Impulsivity and compulsivity as parallel mediators of emotion dysregulation in eating-related addictive-like behaviors, alcohol use, and compulsive exercise

Binge drinking at time of bariatric surgery is associated with liver disease, suicides, and increases long-term mortality

BACKGROUND AND AIMS

Alcohol use disorder has been reported in patients undergoing bariatric procedures, but the pattern of alcohol consumption has not been evaluated. We investigated the prevalence, risk factors, and impact of binge drinking (BD) at the time of surgery and during follow-up.

METHODS

A prospective, longitudinal study of subjects undergoing bariatric surgery was included in the LABS-2 registry between 2006 and 2009. Participants with AUDIT questionnaire at the time of surgery and a minimum of 12 months follow-up were included. BD was defined as consuming ≥5 drinks on at least 1 occasion in the previous month. Liver biopsies were obtained during bariatric procedures in not all cases. Survival analysis was performed with the adjusted Cox regression model and competing risk.

RESULTS

A total of 2257 subjects were included, with a median follow-up of 79 months. The prevalence of BD at time of surgery was 12%, and it raised up to 23% during follow-up. Patients with BD predominantly had a binge eating disorder (OR=1.35 [95% CI: 1.04-1.76]), regularly consumed fast food [OR=1.4 (95% CI: 1.07-1.85)] and used other drugs (OR=2.65 [95% CI: 1.74-4.04]). Within liver biopsies evaluation, BD showed higher hepatic iron deposits (OR=3.00 [95% CI: 1.25-7.21]). BD at the time of surgery was associated with a higher risk of BD during follow-up (OR=10.49 [95% CI: 7.86-14.00]) and long-term mortality (HR: 3.21 [95% CI: 1.67-6.18]). Specific causes of death in these patients with BD were liver disease (p=0.020), suicide (p=0.015), neoplasms (p=0.034), and respiratory (p=0.025).

CONCLUSIONS

The prevalence of BD in patients undergoing bariatric surgery is high and increases the risk of postoperative liver disease, suicides, and long-term mortality.

Maladaptive exercise in eating disorders: lifetime and current impact on mental health and treatment seeking

BACKGROUND

Many patients with eating disorders report exercise as a central symptom of their illness-as a way to compensate for food intake, prevent weight-gain, and/or reduce negative affect. Previous findings show associations between maladaptive exercise and more severe eating disorder pathology, higher risk for relapse, other co-morbid symptoms, and worse treatment outcome.

METHODS

In this study, we included 8252 participants with eating disorders and investigated associations between maladaptive exercise (both lifetime and current) and ED pathology, illness duration, depression, anxiety, self-harm and suicidal ideation, and treatment seeking patterns in individuals with lifetime maladaptive exercise. Participants were included via the Swedish site of the large global study The Eating Disorders Genetics Initiative (EDGI) and completed measures of both lifetime and current symptomatology.

RESULTS

Results indicate that lifetime maladaptive exercise is associated with higher prevalence of lifetime depression and anxiety and with patients more often receiving treatment, although these results need to be investigated in future studies. Current maladaptive exercise was associated with more severe ED symptoms, and higher levels of depression, anxiety, obsessive-compulsive traits, and suicidal ideation.

CONCLUSIONS

Our findings point to the complexities of exercise as an eating disorder symptom and the need for clearly assessing and acknowledging this, as well as tailoring interventions to treat this symptom to achieve sustainable recovery.

Transdiagnosis of alcohol use and psychopathologies: A systematic review

Multiple diagnoses are the rule in Mental Health and alcohol use disorder (AUD) is a psychopathology with many comorbidities, requiring interventions that consider common factors, which means using a transdiagnostic perspective. This study aimed to identify in the scientific literature the main common transdiagnostic factors that link AUD to other psychopathologies in people over 18 years of age. A systematic review of the literature was carried out in the portals of the databases Pubmed, PsychINFO and CAPES. 37 articles were selected for analysis, which resulted in 25 transdiagnostic factors linked to AUD and to several other related disorders and health conditions. The results emphasize the variety of disorders and health conditions related to AUD, which highlights the importance of transdiagnostic factors for these conditions as targets for both scientific research and therapeutic interventions for this population.

The neurocognitive correlates of non-substance addictive behaviors

Neurocognitive deficits have been implicated as transdiagnostic risk markers of substance use disorders. However, these have yet to be comprehensively evaluated in other, non-substance addictions. In a large, general community sample (N = 475) the present study evaluated the neurocognitive correlates of problem alcohol use and three non-substance-related addictive behaviors: addictive eating (AE), problematic pornography use (PPU), and problematic use of the internet (PUI), to identify potential shared and distinct neurocognitive correlates. A sample of Australian residents (54.4 % female M[SD] age = 32.4[11.9] years) completed a comprehensive online assessment of neurocognitive tasks tapping into eight distinct expert-endorsed domains purportedly associated with addiction. Multiple linear regressions with bootstrapping were used to examine associations among each addictive behavior of interest and neurocognition, trait impulsivity, and compulsivity, as well as key covariates. Neurocognition was differentially associated with each addictive behavior. None of the neurocognitive domains were significantly associated with problematic alcohol use or AE (p >.05), poorer performance monitoring was significantly associated with higher levels of PPU and PUI (β = -0.10, p =.049; β = -0.09, p =.028), and a preference for delayed gratification was associated with more severe PUI (β = -0.10, p =.025). Our findings have theoretical implications for how we understand non-substance addiction and suggest the need for a more nuanced approach to studying addictive behaviors that take into account the underlying neurocognitive mechanisms associated with each type of addiction.

Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB)

INTRODUCTION

Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density.

METHOD AND ANALYSIS

This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

ETHICS AND DISSEMINATION

The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

TRIAL REGISTRATION NUMBER

NCT05587270.

Challenging inhibitory control with high- and low-calorie food: A behavioural and TMS study

Most people are often tempted by their impulses to "indulge" in high-calorie food, even if this behaviour is not consistent with their goal to control weight in the long term and might not be healthy. The outcome of this conflict is strongly dependent on inhibitory control. It has already been reported that individuals with weaker inhibitory control consume more high-calorie food, are more often unsuccessful dieters, overweight or obese compared to people with more effective inhibitory control. In the present study, we aimed at investigating inhibitory control in the context of human eating behaviour. A sample of 20 healthy normal-weight adults performed a 50% probability visual affective Go/NoGo task involving food (high- and low-calorie) and non-food images as stimuli. Single-pulse transcranial magnetic stimulation (TMS) was administered over the right primary motor cortex (M1) either 300 ms after image presentation to measure corticospinal excitability during the different stimulus categories or 300 ms after the appearance of a fixation point, as a control stimulation condition. The experimental session consisted of a food target and a non-food target block. Behavioural outcomes showed a natural implicit inclination towards high-calorie food in that participants were faster and more accurate compared to the other categories. This advantage was selectively deleted by TMS, which slowed down reaction times. MEPs did not differ according to the stimulus category, but, as expected, were bigger for Go compared to NoGo trials. Participants judged high-calorie food also as more appetising than low-calorie food images. Overall, our results point to a differential modulation when targeting inhibitory control, in favour of the more palatable food category (high-calorie). Present data suggest that the activity of the motor system is modulated by food nutritional value, being more engaged by appetising food. Future work should explore to what extent these processes are affected in patients with eating disorders and should aim to better characterise the related dynamics of cortical connectivity within the motor network.

The Relationship between Binge Drinking and Binge Eating in Adolescence and Youth: A Systematic Review and Meta-Analysis

Adolescence and youth are critical periods in which alcohol consumption is usually initiated, especially in the form of binge drinking. In recent years, it is increasingly common to find adolescents and young people who also present binge behaviors towards unhealthy food with the aim of alleviating their anxiety (emotional eating) and/or because of impulsive personality. Despite the social and health relevance of this issue, it remains scarcely studied and more preventive research needs to be developed. Our meta-analysis study aimed to evaluate the relationship and co-occurrence of both binge behaviors during adolescence and young adulthood to clarify the link between binge drinking and eating. Selective literature search on different online databases was performed. We identified discrete but significant results regarding the direct association between binge drinking and binge eating in correlation coefficients and odds ratio. Future research should focus on the common psychological background and motives behind these problematic behaviors owing to their clinical implications for effective prevention and treatment.

Benefits, Risks and Gender Differences in Sport, and Exercise Dependence: Key Role of Alexithymia

The literature has long highlighted the benefits of sport, but too much sport could indicate a dependence without a substance, namely exercise dependence. The literature has only recently investigated this issue and therefore several questions are open, particularly with regard to psychopathological significance and gender differences. The aim of this paper is to investigate whether young subjects (M = 20 years) with a risk of exercise dependency and non-dependent symptomatic display other behavioural and psychological suffering and discomforts, or whether such an investment in physical activity is compatible with a framework of relative well-being; and if there are differences related to gender. A total of 396 subjects were involved in this study. Exercise Dependence Scale, Toronto Alexithymia Scale, Subjective Happiness Scale, Satisfaction with Life Scale and an ad hoc questionnaire with information relating to the consumption of alcohol, soft and hard drugs, quality of sleep and nutrition, affective and friendship relationships, hobbies, presence of psychological or physical disorders, motivations for sporting activity, and any traumatic experiences were used. With regard to the Exercise Dependence Scale (EDS), the prevalence of subjects at risk of exercise dependence was 1.5% and that of non-dependents symptomatic was 31.3%. Considering only men, the percentage of subjects at risk of exercise dependence rose to 3% and that of non-dependents symptomatic to 47.9%. Our data support the hypothesis that the risk of exercise dependence and the symptomatic condition without dependence can occur in situations of relative well-being (happiness, satisfaction, relationships) without significant associations with other problematic behaviours. Modest consumption of soft drugs is reported in non-dependent symptomatic subjects. The hypothesis of increased levels of alexithymia is confirmed but limited to the male gender. Gender differences are confirmed in the frequency and motivation to practice sport and in the risk of dependence. It is important that the assessment of addiction risk is integrated with the assessment of alexithymia and personal and social resources over time.