Compulsive overeating as an addiction disorder. A review of theory and evidence

Problem Drinking, Gambling and Eating – Three Problems, One Understanding? A Qualitative Comparison between French and Finnish Social Workers

Aim

Culture Is often used as a wildcard in cross-cultural studies. This article proposes a more diverse understanding of culture, as layered from “deep structures” towards institutional arrangements. It analyses which cultural levels are involved in Finnish and French social workers' understanding of problem drinking, gambling and eating.

Design

A stimulated focus group method (Reception Analytical Group Interview) RAGI was applied to eight groups of Finnish and five groups of French social workers not specialised in addiction. The interviews were analysed with a semi-otic approach.

Results

Finnish social workers understand problem drinking, gambling and eating as rooted in society and harming the social environment. It is the individual's responsibility to solve the problem. French social workers conceptualise only problem eating similar to problem drinking as being caused by an individual defect. They identify problem gambling as a social issue.

Conclusions

The results imply that both the institutional context and structures deeper in culture influence how we conceptualise excessive behaviours. This shows the usefulness of a layered concept of culture. The article recommends caution in using “addiction” as an umbrella concept for all kinds of excessive behaviours, as the perception of each problem depends not only on culture, but on the different cultural levels. Problem gambling in particular seems to evoke multiple understandings.

Behind binge eating: A review of food-specific adaptations of neurocognitive and neuroimaging tasks

Recurrent binge eating, or overeating accompanied by a sense of loss of control, is a major public health concern. Identifying similarities and differences among individuals with binge eating and those with other psychiatric symptoms and characterizing the deficits that uniquely predispose individuals to eating problems are essential to improving treatment. Research suggests that altered reward and control-related processes may contribute to dysregulated eating and other impulsive behaviors in binge-eating populations, but the best methods for reliably assessing the contributions of these processes to binge eating are unclear. In this review, we summarize standard neurocognitive and neuroimaging tasks that assess reward and control-related processes, describe adaptations of these tasks used to study eating and food-specific responsivity and deficits, and consider the advantages and limitations of these tasks. Future studies integrating both general and food-specific tasks with neuroimaging will improve understanding of the neurocognitive processes and neural circuits that contribute to binge eating and could inform novel interventions that more directly target or prevent this transdiagnostic behavior.

Liking, wanting, and the incentive-sensitization theory of addiction

Rewards are both "liked" and "wanted," and those 2 words seem almost interchangeable. However, the brain circuitry that mediates the psychological process of "wanting" a particular reward is dissociable from circuitry that mediates the degree to which it is "liked." Incentive salience or "wanting," a form of motivation, is generated by large and robust neural systems that include mesolimbic dopamine. By comparison, "liking," or the actual pleasurable impact of reward consumption, is mediated by smaller and fragile neural systems, and is not dependent on dopamine. The incentive-sensitization theory posits the essence of drug addiction to be excessive amplification specifically of psychological "wanting," especially triggered by cues, without necessarily an amplification of "liking." This is because of long-lasting changes in dopamine-related motivation systems of susceptible individuals, called "neural sensitization." A quarter-century after its proposal, evidence has continued to grow in support the incentive-sensitization theory. Further, its scope is now expanding to include diverse behavioral addictions and other psychopathologies. (PsycINFO Database Record

[Eating behavior in pediatric obesity: Of the advantages of combining the neurobiological and neuropsychological approaches]

Obesity is currently considered a major public health concern, as shown by the growing number of people with excess weight, alarmingly in infants, and despite medical care. Many studies have underlined the reasons for medical care failure caused by an inability to sustain a resistant behavior towards palatable food (high sugar and fat content). Hence, previous research has highlighted connections between excessive eating behavior and the activity of neurotransmitters in brain areas involved in affective behavior and the reward circuit. Reduction of the dopaminergic activity in the prefrontal orbital and limbic cortex may raise the question of executive skills, which play a major role in social adaptation and behavior control. These findings remind us of the need to grasp environmental and behavioral factors to better identify cognitive and affective profiles and improve childhood obesity treatment.

Multidimensional assessment of impulsivity in relation to obesity and food addiction

Based on similarities between overconsumption of food and addictive drugs, there is increasing interest in "food addiction," a compulsive eating pattern defined using symptoms parallel to substance use disorders. Impulsivity, a multidimensional construct robustly linked to drug addiction, has been increasingly examined as an obesity determinant, but with mixed findings. This study sought to clarify relations between three major domains of impulsivity (i.e., impulsive personality traits, discounting of delayed rewards, and behavioral inhibition) in both obesity and food addiction. Based on the association between impulsivity and compulsive drug use, the general hypothesis was that the impulsivity-food addiction relation would be stronger than and responsible for the impulsivity-obesity relation. Using a cross-sectional dimensional design, participants (N = 181; 32% obese) completed a biometric assessment, the Yale Food Addiction Scale (YFAS), the UPPS-P Impulsive Behavior Scales, a Go/NoGo task, and measures of monetary delay discounting. Results revealed significantly higher prevalence of food addiction among obese participants and stronger zero-order associations between impulsivity indices and YFAS compared to obesity. Two aspects of impulsivity were independently significantly associated with food addiction: (a) a composite of Positive and Negative Urgency, reflecting proneness to act impulsively during intense mood states, and (b) steep discounting of delayed rewards. Furthermore, the results supported food addiction as a mediator connecting both urgency and delay discounting with obesity. These findings provide further evidence linking impulsivity to food addiction and obesity, and suggest that food addiction may be a candidate etiological pathway to obesity for individuals exhibiting elevations in these domains.

Emotion Regulation and Mentalization in People at Risk for Food Addiction

Researchers investigated the association among food addiction, difficulties in emotion regulation, and mentalization deficits in a sample of 322 Italian adults from the general population. All participants were administered the Italian versions of the Yale Food Addiction Scale (I-YFAS), the Difficulties in Emotion Regulation Scale, the Mentalization Questionnaire, the Binge Eating Scale, and the Michigan Alcohol Screening Test. Of respondents, 7.1% reported high food-addiction symptoms (ie, 3 or more symptoms of food addiction on the I-YFAS). In bivariate analyses, high food-addiction symptoms were associated with more difficulties in emotion regulation and mentalization deficits. In the multivariate analysis, high food-addiction symptoms remained independently associated with mentalization deficits, but not with difficulties in emotion regulation. Our data suggest that mentalization may play an important role in food addiction by making it difficult for an individual to understand his or her own inner mental states as well as the mental states of others, especially when powerful emotions arise.

Patterned feeding induces neuroendocrine, behavioral and genetic changes that promote palatable food intake

BACKGROUND

Selection of a healthy diet is the cornerstone for treating obesity and metabolic disease. Unfortunately, the majority of diets fail leading to weight regain and in some cases, pathological feeding behavior. We hypothesize that alternating bouts of caloric overconsumption and caloric restriction, behavioral manifestations of dieting induce neuroendocrine, behavioral and genetic changes that promote future bouts of palatable food intake.

METHODS

To test this hypothesis, we subjected male Long-Evans rats to a high-fat diet (HFD) feeding paradigm that induced a pattern of caloric overconsumption and caloric restriction. Under these conditions we measured operant responding for sucrose, pre-meal ghrelin secretion, the effects of peripheral ghrelin blockade on patterned feeding, HFD intake in an aversive environment and mRNA expression of the ghrelin receptor, orexin, orexin-1 and 2 receptors, and FTO in the medial prefrontal cortex, lateral hypothalamus and ventral tegmental area.

RESULTS

Rats subjected to this feeding regimen displayed increased ghrelin levels prior to HFD exposure and blockade of this response attenuated patterned feeding behavior. In addition, patterned feeding promoted enhanced motivation for sucrose, diminished extinction of this response and increased HFD intake in an aversive environment. The neuroendocrine and behavioral changes correlated with increased hypothalamic expression of the ghrelin receptor and FTO.

CONCLUSION

Collectively, these data indicate that patterns of feeding that include caloric overconsumption and caloric restriction induce neuroendocrine and neurobiological changes that signify an enhanced drive for palatable food.

A Substance Called Food: Long-Term Psychodynamic Group Treatment for Compulsive Overeating

Obesity has proven difficult to treat. Many approaches neglect to address the deep-rooted underlying psychological issues. This paper describes a psychodynamically oriented approach to treating compulsive overeating as an addiction. Common to all addictions is a compulsion to consume a substance or engage in a behavior, a preoccupation with using behavior and rituals, and a lifestyle marked by an inability to manage the behavior and its harmful consequences. The approach represents a shift away from primarily medical models of intervention to integrated models focusing on the psychological underpinnings of obesity. Long-term psychodynamic group psychotherapy is recommended as a primary treatment.

Genetic epidemiology of eating disorders

PURPOSE OF REVIEW

We capture recent findings in the field of genetic epidemiology of eating disorders. As analytic techniques evolve for twin, population, and molecular genetic studies, new findings emerge at an accelerated pace. We present the current status of knowledge regarding the role of genetic and environmental factors that influence risk for eating disorders.

RECENT FINDINGS

We focus on novel findings from twin studies, population studies using genetically informative designs, and molecular genetic studies. Over the past 2 years, research in this area has yielded insights into: comorbidity with other psychiatric and medical disorders and with metabolic traits; developmental factors associated with the emergence of eating disorders; and the molecular genetics of anorexia nervosa.

SUMMARY

Insights from genetic epidemiology provide an important explanatory model for patients with eating disorders, family members, and clinicians. Understanding core biological determinants that explain the severity and persistence of the illnesses, their frequent co-occurrence with other conditions, and their familial patterns raises awareness and increases compassion for individuals living with these disorders. Large-scale genomic studies are currently underway. Ultimately, this domain of research may pave the way to greater understanding of the underlying neurobiology and inform the development of novel and effective interventions.

A commentary on the "eating addiction" versus "food addiction" perspectives on addictive-like food consumption

The food addiction construct posits that vulnerable individuals may experience an addictive-like response to certain foods, such as those high in fat and refined carbohydrates. Recently, an alternative model to food addiction was proposed, suggesting that the act of eating may be a behavioral addiction that can trigger an addictive-like response in susceptible individuals. One major rationale for the eating addiction framework is that the assessment of food addiction is based on behavioral indicators, such as consuming greater quantities of food than intended and eating certain foods despite negative consequences. It is also suggested that the lack of investigation into which foods and food attributes (e.g., sugar) may have an addictive potential is evidence that food addiction does not parallel a substance-based addiction and more closely resembles a behavioral addiction. The present paper provides a commentary suggesting that the substance-based, food-addiction framework is more appropriate than the behavioral-addiction, eating-addiction perspective to conceptualize addictive-like food consumption. In order to illustrate this point, this manuscript will discuss behavioral components characteristic of all substance-use disorders, preliminary evidence to suggest that all foods are not equally associated with addictive-like eating, and key differences between the hypothesized eating addiction phenotype and the only existing behavioral addiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling disorder. Further, this paper will consider implications of applying an addiction label to food versus eating and suggest future research directions to evaluate whether food addiction is a valid and clinically useful construct.

Health-related quality of life and its association with alexithymia and difficulties in emotion regulation in patients with psoriasis

BACKGROUND

Health-related quality of life (HRQoL) in psoriasis patients could be negatively affected by medical (e.g., obesity) and psychological (e.g., depression, anxiety, and alexithymia) conditions the presence of which suggests difficulties in understanding and regulating inner states and emotions. Thus, the aim of this study was to investigate HRQoL and its association with obesity and difficulties in understanding and regulating inner states and emotions in patients with psoriasis. A second objective was to examine whether the presence of difficulties in understanding and regulating inner states and emotions may mediate the association between psoriasis and poor HRQoL.

METHOD

One hundred adult outpatients and 97 healthy controls were administered a checklist assessing major socio-demographic variables, and measures of HRQoL, difficulties in emotion regulation, alexithymia, anxiety, depression, and food craving.

RESULTS

Psoriasis patients (compared to controls) reported more frequently obesity, alexithymia, anxiety, depression and food craving, and reported lower scores on the mental and physical components of HRQoL. A mediation model, with mental health as the dependent variable, indicated significant direct and indirect (through BMI, difficulties in emotion regulation, anxiety, depression, and food craving) effects of psoriasis on the quality of life, so that psoriasis was associated with worse mental health. A second mediation model with physical health as dependent variable indicated only a significant indirect effect (through BMI and depression) of psoriasis on the quality of life.

CONCLUSIONS

Psoriasis is characterized by poor HRQoL and the presence of difficulties in understanding and regulating inner states and emotions. In patients with psoriasis the possible influence of food craving on abnormal eating habits should be carefully assessed.

THE ALCOHOL CONSUMPTION IS AMENDED AFTER BARIATRIC SURGERY? AN INTEGRATIVE REVIEW

Background

Bariatric surgery has been an alternative when conservative methods of weight loss fail. Patients undergoing bariatric surgery have an increased risk of up to 6.5% of problems related to alcohol

Objective:

Integrative review out to analyze the change of alcohol consumption in this public

Method:

Database was accessed from June of 2015 to January of 2016 by searching "bariatric surgery" AND "alcoholism", and their Portuguese equivalents. ScienceDirect, PubMed, Lilacs and Medline, besides manual search, were searched. To be included, the paper should have been published between 2005-2016 and related to bariatric surgery and alcoholism. Theses, dissertations, unpublished papers, case reports and theoretical studies were excluded, and a database was subsequently composed

Results:

In 2005 there was only a review of change in alcohol metabolism in patients undergoing bariatric surgery. There were no publications in 2006. In 2007, only one study was published, and it did not meet the inclusion criteria. In 2010, there was an increase of 13% in publications and of 20% in 2012, reaching 40% in 2013

Conclusion:

The prevalence and incidence of alcohol consumption in relation to the postoperative time was six months to three years with higher incidence for follow-up treatment by men. Roux-en-Y gastric bypass showed greater association with increased consumption of alcohol during the postoperative period. Alcohol consumption proved to be essential to be faced in bariatric surgery.

The ABBA study - approach bias modification in bulimia nervosa and binge eating disorder: study protocol for a randomised controlled trial

BACKGROUND

The core symptoms of bulimia nervosa (BN) and binge eating disorder (BED) are recurrent episodes of binge eating. Despite negative psychological and physical consequences, BN/BED patients show uncontrollable approach tendencies towards food. This cognitive bias occurs at an early stage of information processing. Cognitive bias modification (CBM) directly targets such biases and has been shown to be effective in treating several mental disorders. In alcohol addiction, automatic action tendencies towards alcohol cues and relapse rates were successfully reduced by a specific form of CBM, termed approach bias modification. Based on these findings and data from a proof-of-concept study in people with high levels of food craving, CBM is considered a promising new treatment approach for BN/BED. Given the similarities between BN/BED and addictive disorders, the rationale for using approach bias modification appears to be particularly strong. The aim of the present study is to examine whether, compared to a sham training, computerised approach bias modification (10 sessions) can reduce binge-eating episodes in BN/BED patients from pre-treatment to follow-up. Additionally, we will investigate whether this CBM programme also reduces global eating disorder psychopathology, trait and cue-elicited food craving, food intake as well as approach and attentional bias towards visual food cues. Treatment acceptance will be determined by attrition rates and responses on a feedback form.

METHODS

This is a double-blind, randomised, placebo-controlled, parallel-group superiority trial with two parallel arms. A total of 54 BN/BED patients will be recruited. Approach bias towards food will be retrained by a computer task adopting an implicit learning paradigm. Patients in the control condition (sham) will conduct a similar task but will not be trained to avoid food cues. Methods against bias include public registration, randomisation by a central study office, standardisation of the treatments and blinding of assessors. Furthermore, the session number and duration will be equivalent in the two conditions.

DISCUSSION

This is the first registered randomised controlled trial of approach bias modification in a clinical BN/BED sample. Results from this study will provide an indication of the efficacy of approach bias modification training for BN/BED and the potential mechanisms of action underlying this treatment.

TRIAL REGISTRATION

DRKS00010231 (retrospectively registered on 24 March 2016; first version).

Modification of EEG functional connectivity and EEG power spectra in overweight and obese patients with food addiction: An eLORETA study

We evaluated the modifications of electroencephalographic (EEG) power spectra and EEG connectivity in overweight and obese patients with elevated food addiction (FA) symptoms. Fourteen overweight and obese patients (3 men and 11 women) with three or more FA symptoms and fourteen overweight and obese patients (3 men and 11 women) with two or less FA symptoms were included in the study. EEG was recorded during three different conditions: 1) five minutes resting state (RS), 2) five minutes resting state after a single taste of a chocolate milkshake (ML-RS), and 3) five minutes resting state after a single taste of control neutral solution (N-RS). EEG analyses were conducted by means of the exact Low Resolution Electric Tomography software (eLORETA). Significant modification was observed only in the ML-RS condition. Compared to controls, patients with three or more FA symptoms showed an increase of delta power in the right middle frontal gyrus (Brodmann Area [BA] 8) and in the right precentral gyrus (BA 9), and theta power in the right insula (BA 13) and in the right inferior frontal gyrus (BA 47). Furthermore, compared to controls, patients with three or more FA symptoms showed an increase of functional connectivity in fronto-parietal areas in both the theta and alpha band. The increase of functional connectivity was also positively associated with the number of FA symptoms. Taken together, our results show that FA has similar neurophysiological correlates of other forms of substance-related and addictive disorders suggesting similar psychopathological mechanisms.

Dissociated Accumbens and Hippocampal Structural Abnormalities across Obesity and Alcohol Dependence

BACKGROUND

Processing of food and drug rewards involves specific neurocircuitry, and emerging evidence implicates subcortical abnormalities, particularly the nucleus accumbens and hippocampus. We specifically hypothesized that these 2 established regions in addiction neurocircuitry are associated with distinctive in vivo structural abnormalities in obesity and alcohol dependence.

METHODS

To specifically investigate anatomically discrete volumetric changes associated with overconsumption of different rewards, we acquired T1 MRI data from 118 subjects in 3 groups comprising obesity (n=42), alcohol dependence (n=32), and healthy volunteer controls (n=44). To exploit novel methods of automated hippocampal subfield segmentation, we used Freesurfer software to generate volumetric data in subject groups for the hippocampal subiculum and its major striatal efferent target, the nucleus accumbens. Hypothesis-led, selective group difference comparisons were analyzed.

RESULTS

We found markedly greater accumbens volumes (P=.002) and relatively preserved hippocampal subfield volumes in obesity. Conversely, in alcohol dependence, we found preserved accumbens volumes but atrophy of specific ventral hippocampal subfields, the subiculum and presubiculum. Smaller global subcortical gray-matter volume was found in the alcohol dependence group only.

CONCLUSIONS

Reward neurocircuitry including the accumbens and ventral hippocampus may show key structural abnormalities in disorders involving processing of both food and drug rewards, although the foci of disruption may vary as a function of reward modality. Structural differences may subserve altered reward and motivational processes in obesity and alcohol dependence and represent a potential biomarker for therapeutic targeting in key public health disorders.

Childhood trauma in obese and overweight women with food addiction and clinical-level of binge eating

Childhood trauma (CT) is considered a major risk factor for several disorders as well as for the development of eating psychopathology and adult obesity. The main aims of the present study were to assess in overweight and obese women: (i) the independent association between CT and food addiction (FA), and (ii) CT in patients with both FA and clinical-level of binge eating (BE), versus patients who only engage in FA or BE. Participants were 301 overweight and obese women seeking low-energy-diet therapy. All of the patients were administered self-report measures investigating FA, BE, CT, anxiety and depressive symptoms. CT severity was moderately and positively associated with both FA (r=0.37; p<0.001) and BE (r=0.36; p<0.001) severity. The association between FA and CT remained significant after controlling for potential confounding variables. Furthermore, compared to patients without dysfunctional eating patterns, the co-occurrence of FA and BE was associated with more severe CT as well as with more severe psychopathology (i.e., anxiety and depressive symptoms) and higher BMI. Our results suggest that clinicians should carefully assess the presence of CT in individuals who report dysfunctional eating patterns in order to develop treatment approaches specifically for obese and overweight patients with a history of CT.

[Food addiction: Definition, measurement and limits of the concept, associated factors, therapeutic and clinical implications]

Addictions, which are characterized by the inability to control a behavior despite existence of physical or psychological consequences, have biological, psychological and social determinants. Although the possibility of developing an addiction to some psychoactive substances (e.g. alcohol, tobacco, cannabis) and to gambling (i.e., gambling disorder) is now well demonstrated, the possibility to develop a non-drug addiction (i.e., behavioral addiction) to certain behaviors which provide pleasure (e.g. eating, having sex, buying things) is still in debate. The concept of food addiction, which refers to people who exhibit substance dependence criteria in relation to some high-fat and high-sugar foods, was recently proposed by applying substance dependence DSM criteria to eating behavior. To assess food addiction, the Yale Food Addiction Scale is now the only self-administered questionnaire (diagnosis and estimate of the number of symptoms of food addiction). Prevalence for food addiction is higher in overweight and obese patients, and in patients with certain psychopathological characteristics (i.e., depression, Attention Deficit Hyperactivity Disorder, high impulsivity), in patients who are single and in patients with neurobiological alterations in the reward system. However, it is still unclear whether food addiction is necessary associated with subsequent increase in body weight and/or obesity. An increasing number of studies demonstrated that drug addiction and food addiction shares some similar clinical, neurobiological and psychopathological and sociocultural risk factors. To test the pertinence to include food addiction as an addiction, it would be interesting to conduct future studies in patients who may experience harms related to their food addiction, including not only patients with obesity, but also patients with metabolic syndrome, type 2 diabetes, hypertension, dyslipidemia, atherosclerosis, stroke, or coronary heart disease. Food addiction is a clinical and multidimensional concept which requires integrated care with psychotherapy, pharmacological and social lines of approach. This concept has also practical implications in terms of prevention and public health (e.g., prevention, brief interventions, possible law enforcement regarding some kinds of food which could present some addictive properties).

The Neurobiology of "Food Addiction" and Its Implications for Obesity Treatment and Policy

There is a growing view that certain foods, particularly those high in refined sugars and fats, are addictive and that some forms of obesity can usefully be treated as a food addiction. This perspective is supported by a growing body of neuroscience research demonstrating that the chronic consumption of energy-dense foods causes changes in the brain's reward pathway that are central to the development and maintenance of drug addiction. Obese and overweight individuals also display patterns of eating behavior that resemble the ways in which addicted individuals consume drugs. We critically review the evidence that some forms of obesity or overeating could be considered a food addiction and argue that the use of food addiction as a diagnostic category is premature. We also examine some of the potential positive and negative clinical, social, and public policy implications of describing obesity as a food addiction that require further investigation.

Differential Effects of Reward Drive and Rash Impulsivity on the Consumption of a Range of Hedonic Stimuli

Background and aims Impulsivity has consistently been associated with over-consumption and addiction. Recent research has reconceptualized impulsivity as a two-dimensional construct ( Dawe, Gullo, & Loxton, 2004 ). This study explores the relationship of the two components of impulsivity, reward drive (RD) and rash impulsivity (RI), on a broad group of 23 hedonic consumption behaviors (e.g., gambling, substance use, eating, and media use). We tentatively grouped the behaviors into three descriptive classes: entertainment, foodstuffs, and illicit activities and substances. Results RD and RI positively predicted elevated levels of consumption in a community sample (N=5,391; 51% female), for the vast majority of the behaviors considered. However, the effect sizes for RD and RI varied significantly depending on the behavior; a pattern that appeared to be at least partially attributable to the class of consumption. Results support the view that RD is related more strongly to the consumption of products that provide social engagement or a sense of increased status; whereas RI better reflects an approach toward illicit or restricted products that are intensely rewarding with clear negative consequences. Discussion and conclusion Results support the utility of the two-factor model of impulsivity in explaining individual differences in patterns of hedonic consumption in the general population. We discuss findings in terms of strengthening current conceptualizations of RI and RD as having distinct implications with respect to health-related behaviors.

Shared and unique mechanisms underlying binge eating disorder and addictive disorders

Scientific interest in "food addiction" is growing, but the topic remains controversial. One critique of "food addiction" is its high degree of phenotypic overlap with binge eating disorder (BED). In order to examine associations between problematic eating behaviors, such as binge eating and "food addiction," we propose the need to move past examining similarities and differences in symptomology. Instead, focusing on relevant mechanisms may more effectively determine whether "food addiction" contributes to disordered eating behavior for some individuals. This paper reviews the evidence for mechanisms that are shared (i.e., reward dysfunction, impulsivity) and unique for addiction (i.e., withdrawal, tolerance) and eating disorder (i.e., dietary restraint, shape/weight concern) frameworks. This review will provide a guiding framework to outline future areas of research needed to evaluate the validity of the "food addiction" model and to understand its potential contribution to disordered eating.

Dimensionality of Cognitions in Behavioral Addiction

Cognitive constructs provide conceptual frameworks for transpathological characterization and improved phenotyping of apparently disparate psychiatric groups. This dimensional approach can be applied to the examination of individuals with behavioral addictions, for example, towards gambling, video-games, the internet, food, and sex, allowing operationalization of core deficits. We use this approach to review constructs such as impulsivity, compulsivity, and attention regulation, which may be most relevant, applicable, and successful for the understanding and subsequent treatment of the addictions.

Sex Differences in Behavioral Dyscontrol: Role in Drug Addiction and Novel Treatments

The purpose of this review is to discuss recent findings related to sex differences in behavioral dyscontrol that lead to drug addiction, and clinical implications for humans are discussed. This review includes research conducted in animals and humans that reveals fundamental aspects of behavioral dyscontrol. The importance of sex differences in aspects of behavioral dyscontrol, such as impulsivity and compulsivity, is discussed as major determinants of drug addiction. Behavioral dyscontrol during adolescence is also an important consideration, as this is the time of onset for drug addiction. These vulnerability factors additively increase drug-abuse vulnerability, and they are integral aspects of addiction that covary and interact with sex differences. Sex differences in treatments for drug addiction are also reviewed in terms of their ability to modify the behavioral dyscontrol that underlies addictive behavior. Customized treatments to reduce behavioral dyscontrol are discussed, such as (1) using natural consequences such as non-drug rewards (e.g., exercise) to maintain abstinence, or using punishment as a consequence for drug use, (2) targeting factors that underlie behavioral dyscontrol, such as impulsivity or anxiety, by repurposing medications to relieve these underlying conditions, and (3) combining two or more novel behavioral or pharmacological treatments to produce additive reductions in drug seeking. Recent published work has indicated that factors contributing to behavioral dyscontrol are an important target for advancing our knowledge on the etiology of drug abuse, intervening with the drug addiction process and developing novel treatments.

Roles of "Wanting" and "Liking" in Motivating Behavior: Gambling, Food, and Drug Addictions

The motivation to seek out and consume rewards has evolutionarily been driven by the urge to fulfill physiological needs. However in a modern society dominated more by plenty than scarcity, we tend to think of motivation as fueled by the search for pleasure. Here, we argue that two separate but interconnected subcortical and unconscious processes direct motivation: "wanting" and "liking." These two psychological and neuronal processes and their related brain structures typically work together, but can become dissociated, particularly in cases of addiction. In drug addiction, for example, repeated consumption of addictive drugs sensitizes the mesolimbic dopamine system, the primary component of the "wanting" system, resulting in excessive "wanting" for drugs and their cues. This sensitizing process is long-lasting and occurs independently of the "liking" system, which typically remains unchanged or may develop a blunted pleasure response to the drug. The result is excessive drug-taking despite minimal pleasure and intense cue-triggered craving that may promote relapse long after detoxification. Here, we describe the roles of "liking" and "wanting" in general motivation and review recent evidence for a dissociation of "liking" and "wanting" in drug addiction, known as the incentive sensitization theory (Robinson and Berridge 1993). We also make the case that sensitization of the "wanting" system and the resulting dissociation of "liking" and "wanting" occurs in both gambling disorder and food addiction.

Sugar addiction: the state of the science

PURPOSE

As obesity rates continue to climb, the notion that overconsumption reflects an underlying 'food addiction' (FA) has become increasingly influential. An increasingly popular theory is that sugar acts as an addictive agent, eliciting neurobiological changes similar to those seen in drug addiction. In this paper, we review the evidence in support of sugar addiction.

METHODS

We reviewed the literature on food and sugar addiction and considered the evidence suggesting the addictiveness of highly processed foods, particularly those with high sugar content. We then examined the addictive potential of sugar by contrasting evidence from the animal and human neuroscience literature on drug and sugar addiction.

RESULTS

We find little evidence to support sugar addiction in humans, and findings from the animal literature suggest that addiction-like behaviours, such as bingeing, occur only in the context of intermittent access to sugar. These behaviours likely arise from intermittent access to sweet tasting or highly palatable foods, not the neurochemical effects of sugar.

CONCLUSION

Given the lack of evidence supporting it, we argue against a premature incorporation of sugar addiction into the scientific literature and public policy recommendations.

SRT-Joy - computer-assisted self-regulation training for obese children and adolescents: study protocol for a randomized controlled trial

Background

Obesity is not only a highly prevalent disease but also poses a considerable burden on children and their families. Evidence is increasing that a lack of self-regulation skills may play a role in the etiology and maintenance of obesity. Our goal with this currently ongoing trial is to examine whether training that focuses on the enhancement of self-regulation skills may increase the sustainability of a complex lifestyle intervention.

Methods/Design

In a multicenter, prospective, parallel group, randomized controlled superiority trial, 226 obese children and adolescents aged 8 to 16 years will be allocated either to a newly developed computer-training program to improve their self-regulation abilities or to a placebo control group. Randomization occurs centrally and blockwise at a 1:1 allocation ratio for each center. This study is performed in pediatric inpatient rehabilitation facilities specialized in the treatment of obesity. Observer-blind assessments of outcome variables take place at four times: at the beginning of the rehabilitation (pre), at the end of the training in the rehabilitation (post), and 6 and 12 months post-rehabilitation intervention. The primary outcome is the course of BMI-SDS over 1 year after the end of the inpatient rehabilitation. Secondary endpoints are the self-regulation skills. In addition, health-related quality of life, and snack intake will be analyzed.

Discussion

The computer-based training programs might be a feasible and attractive tool to increase the sustainability of the weight loss reached during inpatient rehabilitation.

Trial registration

The present study protocol was registered on 13 July 2015 at German Clinical Trials Register: DRKS00007879.

Genetic Similarities between Compulsive Overeating and Addiction Phenotypes: A Case for "Food Addiction"?

There exists a continuous spectrum of overeating, where at the extremes there are casual overindulgences and at the other a 'pathological' drive to consume palatable foods. It has been proposed that pathological eating behaviors may be the result of addictive appetitive behavior and loss of ability to regulate the consumption of highly processed foods containing refined carbohydrates, fats, salt, and caffeine. In this review, we highlight the genetic similarities underlying substance addiction phenotypes and overeating compulsions seen in individuals with binge eating disorder. We relate these similarities to findings from neuroimaging studies on reward processing and clinical diagnostic criteria based on addiction phenotypes. The abundance of similarities between compulsive overeating and substance addictions puts forth a case for a 'food addiction' phenotype as a valid, diagnosable disorder.

Cognitive biases in binge eating disorder: the hijacking of decision making

Binge eating disorder (BED) is the most common of eating disorders and is characterized by excessive, out-of-control, rapid food intake. This review focuses on cognitive impairments in BED, which represent an endophenotype that mediates brain function and behavior. Here we focus on reviewing impulsivity, compulsivity, attentional biases to food cues, and executive function. Behavioral regulation in BED appears to be influenced by the context of motivationally salient food cues and the degree of obesity. Deficits in delay discounting and risk taking under ambiguity are impaired in obesity irrespective of BED status. However, in BED subjects with milder obesity, greater risk seeking under explicit probabilistic risk is observed to monetary rewards, whereas this shifts to risk aversion and enhanced delay discounting in more severe obesity. Relative to non-BED obese subjects, BED is characterized by enhanced behavioral inflexibility or compulsivity across multiple domains, with subjects selecting the same choices despite change in relevance (set shifting), being no longer rewarding (habit formation), or irrespective of outcome (perseveration). The context of food cues was associated with multiple attentional and early and late inhibitory impairments and enhanced memory bias, although BED patients also have generalized cognitive interference in working memory. These findings may help explain the phenotype of binge eating. Motivationally salient food cues provoke attentional and memory biases along with impairing response inhibitory processes. Those with BED are also more susceptible to cognitive interference and have impaired decisional impulsivity, with the tendency to inflexibly stick with the same choices irrespective of changes in context. These findings suggest critical cognitive domains that may guide therapeutic interventions.

The epidemiology and genetics of binge eating disorder (BED)

This narrative review provides an overview of the epidemiology of binge eating disorder (BED), highlighting the medical history of this disorder and its entry as an independent condition in the Feeding and Eating Disorders section of the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Estimates of prevalence are provided, as well as recognition that the female to male ratio is lower in BED than in other eating disorders. Evidence is also provided of the most common comorbidities of BED, including mood and anxiety disorders and a range of addiction disorders. In addition, discussion of the viewpoint that BED itself may be an addiction - at least in severe cases - is presented. Although the genetic study of BED is still in its infancy, current research is reviewed with a focus on certain neurotransmitter genes that regulate brain reward mechanisms. To date, a focal point of this research has been on the dopamine and the μ-opioid receptor genes. Preliminary evidence suggests that a predisposing risk factor for BED may be a heightened sensitivity to reward, which could manifest as a strong dopamine signal in the brain's striatal region. Caution is encouraged, however, in the interpretation of current findings, since samples are relatively small in much of the research. To date, no genome-wide association studies have focused exclusively on BED.

Food craving as a mediator between addictive-like eating and problematic eating outcomes

BACKGROUND

There is growing interest and debate about whether an addictive process contributes to problematic eating outcomes, such as obesity. Craving is a core component of addiction, but there has been little research on the relationship between addictive-like eating, craving, and eating-related concerns. In the current study, we examine the effect of both overall food craving and craving for different types of food on the relationship between addictive-like eating symptoms and elevated body mass index (BMI) and binge eating episodes.

METHODS

In a community sample (n=283), we conducted analyses to examine whether overall craving mediated the association between addictive-like eating and elevated BMI, as well as binge eating frequency. We also ran separate mediational models examining the indirect effect of cravings for sweets, fats, carbohydrates, and fast food fats on these same associations.

RESULTS

Overall food craving was a significant partial mediator in the relationships between addictive-like eating and both elevated BMI and binge eating episodes. Cravings for sweets and other carbohydrates significantly mediated the relationship between addictive-like eating and binge eating episodes, while cravings for fats significantly mediated the relationship between addictive-like eating and elevated BMI.

CONCLUSIONS

Craving appears to be an important component in the pathway between addictive-like eating and problematic eating outcomes. The current results highlight the importance of further evaluating the role of an addictive process in problematic eating behaviors and potentially targeting food cravings in intervention approaches.

Impulsivity and emotion dysregulation as predictors of food addiction

Food addiction is the clinical occurrence in which individuals develop physical and psychological dependencies on high fat, high sugar, and highly palatable foods. Past research has demonstrated a number of similarities between food addiction and drug use disorders including the activation of specific brain regions and neurotransmitters, disrupted neuronal circuitry, and behavioral indicators of addiction such as continued use despite negative consequences. The present study examined the role of impulsivity and emotion dysregulation in food addiction as both play salient roles in drug use disorders. Poisson regression analyses using data from 878 undergraduate students revealed negative urgency, the tendency to act impulsively when under distress, and emotion dysregulation positively predicted symptom count on the Yale Food Addiction Scale (Gearhardt, Corbin, & Brownell, 2009) whereas a lack of premeditation negatively predicted symptom count (all ps<0.05). Future research is needed to confirm precursors to eating episodes in food addiction, elucidate causal mechanisms, and support an explanatory model of food addiction.

Obesity, paternalism and fairness

Many liberal theories are committed to the promotion of population health, and the principle of non-interference in individual life plans. Public health interventions often bring out a tension between these two values. In this paper, I examine this tension by assessing the justifiability of liberty-restricting policies in the field of obesity prevention. As I want to show, a 'soft' form of paternalism, which interferes with people's choices to safeguard their true interests, goes some way in justifying such policies, but it leaves unaddressed the problem of limiting the liberty of those whose true interest is in pursuing an unhealthy lifestyle. I argue that in this latter case, the key to reconcile the promotion of population health with the respect for individual liberty is distributive justice: when we cannot help those who care about their health without doing the same for those who do not, fairness will often require us to do so.

Transcranial direct current stimulation (tDCS) in behavioral and food addiction: a systematic review of efficacy, technical, and methodological issues

Objectives: Behavioral addictions (BA) are complex disorders for which pharmacological and psychotherapeutic treatments have shown their limits. Non-invasive brain stimulation, among which transcranial direct current stimulation (tDCS), has opened up new perspectives in addiction treatment. The purpose of this work is to conduct a critical and systematic review of tDCS efficacy, and of technical and methodological considerations in the field of BA.

Methods: A bibliographic search has been conducted on the Medline and ScienceDirect databases until December 2014, based on the following selection criteria: clinical studies on tDCS and BA (namely eating disorders, compulsive buying, Internet addiction, pathological gambling, sexual addiction, sports addiction, video games addiction). Study selection, data analysis, and reporting were conducted according to the PRISMA guidelines.

Results: Out of 402 potential articles, seven studies were selected. So far focusing essentially on abnormal eating, these studies suggest that tDCS (right prefrontal anode/left prefrontal cathode) reduces food craving induced by visual stimuli.

Conclusions: Despite methodological and technical differences between studies, the results are promising. So far, only few studies of tDCS in BA have been conducted. New research is recommended on the use of tDCS in BA, other than eating disorders.

Impaired decision making under ambiguity but not under risk in individuals with pathological buying-behavioral and psychophysiological evidence

Pathological buying (PB) is described as dysfunctional buying behavior, associated with harmful consequences. It is discussed whether decision-making deficits are related to PB, because affected individuals often choose the short-term rewarding option of buying despite persistent negative long-term consequences. We investigated 30 patients suffering from PB and 30 matched control participants with two different decision-making tasks: the Iowa Gambling Task (IGT) measures decisions under ambiguity and involves emotional feedback processing, whereas the Game of Dice Task (GDT) measures decisions under risk and can be solved strategically. Potential emotional and cognitive correlates of decision making were investigated by assessing skin conductance response (SCR) and executive functioning. In comparison to the control participants, the patients showed more disadvantageous decisions under ambiguity in the IGT. These data were supported by the SCR results: patients failed to generate SCRs that usually occur before disadvantageous decisions. The physiological and behavioral performance on decisions under risk and executive functioning did not differ between groups. Thus, deficits in emotional feedback processing might be one potential factor in etiology and pathogenesis of PB and should be considered in theory and treatment.

Intermittent-access binge consumption of sweet high-fat liquid does not require opioid or dopamine receptors in the nucleus accumbens

Binge eating disorders are characterized by episodes of intense consumption of high-calorie food. In recently developed animal models of binge eating, rats given intermittent access to such food escalate their consumption over time. Consumption of calorie-dense food is associated with neurochemical changes in the nucleus accumbens, including dopamine release and alterations in dopamine and opioid receptor expression. Therefore, we hypothesized that binge-like consumption on intermittent access schedules is dependent on opioid and/or dopamine neurotransmission in the accumbens. To test this hypothesis, we asked whether injection of dopamine and opioid receptor antagonists into the core and shell of the accumbens reduced consumption of a sweet high-fat liquid in rats with and without a history of intermittent binge access to the liquid. Although injection of a μ opioid agonist increased consumption, none of the antagonists (including μ opioid, δ opioid, κ opioid, D1 dopamine and D2 dopamine receptor antagonists, as well as the broad-spectrum opioid receptor antagonist naltrexone) reduced consumption, and this was the case whether or not the animals had a prior history of intermittent access. These results suggest that consumption of sweet, fatty food does not require opioid or dopamine receptor activation in the accumbens even under intermittent access conditions that resemble human binge episodes.

Estágios motivacionais para mudança de comportamento em indivíduos que iniciam tratamento para perda de peso

Objetivo Embora existam programas efetivos para tratamento da obesidade, são grandes as taxas de abandono. O objetivo deste trabalho foi investigar o estágio motivacional em que se encontravam pacientes com sobrepeso ou obesidade I e II atendidos em ambulatório de Nutrição e seus fatores associados. Métodos Trata-se de um estudo transversal, com amostragem por conveniência, em que foram coletadas informações da história clínica, antropometria, compulsão alimentar (BES – Binge Eating Scale) e motivação para o tratamento (URICA – University of Rhode Island Change Assessment Scale). Resultados Dos 48 avaliados, 29,2% encontravam-se em pré-contemplação, 41,7%, em contemplação e 29,2%, em ação. Quem procurou tratamento para controle de alguma comorbidade além da perda de peso teve maior escore de prontidão (p = 0,024). Motivação não foi relacionada ao estado nutricional nem à tentativa anterior de perda de peso, mas relacionou-se à orientação profissional anterior (p = 0,005). Dos 26,8% que apresentavam sintomatologia moderada ou grave para compulsão alimentar, 90,9% estavam em contemplação, com diferença significativa quanto à pré-contemplação (p = 0,001) e à ação (p = 0,02). Conclusão Esses resultados sugerem que parte dos indivíduos que procuram tratamento para perda de peso não o faz com a motivação necessária e que, se o aconselhamento profissional quanto à importância da perda de peso ocorresse antes que patologias associadas à obesidade se instalassem, indivíduos mais motivados poderiam procurar tratamento e evitar tais complicações.

Stress, cues, and eating behavior. Using drug addiction paradigms to understand motivation for food

Eating patterns that lead to overconsumption of high fat, high sugar (HFHS) foods share similar features with addictive behaviors. Application of addiction paradigms, such as stress inductions, cue reactivity and behavioral economic assessments, to the study of motivation for HFHS food consumption may be a promising means of understanding food consumption. To date, few studies have investigated the interaction of stress and environmental cues on craving, and no study leveraged the state relative reinforcing value of foods (RRVfood) under varying conditions of affective states, the foci of the current study. This study used a mixed factorial design (Mood Induction: Neutral, Stress; Cues: Neutral, Food) with repeated measures on time (Baseline, Post-Mood Induction, Post-Cue Exposure). Participants (N = 133) were community adults who endorsed liking of HFHS snacks but denied eating pathology. The primary DVs were subjective craving and RRVfood. Negative and positive affect (NA, PA), the amount of food consumed, and latency to first bite were also examined. Participants in the Stress condition reported no change in craving or RRVfood. Exposure to food cues significantly increased participants' craving and RRVfood, but an interaction of stress and cues was not present. Participants did not differ on how many calories they consumed based on exposure to stress or food cues, but participants in the food cues condition had a shorter latency to the first bite of food. This study highlights the importance of environmental cues in food motivation. It also demonstrates the utility of using RRVfood to further characterize food motivation.

A novel measure of compulsive food restriction in anorexia nervosa: validation of the Self-Starvation Scale (SS)

The characteristic relentless self-starvation behaviour seen in Anorexia Nervosa (AN) has been described as evidence of compulsivity, with increasing suggestion of transdiagnostic parallels with addictive behaviour. There is a paucity of standardised self-report measures of compulsive behaviour in eating disorders (EDs). Measures that index the concept of compulsive self-starvation in AN are needed to explore the suggested parallels with addictions. With this aim a novel measure of self-starvation was developed (the Self-Starvation Scale, SS). 126 healthy participants, and 78 individuals with experience of AN, completed the new measure along with existing measures of eating disorder symptoms, anxiety and depression. Initial validation in the healthy sample indicated good reliability and construct validity, and incremental validity in predicting eating disorder symptoms. The psychometric properties of the SS scale were replicated in the AN sample. The ability of this scale to predict ED symptoms was particularly strong in individuals currently suffering from AN. These results suggest the SS may be a useful index of compulsive food restriction in AN. The concept of 'starvation dependence' in those with eating disorders, as a parallel with addiction, may be of clinical and theoretical importance.