Psychometric evaluation of the behavioral inhibition/behavioral activation system scales and the sensitivity to punishment and sensitivity to reward questionnaire in a sample of eating disordered patients

Neural correlates of the revised reinforcement sensitivity theory: A cross-sectional structural neuroimaging study in middle-aged adults

The revised reinforcement sensitivity theory (RST) proposes that neurobiological systems control behavior: the fight-flight-freeze (FFFS) for avoidance of threat; behavioral approach/activation (BAS) for approach to rewards; and behavioral inhibition (BIS) for conflict resolution when avoidance and approach are possible. Neuroimaging studies have confirmed some theoretical associations between brain structures and the BAS and BIS; however, little representative population data are available for the FFFS. We investigated the neural correlates of the revised RST in a sample of 404 middle-aged adults (Mage = 47.18 (SD = 1.38); 54.5% female). Participants underwent structural magnetic resonance imaging and completed health questionnaires and the BIS/BAS/FFFS scales. We used multiple regression analyses to investigate the association between scale scores and volumes of a priori theoretically linked regions of interest while controlling for sex, age, intracranial volume, and cardio-metabolic variables; and conducted exploratory analyses on cortical thickness. The BIS was negatively associated with hippocampus laterality. At standard significance levels, the fear component of the FFFS was positively associated with anterior cingulate cortex; the BAS was positively associated with bilateral caudate; and the BIS was positively associated with posterior cingulate cortex volume. Furthermore, these neurobiological systems showed distinct patterns of association with cortical thickness though future work is needed. Our results showed that the neurobiological systems of the revised RST characterized in rodents can also be identified in the human brain.

Impulsivity and reward and punishment sensitivity among patients admitted to a specialized inpatient eating disorder treatment program

Introduction

Eating disorders (EDs) are conceptualized as disorders of under- and over-control, with impulsivity reflecting under-control. Extant research indicates that impulsivity and related factors such as reward sensitivity and punishment sensitivity may serve as trait-level transdiagnostic risk and/or maintenance factors in EDs. Findings on impulsivity and reward and punishment sensitivity by diagnosis are mixed and research on the relationship between these factors and ED symptoms, hospital course, and treatment outcomes is limited.

Methods

Participants (N = 228) were patients admitted to a specialized inpatient behavioral treatment program for EDs who agreed to participate in a longitudinal study and completed self-report measures of impulsivity, reward sensitivity, and punishment sensitivity at admission. Weight and ED symptomatology were measured at admission and discharge. Hospital course variables included length of stay and premature treatment dropout.

Results

Impulsivity was lower in individuals with anorexia nervosa (AN) restricting type compared to those with AN binge/purge type or bulimia nervosa; no other group differences were observed. Higher impulsivity was associated with greater bulimic symptoms on the Eating Disorder Inventory 2 (EDI-2) at admission. Impulsivity was not related to ED symptoms, weight outcomes, length of hospital stay, or treatment dropout at program discharge.

Conclusion

Impulsivity may help distinguish restrictive versus binge/purge EDs, but does not necessarily relate to discharge outcomes in an intensive inpatient ED program. Findings from this study provide novel contributions to the literature on personality traits in EDs and have important clinical implications. Results suggest that patients with higher levels of impulsivity or reward and punishment sensitivity can be expected to respond to inpatient treatment. Suggestions for future research are discussed.

Greater reliance on model-free learning in adolescent anorexia nervosa: An examination of dual-system reinforcement learning

Alterations in learning and decision-making systems are thought to contribute to core features of anorexia nervosa (AN), a psychiatric disorder characterized by persistent dietary restriction and weight loss. Instrumental learning theory identifies a dual-system of habit and goal-directed decision-making, linked to model-free and model-based reinforcement learning algorithms. Difficulty arbitrating between these systems, resulting in an over-reliance on one strategy over the other, has been implicated in compulsivity and extreme goal pursuit, both of which are observed in AN. Characterizing alterations in model-free and model-based systems, and their neural correlates, in AN may clarify mechanisms contributing to symptom heterogeneity (e.g., binge/purge symptoms). This study tested whether adolescents with restricting AN (AN-R; n = 36) and binge/purge AN (AN-BP; n = 20) differentially utilized model-based and model-free learning systems compared to a healthy control group (HC; n = 28) during a Markov two-step decision-making task under conditions of reward and punishment. Associations between model-free and model-based learning and resting-state functional connectivity between neural regions of interest, including orbitofrontal cortex (OFC), nucleus accumbens (NAcc), putamen, and sensory motor cortex (SMC) were examined. AN-R showed higher utilization of model-free learning compared to HC for reward, but attenuated model-free and model-based learning for punishment. In AN-R only, higher model-based learning was associated with stronger OFC-to-left NAcc functional connectivity, regions linked to goal-directed behavior. Greater utilization of model-free learning for reward in AN-R may differentiate this group, particularly during adolescence, and facilitate dietary restriction by prioritizing habitual control in rewarding contexts.

Relations of behavioral inhibition and activation system sensitivities with vaccination outcomes: Investigating the mediating role of vaccine hesitancy in older adults

The study of behavioral inhibition system (BIS) and behavioral activation system (BAS) sensitivities has produced a multitude of models and frameworks to better understand decision-making and behavior. We extend this research to the study of a vaccination by exploring the relation of BIS and BAS sensitivities with vaccination willingness, receipt, and word-of-mouth. We also assess whether dimensions of vaccine hesitancy mediate these relations, testing whether they are viable explanatory mechanisms. By conducting a multi-wave survey study, our results support that BIS sensitivity does not meaningfully relate to vaccine hesitancy or vaccination outcomes. On the other hand, BAS sensitivity related to detrimental vaccination outcomes, and these effects were mediated by vaccine hesitancy dimensions associated with perceptions that vaccines cause health risks and are not needed for healthy individuals. Based on extant BIS and BAS theory, these results suggest that certain people may see refraining from vaccination as a nonpunishment.

A New Measure of the Revised Reinforcement Sensitivity Theory

Abstract. The reinforcement sensitivity theory (RST) proposes that neurobiological systems mediate behavior and their functioning can be associated with personality. The functions and associations of RST systems were revised into fight–flight–freeze system (FFFS), behavioral approach/activation system (rBAS), and behavioral inhibition system (rBIS); however, there is limited study of the revised systems due to lack of validated measures. We investigated scale structure, sex invariance, and psychometric properties of the revised RST questionnaire (rRST-Q). The rRST-Q showed good fit as a 5-factor structure with free interfactor correlations and was sex invariant, and associations with personality and mental health measures were consistent with theory and literature. The rRST-Q is a reliable measure, and its use will help understand the link between brain, personality, and behavior.

Reward sensitivity, eating behavior, and obesity-related outcomes: A systematic review

INTRODUCTION

Previous research has identified reward sensitivity as an important factor that may contribute to the engagement in eating behavior (e.g., binge eating, emotional eating, etc.) and increase obesity risk. In the current study, we conducted a systematic review of the literature to determine the relationships between reward sensitivity, eating behavior, and obesity-related outcomes. The study focused on two commonly used measures of reward sensitivity in the literature: the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ) and the Behavioral Inhibition Scale/Behavioral Activation Scale (BIS/BAS Scale).

METHOD

We conducted a systematic search to identify studies that analyzed reward sensitivity as a predictor of eating behavior or obesity-related outcomes, and measured reward sensitivity using the SPSRQ or BIS/BAS Scale. The search yielded N=19 total publications included in the review.

RESULTS

Findings indicated that reward sensitivity, primarily measured by summary scores on the SPSRQ or BIS/BAS Scale, were positively associated with a variety of eating behaviors and obesity-related outcomes with small to moderate effect sizes. Findings were most consistent across studies that examined the association between reward sensitivity and eating behavior outcomes (e.g., binge eating, emotional eating) (r values= .08 to .41; p values < .001 to p < .05) and food consumption outcomes (e.g., palatable food intake) (r values = .21 to .40; p < .001 to p values < .05). Findings were less consistent for food craving and BMI outcomes, and revealed these relationships may depend on individual-level factors and/or environment-related factors, (e.g., food cues). A quality evaluation using the Critical Appraisal Tool for Cross-Sectional Studies (AXIS tool) indicated that most studies were rated as moderate to strong quality (84%).

CONCLUSION

Findings indicate that elevated reward sensitivity may be a risk factor for engagement in eating behaviors that may increase obesity risk.

Development and validation of a questionnaire assessing weighing tendencies: the Approach/Avoidance of Weighing Questionnaire (AAWQ)

Frequent weighing to assess shape and weight is common in eating disorders, as is going to great lengths to avoid knowledge of weight. However, few tools exist to measure these different weighing tendencies. This study reports on the development of a self-report measure of weighing tendencies using exploratory and confirmatory factor analysis (EFA; CFA). An EFA using 10 items identified 2 factors and indicated all items should be retained. Two CFAs in two independent samples indicated that a 2-factor, 6-item version fit reasonably well. The factors indicate the tendency to approach weighing and to avoid weighing. Additional evidence of convergent and discriminant validity is presented, covering a number of eating behaviors and relevant behavioral constructs. Findings suggest that individuals characterized by approach weighing tendencies may weight-check to reduce the anxiety and distress of not knowing their weights, and those characterized by avoidance may reduce the anxiety and distress of knowing their weights by avoiding weight-related information. This may have important clinical implications, as the feared stimulus for one group is uncertainty about their weights, whereas for the other, it is awareness of their weights, suggesting different treatment targets. Overall, the AAWQ appears to be a promising tool that may aid in examining weighing tendencies, in turn having the potential to aid in eating disorder cognitive-behavioral clinical case formulation and treatment planning.

Bridging Classical and Revised Reinforcement Sensitivity Theory Research: A Longitudinal Analysis of a Large Population Study

The reinforcement sensitivity theory (RST) proposes that neurobiological systems mediate protective and appetitive behaviours and the functioning of these systems is associated to personality traits. In this manner, the RST is a link between neuroscience, behaviour, and personality. The theory evolved to the present revised version describing three systems: fight-flight-freezing, behavioural approach/activation (BAS), and behavioural inhibition (BIS). However, the most widely available measure of the theory, the BIS/BAS scales, only investigates two systems. Using a large longitudinal community survey, we found that the BIS/BAS scales can be re-structured to investigate the three systems of the theory with a BIS scale, three BAS scales, and a separate fight-flight-freezing system (FFFS) scale. The re-structured scales were age, sex, and longitudinally invariant, and associations with personality and mental health measures followed theoretical expectations and previously published associations. The proposed framework can be used to investigate behavioural choices influencing physical and mental health and bridge historical with contemporary research.

The investigation of mechanisms underlying addictive behaviors: a case-control study

Background: The contradictory nature of behavioral addictions has sustained a nondefinitive debate regarding their construct validity. Objective(s): The current study aims at exploring mechanisms underlying two distinct classes of behaviors-behavioral addictions characterized by core alterations in reward processing systems (ARPS) and behaviors with a main function of maladaptive coping. Methods: This case-control study included 99 treatment-seeking individuals with a primary diagnosis of alcohol use disorder (male: N = 68; female: N = 31) and 74 healthy control (HC) subjects (male: N = 38; female: N = 36). The severity of maladaptive behaviors was measured through the Shorter PROMIS Questionnaire (SPQ). Latent mechanisms were assessed by the Disinhibition Domain of the Personality Inventory for DSM-5 (PID-5-DI) and the Acceptance and Action Questionnaire-II (AAQ-II). Results: The clinical group showed higher severity of behavioral addictions than HC. This difference was not replicated for the other class of maladaptive behaviors, except for compulsive buying. Ordinal regression analysis showed that the clinical group significantly predicted SPQ scores reflecting ARPS, SPQ shopping and starving subscales. This was not replicated for the overall SPQ score capturing maladaptive coping and binge eating behaviors. Controlling for PID-5-DI and AAQ-II scores, which were significantly associated to SPQ subscales, effects of the aforementioned clinical group were not significant. Conclusions: The study highlighted distinct and common mechanisms underlying different classes of maladaptive behaviors. Results supported future neuroscience research for clarifying the role of ARPS in compulsive sex and buying in order to consider them as addictive disorders.

Personality characteristics and medical impact of stimulant laxative abuse in eating disorder patients-a pilot study

BACKGROUND

Stimulant laxative abuse as a purging behavior can be profound in those with eating disorders. However, the psychopathology leading to stimulant laxative abuse is poorly understood. Furthermore, the medical impact of stimulant laxative abuse has not been studied in this population.

METHODS

Six individuals abusing stimulant laxatives underwent a barium enema to assess for evidence of the cathartic colon syndrome and 29 individuals engaging in any purging behaviors completed the Tri-dimensional Personality Questionnaire-Short Form, Sensitivity to Punishment/Sensitivity to Reward Questionnaire-Short Form, Beck Depression Inventory, and the State Trait Anxiety Inventory questionnaires.

RESULTS

Three of the six patients completing the barium enema had the radiographic findings consistent with cathartic colon. Individuals engaging in laxative abuse showed higher Novelty Seeking compared to those engaging in other forms of purging, and those engaging in any form of purging behavior showed greater Sensitivity to Punishment compared to Sensitivity to Reward. There was also the presence of greater Harm Avoidance than Reward Dependence in this population.

CONCLUSION

There may be different psychopathology that contributes to the abuse of stimulant laxatives than that associated with other forms of purging. Regardless of the driving factor, further research is warranted to discover best therapeutic interventions given the potential to develop the cathartic colon syndrome with ongoing use of stimulant laxatives. Cathartic colon is a condition whereby the colon, or lower intestine, is converted into an inert tube incapable of propagating fecal matter. It is thought to develop due to over-use of stimulant laxatives. However, it is unclear if this condition truly exists and whether it contributes to the constipation experienced by individuals with eating disorders who have extensive past histories of abusing laxatives. It is also unclear if laxative abuse presents with different medical complications than other forms of purging. The purpose of this study is to determine whether radiographic evidence of cathartic colon can be found in eating disorder patients abusing stimulant laxatives, whether there are different medical complications with laxative abuse versus other forms of purging, and to examine the psychological composition of individuals who engage in severe laxative abuse. Specifically, the authors investigated the interrelationship between Harm Avoidance and Reward Dependence, with emphasis on gaining a better understanding of Reward Dependence by examining both Sensitivity to Reward and Sensitivity to Punishment in patients who engage in severe laxative abuse. Our findings suggest that stimulant laxative abuse may cause the development of cathartic colon changes and that there may be unique psychopathology that contributes to the abuse of stimulant laxatives. Given the higher Novelty Seeking personality-dimension in those abusing laxatives, it is possible that this purging behavior may be considered addiction-like in nature, which would have distinct treatment implications.

Are Sensitivity to Punishment, Sensitivity to Reward and Effortful Control Transdiagnostic Mechanisms Underlying the Eating Disorder/Obesity Spectrum?

Although it has been postulated that eating disorders (EDs) and obesity form part of a broad spectrum of eating- and weight-related disorders, this has not yet been tested empirically. In the present study, we investigated interindividual differences in sensitivity to punishment, sensitivity to reward, and effortful control along the ED/obesity spectrum in women. We used data on 286 patients with eating disorders (44.6% AN-R, 24.12% AN-BP, and 31.82% BN), 126 healthy controls, and 640 Class II/III obese bariatric patients (32.81% Class II and 67.19% Class III) with and without binge eating. Participants completed the behavioral inhibition and behavioral activation scales, as well as the effortful control scale, to assess sensitivity to punishment and reward and effortful control. Results showed that patients with EDs scored significantly higher on punishment sensitivity (anxiety) compared to healthy controls and Class II/III obese patients; the different groups did not differ significantly on reward sensitivity. Patients with binge eating or compensatory behaviors scored significantly lower on effortful control than patients without binge eating. Differences in temperamental profiles along the ED/obesity spectrum appear continuous and gradual rather than categorical. This implies that it may be meaningful to include emotion regulation and impulse regulation training in the treatment of both EDs and obesity.

From BIS to binge: The role of negative affect in the pathway between personality and binge eating

Recent research has highlighted the utility of using revised Reinforcement Sensitivity Theory (RST) to further understand the individual differences that influence binge eating behaviours. The current study draws on both RST and theoretical models that implicate negative affect in binge eating, with the aim of identifying indirect pathways between individual differences in RST systems and binge eating as mediated through negative affect. Undergraduate students (n = 229, M = 22.67 years of age, SD = 8.95, 76% female) completed self-report measures of revised reinforcement sensitivities, negative affect and binge eating symptoms. Bootstrapped tests of indirect effects showed that negative affect mediated the pathway between the Behavioural Inhibition System (BIS) and binge eating symptoms. Additionally, negative affect mediated the pathway between rash impulsivity and binge eating symptoms. This study supports and extends previous research by highlighting the experience of negative affect as a possible mechanism through which heightened BIS and rash impulsivity leads to binge eating.

Measuring Behavioral Inhibition and Behavioral Activation in Older Adults: Construct Validity of the Dutch BIS/BAS Scales

Research on the validity of the behavioral inhibition system/behavioral approach system (BIS/BAS) scales focused on adolescent, student and adult populations. This study is the first to examine the psychometric properties of the BIS/BAS scales in a community (n = 368) and a clinical sample (n = 160) of older adults. Exploratory structural equation modelling with target rotation to the Carver and White model supported the construct validity of the BIS/BAS scales. Internal consistencies of the scales were generally satisfactory. Female participants scored higher on BIS and BAS-Reward Responsiveness compared with males. The community-dwelling sample scored higher on BAS-Drive and BAS-Reward Responsiveness compared with the clinical sample. Concerning the nomological net, BIS was positively related to Anxiety, Depression, maladaptive coping strategies, Neuroticism and Cluster C personality disorders. BAS was positively related to Openness, Extraversion, Active Confronting and Cluster B personality disorders and negatively related to the schizoid personality disorder. The BIS/BAS Scales are a useful instrument for measuring Gray's theory of personality in older adults.

Clarifying Problems in Behavioural Control: Interface, Lateness and Consciousness

The target paper highlights a number of unresolved issues that, I believe, continue to impede the construction of a viable model of behavioural control in personality psychology; namely, (a) the relationship between controlled and automatic processing (the ‘interface’ problem’) and (b) the time it takes for controlled processes, including consciousness, to be generated (the ‘lateness’ problem). The diversity of views expressed in the commentatories indicates that these are, indeed, real and unresolved problems. This response is structured around the following key questions. (1) How long–term goal planning interfaces with the automatic machinery of behaviour? (2) The extent of the impact of the ‘lateness’ of controlled (including conscious) processes for building models of behavioural control? (3) How best to characterise the personality traits associated with the FFFS, BIS and BAS? (4) How does the BIS control mismatch detection, the generation of error signals, and response inhibition and switching? (5) Is consciousness really a necessary explanatory construct in models of behavioural control? (6) Might neural ‘crosstalk’ of encapsulated action–goal response systems point to the functional significance of consciousness? (7) What are the implications of issues raised in the target paper for lexical and social–cognitive approaches to personality? I conclude by re–iterating the importance of the problems of ‘lateness’ and ‘interface’ for the construction of a viable model of behavioural control sufficient for the fostering of theoretical integration within personality psychology as well as affording the building of conceptual bridges with general psychology. Copyright © 2010 John Wiley & Sons, Ltd.

Non-Suicidal Self-Injury and Pathological Buying in Community Adults and Patients with Eating Disorders: Associations with Reactive and Regulative Temperament

The present study investigated the (co-)occurrence of non-suicidal self-injury (NSSI) and pathological buying (PB) and their associations with reactive/regulative temperament in a sample of female patients with eating disorders (ED) and in a sample of community adults. Our samples consisted of 254 community adults (48.8% female) and 60 female patients with ED. All participants filled out self-report questionnaires to assess NSSI, PB, and reactive/regulative temperament. Prevalence rates of NSSI and PB were respectively 14.5% and 4.8% for community women, 13.1% and 1.5% for community men, and 36.7% and 10% for female patients with ED. Only for community women, NSSI was positively related to PB. NSSI was negatively related to self-regulation in community men and women. Additionally, NSSI was negatively predicted by BAS reactivity in the clinical sample and by the interaction of BAS reactivity and self-regulation in community men. PB was predicted by low self-regulation in the three groups. Additionally, PB was positively predicted by BAS reactivity and by the interaction of BAS reactivity and self-regulation in community women. These findings indicated group differences in the (co-)occurrence of NSSI and PB and in their associations with underlying temperamental characteristics between individuals with and without ED.

Development and Validation of a Short Version of the Reinforcement Sensitivity Theory of Personality Questionnaire (RST-PQ-S)

We conducted three studies (total n = 998) aimed at developing and validating a shortened version of the Reinforcement Sensitivity Theory of Personality Questionnaire (i.e., the RST-PQ-S). In Study 1 (n = 341), twenty-two items were selected from the original RST-PQ, based on both theoretical and empirical criteria. Confirmatory factor analysis (CFA) on this short-form supported the six-factor structure comprising: FFFS, BIS, and four BAS components (Reward Interest, Goal Drive-Persistence, Reward Reactivity, and Impulsivity). The six scale scores showed adequate levels of internal consistency. Construct validity was supported by correlations with established personality measures. In Study 2 (n = 340), CFA results were cross-validated in an independent sample and construct validity was supported by correlations with BIS/BAS scales. In Study 3 (n = 317) test-retest correlations showed acceptable-to-good levels of temporal stability over a four-week interval. Results revealed a substantial overlap with original, full-length RST-PQ, providing evidence for the comparability of the two versions. Latent State-Trait analyses showed that the items of the RST-PQ-S mostly capture interindividual differences that are stable across situations. Taken together, findings indicate that the RST-PQ-S provides an efficient, valid and reliable alterative to the longer RST-PQ.

Application of the Chinese Version of the BIS/BAS Scales in Participants With a Substance Use Disorder: An Analysis of Psychometric Properties and Comparison With Community Residents

Carver and White developed the Behavioral Inhibition/Behavioral Activation Scales (the BIS/BAS Scales) based on Reinforcement Sensitivity Theory proposed by Gray. Subsequent studies proposed that substance abuse was closely related to Behavioral Inhibition System (BIS) and Behavioral Activation System (BAS). However, researches on the psychometric properties of the BIS/BAS scales in clinical samples are scarce. The present study was conducted to analyze the applicability of the BIS/BAS scales in a sample suffering from a substance use disorder (SUD) and undergoing treatment in compulsory detoxification institutions (n = 1117). Meanwhile, 822 community residents were selected for comparison. Confirmatory factor analysis was carried out to examine the construct validity and the results showed that the five-factor model was the best fit for people with a substance use disorder' data. Besides, Cronbach's alpha coefficient for the total scale was 0.808, indicating the satisfactory internal consistency reliability. Analysis of the correlation coefficient of the questionnaire with the corresponding personality traits showed that BAS was more associated with the impulsive trait. Surprisingly, participants with a substance use disorder showed more insensitivity for the reward dimension compared with that of community residents and the result of comparison between two samples supported joint subsystems hypothesis. Generally, the BIS/BAS scales showed good reliability and validity. These findings provide more direct evidence on the personality traits of people with a substance use disorder and should form the basis for further research.

Evidence for a general factor of behavioral activation system sensitivity

Individual differences in one's propensity to engage the behavioral activation system (BAS) and behavioral inhibition system (BIS) have primarily been studied with Caver and White's (1994) BIS/BAS scale. Whereas, Carver and White identified the BIS as a unidimensional scale, they identified three separable BAS group factors - drive, fun seeking, and reward responsiveness -which Carver urged against combining into a BAS total score. Despite this, a BAS total score has been used extensively although researchers have yet to test whether a BAS general factor exists and, if so, whether a BAS total score can be interpreted as primarily being a measure of the general factor. The current study observed that the best fitting BAS factor model of those we tested was a hierarchical model with three group facets and a general factor. This model was largely invariant across both sex and race/ethnicity. We show, for the first time, that a general factor accounts for the majority of the variance in BAS total scores. Due to the superior fit of the hierarchical model and variance accounted for by the general factor, we conclude that researchers are psychometrically justified in using a BAS total score.

Effect of behavioral inhibition system and childhood emotional neglect on serotonergic activity, negative affect, and rejection sensitivity in non-clinical adults

Introduction

Behavioral inhibition system (BIS) has a strong genetic basis, and emotional neglect (EN) in childhood is one of many environmental experiences that can affect individuals. This study aimed to examine the effects and interaction between BIS and EN on central serotonergic activity and other negative affect and cognition.

Methods

A total of 153 non-clinical volunteers (54 men and 99 women; average age, 27.72 years, standard deviation = 6.40) were included in the analyses. The Behavioral Inhibition System scale, Childhood Trauma Questionnaire, and negative affect and cognition (Beck Depression Inventory, State-Trait Anxiety Inventory, and Rejection Sensitivity Questionnaire) were measured. As a biomarker of central serotonergic activity, the loudness dependence of auditory evoked potentials was measured.

Results

High EN was associated with higher loudness dependence of auditory evoked potential (LDAEP) levels and low EN was associated with lower LDAEP levels in high BIS people only. People with high EN people showed significantly higher levels of depression and state anxiety than did those with low EN. Moreover, of people with low BIS, those who had more EN experience had higher levels of rejection sensitivity than did those with less EN experience, while people with high BIS did not show different patterns of rejection sensitivity regardless of the difference of EN.

Conclusions

This study revealed different effects on physiological (loudness dependence of auditory evoked potentials), intrapersonal (depression and state anxiety), and interpersonal aspects (rejection sensitivity) based on the interaction of BIS and EN. Our results suggest that the physiological and interpersonal aspects, but not the intrapersonal aspect, are significantly influenced by the interactive effect of BIS and EN.

Should I stay or should I go? Approach/avoidance conflict and emotional functioning

Personality has long held a prevalent place in the pantheon of psychological research. In the last 40 years, neuropsychological models of personality have become a popular predictor of human behaviour and emotionality. With a particular focus on Gray's Reinforcement Sensitivity Theory, this study investigated the interaction of high Behavioural Activation System (BAS) and Behavioural Inhibition System (BIS) as a predictor of emotional functioning. Participants (n = 499) recruited from the community completed an online survey composed of questions on demographic information, behavioural inhibition and activation, emotional instability and indices of depression, anxiety and mixed depression-anxiety. Consistent with our primary hypothesis, the interaction of high BAS × BIS predicted emotional instability using an observed variable path model. This was subsequently associated with depression, anxiety and mixed depression-anxiety symptoms. Future avenues for research using BIS/BAS monitoring in clinical practice and study limitations are discussed. © 2018 John Wiley & Sons, Ltd.

Similarities and differences in revised reinforcement sensitivities across eating disorder subtypes

Reinforcement Sensitivity Theory has been used to investigate personality in the development and maintenance of disordered eating. However, the vast majority of research from this perspective has been limited by the use of measures developed to assess the original theory, rather than the significantly revised theory, potentially overlooking key personality differences in eating disorder subtypes. The current study aimed to overcome limitations when using measures based on the original theory by investigating differences and similarities in reinforcement sensitivity across eating disorder subtypes and healthy controls. The measure based on the revised theory assesses i) reward sensitivity [goal-drive persistence; reward interest, reward reactivity], ii) impulsivity, iii) behavioural inhibition, and iv) threat sensitivity. A total of 374 women from the community participated, including those with a past or present AN-R diagnosis (AN-R = 109); those with a past or present binge-type ED (Binge-type = 132); and healthy controls (HC = 133). Participants completed a questionnaire assessing personality, eating disorder symptoms, and past or present eating disorder diagnoses. Results showed that both the AN-R and Binge-type groups were higher in behavioural inhibition and threat sensitivity compared to the HC group. The Binge-type group showed higher impulsivity relative to the AN-R and HC group, and lower Goal-Drive Persistence relative to the HC group. The AN-R group showed lower Reward Interest and Reward Responsiveness relative to the HC group. This study supports and extends previous research with the findings of heightened threat and anxiety sensitivity in those with diagnosed eating disorders. Additionally, among those with a past or present eating disorder, the findings implicate impulsivity in differentiating bingeing versus restricting subtypes.

Examining associations among sensitivity to punishment and reward, shame, and eating pathology through tests of mediation

This study investigated associations between sensitivity to punishment and reward, shame, and eating pathology by testing alternative mediation models in which shame mediated associations between temperament and eating pathology or eating pathology mediated associations between temperament and shame. Participants were 96 female undergraduate students who completed questionnaires. Results indicated shame fully mediated the relationship between sensitivity to punishment and eating pathology. Further, eating pathology did not mediate the association between sensitivity to punishment and shame. In contrast, for sensitivity to reward, shame fully mediated the relationship between sensitivity to reward and eating pathology, and eating pathology fully mediated the relationship between sensitivity to reward and shame. If associations are supported by longitudinal research, results suggest that it may be valuable to develop prevention approaches targeting shame to reduce risk for the development of eating pathology for those who are high in sensitivity to punishment. For those higher in sensitivity to reward, interventions targeting shame may reduce risk for eating pathology and those targeting eating pathology may reduce shame.

Social reward and social punishment sensitivity in relation to dietary restraint and binge/purge symptoms

Disordered eating symptoms are associated with disrupted sensitivity to reward and punishment, broadly assessed. However, it is unknown how eating pathology is related to sensitivity to social reward and social punishment specifically. Drawing on Reinforcement Sensitivity Theory, the current study utilized a multi-method design to test whether disordered eating symptoms, specifically dietary restraint (DR) and binge/purge (BP), were similarly or uniquely related to sensitivity to social punishment and social reward. Female university students (N = 110, M = 18.66, SD = 0.89) completed self-report measures and a novel behavioral task measuring willingness to work for or to avoid social feedback. DR and BP symptoms were related to increased self-reported and behavioral sensitivity to social punishment, yet only when symptoms were tested in isolation. DR was associated with increased sensitivity to social reward across self-report and behavioral paradigms. BP symptoms were uniquely and positively related to self-reported sensitivity to social reward, but decreased behavioral sensitivity to social reward. Findings suggest that sensitivity to punishment may be a common factor related to DR and BP, whereas sensitivity to social reward may be a key factor differentiating disordered eating symptoms.

Attachment and motivational systems: Relevance of sensitivity to punishment for eating disorder psychopathology

An altered balance of reward and inhibition systems may explain Eating Disorder (ED) behaviors and could be related to difficulties in socio-emotional processing. According to attachment theory, early interaction with caregivers affects the ability to regulate emotion in adult interpersonal situation. The aim of our study was to investigate if insecure attachment may be related to ED symptomatology through changes in reward and inhibition systems. Seventy-eight people affected by EDs and 45 healthy controls (HC) filled in the Attachment Style Questionnaire (ASQ), the Behavioral Inhibition System-Behavioral Activation System Scale (BIS-BAS) and the Eating Disorders Inventory-2 (EDI-2) questionnaire. ED people reported significantly higher scores than HC in EDI-2 scores, all dimensions of insecure attachment style and sensitivity to punishment (BIS score). In ED patients, ASQ anxiety scores correlated with almost all EDI-2 subscores and sensitivity to punishment. The association between anxious attachment style and ED symptomatology (drive to thinness and body dissatisfaction) was totally mediated by an indirect effect of sensitivity to punishment. These findings suggest, for the first time, increased sensitivity to punishment as a pathway that may explain the relationship between anxious attachment and ED symptomatology highlighting the relevance to target social experiences as an important psychotherapeutic focus.

Parent-Reported BIS/BAS Scales for Children: Factor Structure and Measurement Invariance Across Age and Gender

The present study examined the factor structure and measurement invariance of the Behavioral Inhibition System/Behavioral Approach System (BIS/BAS) scales parent-report in children and adolescents ( N = 1,444, 58% girls) across age (Group 1, 2-5 years; Group 2, 6-9 years; Group 3, 10-13 years; Group 4, 14-18 years old) and gender. The results consistently underscored a four-factor structure, resembling the original factor structure, with one BIS-factor and three BAS-factors. Multigroup confirmatory factor analysis showed full measurement invariance across gender as well as across Group 1 and 2, and Group 2 and 3. Strong measurement invariance was found across Group 3 and 4, Group 1 and 3, and Group 2 and 4. Configural and metric invariance was found across Group 1 and 4. Hence, mean-level BIS/BAS scores can be compared across gender and age although comparison between preschool children (Group 1) and late secondary school children (Group 4) should be done with caution.

Toward an Empirical Multidimensional Structure of Anhedonia, Reward Sensitivity, and Positive Emotionality: An Exploratory Factor Analytic Study

Positive emotionality, anhedonia, and reward sensitivity share motivational and experiential elements of approach motivation and pleasure. Earlier work has examined the interrelationships among these constructs from measures of extraversion. More recently, the Research Domain Criteria introduced the Positive Valence Systems as a primary dimension to better understand psychopathology. However, the suggested measures tapping this construct have not yet been integrated within the structural framework of personality, even at the level of self-report. Thus, this study conducted exploratory factor and exploratory bifactor analyses on 17 different dimensions relevant to approach motivation, spanning anhedonia, behavioral activation system functioning, and positive emotionality. Convergent validity of these dimensions is tested by examining associations with depressive symptoms. Relying on multiple indices of fit, our preferred model included a general factor along with specific factors of affiliation, positive emotion, assertiveness, and pleasure seeking. These factors demonstrated different patterns of association with depressive symptoms. We discuss the plausibility of this model and highlight important future directions for work on the structure of a broad Positive Valence Systems construct.

Attachment Insecurity Predicts Punishment Sensitivity in Anorexia Nervosa

Individuals with anorexia nervosa (AN) experience insecure attachment. We investigated whether insecure attachment is associated with punishment and reward sensitivity in women with AN. Women with AN (n = 24) and comparison women (n = 26) (CW) completed The Eating Disorder Examination Questionnaire, Depression Anxiety Stress Scale, The Attachment Style Questionnaire, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire. Participants with AN returned higher ratings for insecure attachment (anxious and avoidant) experiences and greater sensitivity to punishment (p = 0.001) than CW. In AN, sensitivity to punishment was positively correlated with anxious attachment and negative emotionality but not eating disorder symptoms. Regression analysis revealed that anxious attachment independently predicted punishment sensitivity in AN. Anxious attachment experiences are related to punishment sensitivity in AN, independent of negative emotionality and eating disorder symptoms. Results support ongoing investigation of the contribution of attachment experiences in treatment and recovery.

A Comparison of Reinforcement Sensitivity Theory Measures: Unique Associations With Social Interaction Anxiety and Social Observation Anxiety

Evidence suggests that the behavior inhibition system (BIS) and fight-flight-freeze system play a role in the individual differences seen in social anxiety disorder; however, findings concerning the role of the behavior approach system (BAS) have been mixed. To date, the role of revised reinforcement sensitivity theory (RST) subsystems underlying social anxiety has been measured with scales designed for the original RST. This study examined how the BIS, BAS, and fight, flight, freeze components of the fight-flight-freeze system uniquely relate to social interaction anxiety and social observation anxiety using both a measure specifically designed for the revised RST and a commonly used original RST measure. Comparison of regression analyses with the Jackson-5 and the commonly used BIS/BAS Scales revealed important differences in the relationships between RST subsystems and social anxiety depending on how RST was assessed. Limitations and future directions for revised RST measurement are discussed.

Food Approach and Food Avoidance in Young Children: Relation with Reward Sensitivity and Punishment Sensitivity

It has recently been suggested that individual differences in Reward Sensitivity and Punishment Sensitivity may determine how children respond to food. These temperamental traits reflect activity in two basic brain systems that respond to rewarding and punishing stimuli, respectively, with approach and avoidance. Via parent-report questionnaires, we investigate the associations of the general motivational temperamental traits Reward Sensitivity and Punishment Sensitivity with Food Approach and Food Avoidance in 98 preschool children. Consistent with the conceptualization of Reward Sensitivity in terms of approach behavior and Punishment Sensitivity in terms of avoidance behavior, Reward Sensitivity was positively related to Food Approach, while Punishment Sensitivity was positively related to Food Avoidance. Future research should integrate these perspectives (i.e., general temperamental traits Reward Sensitivity and Punishment Sensitivity, and Food Approach and Avoidance) to get a better understanding of eating behavior and related body weight.

Internet addiction and problematic Internet use: A systematic review of clinical research

AIM

To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science.

METHODS

Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally.

RESULTS

The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment.

CONCLUSION

A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.

Factor structure and psychometric properties of a French and German shortened version of the Behavioural Inhibition System/Behavioural Activation System scales

The Behavioural Inhibition System/Behavioural Activation System scales (BIS/BAS scales) constitute one of the most prominent questionnaires to assess individual differences in sensitivity to punishment and reward. However, some studies questioned its validity, especially that of the French and German translations. The aim of the present study was to re-evaluate the psychometric characteristics of the BIS/BAS scales in a large sample of French- and German-speaking young Swiss men (N = 5872). Results showed that factor structures previously found in the literature did not meet the standards of fit. Nine items had to be removed to achieve adequate fit statistics in confirmatory factor analysis, yielding a shortened version with four factors: one BIS factor comprising five items and three BAS factors, namely Reward Reactivity, Drive and Fun Seeking, each comprising two items. Convergent validity and group invariance analyses suggest that the shortened BIS/BAS scales constitute a valid and reliable instrument. Researchers interested in assessing individual differences in BIS and BAS reactivity in French- and German-speaking individuals should avoid using the BIS/BAS scales as originally specified. The shortened version may be a sound alternative at least in samples of young adults. Its shorter format may be particularly suited for surveys with constraints on questionnaire length.

Gender differences in the relationship between impulsivity and disordered eating behaviors and attitudes

OBJECTIVE

We investigated relationships among gender, impulsivity and disordered eating in healthy college students.

METHOD

Participants (N=1223) were healthy, undergraduate men (28.5%) and women (71.5%), who completed the Barratt Impulsiveness Scale - Version 11 (BIS-11) and a four-factor version of the Eating Attitudes Test (EAT-16).

RESULTS

As predicted, mean scores on all four EAT-16 factors were significantly higher for women than for men. Attentional impulsivity was related to poorer self-perception of body shape, more dieting, and a greater preoccupation with food for the sample as a whole. Moreover, motor impulsivity was related to poorer self-perceptions of body shape and a greater preoccupation with food. However, no gender differences emerged in the relationship between impulsivity and disordered eating attitudes.

DISCUSSION

This study elucidates the role of impulsivity in disordered eating behaviors among non-clinical college students. For both women and men, attentional and motor impulsivity were related to disordered eating attitudes and behaviors. Overall, these findings suggest that different facets of impulsivity are related to disordered eating attitudes and behaviors in a non-clinical college population.

Abnormal Social Reward Responses in Anorexia Nervosa: An fMRI Study

Patients with anorexia nervosa (AN) display impaired social interactions, implicated in the development and prognosis of the disorder. Importantly, social behavior is modulated by reward-based processes, and dysfunctional at-brain-level reward responses have been involved in AN neurobiological models. However, no prior evidence exists of whether these neural alterations would be equally present in social contexts. In this study, we conducted a cross-sectional social-judgment functional magnetic resonance imaging (fMRI) study of 20 restrictive-subtype AN patients and 20 matched healthy controls. Brain activity during acceptance and rejection was investigated and correlated with severity measures (Eating Disorder Inventory -EDI-2) and with personality traits of interest known to modulate social behavior (The Sensitivity to Punishment and Sensitivity to Reward Questionnaire). Patients showed hypoactivation of the dorsomedial prefrontal cortex (DMPFC) during social acceptance and hyperactivation of visual areas during social rejection. Ventral striatum activation during rejection was positively correlated in patients with clinical severity scores. During acceptance, activation of the frontal opercula-anterior insula and dorsomedial/dorsolateral prefrontal cortices was differentially associated with reward sensitivity between groups. These results suggest an abnormal motivational drive for social stimuli, and involve overlapping social cognition and reward systems leading to a disruption of adaptive responses in the processing of social reward. The specific association of reward-related regions with clinical and psychometric measures suggests the putative involvement of reward structures in the maintenance of pathological behaviors in AN.

Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature

Several existing conceptual models and psychological interventions address or emphasize the role of emotion dysregulation in eating disorders. The current article uses Gratz and Roemer's (2004) multidimensional model of emotion regulation and dysregulation as a clinically relevant framework to review the extant literature on emotion dysregulation in anorexia nervosa (AN) and bulimia nervosa (BN). Specifically, the dimensions reviewed include: (1) the flexible use of adaptive and situationally appropriate strategies to modulate the duration and/or intensity of emotional responses, (2) the ability to successfully inhibit impulsive behavior and maintain goal-directed behavior in the context of emotional distress, (3) awareness, clarity, and acceptance of emotional states, and (4) the willingness to experience emotional distress in the pursuit of meaningful activities. The current review suggests that both AN and BN are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders. The review concludes with a discussion of the clinical implications of the findings, as well as a summary of limitations of the existing empirical literature and suggestions for future research.

Temperamental differences between adolescents and young adults with or without an eating disorder

OBJECTIVE

There is an increasing interest into the role of temperament, and more specifically the traits Sensitivity to Punishment (SP) and Sensitivity to Reward (SR), in the occurrence of eating disorder (ED) symptoms. However, the results on this topic are inconsistent, different instruments are used to measure SP and SR and there is a lack of research on adolescents and young adults, although they form a group at risk to develop an ED. Therefore, the present objective was to study personality profiles co-occurring with specific EDs in adolescents and young adults.

METHOD

The present study examined the levels of SP and SR for different ED-diagnoses, namely Anorexia Nervosa of the Restricting type (AN-R; n=41), Anorexia Nervosa of the Binge/Purge type (AN-B/P; n=20) and Bulimia Nervosa (BN; n=30), and compared these with a Healthy Control group (HC; n=292). SP and SR were measured by three different temperament questionnaires in order to rule out instrument-specific findings. Only female participants between the age of 14 and 25 years were included.

RESULTS

SP was transdiagnostically increased compared to HCs, whereas SR was lower in AN-R patients compared to BN patients. These results were independent of the questionnaire being used.

DISCUSSION

Further research is necessary to explain how these traits may influence specific ED-symptoms.

Personality profiles in Eating Disorders: further evidence of the clinical utility of examining subtypes based on temperament

Despite recent modifications to the DSM-V diagnostic criteria for Eating Disorders (ED; American Psychiatric Association, 2013), sources of variability in the clinical presentation of ED patients remain poorly understood. Consistent with previous research that has used underlying personality dimensions to identify distinct subgroups of ED patients, the present study examined (1) whether we could identify clinically meaningful subgroups of patients based on temperamental factors including Behavioral Inhibition (BIS), Behavioral Activation (BAS) and Effortful Control (EC), and (2) whether the identified subgroups would also differ with respect to ED, Axis-I and Axis-II psychopathology. One hundred and forty five ED inpatients participated in this study. Results of a k-means analysis identified three distinct groups of patients: an Overcontrolled/Inhibited group (n=53), an Undercontrolled/Dysregulated group (n=58) and a Resilient group (n=34). Further, group comparisons revealed that patients in the Undercontrolled/Dysregulated group demonstrated more severe symptoms of bulimia, hostility and Cluster B Personality Disorders compared to the other groups, while patients in the Resilient group demonstrated the least severe psychopathology. These findings have important implications for understanding how individual differences in personality may impact patterns of ED symptoms and co-occurring psychopathology in patients with ED.

Clarifying the measurement and the role of the behavioral inhibition system in alcohol misuse

BACKGROUND

In response to conflicting reward (Behavioral Approach System [BAS]) and/or punishment cues (Fight-Flight-Freeze System [FFFS]) the Behavioral Inhibition System (BIS) inhibits behavior, leading to increased attention to threat, high anxiety, and behavioral ambivalence. The role of BIS in alcohol misuse is complex, as anxiety promotes self-medication drinking, while attention to threat (e.g., negative outcomes of heavy drinking) may reduce risk. Theory suggests that a concurrent strong BAS may bias BIS-conflict in favor of alcohol approach, while a concurrent strong FFFS may increase the likelihood of alcohol avoidance. However, few studies measure BIS as a conflict system, and no studies incorporate such a measure into examinations of alcohol misuse. Our study goals were to (i) test the Motivational Flanker Task (MFT) as a new laboratory measure of the BIS, BAS, and FFFS; and (ii) use the MFT, in conjunction with self-report measures, to test BAS and FFFS as moderators of the BIS-alcohol misuse relation. We hypothesized that an elevated BIS would predict heavy drinking and alcohol-related problems, but only when BAS was high. Further, we expected an elevated BIS to be associated with reduced alcohol misuse, but only when FFFS was high.

METHODS

Students (N = 198) completed self-reports of BIS/BAS/FFFS and drinking behavior, and 2 reaction time tasks: MFT and Point Scoring Reaction Time Task (PSRTT). The PSRTT is a published measure of the revised BIS.

RESULTS

MFT BIS conflict was associated with self-report and PSRTT measures. MFT BAS, but not FFFS, was associated with self-reports. As expected, elevated BIS was associated with heavy drinking, but only when BAS-Drive and BAS-Fun Seeking was also high. FFFS was not supported as a moderator of the BIS-alcohol misuse association.

CONCLUSIONS

Results support the MFT as a promising measure of the revised BIS. Considering the joint effects of BIS and BAS clarified risk for alcohol misuse.

Too strict or too loose? Perfectionism and impulsivity: the relation with eating disorder symptoms using a person-centered approach

Although both perfectionism (i.e. personal standards perfectionism and evaluative concerns perfectionism) and impulsivity have been shown to be implicated in eating disorders, no previous studies have examined the interplay between both personality dimensions in their association with eating disorder symptoms. This is the first study to investigate the relationship between empirically derived personality subtypes based on perfectionism and impulsivity and eating disorder symptoms (i.e., dietary restraint, and concerns over eating, weight and shape). Cluster analysis was used to establish naturally occurring combinations of perfectionism and impulsivity in adolescent boys and girls (N=460; M age=14.2 years, SD=.90). Evidence was obtained for four personality profiles: (1) a resilient subtype (low on perfectionism and impulsivity), (2) pure impulsivity subtype (high on impulsivity only), (3) pure perfectionism subtype (high on perfectionism only), and (4) combined perfectionism/impulsivity subtype (high on both perfectionism and impulsivity). Participants in these four clusters showed differences in terms of eating disorder symptoms in that participants with a combination of high perfectionism and high impulsivity (rather than the presence of one of these two characteristics alone) had the highest levels of ED symptoms. These findings shed new light on extant theories concerning ED.

Heightened sensitivity to punishment and reward in anorexia nervosa

OBJECTIVE

The aim of this study was to investigate reinforcement sensitivity in anorexia nervosa (AN). It was tested whether self-reported punishment (PS) and reward sensitivity (RS) differed between adolescents with AN and healthy controls, and/or between AN-subtypes. In addition, the predictive validity of PS and RS was examined for AN symptoms one year later.

METHOD

In total, 165 female adolescents admitted for treatment of AN or eating disorder not otherwise specified resembling AN and 72 controls participated in the study. Participants completed measurements for eating disorder severity and the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ). Percentage of underweight and severity of AN symptoms were measured again after one year in individuals with AN.

RESULTS

Individuals with AN scored higher on PS and RS than controls. In addition, the AN purging type showed higher PS than the AN restrictive type, whereas there were no differences in RS between AN-subtypes. Regression analyses indicated that PS and RS were independently associated with the degree of eating disorder symptoms, whereas only PS was related to percentage underweight. Yet, neither RS nor PS were related to percentage of underweight and AN symptoms after one year.

DISCUSSION

Although the present study clearly demonstrated that heightened punishment and reward sensitivity are both linked to AN, there was no evidence that these characteristics are also involved in the course of AN symptoms.