Increased salivation to mirror exposure in women with binge eating disorder

One body, two faces: How double standards influence body evaluation in women with binge-eating disorder compared to mentally healthy women with higher weight and average weight

OBJECTIVE

Research has found evidence that women with anorexia nervosa (AN) and bulimia nervosa (BN) apply different standards for themselves than for others when evaluating bodies, an aspect of a disturbed body image. This study investigates whether women with binge-eating disorder (BED) likewise show self-deprecating double standards (DS).

METHODS

Women with BED (n = 40), women with higher weight (n = 40) and women with average weight (n = 40) viewed a presentation of different builds, including their individual ideal body, which were presented once with participants' own and once with an unknown woman's face. After each presentation, participants rated their emotional response regarding arousal and valence, and evaluated the body's attractiveness, body fat and muscle mass. DS were defined as the difference in ratings of the same body with one's own and the unknown face.

RESULTS

Women with BED showed a higher degree of negative emotions in response to a thin and a high-weight build, rated lower levels of body attractiveness for an athletic build, and displayed more arousal for almost all builds presented with their own compared to with another face. While women with BED showed a higher burden on measures of eating pathology and body image than the other groups, DS were not more pronounced in women with BED.

DISCUSSION

The findings contradict DS as a characteristic feature of BED, but underline "normative" DS for higher-weight/high-weight builds, reflecting weight stigmatization. Psychoeducation on these DS might complement cognitive-behavioral therapy in BED in order to reduce negative emotions.

PUBLIC SIGNIFICANCE

A bias in body evaluation has been proven in women with anorexia and BN, but no research has examined this in women with BED. This study provides evidence of DS in body evaluation in women with BED, compares the extent of DS between women with BED, higher weight, and average weight, and investigates individual body ideals in women with BED and higher weight.

Anodal stimulation of inhibitory control and craving in satiated restrained eaters

OBJECTIVES

Eating and weight disorders are severe and complex clinical conditions which, among other behaviors, include (attempts at) restrained eating, food avoidance, following dietary rules, and overeating. Comparable to women with obesity, restrained eaters (RE) without formal eating disorder diagnosis are worse at inhibiting their motor responses than unrestrained eaters (URE). According to neuroimaging studies, the right inferior frontal gyrus (rIFG) is involved in inhibitory control which, in turn, could be improved by neuromodulation such as anodal transcranial direct current stimulation (tDCS) across rIFG.

METHODS

This double-blind sham-controlled cross-over study was conducted after a standardized breakfast. Normal-weight female RE und URE performed a stop-signal task (SST) with food and non-food stimuli during sham or anodal tDCS. Food craving, hunger, and satiety were self-reported before and after tDCS. We employed a mixed between-subjects (group: RE vs. URE) and within-subjects factorial design (tDCS: anodal tDCS vs. sham; stimuli: food vs. control pictures).

RESULTS

Breakfast consumption was comparable for RE and URE, as well as craving, hunger, and thirst. Regarding inhibitory control, a significant two-way interaction between group and tDCS ermerged: RE had longer stop-signal reaction times (SSRTs) during sham tDCS, but they improved to the level of URE by application of anodal tDCS.

DISCUSSION

Results replicated an inhibitory control deficit in RE with longer SSRTs compared to URE without stimulation. During anodal tDCS to the rIFG, reduced SSRTs in RE indicated an improvement in inhibitory control. The findings suggest a specificity of rIFG stimulation in at-risk groups with regards to inhibitory control irrespective of craving.

Die Spiegelkonfrontationstherapie zur Behandlung von Körperbildstörungen bei Essstörungen – Evidenz, Wirkmechanismen und Vorgehensweise

Zusammenfassung. Körperbildprobleme sind ein Kernmerkmal von Essstörungen. Daher gilt eine Verbesserung des Körperbildes bei der Behandlung von Essstörungen als zentrales Therapieziel. Verschiedene empirische Befunde weisen auf die Spiegelkonfrontation als wirksame Methode zur Reduktion von Körperbildstörungen hin. Ziel dieses Übersichtsartikels ist es, den aktuellen Stand der wissenschaftlichen Literatur zum Thema Spiegelkonfrontationstherapie bei Essstörungen darzulegen. Insbesondere sollen die Wirksamkeitsstudien getrennt für nicht-klinische, körperunzufriedene Gruppen mit und ohne Übergewicht sowie die verschiedenen Essstörungsgruppen systematisiert und unterschiedliche Vorgehensweisen beschrieben werden. Der Übersichtsartikel liefert Hinweise dafür, dass die Spiegelkonfrontationstherapie bei Hochrisikogruppen mit erhöhter Körperunzufriedenheit sowie bei Essstörungen zu positiven Veränderungen hinsichtlich der kognitiv-affektiven und behavioralen Komponente des Körperbildes führt. Jedoch mangelt es insgesamt an randomisiert-kontrollierten Studien, die die Wirksamkeit der Spiegelkonfrontationstherapie mit ausreichend großen Stichproben gezielt untersuchen – vor allem bei der Anorexia nervosa. Der Übersichtsartikel schließt mit einer Diskussion über mögliche Wirkmechanismen, (Kontra–)‌Indikationen und einem Ausblick für zukünftige Forschung ab.

Body exposure, its forms of delivery and potentially associated working mechanisms: How to move the field forward

Background

Body image disturbance (BID) is a hallmark feature of eating disorders (EDs) and has proven to be involved in their etiology and maintenance. Therefore, the targeting of BID in treatment is crucial, and has been incorporated in various treatment manuals. One of the most common techniques in the treatment of BID is body exposure (BE), the confrontation with one’s own body. BE has been found to be effective in individuals with EDs or high body dissatisfaction. However, BE is applied in a multitude of ways, most of which are based on one or a combination of the hypothesized underlying working mechanisms, with no differential effectiveness known so far.

Method

The aim of this paper is to selectively review the main hypothesized working mechanisms of BE and their translation into therapeutic approaches.

Results and Conclusion

Specifically, we underline that studies are needed to pinpoint the proposed mechanisms and to develop an empirically informed theoretical model of BE. We provide a framework for future studies in order to identify working mechanisms and increase effectiveness of BE.

Cognitive-Emotional Involvement During Mirror Exposure Is Not Accompanied by Physiological Activation in Binge Eating Disorder

Body image interventions have been shown to reduce self-reported cognitive-emotional facets of body image disturbance in binge eating disorder (BED). However, more objective assessment methods are required to evaluate the effects of these interventions. Therefore, the present study aimed at investigating the usefulness of vocally encoded emotional arousal as physiological correlate of body dissatisfaction during mirror exposure in women with BED. Women with BED (n = 60) and weight-matched controls (CG; n = 60) participated in an experimental thought-sampling procedure including a mirror exposure and a control condition in a repeated-measures design. Fundamental frequency as a vocal correlate of emotional arousal as well as negative, neutral, and positive body-related cognitions during both conditions were analyzed. In line with our hypotheses, the BED group verbalized more negative, and less positive and neutral body-related cognitions during the mirror exposure condition compared to the CG. Contrary to our hypotheses, though, there was a stronger increase in physiological arousal between the control and the mirror exposure condition in the CG relative to the BED group. Furthermore, a significant negative correlation between fundamental frequency and the severity of cognitive-emotional body image disturbances emerged. The findings indicate a cognitive-emotional over-involvement with physical appearance during mirror exposure in women with BED compared to weight-matched controls in the absence of a corresponding physiological pattern. Results are discussed in terms of an impaired ability of women with BED to show adequate physiological responses to body-related stress. In addition, methodological recommendations for future research are presented.

Cue reactivity, habituation, and eating in the absence of hunger in children with loss of control eating and attention-deficit/hyperactivity disorder

OBJECTIVE

Childhood loss of control (LOC) eating and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid conditions and present with disordered eating behaviors, such as overeating. This study sought to delineate shared and specific abnormalities in physiological, cognitive-motivational, and behavioral components of food-specific impulsivity in children with LOC eating and ADHD. Specifically, children's reactivity and habituation to food and eating in the absence of hunger were examined.

METHODS

Within this community-based study, four groups of 8-13-year-old children with LOC eating (n = 24), ADHD (n = 32), comorbid LOC eating/ADHD (n = 9), and matched controls (n = 34) received a standard laboratory test meal to establish satiety and were then exposed to their favorite snack food in a cue exposure/reactivity trial, while salivation and desire to eat were repeatedly assessed. Subsequently, they were offered a variety of snack foods ad libitum.

RESULTS

Children with LOC eating, ADHD, and LOC/ADHD did not differ from controls in salivary reactivity and habituation to food cues. Children with LOC eating and ADHD showed greater cue reactivity of the desire to eat than controls, but groups did not differ in its longer-term increments. At free access, only children with LOC/ADHD consumed significantly more energy than controls. Longer-term increments of desire to eat predicted greater energy intake beyond LOC/ADHD group status.

DISCUSSION

Desire to eat among children with comorbid LOC eating and ADHD was associated with overeating in the absence of hunger, which may contribute to excess weight gain. Delineation of the specific features of childhood LOC eating versus ADHD warrants further study.

Different Facets of Body Image Disturbance in Binge Eating Disorder: A Review

The goal of the present review is to give an overview of the current findings on various facets of body image disturbance in Binge Eating Disorder such as body dissatisfaction, overconcern with weight and shape, body-related checking and avoidance behavior, misperception of body size, and body-related cognitive bias. In addition, treatments for a disturbed body image in BED and evidence of body image disturbance in youth with binge eating are reviewed. The results show that a disturbed body image in BED is present in the form of overconcern with weight and shape. Furthermore, there are hints that body dissatisfaction, as well as body-related checking and avoidance behavior, are also impaired. Research concerning misperception of body size in BED has been neglected so far, but first findings show that individuals with BED rate their own body shape rather accurately. Furthermore, there are first hints that body-related cognitive biases are present in individuals with BED. Moreover, in children and adolescents, there are first hints that body dissatisfaction, as well as shape and weight concerns, seem to be associated with loss of control and binge eating. Treatments aimed directly at the convertibility of a disturbed body image in BED have revealed encouraging outcomes. In conclusion, body image disturbance seems to occur in BED, and first studies show that it can be treated effectively.

Consumption Simulations Induce Salivation to Food Cues

Salivation to food cues is typically explained in terms of mere stimulus-response links. However, food cues seem to especially increase salivation when food is attractive, suggesting a more complex psychological process. Adopting a grounded cognition perspective, we suggest that perceiving a food triggers simulations of consuming it, especially when attractive. These simulations then induce salivation, which effectively prepares the body for eating the food. In two experiments, we systematically examined the role of simulations on salivation to food cues. As stimuli, both experiments used an attractive, a neutral, and a sour food, as well as a non-food control object. In Experiment 1, participants were instructed to simulate eating every object they would be exposed to. We then exposed them to each object separately. Salivation was assessed by having participants spit their saliva into a cup after one minute of exposure. In Experiment 2, we instructed half of participants to simulate eating each object, and half to merely look at them, while measuring salivation as in Experiment 1. Afterwards, participants rated their simulations and desire to eat for each object separately. As predicted, foods increased salivation compared to the non-food control object, especially when they were attractive or sour (Exp. 1 and 2). Importantly, attractive and sour foods especially increased salivation when instructed to simulate (Exp. 2). These findings suggest that consumption simulations play an important role in inducing salivary responses to food cues. We discuss directions for future research as well as the role of simulations for other appetitive processes.

Emotion regulation model in binge eating disorder and obesity--a systematic review

Deficits in emotion regulation processes are a common and widely used explanation for the development and maintenance of binge eating disorder (BED). It is assumed that BED patients - as they have difficulty regulating their negative emotions - use binge eating to cope with these emotions and to find relief. However, the number of experimental studies investigating this assumption is scarce and the differentiation of obese individuals with and without BED regarding the emotion regulation model is not verified. We reviewed literature for experimental studies investigating the emotion regulation model in obese patients (OB) with and without BED. Our search resulted in 18 experimental studies examining the triggering effect of negative emotions for binge eating or its effects on subsequent relief. We found evidence indicating that negative emotion serves as a trigger for binge eating in the BED group unlike the obese group without BED. Considering the small number of studies, we found evidence for a (short-term) improvement of mood through food intake, irrespective of group.