Shared and unique mechanisms underlying binge eating disorder and addictive disorders

The influencing factors in food addiction of nursing students: A qualitative study

PURPOSE

This study aims to determine the factors that influence food addiction (FA) in female nursing students.

DESIGN AND METHODS

Twenty-four out of 51 (mean age = 19.8 ± 1.36) women were identified from a sample of 645, who met the diagnostic criteria of FA using the Yale Food Addiction Scale (YFAS), and participated in this qualitative study.

FINDINGS

Results of the study revealed that the factors affecting FA in students were conceptualized under four themes: "Social circle," "Situational and emotional signs," "Cognitive process," and "Weight gain and quality of life."

PRACTICE IMPLICATIONS

It is recommended to offer specific intervention programs including personal or group counseling for those, recognized as having FA based on an addiction model, and to have a successful therapy.

Correcting the reward imbalance in binge eating: A pilot randomized trial of reward re-training treatment

Behavioral treatments for psychological disorders characterized by reward-driven maladaptive behaviors (e.g., substance use disorder, eating disorders, behavioral addictions) primarily seek to reduce hyper-reward response to disorder-specific stimuli. Suboptimal outcomes for these treatments highlight the need to also target hypo-reward response to day-to-day life activities. The present study sought to conduct an initial test of a novel behavioral treatment, Reward Re-Training (RRT) to target hyper- and hypo-reward response in individuals with binge eating. Individuals with binge eating (N = 23) were randomly assigned to either 10 weeks of outpatient, group-based RRT treatment or a waitlist control. RRT was found to be feasible and acceptable, demonstrated large impacts on both hypo- and hyper-reward response (measured by self-report (pre-to post-treatment ηp2 range 0.38-0.58) and neural activation via fMRI), and was efficacious in reducing eating disorder pathology (ηp2 range 0.40-0.64, including binge eating, ηp2 = 0.64) compared to waitlist control (ηp2 range 0.00-0.04). This pilot data provides preliminary support for the feasibility, acceptability, and effectiveness of a novel treatment targeting reward imbalance for individuals with binge eating. Future evaluations of RRT may benefit from an active treatment comparison condition and a follow-up assessment to examine persistence of positive outcomes.

Disentangling binge eating disorder and food addiction: a systematic review and meta-analysis

BACKGROUND AND AIMS

The concept of "Food Addiction" has been based on criteria of Substance Use Disorder. Several studies suggested a relationship between food addiction and eating disorders, but little is known about its extent or role. We aim at exploring if food addiction is coincident with a specific eating disorder (binge eating disorder appears the closest) or it is a separate diagnostic entity that afflicts in comorbidity with eating disorders or other conditions like obesity or even in the general population.

METHODS

This systematic review and meta-analysis analyzed observational studies with a comparative estimation on rates of subjects affected by binge eating disorder and food addiction.

RESULTS

Binge eating disorder shows higher comorbidity with food addiction compared to other eating disorders (OR = 1.33, 95% CI, 0.64-2.76; c² = 4.42; p = 0.44;I² = 0%), or each eating disorder [anorexia nervosa purging type (OR = 1.93, 95% CI, 0.20-18.92; p = 0.57) and restrictive type (OR = 8.75, 95% CI, 1.08-70.70; p = 0.04)], obese patients (OR = 5.72, 95% CI, 3.25-10.09; p =  < 0.0001) and individuals from the general population (OR = 55.41, 95% CI, 8.16-376.10; c² = 18.50; p < 0.0001; I² = 0%)but has decreased prevalence when compared to bulimia nervosa (OR = 0.85, 95% CI, 0.33-2.22; c² = 0.35; p = 0.74; I² = 0%).

DISCUSSION AND CONCLUSIONS

Our data show that the prevalence of food addiction in binge eating disorder is higher than in other eating disorders except in bulimia nervosa. Moreover, it is a separate diagnostic reality and can be detected in people without mental illness and in the general population. Food addiction might have a prognostic value, since in comorbidity, and should be addressed to boost treatment efficacy and patient's recovery.

LEVEL OF EVIDENCE

I: Evidence obtained systematic reviews and meta-analyses.

Food Addiction: a Deep Dive into ‘Loss of Control’ and ‘Craving’

Purpose of Review

The majority of existing research discusses food addiction (FA) classification, which provides information for different groups and which groups may or may not be affected to differing degrees. Fewer studies report FA symptom scores, and fewer still report on individual symptoms. This paper discusses the symptoms of craving and loss of control as they are common FA symptoms that demonstrate similarities with both substance use disorders and some eating disorder pathology.

Recent Findings

Loss of control presents parallels with disordered eating, particularly binge eating disorder. Craving refers to the powerful or strong desire for something and, in contrast to lack of control, presents most overlap with substance use disorders.

Summary

While not the most common symptoms reported in published research, loss of control and craving attract attention because of parallels with substance use and eating disorder pathology, and research has increasingly focused on these symptoms in recent years.

Mapping the landscape and structure of global research on binge eating disorder: Visualization and bibliometric analysis

BACKGROUND

Binge-eating disorder (BED) is a clinical syndrome and is considered the most common type of eating disorder. However, our understanding of the global performance and progress of BED research is limited.

AIM

To describe and perform a bibliometric analysis of the state of BED research.

METHODS

The term 'Binge eating' was searched in the title throughout the previous year's up to December 31, 2020. We searched the Scopus and Reference Citation Analysis for publications on Binge eating. The VOSviewer software version 1.6.17 was used to produce the network visualization map of the most frequent author, collaborative relationships between countries/regions, and to determine the hotspots related to binge eating research. In addition, conventional bibliometric indicators were generated.

RESULTS

The search strategy found 2713 total articles and an average of 62 articles per year. Among them, 'Article' represented 82.49% of the publications (n = 2238 articles) and was the most frequent type, followed by reviews (n = 243; 8.96%). The number of publications increased steadily during the last decade of the study period. One hundred and thirty-two countries contributed to binge eating research, with 1495 (55.11%) articles published in the United States, followed by Italy with 256 (9.44%), the United Kingdom with 183 (6.75%), and Germany with 182 (6.71%). Currently, the main hot topics related to BED are 'type of treatment and management and treatment provided to BED"; "processes and pathways to binge eating"; and 'diagnosis, signs and symptoms, comorbidities and prevalence and associated factors with BED'.

CONCLUSION

The number of publications has increased noticeably during the previous decade. There are indeed relatively few publications on BED from low-and middle-income nations, so much is to be learned from the experience of all countries. Studies on this topic are critical in all countries to discover risk factors and effective intervention measures. Although our findings are preliminary, they imply that the future prospects for interventions aimed at BED management are bright, focusing on complex models of care and long-term maintenance of therapeutic gains.

Brain regulation of hunger and motivation: The case for integrating homeostatic and hedonic concepts and its implications for obesity and addiction

Obesity and other eating disorders are marked by dysregulations to brain metabolic, hedonic, motivational, and sensory systems that control food intake. Classic approaches in hunger research have distinguished between hedonic and homeostatic processes, and have mostly treated these systems as independent. Hindbrain structures and a complex network of interconnected hypothalamic nuclei control metabolic processes, energy expenditure, and food intake while mesocorticolimbic structures are though to control hedonic and motivational processes associated with food reward. However, it is becoming increasingly clear that hedonic and homeostatic brain systems do not function in isolation, but rather interact as part of a larger network that regulates food intake. Incentive theories of motivation provide a useful route to explore these interactions. Adapting incentive theories of motivation can enable researchers to better how motivational systems dysfunction during disease. Obesity and addiction are associated with profound alterations to both hedonic and homeostatic brain systems that result in maladaptive patterns of consumption. A subset of individuals with obesity may experience pathological cravings for food due to incentive sensitization of brain systems that generate excessive 'wanting' to eat. Further progress in understanding how the brain regulates hunger and appetite may depend on merging traditional hedonic and homeostatic concepts of food reward and motivation.

Childhood trauma and food addiction: The role of emotion regulation difficulties and gender differences

OBJECTIVE

Childhood trauma has been associated with substance use disorders (SUDs), but less research has investigated its association with food addiction (i.e., compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). Existing research on childhood trauma and food addiction has focused primarily on women from restricted samples. Further, emotion dysregulation difficulties are implicated in both childhood trauma and food addiction, but research has not explored whether it may play a mediating role.

METHOD

Thus, the current study utilizes a sample of 310 participants recruited from Amazon Mechanical Turk (mean age = 41.3 years old, 47.4% men, 78.7% white) to investigate the mediating role of emotion dysregulation in the association between childhood trauma and food addiction. We also conducted exploratory analyses to investigate for gender differences in these associations. Gender-stratified correlational matrixes were conducted to investigate association between childhood trauma, food addiction, and emotional dysregulation. Moderated mediation models and multilevel regressions were also conducted to identify the role of gender in the association between childhood trauma, food addiction, and emotion dysregulation.

RESULTS

Emotion dysregulation was found to partially mediate the associations between food addiction and childhood trauma and gender was found to moderate associations between childhood trauma and emotion dysregulation, as well as childhood trauma and food addiction. Both moderating pathways were significantly stronger for men compared to women.

DISCUSSION

Results suggests that emotion dysregulation may be one important mediator in the association between childhood trauma and food addiction, particularly for men. The identification of other potential mechanisms contributing to the association between childhood trauma and food addiction and the use of longitudinal measurement strategies will be important in future research.

Clinical Considerations of Ultra-processed Food Addiction Across Weight Classes: an Eating Disorder Treatment and Care Perspective

Purpose of Review

To examine the prevalence rates of ultra-processed food addiction across different weight classes and offer guidelines for diagnosis and treatment. Clinicians are provided with practical considerations in the assessment of ultra-processed food addiction beyond the use of validated instruments.

Recent Findings

The weighted mean prevalence of ultra-processed food addiction is approximately 20% worldwide and varies widely based on the sample. At first glance, there appears a linear relationship between ultra-processed food addiction and BMI class. Further investigation indicates a J-shaped curve with heightened prevalence among the underweight. These findings highlight the need to assess for additional factors that may increase objective or subjective food addiction symptoms including eating disorders, dietary restraint, and other mental health diagnoses.

Summary

While clinical considerations across different weight classes vary, overemphasis on weight status may detract from the clinical utility of the ultra-processed food addiction construct. Considering weight status in conjunction with other psychiatric symptoms helps to better understand the various biopsychosocial mechanisms that influence eating behavior and can inform individualized treatment strategies.

Limitations of the protective measure theory in explaining the role of childhood sexual abuse in eating disorders, addictions, and obesity: an updated model with emphasis on biological embedding

In addition to its immediate negative consequences, childhood sexual abuse is associated with lifelong deleterious mental and physical health outcomes. This review employs a biopsychosocial perspective to better understand pathways from childhood sexual abuse to eating disorders, food and drug addictions, and obesity across the life course. Guided by an updated conceptual model, this review delineates how the biological embedding of childhood sexual abuse triggers a cascade of interrelated conditions that often result in failed attempts at weight suppression and eventually obesity. Such biological embedding involves pathways such as inflammation, allostatic load, reward sensitivity, activation of the hypothalamic-pituitary-adrenal axis, epigenetics, and structural and functional changes in the brain. These pathways are in turn theorized to lead to food addiction, substance use disorder, and eating disorders-each with potential pathways toward obesity over time. Predisposing factors to childhood sexual abuse including gender, culture, and age are discussed. This model calls into question the longstanding "protective measure" theory that purports individuals exposed to sexual abuse will deliberately or subconsciously gain weight in attempt to prevent future victimization. A more comprehensive understanding of the mechanisms by which childhood sexual abuse becomes biologically embedded may help clinicians and survivors normalize and/or address disordered eating and weight-related outcomes, as well as identify intervention strategies.Level of evidence: Level V: opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Eating disorders and subsequent risk of substance use disorders involving illicit drugs: a Danish nationwide register-based cohort study

PURPOSE

No study has investigated the ongoing risk of substance use disorders involving illicit drugs (ISUD) after first eating disorder (ED) and whether the pattern of risk differs according to types of ED and ISUD. Therefore, we aimed to longitudinally assess the risk of a subsequent diagnosis of any ISUD (pooled category) and specific ISUD after a first-time diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or unspecified ED (USED).

METHODS

A retrospective cohort study using data from Danish nationwide registers identified 20,759 ED patients and 83,038 matched controls (1:4 ratio). Risk of any ISUD diagnosis after first ED diagnosis was estimated by generating hazard ratios (HR). Logistic regression was applied to assess associations between each ED and specific ISUD.

RESULTS

Patients with AN, BN, and USED (without a prior ISUD diagnosis) exhibited an increased relative risk of a subsequent diagnosis of any ISUD compared with respective controls, and the elevated risk persisted over 10 years (AN, adjusted HRs ranging from 1.60 [99% CI 1.15-2.24] to 5.16 [3.14-8.47]; BN, 2.35 [1.46-3.79] to 14.24 [6.88-29.47]; USED, 2.86 [1.35-3.79] to 8.56 [3.31-29.47]). The highest estimates were observed during the first year of follow-up. Each ED type was associated with an increased likelihood of all types of ISUD. AN and USED were most strongly associated with sedatives/hypnotics, BN with other illegal substances (e.g., ecstasy and hallucinogens).

CONCLUSIONS

ED patients have a considerable risk for subsequent ISUD. Prevention efforts and treatment targeting ISUD are likely required to improve ED treatment prognosis.

“Sound” Decisions: The Combined Role of Ambient Noise and Cognitive Regulation on the Neurophysiology of Food Cravings

Our ability to evaluate long-term goals over immediate rewards is manifested in the brain’s decision circuit. Simplistically, it can be divided into a fast, impulsive, reward “system 1” and a slow, deliberate, control “system 2.” In a noisy eating environment, our cognitive resources may get depleted, potentially leading to cognitive overload, emotional arousal, and consequently more rash decisions, such as unhealthy food choices. Here, we investigated the combined impact of cognitive regulation and ambient noise on food cravings through neurophysiological activity. Thirty-seven participants were recruited for an adapted version of the Regulation of Craving (ROC) task. All participants underwent two sessions of the ROC task; once with soft ambient restaurant noise (∼50 dB) and once with loud ambient restaurant noise (∼70 dB), while data from electroencephalography (EEG), electrodermal activity (EDA), and self-reported craving were collected for all palatable food images presented in the task. The results indicated that thinking about future (“later”) consequences vs. immediate (“now”) sensations associated with the food decreased cravings, which were mediated by frontal EEG alpha power. Likewise, “later” trials also increased frontal alpha asymmetry (FAA) —an index for emotional motivation. Furthermore, loud (vs. soft) noise increased alpha, beta, and theta activity, but for theta activity, this was solely occurring during “later” trials. Similarly, EDA signal peak probability was also higher during loud noise. Collectively, our findings suggest that the presence of loud ambient noise in conjunction with prospective thinking can lead to the highest emotional arousal and cognitive load as measured by EDA and EEG, respectively, both of which are important in regulating cravings and decisions. Thus, exploring the combined effects of interoceptive regulation and exteroceptive cues on food-related decision-making could be methodologically advantageous in consumer neuroscience and entail theoretical, commercial, and managerial implications.

Psychometric properties of the Chinese version of the modified Yale Food Addiction Scale version 2.0 (C-mYFAS 2.0): Prevalence of food addiction and relationship with resilience and social support

PURPOSE

This study aimed to examine the psychometric properties of the Chinese version of the modified Yale Food Addiction Scale 2.0 (C-mYFAS 2.0) and to analyze the prevalence of food addiction among Chinese college students and its relationship with resilience and social support.

METHODS

A total of 1132 Chinese college students completed the C-mYFAS 2.0, BES, EAT-26, PHQ-9, GAD-7, TFEQ-18, CD-RISC-10, and PSSS. Confirmatory factor analysis was used to evaluate the factor structure of the C-mYFAS 2.0 and psychometric properties were assessed. Test-retest reliability was evaluated in a sub-sample (n = 62). Spearman correlation and logistic regression were used to examine the relationship between resilience, social support, and food addiction.

RESULTS

The prevalence of food addiction according to the C-mYFAS 2.0 was 6.2%. Confirmatory factor analyses suggested a single-factor structure (comparative fit index = 0.961). The C-mYFAS 2.0 had good test-retest reliability and internal consistency (Kuder-Richardson's α = 0.824). Good convergent validity was indicated by correlations with binge eating, eating disorder symptoms, depressive symptoms, generalized anxiety symptoms, uncontrolled eating, emotional eating, and BMI (ps < 0.001). Appropriate divergent validity was reflected by no association with cognitive restraint. Finally, binge eating was significantly predicted by C-mYFAS 2.0, depressive symptoms, and eating disorder symptoms (ps < 0.001), confirming incremental validity. In addition, our study found that poorer resilience and social support were related to food addiction (ps < .001).

CONCLUSIONS

The C-mYFAS 2.0 is a brief but reliable and valid screening instrument for food addiction among Chinese college students. In addition, we found that resilience and social support were negatively associated with food addiction.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Trait Impulsivity and Choice Impulsivity in Young Adult Students With Probable Binge Eating Disorder

BACKGROUND

Binge eating disorder (BED) as a public health problem has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Akin to addictive disorders, impulsivity-related neuropsychological constructs might be potentially involved in the onset and development of BED. However, it remains unclear which facets of impulsivity are connected to overeating and binge eating behaviors among non-clinical populations. The present study aimed to detect the relationship between impulsivity and binge eating both on the personality-trait and behavioral-choice levels in undiagnosed young adults.

METHODS

Fifty-eight individuals with probable BED and 59 healthy controls, matched on age, gender, and educational level, were assessed by using a series of self-report measurements, including the Barratt Impulsiveness Scale (BIS-11), UPPS-P Impulsive Behaviors Scale (UPPS-P), Delay Discounting Test (DDT), and Probability Discounting Test (PDT).

RESULTS

Multivariate analysis of variance models revealed that compared with healthy controls, the probable BED group showed elevated scores on the BIS-11 Attentional and Motor impulsiveness, and on the UPPS-P Negative Urgency, Positive Urgency, and Lack of Perseverance. However, the probable BED subjects had similar discounting rates on the DDT and PDT with healthy controls. Regression models found that Negative Urgency was the only positive predictor of binge eating behavior.

CONCLUSIONS

These findings suggested that typical facets of trait impulsivity, which have been recognized in addictive disorders, were associated with binge eating in young adults, whereas choice impulsivity was not aberrantly seen in the same probable BED sample. This study might promote a better understanding of the pathogenesis of BED.

Anti-saccade as a Tool to Evaluate Neurocognitive Impairment in Alcohol Use Disorder

It has been widely shown that chronic alcohol use leads to cognitive dysfunctions, especially inhibitory control. In an extension of the traditional approach, this research field has benefited from the emergence of innovative measures, among which is an anti-saccade, allowing direct and sensitive measure of the eye movements indexing attention bias to alcohol-related cues and the capability of inhibiting the reflexive saccades to the cues. During the past decade, there are numerous reports showing that drinkers make more unwanted reflexive saccades and longer latency in the anti-saccade task. These increased errors are usually explained by the deficits in inhibitory control. It has been demonstrated that inhibitory control on eye movement may be one of the earliest biomarkers of the onset of alcohol-related cognitive impairments. This review summarizes how an anti-saccade task can be used as a tool to investigate and assess the cognitive dysfunctions and the early detection of relapsing risk of alcohol dependence.

Prevalence of tobacco smoking in a sample of general secondary school students in Cairo and its correlation to other psychiatric disorders

Background

Tobacco smoking is considered currently a global public health concern among youth especially school students. There is a scarcity of data about the impact of this global phenomenon in Middle Eastern countries. This study assesses the prevalence of tobacco smoking, including conventional cigarettes, E-cigarettes, and water pipe and its sociodemographic and psychiatric correlates among a sample of general secondary school students in Cairo, Egypt.

Results

A convenient sample of 391 Egyptian general secondary students from different areas of Greater Cairo were assessed using the Socioeconomic scale, Fagerstrom Test For Nicotine Dependence, The Lebanon Water pipe Dependence Scale, questionnaire for electronic cigarette use, Barratt impulsivity scale 11, and The MINI International Neuropsychiatric Interview for Children and Adolescents. 12.8% (n = 50) were smokers. There is a significant relation between family history of smoking and substance use and smoking and significant relation between smoking, impulsivity, and mood symptoms.

Conclusions

Prevalence of tobacco smoking in Egyptian adolescents was 12.8% with significant relation between smoking and impulsivity and mood symptoms.

The prevalence of substance use disorders and substance use in anorexia nervosa: a systematic review and meta-analysis

AIM

Individuals with anorexia nervosa (AN) often present with substance use and substance use disorders (SUDs). However, the prevalence of substance use and SUDs in AN has not been studied in-depth, especially the differences in the prevalence of SUDs between AN types [e.g., AN-R (restrictive type) and AN-BP (binge-eating/purge type]. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of SUDs and substance use in AN samples.

METHOD

Systematic database searches of the peer-reviewed literature were conducted in the following online databases: MEDLINE, PsycINFO, Embase, and CINAHL from inception to January 2021. We restricted review eligibility to peer-reviewed research studies reporting the prevalence for either SUDs or substance use in individuals with AN. Random-effects meta-analyses using Freeman-Tukey double arcsine transformations were performed on eligible studies to estimate pooled proportions and 95% confidence intervals (CIs).

RESULTS

Fifty-two studies met the inclusion criteria, including 14,695 individuals identified as having AN (mean age: 22.82 years). Random pooled estimates showed that substance use disorders had a 16% prevalence in those with AN (AN-BP = 18% vs. AN-R = 7%). Drug abuse/dependence disorders had a prevalence of 7% in AN (AN-BP = 9% vs. AN-R = 5%). In studies that looked at specific abuse/dependence disorders, there was a 10% prevalence of alcohol abuse/dependence in AN (AN-BP = 15% vs. AN-R = 3%) and a 6% prevalence of cannabis abuse/dependence (AN-BP = 4% vs. AN-R = 0%). In addition, in terms of substance use, there was a 37% prevalence for caffeine use, 29% prevalence for alcohol use, 25% for tobacco use, and 14% for cannabis use in individuals with AN.

CONCLUSION

This is the most comprehensive meta-analysis on the comorbid prevalence of SUDs and substance use in persons with AN, with an overall pooled prevalence of 16%. Comorbid SUDs, including drugs, alcohol, and cannabis, were all more common in AN-BP compared to AN-R throughout. Therefore, clinicians should be aware of the high prevalence of SUD comorbidity and substance use in individuals with AN. Finally, clinicians should consider screening for SUDs and integrating treatments that target SUDs in individuals with AN. Individuals with anorexia nervosa (AN) may also present with substance use or have a substance use disorder (SUDs). Thus, we conducted a systematic review and meta-analysis to determine the prevalence of substance use and substance use disorders in individuals with AN. We examined published studies that reported the prevalence of either substance use or SUDs in individuals with AN. We found that substance use disorders had a 16% prevalence and that drug abuse/dependence disorders had a prevalence of 7% in those with AN. These rates were much higher in individuals with binge-eating/purging type compared to the restrictive AN. However, many specific substance use disorders and substance use types were low in individuals with AN. Nonetheless, clinicians should be aware of the high prevalence of SUD comorbidity and substance use in individuals with AN.

Binge eating among young adults: association with sociodemographic factors, nutritional intake, dietary n-6:n-3 ratio and impulsivity

Binge eating behaviour (BE) is the major symptom of binge eating disorder (BED). This study aimed to compare the nutritional intake in the presence or absence of BE, with a particular focus on dietary n-6:n-3 ratio, to assess the association between BE and impulsivity and the mediating effect of BMI on this association. A total of 450 university students (age 18-28 years) participated. The self-administered questionnaires were a semi-quantitative FFQ and the UPPS-P Impulsive Behavior Scale and the binge eating scale. The average BE score was 11·6 (se 7·388), and 20 % of the total participants scored above the cut-off of 17, thus presenting BE with 95 % CI of 16·3, 23·7 %. Our study revealed that greater BMI, higher total energy intake, greater negative urgency and positive urgency scores were significantly associated with BE. Participants with high value of dietary n-6:n-3 ratio were 1·335 more at risk to present a BE compared with those with a lower value of this ratio (P = 0·017). The relationship between BE score and UPPS domains score was not mediated by the BMI. This is the first study reporting a link between high dietary n-6:n-3 ratio and BE as well as the fact that BE was linked to both, negative and positive urgencies, and that the association between BE and impulsivity was not mediated by BMI. These findings can help to deal more efficiently with people suffering from BE, a symptom that can precede the development of BED.

Sleep dysregulation in binge eating disorder and "food addiction": the orexin (hypocretin) system as a potential neurobiological link

It has been proposed that binge eating reflects a pathological compulsion driven by the "addictive" properties of foods. Proponents of this argument highlight the large degree of phenomenological and diagnostic overlap between binge eating disorder (BED) and substance use disorders (SUDs), including loss of control over how much is consumed and repeated unsuccessful attempts to abstain from consumption, as well as commonalities in brain structures involved in food and drug craving. To date, very little attention has been given to an additional behavioral symptom that BED shares with SUDs-sleep dysregulation-and the extent to which this may contribute to the pathophysiology of BED. Here, we review studies examining sleep outcomes in patients with BED, which collectively point to a heightened incidence of sleep abnormalities in BED. We identify the orexin (hypocretin) system as a potential neurobiological link between compulsive eating and sleep dysregulation in BED, and provide a comprehensive update on the evidence linking this system to these processes. Finally, drawing on evidence from the SUD literature indicating that the orexin system exhibits significant plasticity in response to drugs of abuse, we hypothesize that chronic palatable food consumption likewise increases orexin system activity, resulting in dysregulated sleep/wake patterns. Poor sleep, in turn, is predicted to exacerbate binge eating, contributing to a cycle of uncontrolled food consumption. By extension, we suggest that pharmacotherapies normalizing orexin signaling, which are currently being trialed for the treatment of SUDs, might also have utility in the clinical management of BED.

Highly processed food addiction: A concept analysis

AIM

This concept analysis aims to clarify the highly processed food addiction (HPFA) concept and discuss its implications for treating obesity.

BACKGROUND

Emerging empirical evidence suggests addictive-like eating may contribute to obesity in some individuals, increasing interest in HPFA's role in obesity. Clarifying the HPFA concept will aid in developing individualized interventions for patients with obesity and HPFA.

DESIGN

This concept analysis followed Walker and Avant's approach. The case studies are of participants in a study that included individuals with and without HPFA (Yale Food Addiction Scale 2.0-diagnosed).

DATA SOURCE

We searched PubMed, CINAHL, PsychInfo, and Ebscohost databases. Keywords were "food addiction" and "food addiction concept."

REVIEW METHODS

Criteria included recent reviews and empirical studies that measured HPFA and focused on HPFA characteristics and/or treatment implications.

RESULTS

The model case displayed all 11-substance use disorder (SUD) symptoms and clinical significance, supporting a severe HPFA diagnosis. The contrary case was negative for all YFAS 2.0 symptoms and clinical significance and did not eat compulsively or experience cravings. The borderline case met the minimum symptom criteria for severe HPFA but not clinical significance. Clinical interviews may help determine whether such individuals truly exhibit addictive-like eating behaviors.

CONCLUSIONS

Growing empirical evidence and our case studies support the HPFA concept and the utility of the YFAS/YFAS 2.0 for identifying a distinct subset of individuals with overweight/obesity who may benefit from interventions developed to treat established SUDs. Future research should examine HPFA separately and in relation to obesity and eating disorders and include longitudinal studies and gender-balanced samples.

A cross-sectional examination of reported changes to weight, eating, and activity behaviors during the COVID-19 pandemic among United States adults with food addiction

Prior studies have demonstrated the effects of the COVID-19 pandemic on weight management and lifestyle behaviors, though identification of who may be at greatest risk for negative consequences has not been fully explored. Addictive-like eating behavior, or food addiction, has been associated with an array of problematic eating behaviors, which may suggest heightened susceptibility to poorer outcomes. In this online, cross-sectional study, adults (ages 18–78; M = 42.36, SD = 13.08) living in the United States (n = 288) completed questionnaires assessing food addiction and reported changes to their weight, eating, and physical activity before and during the COVID-19 pandemic. Individuals with food addiction gained an average of 12.42 lb (5.63 kg) since March 2020, compared to an average weight gain of 2.14 lb (0.97 kg) for those without food addiction (p < .001). Linear regression analyses controlling for age and body mass index (BMI) showed that food addiction was independently associated with higher weight gain (B = 9.28, t = 4.97, p < .001), greater intake of ultra-processed foods before and during COVID-19 (B = 1.08, t = 5.71, p < .001; B = 1.18, t = 6.42, p < .001, respectively), greater attribution of their overall current eating behaviors to COVID-19 circumstances (B = 23.19, t = 4.62, p < .001), and higher distress about their overall current eating behaviors (B = −22.12, t = −2.50, p = .01). Interaction effects demonstrated that individuals with food addiction who are older may be at particularly high risk for weight gain and distress. The present research suggests that food addiction is a uniquely meaningful phenotype, beyond the effects of BMI, to identify risk for the negative consequences of COVID-19. Individuals with food addiction, particularly those who are older, may benefit from support with weight management and addictive-like eating as the COVID-19 pandemic persists and resolves.

General impulsivity in binge-eating disorder

BACKGROUND

The nature and significance of impulse-control difficulties in binge-eating disorder (BED) are uncertain. Most emerging research has focused on food-specific rather than general impulsivity. The current study examines the clinical presentation of patients with BED categorized with and without clinical levels of general impulsivity.

METHOD

A total of 343 consecutive treatment-seeking patients with BED were categorized as having BED with general impulsivity (GI+; N = 73) or BED without general impulsivity (GI-: N = 270) based on structured diagnostic and clinical interviews. The groups were compared on demographic, developmental, and psychological features, and on rates of psychiatric and personality comorbidity.

RESULTS

Individuals with BED and general impulsivity (GI+) reported greater severity of eating-disorder psychopathology, greater depressive symptoms, and greater rates of comorbidity than those without general impulsivity (GI-).

CONCLUSIONS

A subtype of individuals with BED and general impulsivity may signal a more severe presentation of BED characterized by heightened and broader psychopathology. Future work should investigate whether these impulse-control difficulties relate to treatment outcomes.

Food preferences and YFAS/YFAS-C scores in schoolchildren and university students

PURPOSE

Food addiction (FA) is one of the causes of widespread obesity in modern society. It was shown that there is an age-associated increase in incidence rate of FA in adolescents/young adults. The purpose of this study was to analyze food preferences in schoolchildren and university students with FA.

METHODS

High school and university students (N = 1607; age: 17.8 ± 2.7 years; girls: 77.0%) located in four settlements of Russia anonymously took part in the study. Study participants provided personal data (age, sex, height, and weight) and completed the Yale Food Addiction Scale, the Zung Self-Rating Depression Scale and the Munich ChronoType Questionnaire. In addition, they indicated food products with which they had problems.

RESULTS

The frequency of detection of FA among university students was twice as high as among schoolchildren. University students with FA were 20.2% more likely than schoolchildren to report the symptom 'use continues despite knowledge of adverse consequences,' and 13.7% more likely to report the symptom 'tolerance.' Schoolchildren and university students with FA most often noted that foods high in sugar and fat were problematic. University students with FA also reported that foods with a high carbohydrate content were problematic.

CONCLUSION

In university students with FA, in comparison with schoolchildren with FA, there is an increase in list of problematic food products, mainly due to products with a high carbohydrate content.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Neuroanatomical Correlates of Binge-Eating Behavior: At the Roots of Unstoppable Eating

Binge-eating refers to episodes of uncontrolled eating accompanied by a perceived loss of control, which can be common in the general population. Given the profound negative consequences of persistent binge-eating such as weight and eating disorders, it is vital to determine what makes someone more vulnerable than others to engage in such a conduct. A total of 42 normal-weight individuals (21 with binge-eating episodes and 21 without binge-eating episodes) underwent a structural magnetic resonance imaging measurement and Voxel-based morphometry (VBM) was used to assess between-group differences in terms of gray matter volume (GMV), together with self-report impulsivity and binge-eating measures. The results showed binge-eating individuals as characterized by higher trait impulsivity and greater regional GMV in the left middle frontal gyrus: however, the GMV in this region appeared to be positively correlated only with measures of binge-eating but not with trait impulsivity measures. These findings provide novel insights on the neurobiological roots of BE in normal-weight individuals and highlight how this behavior can be associated with brain morphometric changes within prefrontal regions also in a non-clinical population. Overall, this study provides a further characterization of the neural correlates of binge-eating and novel insights into the treatment of its more severe pathological forms.

A systematic review of binge eating, loss of control eating, and weight loss in children and adolescents

OBJECTIVE

This review synthesizes literature on changes in binge eating (BE) and loss of control eating (LOC) following weight loss and the association between BE/LOC and weight loss in children and adolescents.

METHODS

A systematic literature search was conducted in PubMed, Scopus, and PsycInfo. Eligible studies included all peer-reviewed journal articles of primary research that assessed BE/LOC and weight change following a weight-loss intervention in individuals under 18 years of age.

RESULTS

The 29 articles included studies on behavioral therapy, pharmacotherapy, and surgical interventions. Of the 14 studies that assessed the relationship between weight loss and BE/LOC at baseline, 4 showed that higher baseline BE/LOC was associated with less weight loss, whereas 10 showed no significant association. BE/LOC behaviors significantly decreased following weight-loss interventions in 20 of 21 studies. A greater decrease in BE/LOC was associated with improved weight loss in 4 of 9 studies that assessed this change.

CONCLUSIONS

Weight-loss interventions are associated with improved BE/LOC in youth with obesity. The persistence of BE/LOC symptoms may be associated with less weight loss. These results can aid in guiding future treatment for youth with BE/LOC seeking weight-loss treatment.

French validation of the addiction-like eating behavior scale and its clinical implication

PURPOSE

The first conception of food addiction (FA) as substance addiction, measured by the Yale Food Addiction Scale (YFAS), is controversial. Some proposed that FA would be better conceptualized with a behavioral approach. In accordance with this conceptualization, Ruddock and colleagues published a new self-reported scale for food addiction, the Addiction-like Eating Behavior Scale (AEBS). Overall, preliminary validation of the scale demonstrated good psychometric properties with a community sample. The aim of the present study is twofold, to validate the French-Canadian version of the AEBS with a community sample and to examine how well the instrument fits into a clinical sample with overweight/obesity.

METHODS

A community sample (N = 466) and a clinical sample with overweight/obesity seeking help for their eating difficulties (N = 126) completed an online survey regarding FA, binge eating, dietary restraint, depression, and BMI. Factor analysis, internal consistency, and construct validity were assessed.

RESULTS

With the community sample, factorial structure, and psychometric properties of the AEBS were replicated. With the clinical sample, proper convergent validity was demonstrated with the YFAS 2.0 and binge eating, and proper divergent validity was demonstrated with dietary restraint. Among the clinical sample, AEBS explain similar variance of BMI and depression level when compared to YFAS 2.0.

CONCLUSION

This study provided evidence that the French-Canadian version of the AEBS is a valid measure of food addiction, but it did not permit to establish advantages over YFAS 2.0 with a clinical sample. Clinical implications of the AEBS and FA characteristic are discussed.

LEVEL OF EVIDENCE

Level V, cross-sectional, descriptive study.

The role of rash-impulsivity, emotional dysregulation and reward drive in comorbid disordered eating and substance use disorders

Purpose

Substance use disorder (SUD) frequently co-occurs with other psychological conditions, such as eating disorders (EDs). Psychological factors such as emotional dysregulation, rash impulsivity (RI) and reward sensitivity (RS) play a role in the etiology of each disorder, yet little is known about the combined effects of these on comorbid SUDs and EDs or disordered eating behaviours (DEBs). This study aims to examine the role of these psychological factors in comorbid DEBs and SUDs among individuals in treatment for SUDs. The role of gender is tested as a moderator.

Design/methodology/approach

A cross-sectional self-report survey was completed by 131 participants attending Australian residential substance use treatment centres. A binomial logistic regression analysis was performed to examine the effects of emotional dysregulation, RI and RS on comorbid DEB and SUD. Further, moderation analyses were used to examine the moderating effect for gender on the relationship between these three personality variables and comorbidity.

Findings

The most commonly reported primary substance of use was alcohol (43.5%), followed by amphetamines (38.6%). Findings showed that emotional dysregulation and RI were significantly related to an increase in comorbidity likelihood; however, RS was not. Gender moderated the relationship between comorbidity and RI only.

Originality/value

The significant positive relationship found between RI and comorbidity for females only was a novel finding for the current study. Further research is needed to develop an understanding of the etiology of comorbidity.

Converging vulnerability factors for compulsive food and drug use

Highly palatable foods and substance of abuse have intersecting neurobiological, metabolic and behavioral effects relevant for understanding vulnerability to conditions related to food (e.g., obesity, binge eating disorder) and drug (e.g., substance use disorder) misuse. Here, we review data from animal models, clinical populations and epidemiological evidence in behavioral, genetic, pathophysiologic and therapeutic domains. Results suggest that consumption of highly palatable food and drugs of abuse both impact and conversely are regulated by metabolic hormones and metabolic status. Palatable foods high in fat and/or sugar can elicit adaptation in brain reward and withdrawal circuitry akin to substances of abuse. Intake of or withdrawal from palatable food can impact behavioral sensitivity to drugs of abuse and vice versa. A robust literature suggests common substrates and roles for negative reinforcement, negative affect, negative urgency, and impulse control deficits, with both highly palatable foods and substances of abuse. Candidate genetic risk loci shared by obesity and alcohol use disorders have been identified in molecules classically associated with both metabolic and motivational functions. Finally, certain drugs may have overlapping therapeutic potential to treat obesity, diabetes, binge-related eating disorders and substance use disorders. Taken together, data are consistent with the hypotheses that compulsive food and substance use share overlapping, interacting substrates at neurobiological and metabolic levels and that motivated behavior associated with feeding or substance use might constitute vulnerability factors for one another. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Addiction Transfer and Other Behavioral Changes Following Bariatric Surgery

Despite its important treatment implications for obesity and related comorbidities, bariatric surgery requires several behavioral changes that warrant comprehensive evaluation and support before and after surgery. This article outlines emerging scientific and anecdotal evidence for addiction transfer after bariatric surgery. Other common behavioral changes that impact adherence, weight loss, and psychiatric risk after surgery are also reviewed. Last, recommendations for presurgical psychological evaluation and postoperative support are provided.

Naturalistic and Uncontrolled Pilot Study on the Efficacy of Vortioxetine in Binge Eating Disorder With Comorbid Depression

Background: Binge eating disorder (BED) is clinically relevant by virtue of the global impairment, poor quality of life, and increased overall medical morbidity. The high comorbidity with psychiatric disorders, particularly depression, has received attention as a possible mediator of the poor outcome. Further, BED and depression share cognitive dysfunctions. This naturalistic and uncontrolled pilot study aimed at evaluating the efficacy of vortioxetine (VTX) on depressive symptoms in patients with BED, secondly the efficacy in improving a broad array of executive functions, and third to explore the effect on eating behavior and body weight. Methods: This pilot study involved 30 patients with BED and comorbid MDD, treated with VTX for 24 weeks. Assessments were run at baseline (t 0), 4 (t 1), 8 (t 2), 12 (t 3), and 24 (t 4) weeks. Changes in depressive symptoms (HDRS and BDI), executive functions, eating behaviors (binge frequency and severity, night eating, food addiction), and body weight were estimated after treatment with VTX through GLM. Results: Significant improvements emerged after treatment with VTX in: depression (HDRS p < 0.001; BDI p = 0.002) regardless the dose of VTX and first diagnosis (BED/MDD), working memory (RAVLT acquisition p = 0.01, delay recall p < 0.001, RCFT percentage of recall p = 0.01, and Attentional Matrices p = 0.05), binge days frequency (p < 0.001), binge eating severity (BES p < 0.001), night eating (p = 0.001), food addiction (YFAS 2.0 p = 0.039), and body weight (p = 0.039). The improvement in depressive symptoms was associated with the concurrent improvement in night eating as assessed by the I-NEQ. Conclusions: VTX can be a valid therapeutic choice for patients with BED with comorbid depression in controlling the depressive symptoms, working memory, and eating behavior. Indeed, by acting on affective symptoms, neurocognitive functioning, and eating behaviors, it confirms the results already obtained with VTX in other disorders, expanding them to BED.

A narrative review of highly processed food addiction across the lifespan

Evidence is growing that highly processed (HP) foods (i.e., foods high in refined carbohydrates and fat) are highly effective in activating reward systems and may even be capable of triggering addictive processes. Unlike traditional drugs of abuse, exposure to HP foods is common very early in development. HP food addiction has been associated with negative outcomes, including higher body mass index (BMI), more frequent binge eating, greater failure in weight loss treatment trials, and poorer mental and physical health. Although most research on HP food addiction has been conducted using adult samples, research on this topic now spans across the life span beginning in utero and extending through older adulthood. HP food addiction and related reward-based changes are associated with negative outcomes at every life stage, which has important implications for developmentally tailored prevention and treatment efforts. Using a developmentally informed approach, the current study comprehensively reviews the existing research on HP food addiction across the lifespan and highlights important areas of future research.

Impact of High Fat Diet and Ethanol Consumption on Neurocircuitry Regulating Emotional Processing and Metabolic Function

The prevalence of psychiatry disorders such as anxiety and depression has steadily increased in recent years in the United States. This increased risk for anxiety and depression is associated with excess weight gain, which is often due to over-consumption of western diets that are typically high in fat, as well as with binge eating disorders, which often overlap with overweight and obesity outcomes. This finding suggests that diet, particularly diets high in fat, may have important consequences on the neurocircuitry regulating emotional processing as well as metabolic functions. Depression and anxiety disorders are also often comorbid with alcohol and substance use disorders. It is well-characterized that many of the neurocircuits that become dysregulated by overconsumption of high fat foods are also involved in drug and alcohol use disorders, suggesting overlapping central dysfunction may be involved. Emerging preclinical data suggest that high fat diets may be an important contributor to increased susceptibility of binge drug and ethanol intake in animal models, suggesting diet could be an important aspect in the etiology of substance use disorders. Neuroinflammation in pivotal brain regions modulating metabolic function, food intake, and binge-like behaviors, such as the hypothalamus, mesolimbic dopamine circuits, and amygdala, may be a critical link between diet, ethanol, metabolic dysfunction, and neuropsychiatric conditions. This brief review will provide an overview of behavioral and physiological changes elicited by both diets high in fat and ethanol consumption, as well as some of their potential effects on neurocircuitry regulating emotional processing and metabolic function.

The Neurobiology of Binge-eating Disorder Compared with Obesity: Implications for Differential Therapeutics

PURPOSE

Emerging work indicates divergence in the neurobiologies of binge-eating disorder (BED) and obesity despite their frequent co-occurrence. This review highlights specific distinguishing aspects of BED, including elevated impulsivity and compulsivity possibly involving the mesocorticolimbic dopamine system, and discusses implications for differential therapeutics for BED.

METHODS

This narrative review describes epidemiologic, clinical, genetic, and preclinical differences between BED and obesity. Subsequently, this review discusses human neuroimaging work reporting differences in executive functioning, reward processing, and emotion reactivity in BED compared with obesity. Finally, on the basis of the neurobiology of BED, this review identifies existing and new therapeutic agents that may be most promising given their specific targets based on putative mechanisms of action relevant specifically to BED.

FINDINGS

BED is characterized by elevated impulsivity and compulsivity compared with obesity, which is reflected in divergent neurobiological characteristics and effective pharmacotherapies. Therapeutic agents that influence both reward and executive function systems may be especially effective for BED.

IMPLICATIONS

Greater attention to impulsivity/compulsivity-related, reward-related, and emotion reactivity-related processes may enhance conceptualization and treatment approaches for patients with BED. Consideration of these distinguishing characteristics and processes could have implications for more targeted pharmacologic treatment research and interventions.

Examining Self-Weighing Behaviors and Associated Features and Treatment Outcomes in Patients with Binge-Eating Disorder and Obesity with and without Food Addiction

Food addiction (FA) has been linked to clinical features in binge-eating disorder (BED) and obesity. A feature of behavioral weight loss (BWL) treatment involves frequent weighing. However, little is known regarding how frequency of self-weighing and related perceptions are associated with BWL outcomes among individuals with BED and obesity stratified by FA status. Participants (n = 186) were assessed with the Eating Disorder Examination before and after BWL treatment. Mixed effects models examined FA (presence/absence) before and after (post-treatment and 6- and 12-month follow-up) treatment and associations with frequency of weighing and related perceptions (reactions to weighing, sensitivity to weight gain and shape/weight acceptance). Participants with FA reported more negative reactions to weighing and less acceptance of shape/weight throughout treatment and follow-ups, and both variables were associated with greater disordered eating at follow-ups among participants with FA. Sensitivity to weight gain decreased over time independent of FA status. Frequency of weighing was associated with a greater likelihood of achieving 5% weight loss only among those without FA. Reactions to weighing and sensitivity to weight gain are associated with FA and poorer treatment outcomes in individuals with BED and obesity. Targeting these features may improve BWL outcomes among individuals with BED, obesity and FA.

Binge Eating and Binge Drinking: A Two-Way Road? An Integrative Review

Unhealthy diet and alcohol are serious health problems, especially in adolescents and young adults. "Binge" is defined as the excessive and uncontrolled consumption of food (binge eating) and alcohol (binge drinking). Both behaviors are frequent among young people and have a highly negative impact on health and quality of life. Several studies have explored the causes and risk factors of both behaviors, and the evidence concludes that there is a relationship between the two behaviors. In addition, some research postulates that binge eating is a precipitating factor in the onset and escalation of excessive alcohol consumption, while other studies suggest that alcohol consumption leads to excessive and uncontrollable food consumption. Given that no review has yet been published regarding the directionality between the two behaviors, we have set out to provide an upto- date overview of binge eating and binge drinking problems, analyzing their commonalities and differences, and their uni- and bidirectional associations. In addition, we explore the reasons why young people tend to engage in both behaviors and consider directions for future research and clinical implications.

Understanding the Influence of Eating Patterns on Binge Drinking: A Mediation Model

BACKGROUND

Binge drinking is an important health problem, and it has been related to binge eating and fat intake in animal models, but this relationship has not been tested in humans. The first objective of this study was to analyze whether binge eating and fat intake are related to binge drinking in a youth sample. The second objective was to analyze whether binge eating and fat intake mediate the relationship between individual factors associated with binge eating and fat intake (sex, body mass index (BMI), drive for thinness, body dissatisfaction, eating styles, impulsivity, and food addiction) and binge drinking.

METHODS

A sample of 428 undergraduate students filled out several questionnaires on binge drinking, binge eating, fat intake, drive for thinness, body dissatisfaction, eating styles, food addiction, and impulsivity.

RESULTS

Results showed an excellent model fit: χ2(25) = 30.342 (p = 0.212), comparative fit index (CFI) = 0.992, root mean squared error of approximation (RMSEA) = 0.022 [90% CI = 0.000, 0.047]. Binge eating and fat intake were positively related to binge drinking. Furthermore, emotional eating, external eating, and food addiction showed positive and statistically significant indirect relationships with binge drinking, whereas the relationship with restrained eating was negative.

CONCLUSIONS

These findings point to the need to use a broader approach in understanding and preventing binge drinking in the youth population by showing the influence of the eating pattern on this problem. This information could be helpful in preventing future behaviors and improving interventions that address health risk behaviors.

Differences in eating disorder symptoms and affect regulation for residential eating disorder patients with problematic substance use

PURPOSE

The aim of the current study was to investigate differences in treatment outcomes for residential eating disorder (ED) treatment patients diagnosed with comorbid substance use disorders (SUDs), particularly differences in ED pathology and affect dysregulation.

METHOD

Secondary data analysis was conducted on data from a previous study of 140 patients at a residential ED facility. SUD was diagnosed by a staff psychiatrist upon admission, and SUD diagnosis was extracted from electronic health records for the current study. Self-report measures of eating pathology and affect dysregulation from pre-treatment and post-treatment assessments were analyzed.

RESULTS

20.1% of the sample (n = 29) were diagnosed with a substance use disorder at the start of treatment. Contrary to hypotheses, those with comorbid SUD did not significantly differ in eating pathology severity, depression symptoms, emotion dysregulation, or psychological acceptance at baseline. Also contrary to hypotheses, individuals with comorbid SUD and ED evidenced slightly larger improvements in certain areas of eating pathology and affect dysregulation throughout treatment than those with ED diagnosis only.

CONCLUSIONS

These findings suggest that residential ED treatment is an appropriate treatment choice for individuals with comorbid SUD. The observed improvements in affect dysregulation combined with a period of forced abstinence from maladaptive affect regulation behaviors may explain these positive results, though more research is needed to test the mechanisms of action of residential treatment for this population.

LEVEL OF EVIDENCE

IV, multiple time series analysis.

Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications

The role of stress, trauma, and adversity particularly early in life has been identified as a contributing factor in both drug and food addictions. While links between traumatic stress and substance use disorders are well documented, the pathways to food addiction and obesity are less established. This review focuses on psychosocial and neurobiological factors that may increase risk for addiction-like behaviors and ultimately increase BMI over the lifespan. Early childhood and adolescent adversity can induce long-lasting alterations in the glucocorticoid and dopamine systems that lead to increased addiction vulnerability later in life. Allostatic load, the hypothalamic-pituitary-adrenal axis, and emerging data on epigenetics in the context of biological embedding are highlighted. A conceptual model for food addiction is proposed, which integrates data on the biological embedding of adversity as well as upstream psychological, social, and environmental factors. Dietary restraint as a feature of disordered eating is discussed as an important contextual factor related to food addiction. Discussion of various public health and policy considerations are based on the concept that improved knowledge of biopsychosocial mechanisms contributing to food addiction may decrease stigma associated with obesity and disordered eating behavior.

Binge Eating and Addictive-Like Behaviours in Males and Females

INTRODUCTION

Binge eating is a common behaviour that is strongly linked to both obesity and eating disorder. There is evidence that binge eating commonly co-occurs with other problematic and addictive-like behaviours; however, this has not been explored systematically. The present study aimed to examine the relationship between binge eating, body weight, disordered eating behaviours and associated addictive-like behaviours, with particular attention paid to gender differences.

METHOD

A community sample (N = 500; 75% female, M_age = 32.5 years) reported disordered eating behaviours (i.e. binge eating, purging, restriction of eating, compulsive exercise), body mass index (BMI), food addiction, starvation addiction, exercise dependence, tobacco use and alcohol consumption.

RESULTS

42% of females and 21% of males reported binge eating during the past four weeks. Binge eating was significantly associated with all investigated behaviours in females, and with purging, compulsive exercise and overweight/obesity in males. Controlling for BMI, self-starvation predicted binge eating in males (OR = 1.07), while food addiction (OR = 1.73) and alcohol dependence (OR = 1.11) predicted binge eating in females.

CONCLUSIONS

The multiple associations between binge eating and addictive-like behaviors supports broad screening and generalized prevention efforts. Prevention efforts should reflect gender differences.

Oleoylethanolamide decreases frustration stress-induced binge-like eating in female rats: a novel potential treatment for binge eating disorder

Binge eating disorder (BED) is the most frequent eating disorder, for which current pharmacotherapies show poor response rates and safety concerns, thus highlighting the need for novel treatment options. The lipid-derived messenger oleoylethanolamide (OEA) acts as a satiety signal inhibiting food intake through the involvement of central noradrenergic and oxytocinergic neurons. We investigated the anti-binge effects of OEA in a rat model of binge-like eating, in which, after cycles of intermittent food restrictions/refeeding and palatable food consumptions, female rats show a binge-like intake of palatable food, following a 15-min exposure to their sight and smell ("frustration stress"). Systemically administered OEA dose-dependently (2.5, 5, and 10 mg kg^-1) prevented binge-like eating. This behavioral effect was associated with a decreased activation (measured by mapping the expression of c-fos, an early gene widely used as a marker of cellular activation) of brain areas responding to stress (such as the nucleus accumbens and amygdala) and to a stimulation of areas involved in the control of food intake, such as the VTA and the PVN. These effects were paralleled, also, to the modulation of monoamine transmission in key brain areas involved in both homeostatic and hedonic control of eating. In particular, a decreased dopaminergic response to stress was observed by measuring dopamine extracellular concentrations in microdialysates from the nucleus accumbens shell, whereas an increased serotonergic and noradrenergic tone was detected in tissue homogenates of selected brain areas. Finally, a decrease in corticotropin-releasing factor (CRF) mRNA levels was induced by OEA in the central amygdala, while an increase in oxytocin mRNA levels was induced in the PVN. The restoration of a normal oxytocin receptor density in the striatum paralleled the oxytocinergic stimulation produced by OEA. In conclusion, we provide evidence suggesting that OEA might represent a novel potential pharmacological target for the treatment of binge-like eating behavior.

The behavioral pathway model to overweight and obesity: coping strategies, eating behaviors and body mass index

PURPOSE

Obese and overweight people deal with more daily problems and stressful situations than normal-weight individuals, for example, discrimination and bias. The aims of the present study were twofold: to identify differences between overweight and normal-weight people in coping strategies and eating behaviors, and to examine the relationship between coping strategies, eating behaviors and BMI.

METHODS

Sample of the present study consisted of 473 participants, 76.7% women (mean age = 32.7; SD = 11.4). Participants completed an ad hoc sociodemographic data questionnaire, the Coping Strategies Inventory, and the Dutch Eating Behavior Questionnaire. Welch's t test and X² comparison analysis were used to identify differences in coping strategies and eating behaviors, according two BMI groups, normal weight and overweight. To analyze the relationship between coping strategies, eating behaviors and BMI, a structural equation modeling was conducted.

RESULTS

Overweight participants score significantly higher in passive coping strategies such as self-criticism, wishful thinking and social withdrawal, and unhealthy eating behaviors such as emotional eating and restrained eating. Structural equation modeling included these variables, coping strategies are more likely to conduct to unhealthy eating behaviors and these are more likely to promote and maintain a high BMI. The model showed an adequate data fit.

CONCLUSIONS

This research proposes a relationship between the variables analyzed. It has been proved that passive coping strategies predict a high BMI via unhealthy eating behaviors, especially emotional eating. These results are promising to improve the current prevention obesity programs and weight control treatments.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

An evaluation of food addiction as a distinct psychiatric disorder

OBJECTIVE

To evaluate the state of the literature for whether food addiction may warrant consideration as a distinct psychiatric disorder in the Diagnostic and Statistical Manual (DSM) using Blashfield et al.'s (1990; Comprehensive Psychiatry, 31(1), 15-19) five criteria. This framework was utilized because it has recently been applied to examine the diagnostic utility of several eating disorder phenotypes. The criteria are: (a) at least 50 journal articles published on the proposed syndrome in the past 10 years; (b) proposal of diagnostic criteria and assessment measures; (c) clinician reliability in diagnosis; (d) cohesiveness of the proposed diagnostic criteria; and (e) differentiation from similar, existing diagnostic categories.

METHOD

For each criterion, a literature review was conducted to examine if the minimum qualification had been met, and key findings were discussed.

RESULTS

Two of the criteria (literature and differentiation) have been empirically supported to extent specified. Two criteria (diagnostic criteria and syndrome) have been partially fulfilled, due to only having self-report assessment measures and no examination of the odds ratios for meeting more than one symptom, respectively. Clinician reliability has not yet been evaluated.

DISCUSSION

The existing literature suggests that food addiction may warrant consideration as a proposed diagnostic category in the DSM, though future research is needed to fulfill Blashfield et al.'s (1990; Comprehensive Psychiatry, 31(1), 15-19) criteria. The development of a semi-structured interview would be an impactful contribution for addressing these gaps.

Specific gut microbial, biological, and psychiatric profiling related to binge eating disorders: A cross-sectional study in obese patients

BACKGROUND & AIMS

Binge eating disorder (BED) is a frequent eating disorder associated with obesity and co-morbidities including psychiatric pathologies, which represent a big health burden on the society. The biological processes related to BED remain unknown. Based on psychological testing, anthropometry, clinical biology, gut microbiota analysis and metabolomic assessment, we aimed to examine the complex biological and psychiatric profile of obese patients with and without BED.

METHODS

Psychological and biological characteristics (anthropometry, plasma biology, gut microbiota, blood pressure) of 101 obese subjects from the Food4Gut cohort were analysed to decipher the differences between BED and Non BED patients, classified based on the Questionnaire for Eating Disorder Diagnosis (Q-EDD). Microbial 16S rDNA sequencing and plasma non-targeted metabolomics (liquid chromatography-mass spectrometry) were performed in a subcohort of 91 and 39 patients respectively.

RESULTS

BED subjects exhibited an impaired affect balance, deficits in inhibition and self-regulation together with marked alterations of eating behaviour (increased emotional and external eating). BED subjects displayed a lower blood pressure and hip circumference. A decrease in Akkermansia and Intestimonas as well as an increase in Bifidobacterium and Anaerostipes characterized BED subjects. Interestingly, metabolomics analysis revealed that BED subjects displayed a higher level of one food contaminants, Bisphenol A bis(2,3-dihydroxypropyl) ether (BADGE.2H(2)O) and a food derived-metabolite the Isovalerylcarnitine.

CONCLUSIONS

Non-targeted omics approaches allow to select specific microbial genera and two plasma metabolites that characterize BED obese patients. Further studies are needed to confirm their potential role as drivers or biomarkers of binge eating disorder. Food4gut, clinicaltrial.gov:NCT03852069, https://clinicaltrials.gov/ct2/show/NCT03852069.

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

Considering Food Addiction through a Cultural Lens

Purpose of Review

Research suggests that cultural factors influence eating behaviors, however little is known about the relationship between food addiction and culture. This narrative review aimed to i) review theoretically related work on the relationship between sociocultural demographic variables, food cravings, and eating disorders; ii) review the available literature assessing cultural aspects of food addiction, specifically the rates of food addiction across the globe and notable differences in relevant sociodemographic variables: race, ethnicity, gender and acculturation level; iii) discuss the potential impact of culture on our current understanding of food addiction and future research directions emphasizing the inclusion of sociocultural variables.

Recent Findings

Preliminary data suggest that food addiction symptoms occur cross-culturally, and that there may be significant differences between sociodemographic groups. Issues related to adequate lexicalization of concepts central to food addiction (e.g., craving, addiction) and global variations in eating culture and presentation of similar constructs (e.g. binge-eating) contribute to questions raised and identify avenues for further research.

Summary

Multidimensional cultural assessment is called for to characterize food addiction among diverse groups and improve our understanding of the etiology, maintenance, and sequelae of food addiction cross-culturally.

Measurement, prevalence, and psychological risk factors associated with addictive food consumption: Development of a new food addiction scale and evidence from a national largescale sample

BACKGROUND AND AIMS

To date, a number of studies have investigated the prevalence and correlates of addictive food consumption. However, these studies have mostly relied on models that comprised a narrow range of variables in often small and heterogenous samples. The purpose of the present study was to comprehensively examine the measurement aspects, the prevalence, and the psychological correlates of addictive eating among a largescale national sample of Turkish adults.

METHOD

Participants (N = 24,380, 50% men, Mage = 31.79 years, age range = 18-81 years) completed a battery of tests including the Food Addiction Risk Questionnaire (FARQ), the Brief Symptom Inventory, the Toronto Alexithymia Scale, the Positive and Negative Affect Schedule, and the Experiences in Close Relationships-Revised.

RESULTS

According to analyses conducted, the FARQ had a uni-dimensional factor structure. Based on Item Response Theory (IRT) calculated cut-off scores, 2.3% of the participants were at risk of addictive eating patterns, whilst criteria varied in their discriminating ability. The correlates of addictive food consumption were being male, being younger, having lower education, presenting with higher alcohol use, psychiatric symptoms, alexithymia, positive/negative affect, and anxious attachment.

CONCLUSION

These results suggest that a minority of Turkish community are at risk for addictive food consumption and that adverse psychological states promote this problematic behavior.

Alcohol consumption and risk for feeding and eating disorders in adolescence: The mediating role of drinking motives

BACKGROUND

A complex and bidirectional association has been assumed between feeding and eating disorders (FEDs) and alcohol consumption. Previous research has demonstrated that alcohol use among individuals with different forms of FEDs is more frequently motivated by two subtypes of internal drinking motives: coping and enhancement motives. Namely, these individuals might use alcohol primarily to regulate internal states, such as to mitigate negative emotions or enhance positive emotions.

OBJECTIVES

The present study investigated the mediating role of internal drinking motives on the association between risk for FEDs and alcohol consumption over the effects of relevant covariates, such as depressive symptoms or body mass index (BMI).

METHODS

Hungarian data of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 2015 were used. The final sample included responses from 5457 adolescents (50% males; mean age: 16.62 years). Validated self-report psychometric instruments assessed the level of alcohol use, depressive symptoms and risk for FEDs, and drinking motives.

RESULTS

Risk for FEDs presented a significant positive relationship with internal drinking motives and alcohol use. In the mediation analysis, a significant indirect effect was identified between risk for FEDs and alcohol use via internal drinking motives among females.

CONCLUSIONS

Results demonstrated that risk for FEDs was positively associated with internal drinking motives and alcohol use. An indirect effect of risk for FEDs on alcohol consumption via internal drinking motives was discriminated over the impact of depressive symptoms. However, the latter relationship was only found among females which may highlight the gender differences in the relationship between risk for FEDs and alcohol use.

Toward a unifying theory of dysregulated behaviors

Dysregulated behaviors, defined as active behaviors that have short-term benefits but cause serious recurrent long-term distress or impairment to the individual and/or those around them, include behaviors such as suicidal and nonsuicidal self-injury, aggression, and substance use. These behaviors are common and costly to the individual, their friends and family, and society. Despite similar etiological models and interventions, dysregulated behaviors have largely been studied in isolation from one another. The goals of this paper were to a) define dysregulated behaviors as a coherent class of behaviors, b) review the prevalence and consequences of dysregulated behaviors, c) outline how dysregulated behaviors fit into current models of psychopathology, and d) describe the key questions to be addressed by future research in this area. It is argued that integrating across theories of discrete dysregulated behaviors can help provide aid in the development of etiological models, which in turn can improve prevention and intervention for dysregulated behaviors.

Latent classes of lifetime drug use disorder in national epidemiological survey on alcohol and related conditions - III

AIMS/BACKGROUND

People diagnosed with multiple drug use disorders are high-risk subpopulations, but changes in diagnostic classification and drug use prevalence mean patterning of drug use disorders has changed in the past decade. We analyzed comorbidity patterns of lifetime drug use disorder in a general population sample.

DESIGN

Using latent class analysis, we derived lifetime drug use disorder classes based on dichotomous indicators of sedative, cannabis, opioid, cocaine, stimulant, hallucinogen, inhalant/solvent, club drug, heroin, and other drug use disorders in the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309). Multinomial models assessed associations between sociodemographic and clinical correlates and latent class status.

RESULTS

Four latent classes of lifetime substance use disorder were identified: A very low risk class, a class with high opioid, sedative and heroin comorbidity, a class based on cocaine and stimulant comorbidity, and class with high likelihood of multiple lifetime drug use disorders. All higher risk classes were associated with higher risk of lifetime personality disorder and mood disorder. Conduct disorder was also associated with higher risk, but level of risk varied by class. Opioid and sedative class was associated with higher odds of lifetime eating disorder diagnosis.

CONCLUSIONS

Comorbidity of drug use disorders is associated with a range of lifetime mental health disorder diagnoses. Unlike previous research, we did not identify a cannabis use class, possibly due to changes in diagnostic criteria and cannabis prevalence rates.