correlates in female college students

A screening questionnaire for bulimic symptoms was completed by 244 college women. Approximately 79% reported binge eating (uncontrolled, excessive eating) occurrences. Twenty women (8.2% of the sample) reported self-induced vomiting after binge eating or "normal" meals. A subsample of 31 students were interviewed and administered the Restraint Scale, Compulsive Eating Scale, Beck Depression Inventory, Sixteen Personality Factor Questionnaire, and The Tennessee Self Concept Scale. Results showed a number of significant differences among students who binged only (" bingers "), self-induced vomiting (" purgers "), or did not binge or purge ("controls"). Bingers and purgers showed greater restrained eating tendencies and compulsive eating behaviors. On the 16PF, purgers scored lower on Factor Q3, which suggests lowered will control and less regard for social demands. Purgers also showed lower self-esteem, particularly in the areas of identity and family self-concept.