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Duriez P, Tolle V, Ramoz N, Kimmel E, Charron S, Viltart O, Lebrun N, Bienvenu T, Fadigas M, Oppenheim C, Gorwood P. Assessing biomarkers of remission in female patients with anorexia nervosa (REMANO): a protocol for a prospective cohort study with a nested case-control study using clinical, neurocognitive, biological, genetic, epigenetic and neuroimaging markers in a French specialised inpatient unit. BMJ Open 2024; 14:e077260. [PMID: 38925688 PMCID: PMC11208877 DOI: 10.1136/bmjopen-2023-077260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe psychiatric disorder associated with frequent relapses and variability in treatment responses. Previous literature suggested that such variability is influenced by premorbid vulnerabilities such as abnormalities of the reward system. Several factors may indicate these vulnerabilities, such as neurocognitive markers (tendency to favour delayed reward, poor cognitive flexibility, abnormal decision process), genetic and epigenetic markers, biological and hormonal markers, and physiological markers.The present study will aim to identify markers that can predict body mass index (BMI) stability 6 months after discharge. The secondary aim of this study will be focused on characterising the biological, genetic, epigenetic and neurocognitive markers of remission in AN. METHODS AND ANALYSIS One hundred and twenty-five (n=125) female adult inpatients diagnosed with AN will be recruited and evaluated at three different times: at the beginning of hospitalisation, when discharged and 6 months later. Depending on the BMI at the third visit, patients will be split into two groups: stable remission (BMI≥18.5 kg/m²) or unstable remission (BMI<18.5 kg/m²). One hundred (n=100) volunteers will be included as healthy controls.Each visit will consist in self-reported inventories (measuring depression, anxiety, suicidal thoughts and feelings, eating disorders symptoms, exercise addiction and the presence of comorbidities), neurocognitive tasks (Delay Discounting Task, Trail-Making Test, Brixton Test and Slip-of-action Task), the collection of blood samples, the repeated collection of blood samples around a standard meal and MRI scans at rest and while resolving a delay discounting task.Analyses will mainly consist in comparing patients stabilised 6 months later and patients who relapsed during these 6 months. ETHICS AND DISSEMINATION Investigators will ask all participants to give written informed consent prior to participation, and all data will be recorded anonymously. The study will be conducted according to ethics recommendations from the Helsinki declaration (World Medical Association, 2013). It was registered on clinicaltrials.gov on 25 August 2020 as 'Remission Factors in Anorexia Nervosa (REMANO)', with the identifier NCT04560517 (for more details, see https://clinicaltrials.gov/ct2/show/record/NCT04560517). The present article is based on the latest protocol version from 29 November 2019. The sponsor, Institut National de la Santé Et de la Recherche Médicale (INSERM, https://www.inserm.fr/), is an academic institution responsible for the monitoring of the study, with an audit planned on a yearly basis.The results will be published after final analysis in the form of scientific articles in peer-reviewed journals and may be presented at national and international conferences. TRIAL REGISTRATION NUMBER clinicaltrials.govNCT04560517.
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Affiliation(s)
- Philibert Duriez
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Vulnerability to Psychiatric and Addictive Disorders", Université Paris Cité, Paris, France
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Virginie Tolle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Vulnerability to Psychiatric and Addictive Disorders", Université Paris Cité, Paris, France
| | - Nicolas Ramoz
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Vulnerability to Psychiatric and Addictive Disorders", Université Paris Cité, Paris, France
| | - Etienne Kimmel
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Sylvain Charron
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Université Paris Cité, Paris, France
- Service de Neuroradiologie, Hôpital Sainte-Anne, GHU Paris psychiatrie et neurosciences, Paris, France
| | - Odile Viltart
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Vulnerability to Psychiatric and Addictive Disorders", Université Paris Cité, Paris, France
- CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, University of Lille, Villeneuve d'Ascq, France
| | - Nicolas Lebrun
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Vulnerability to Psychiatric and Addictive Disorders", Université Paris Cité, Paris, France
| | - Thierry Bienvenu
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Vulnerability to Psychiatric and Addictive Disorders", Université Paris Cité, Paris, France
| | - Marie Fadigas
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Catherine Oppenheim
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Université Paris Cité, Paris, France
- Service de Neuroradiologie, Hôpital Sainte-Anne, GHU Paris psychiatrie et neurosciences, Paris, France
| | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team "Vulnerability to Psychiatric and Addictive Disorders", Université Paris Cité, Paris, France
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
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Hill L. Temperament impact on eating disorder symptoms and habit formation: a novel model to inform treatment. J Eat Disord 2024; 12:40. [PMID: 38504375 PMCID: PMC10953227 DOI: 10.1186/s40337-024-00998-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Temperament has long been described as the biological dimension of personality. Due to advancing brain-imaging technology, our understanding of temperament has deepened and transformed over the last 25 years. Temperament combines genetic, neurobiological and trait research. Temperament has been included peripherally in some eating disorder (ED) treatment approaches but has been ignored by most. Temperament fills a fundamental treatment gap by clarifying who is more vulnerable to develop ED and why some individuals are susceptible to specific ED symptoms while others are not. In addition, temperament targets possible treatment solutions. MAIN TEXT There is a need for a novel model that incorporates and explores the role of temperament in ED treatment intervention. This paper is a metaphoric temperament model to inform treatment intervention. It describes how temperament traits influences new decisions which impact new behavioural responses. In turn, it neurobiologically tracks how and why the brain efficiently transforms new decisions into new habits. This model integrates both temperament and habit research to explore (a) what temperament is; (b) how new decisions develop into habits neurobiologically; (c) that the brain wires destructive symptoms into habits in the same way that it wires healthy/productive behaviours into habits; (d) traits that trigger ED symptoms are the same traits that influence productive behaviours; and in regard to treatment implications (e) when treatment structure and intervention target client temperaments, the potential for new healthy "trait-syntonic" habits could develop. CONCLUSIONS This paper introduces a metaphoric model that synthesizes and integrates temperament neurobiological and trait findings with ED symptoms, habits, and client trait-based solutions. The model synthesizes and integrates different research domains to establish a brain-based foundation to inform treatment intervention. The model targets clients' temperament traits as central collections of innate self-expressions that could be utilized as tools to redirect client trait-syntonic ED responses into trait-syntonic productive outcomes. The brain bases of temperament and habit formation serve as a biological foundation for ED treatment intervention.
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Affiliation(s)
- Laura Hill
- Department of Psychiatry, University of California, San Diego, CA, USA.
- Adjunct Associate Clinical Professor of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
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Brown CS, Devine S, Otto AR, Bischoff-Grethe A, Wierenga CE. Greater reliance on model-free learning in adolescent anorexia nervosa: An examination of dual-system reinforcement learning. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.31.24302097. [PMID: 38352608 PMCID: PMC10863009 DOI: 10.1101/2024.01.31.24302097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
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.
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Affiliation(s)
- Carina S. Brown
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California, San Diego
| | | | | | | | - Christina E. Wierenga
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California, San Diego
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Conceição ISR, Garcia-Burgos D, de Macêdo PFC, Nepomuceno CMM, Pereira EM, Cunha CDM, Ribeiro CDF, de Santana MLP. Habits and Persistent Food Restriction in Patients with Anorexia Nervosa: A Scoping Review. Behav Sci (Basel) 2023; 13:883. [PMID: 37998630 PMCID: PMC10669471 DOI: 10.3390/bs13110883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023] Open
Abstract
The aetiology of anorexia nervosa (AN) presents a puzzle for researchers. Recent research has sought to understand the behavioural and neural mechanisms of these patients' persistent choice of calorie restriction. This scoping review aims to map the literature on the contribution of habit-based learning to food restriction in AN. PRISMA-ScR guidelines were adopted. The search strategy was applied to seven databases and to grey literature. A total of 35 studies were included in this review. The results indicate that the habit-based learning model has gained substantial attention in current research, employing neuroimaging methods, scales, and behavioural techniques. Food choices were strongly associated with dorsal striatum activity, and habitual food restriction based on the self-report restriction index was associated with clinical impairment in people chronically ill with restricting AN. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and Regulating Emotions and Changing Habits (REaCH) have emerged as potential treatments. Future research should employ longitudinal studies to investigate the time required for habit-based learning and analyse how developmental status, such as adolescence, influences the role of habits in the progression and severity of diet-related illnesses. Ultimately, seeking effective strategies to modify persistent dietary restrictions controlled by habits remains essential.
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Affiliation(s)
- Ismara Santos Rocha Conceição
- Graduate Program in Food, Nutrition and Health, School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (I.S.R.C.); (P.F.C.d.M.)
| | - David Garcia-Burgos
- Department of Psychobiology, The “Federico Olóriz” Institute of Neurosciences, Biomedical Research Centre, University of Granada, 18071 Granada, Spain;
| | - Patrícia Fortes Cavalcanti de Macêdo
- Graduate Program in Food, Nutrition and Health, School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (I.S.R.C.); (P.F.C.d.M.)
| | | | | | - Carla de Magalhães Cunha
- School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (C.d.M.C.); (C.D.F.R.)
| | - Camila Duarte Ferreira Ribeiro
- School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (C.d.M.C.); (C.D.F.R.)
- Graduate Program in Food Science, Faculty of Pharmacy, Federal University of Bahia, Salvador 40170-115, Brazil
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Bernardoni F, King JA, Hellerhoff I, Schoemann M, Seidel M, Geisler D, Boehm I, Pauligk S, Doose A, Steding J, Gramatke K, Roessner V, Scherbaum S, Ehrlich S. Mouse-cursor trajectories reveal reduced contextual influence on decision conflict during delay discounting in anorexia nervosa. Int J Eat Disord 2023; 56:1898-1908. [PMID: 37415568 DOI: 10.1002/eat.24019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/05/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The capacity of individuals with anorexia nervosa (AN) to forgo immediate food rewards in their long-term pursuit of thinness is thought to reflect elevated self-control and/or abnormal reward sensitivity. Prior research attempted to capture an increased tendency to delay gratification in AN using delay-discounting tasks that assess how rapidly the subjective value of rewards decreases as a function of time until receipt. However, significant effects were mostly subtle or absent. Here, we tested whether the process leading to such decisions might be altered in AN. METHOD We recorded mouse-cursor movement trajectories leading to the final choice in a computerized delay-discounting task (238 trials) in 55 acutely underweight females with AN and pairwise age-matched female healthy controls (HC). We tested for group differences in deviations from a direct choice path, a measure of conflict strength in decision making, and whether group moderated the effect of several predictors of conflict strength (e.g., choice difficulty, consistency). We also explored reaction times and changes in trajectory directions (X-flips). RESULTS No group differences in delay-discounting parameters or movement trajectories were detected. However, the effect of the aforementioned predictors on deviations (and to a lesser extent reaction times) was reduced in AN. DISCUSSION These findings suggest that while delay discounting and conflict strength in decision making are generally unaltered in AN, conflict strength was more stable across different decisions in the disorder. This might enable individuals with AN to pursue (maladaptive) long-term body-weight goals, because particularly conflicting choices may not be experienced as such. PUBLIC SIGNIFICANCE The deviations from a direct path of mouse-cursor movements during a computerized delay-discounting task varied less in people with anorexia nervosa. Assuming such deviations measure decision conflict, we speculate that this increased stability might help people with anorexia nervosa achieve their long-term weight goals, as for them the struggle with the decision to eat high-calorie meals when hungry will be milder, so they would be more likely to skip them.
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Affiliation(s)
- Fabio Bernardoni
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Inger Hellerhoff
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Martin Schoemann
- Department of Psychology, Faculty of Natural sciences, TU Dresden, Dresden, Germany
| | - Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Daniel Geisler
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ilka Boehm
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Sophie Pauligk
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Arne Doose
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Julius Steding
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Katrin Gramatke
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Scherbaum
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Abstract
INTRODUCTION Anorexia nervosa is a frequent eating disorder that affects predominantly young women and may take a severe and chronically worsening course of disease contributing to its high mortality rate. Although a multitude of treatment options exist, this disease still bears a high relapse rate. In light of these facts, an improvement of existing and development of new treatment targets and options is warranted. AREAS COVERED The present review article covers recent developments in psychotherapy associated with the respective neuropsychological and brain alterations as well as highlights current and future pharmacotherapeutic options. EXPERT OPINION Several encouraging developments in the field of psychotherapy such as interventions targeting neurocognitive profiles or addressing reward processing, brain stimulation as well as pharmacological modulation of hormones, namely leptin, oxytocin, ghrelin and nesfatin-1 signaling might be - most likely as part of a multimodal treatment approach - efficacious in order to improve treatment of patients with anorexia nervosa, especially those with a severe course of disease as well as comorbidities. As anorexia nervosa represents a complex and severe mental disorder, it seems most likely that a combination and integration of different evidence-based treatment approaches and settings will contribute to an improved prognosis of this eating disorder. This should be further explored in future studies.
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Affiliation(s)
- Andreas Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders Tübingen (KOMET)
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Katrin Giel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders Tübingen (KOMET)
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Garcia-Burgos D, Wilhelm P, Vögele C, Munsch S. Food Restriction in Anorexia Nervosa in the Light of Modern Learning Theory: A Narrative Review. Behav Sci (Basel) 2023; 13:bs13020096. [PMID: 36829325 PMCID: PMC9952578 DOI: 10.3390/bs13020096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Improvements in the clinical management of anorexia nervosa (AN) are urgently needed. To do so, the search for innovative approaches continues at laboratory and clinical levels to translate new findings into more effective treatments. In this sense, modern learning theory provides a unifying framework that connects concepts, methodologies and data from preclinical and clinical research to inspire novel interventions in the field of psychopathology in general, and of disordered eating in particular. Indeed, learning is thought to be a crucial factor in the development/regulation of normal and pathological eating behaviour. Thus, the present review not only tries to provide a comprehensive overview of modern learning research in the field of AN, but also follows a transdiagnostic perspective to offer testable explanations for the origin and maintenance of pathological food rejection. This narrative review was informed by a systematic search of research papers in the electronic databases PsycInfo, Scopus and Web of Science following PRISMA methodology. By considering the number and type of associations (Pavlovian, goal-directed or habitual) and the affective nature of conditioning processes (appetitive versus aversive), this approach can explain many features of AN, including why some patients restrict food intake to the point of life-threatening starvation and others restrict calorie intake to lose weight and binge on a regular basis. Nonetheless, it is striking how little impact modern learning theory has had on the current AN research agenda and practice.
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Affiliation(s)
- David Garcia-Burgos
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
- Department of Psychobiology, The “Federico Olóriz” Institute of Neurosciences, Biomedical Research Centre, University of Granada, 18071 Granada, Spain
- Correspondence:
| | - Peter Wilhelm
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Simone Munsch
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
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Berner LA, Fiore VG, Chen JY, Krueger A, Kaye WH, Viranda T, de Wit S. Impaired belief updating and devaluation in adult women with bulimia nervosa. Transl Psychiatry 2023; 13:2. [PMID: 36604416 PMCID: PMC9816187 DOI: 10.1038/s41398-022-02257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 01/07/2023] Open
Abstract
Recent models of bulimia nervosa (BN) propose that binge-purge episodes ultimately become automatic in response to cues and insensitive to negative outcomes. Here, we examined whether women with BN show alterations in instrumental learning and devaluation sensitivity using traditional and computational modeling analyses of behavioral data. Adult women with BN (n = 30) and group-matched healthy controls (n = 31) completed a task in which they first learned stimulus-response-outcome associations. Then, participants were required to repeatedly adjust their responses in a "baseline test", when different sets of stimuli were explicitly devalued, and in a "slips-of-action test", when outcomes instead of stimuli were devalued. The BN group showed intact behavioral sensitivity to outcome devaluation during the slips-of-action test, but showed difficulty overriding previously learned stimulus-response associations on the baseline test. Results from a Bayesian learner model indicated that this impaired performance could be accounted for by a slower pace of belief updating when a new set of previously learned responses had to be inhibited (p = 0.036). Worse performance and a slower belief update in the baseline test were each associated with more frequent binge eating (p = 0.012) and purging (p = 0.002). Our findings suggest that BN diagnosis and severity are associated with deficits in flexibly updating beliefs to withhold previously learned responses to cues. Additional research is needed to determine whether this impaired ability to adjust behavior is responsible for maintaining automatic and persistent binge eating and purging in response to internal and environmental cues.
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Affiliation(s)
- Laura A Berner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Vincenzo G Fiore
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joanna Y Chen
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Angeline Krueger
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Thalia Viranda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanne de Wit
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
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Seidel M, King JA, Fürtjes S, Labitzke N, Wronski ML, Boehm I, Hennig J, Gramatke K, Roessner V, Ehrlich S. Increased Habit Frequency in the Daily Lives of Patients with Acute Anorexia Nervosa. Nutrients 2022; 14:nu14193905. [PMID: 36235556 PMCID: PMC9573582 DOI: 10.3390/nu14193905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Strict eating routines and frequent rigid behavior patterns are commonly observed in patients with anorexia nervosa (AN). A recent theory proposes that while these behaviors may have been reinforced initially, they later become habitual. To date, however, research has been overly focused on eating-disorder (ED)-related habits. Over the course of seven days, we applied an ecological momentary assessment (EMA) to investigate the habit frequency and strength of ED-specific (food intake) and ED-unspecific (hygiene) habits in the daily lives of a sample of n = 57 AN and n = 57 healthy controls (HC). The results of the hierarchical models revealed that habits were significantly more likely in patients compared with HC for both categories, independently. Furthermore, a lower body mass index (BMI) was associated with increased habit frequency in AN. Our study strengthens the habit theory of AN by showing the relevance of habits beyond ED-specific behavioral domains. This also supports the development of innovative therapeutic interventions targeting habitual behavior in EDs.
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Affiliation(s)
- Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Correspondence: ; Tel.: +49-(0)351-458-2244
| | - Joseph A. King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Sophia Fürtjes
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Natalie Labitzke
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Marie-Louis Wronski
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Ilka Boehm
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Julius Hennig
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Katrin Gramatke
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital Dresden, 01307 Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
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10
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Characterizing cerebral metabolite profiles in anorexia and bulimia nervosa and their associations with habitual behavior. Transl Psychiatry 2022; 12:103. [PMID: 35292626 PMCID: PMC8924163 DOI: 10.1038/s41398-022-01872-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are associated with altered brain structure and function, as well as increased habitual behavior. This neurobehavioral profile may implicate neurochemical changes in the pathogenesis of these illnesses. Altered glutamate, myo-inositol and N-acetyl aspartate (NAA) concentrations are reported in restrictive AN, yet whether these extend to binge-eating disorders, or relate to habitual traits in affected individuals, remains unknown. We therefore used single-voxel proton magnetic resonance spectroscopy to measure glutamate, myo-inositol, and NAA in the right inferior lateral prefrontal cortex and the right occipital cortex of 85 women [n = 22 AN (binge-eating/purging subtype; AN-BP), n = 33 BN, n = 30 controls]. To index habitual behavior, participants performed an instrumental learning task and completed the Creature of Habit Scale. Women with AN-BP, but not BN, had reduced myo-inositol and NAA concentrations relative to controls in both regions. Although patient groups had intact instrumental learning task performance, both groups reported increased routine behaviors compared to controls, and automaticity was related to reduced prefrontal glutamate and NAA participants with AN-BP. Our findings extend previous reports of reduced myo-inositol and NAA levels in restrictive AN to AN-BP, which may reflect disrupted axonal-glial signaling. Although we found inconsistent support for increased habitual behavior in AN-BP and BN, we identified preliminary associations between prefrontal metabolites and automaticity in AN-BP. These results provide further evidence of unique neurobiological profiles across binge-eating disorders.
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11
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Hartogsveld B, Quaedflieg CWEM, van Ruitenbeek P, Smeets T. Decreased putamen activation in balancing goal-directed and habitual behavior in binge eating disorder. Psychoneuroendocrinology 2022; 136:105596. [PMID: 34839081 DOI: 10.1016/j.psyneuen.2021.105596] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022]
Abstract
Acute stress is associated with a shift from goal-directed to habitual behavior. This stress-induced preference for habitual behavior has been suggested as a potential mechanism by which binge eating disorder (BED) patients succumb to eating large amounts of high-caloric foods in an uncontrolled manner (i.e., binge episodes). While in healthy subjects the balance between goal-directed and habitual behavior is subserved by the anterior cingulate cortex (ACC), insular cortex, orbitofrontal cortex (OFC), anterior caudate nucleus, and posterior putamen, the brain mechanism that underlies this (possibly amplified) stress-induced behavioral shift in BED patients is currently unknown. In the current study, 76 participants (38 BED, 38 healthy controls (HCs)) learned six stimulus-response-outcome associations in a well-established instrumental learning task. Subsequently, three outcomes were selectively devalued, after which participants underwent either a stress induction procedure (Maastricht Acute Stress Test; MAST) or a no-stress control procedure. Next, the balance between goal-directed and habitual behavior was assessed during functional magnetic resonance imaging. Findings show that the balance between goal-directed and habitual behavior was associated with activity in the ACC, insula, and OFC in no-stress HCs. Although stress and BED did not modulate the balance between goal-directed and habitual behavior, BED participants displayed a smaller difference in putamen activation between trials probing goal-directed and habitual behavior compared with HCs when using a ROI approach. We conclude that putamen activity differences between BED and HC could reflect changes in monitoring of response accuracy or reward value, albeit perhaps not sufficiently to induce a measurable shift from goal-directed to habitual behavior. Future research could clarify potential boundary conditions of stress-induced shifts in instrumental behavior in BED patients.
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Affiliation(s)
- B Hartogsveld
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
| | - C W E M Quaedflieg
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - P van Ruitenbeek
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - T Smeets
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands; CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
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12
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Coniglio KA, Cooper M, Selby EA. Behavioral reinforcement of pathological exercise in anorexia nervosa. Int J Eat Disord 2022; 55:184-192. [PMID: 34626127 DOI: 10.1002/eat.23626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022]
Abstract
Pathological exercise in anorexia nervosa (AN) is a harmful behavior associated with a chronic course and poor prognosis. To date, no comprehensive theoretical model exists to describe pathological exercise in the context of AN, and as such, few treatments are effective at promoting direct and sustained pathological exercise extinction. Using a framework put forth by Wise & Koob (2014), debating the relative importance of positive and negative reinforcement in substance use, we present three hypotheses of behavioral reinforcement of exercise, encompassing biological, psychological, and environmental influences. Specifically, we argue that exercise is positively reinforced through receipt of biological and behavioral rewards, negatively reinforced through avoidance of aversive emotions, and that these two systems work in tandem over time to engrain pathological exercise as a habit. We then present suggestions for testing each of these hypotheses as future directions for the field.
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Affiliation(s)
- Kathryn A Coniglio
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Marita Cooper
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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13
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Haynos AF, Widge AS, Anderson LM, Redish AD. Beyond Description and Deficits: How Computational Psychiatry Can Enhance an Understanding of Decision-Making in Anorexia Nervosa. Curr Psychiatry Rep 2022; 24:77-87. [PMID: 35076888 PMCID: PMC8934594 DOI: 10.1007/s11920-022-01320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Despite decades of research, knowledge of the mechanisms maintaining anorexia nervosa (AN) remains incomplete and clearly effective treatments elusive. Novel theoretical frameworks are needed to advance mechanistic and treatment research for this disorder. Here, we argue the utility of engaging a novel lens that differs from existing perspectives in psychiatry. Specifically, we argue the necessity of expanding beyond two historically common perspectives: (1) the descriptive perspective: the tendency to define mechanisms on the basis of surface characteristics and (2) the deficit perspective: the tendency to search for mechanisms associated with under-functioning of decision-making abilities and related circuity, rather than problems of over-functioning, in psychiatric disorders. RECENT FINDINGS Computational psychiatry can provide a novel framework for understanding AN because this approach emphasizes the role of computational misalignments (rather than absolute deficits or excesses) between decision-making strategies and environmental demands as the key factors promoting psychiatric illnesses. Informed by this approach, we argue that AN can be understood as a disorder of excess goal pursuit, maintained by over-engagement, rather than disengagement, of executive functioning strategies and circuits. Emerging evidence suggests that this same computational imbalance may constitute an under-investigated phenotype presenting transdiagnostically across psychiatric disorders. A variety of computational models can be used to further elucidate excess goal pursuit in AN. Most traditional psychiatric treatments do not target excess goal pursuit or associated neurocognitive mechanisms. Thus, targeting at the level of computational dysfunction may provide a new avenue for enhancing treatment for AN and related disorders.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN F 253, USA
| | - Alik S. Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN F 253, USA
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN F 253, USA
| | - A. David Redish
- Department of Neuroscience, University of Minnesota, 6-145 Jackson Hall 321 Church St. SE, Minneapolis, MN 55455, USA
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14
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Tadayonnejad R, Pizzagalli F, Murray SB, Pauli WM, Conde G, Bari AA, Strober M, O'Doherty JP, Feusner JD. White matter tracts characteristics in habitual decision-making circuit underlie ritual behaviors in anorexia nervosa. Sci Rep 2021; 11:15980. [PMID: 34354139 PMCID: PMC8342714 DOI: 10.1038/s41598-021-95300-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
Anorexia nervosa (AN) is a difficult to treat, pernicious psychiatric disorder that has been linked to decision-making abnormalities. We examined the structural characteristics of habitual and goal-directed decision-making circuits and their connecting white matter tracts in 32 AN and 43 healthy controls across two independent data sets of adults and adolescents as an explanatory sub-study. Total bilateral premotor/supplementary motor area-putamen tracts in the habit circuit had a significantly higher volume in adults with AN, relative to controls. Positive correlations were found between both the number of tracts and white matter volume (WMV) in the habit circuit, and the severity of ritualistic/compulsive behaviors in adults and adolescents with AN. Moreover, we found a significant influence of the habit circuit WMV on AN ritualistic/compulsive symptom severity, depending on the preoccupations symptom severity levels. These findings suggest that AN is associated with white matter plasticity alterations in the habit circuit. The association between characteristics of habit circuit white matter tracts and AN behavioral symptoms provides support for a circuit based neurobiological model of AN, and identifies the habit circuit as a focus for further investigation to aid in development of novel and more effective treatments based on brain-behavior relationships.
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Affiliation(s)
- Reza Tadayonnejad
- Division of Neuromodulation, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Room # 57.464, 760 Westwood Plaza, Los Angeles, CA, 90024, USA. .,Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.
| | - Fabrizio Pizzagalli
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA.,Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Wolfgang M Pauli
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.,Artificial Intelligence Platform, Redmond, WA, USA
| | - Geena Conde
- Division of Cognitive Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Ausaf A Bari
- Department of Neursurgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Michael Strober
- Division of Child and Adolescent, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - John P O'Doherty
- Computation and Neural Systems Program and Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Jamie D Feusner
- Division of Cognitive Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Division of Neurosciences and Clinical Translation, University of Toronto, Toronto, ON, Canada
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15
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Favier M, Janickova H, Justo D, Kljakic O, Runtz L, Natsheh JY, Pascoal TA, Germann J, Gallino D, Kang JI, Meng XQ, Antinora C, Raulic S, Jacobsen JP, Moquin L, Vigneault E, Gratton A, Caron MG, Duriez P, Brandon MP, Neto PR, Chakravarty MM, Herzallah MM, Gorwood P, Prado MA, Prado VF, El Mestikawy S. Cholinergic dysfunction in the dorsal striatum promotes habit formation and maladaptive eating. J Clin Invest 2021; 130:6616-6630. [PMID: 33164988 DOI: 10.1172/jci138532] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022] Open
Abstract
Dysregulation of habit formation has been recently proposed as pivotal to eating disorders. Here, we report that a subset of patients suffering from restrictive anorexia nervosa have enhanced habit formation compared with healthy controls. Habit formation is modulated by striatal cholinergic interneurons. These interneurons express vesicular transporters for acetylcholine (VAChT) and glutamate (VGLUT3) and use acetylcholine/glutamate cotransmission to regulate striatal functions. Using mice with genetically silenced VAChT (VAChT conditional KO, VAChTcKO) or VGLUT3 (VGLUT3cKO), we investigated the roles that acetylcholine and glutamate released by cholinergic interneurons play in habit formation and maladaptive eating. Silencing glutamate favored goal-directed behaviors and had no impact on eating behavior. In contrast, VAChTcKO mice were more prone to habits and maladaptive eating. Specific deletion of VAChT in the dorsomedial striatum of adult mice was sufficient to phenocopy maladaptive eating behaviors of VAChTcKO mice. Interestingly, VAChTcKO mice had reduced dopamine release in the dorsomedial striatum but not in the dorsolateral striatum. The dysfunctional eating behavior of VAChTcKO mice was alleviated by donepezil and by l-DOPA, confirming an acetylcholine/dopamine deficit. Our study reveals that loss of acetylcholine leads to a dopamine imbalance in striatal compartments, thereby promoting habits and vulnerability to maladaptive eating in mice.
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Affiliation(s)
- Mathieu Favier
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Helena Janickova
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Damian Justo
- GHU Paris Psychiatrie et Neurosciences (CMME, Hospital Sainte-Anne), Institute of Psychiatry and Neuroscience of Paris (INSERM UMR1266), Paris, France
| | - Ornela Kljakic
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Léonie Runtz
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Joman Y Natsheh
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Jerusalem, Palestine.,Kessler Foundation, East Hanover, New Jersey, USA
| | - Tharick A Pascoal
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jurgen Germann
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Daniel Gallino
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Jun-Ii Kang
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Xiang Qi Meng
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Christina Antinora
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Sanda Raulic
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | | | - Luc Moquin
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Erika Vigneault
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Alain Gratton
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marc G Caron
- Department of Cell Biology and.,Department of Medicine, Duke University, Durham, North Carolina, USA.,Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Philibert Duriez
- GHU Paris Psychiatrie et Neurosciences (CMME, Hospital Sainte-Anne), Institute of Psychiatry and Neuroscience of Paris (INSERM UMR1266), Paris, France
| | - Mark P Brandon
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Pedro Rosa Neto
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.,Department of Biological and Biomedical Engineering and.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mohammad M Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Jerusalem, Palestine.,Center for Molecular and Behavioral Neuroscience, School of Arts & Sciences-Newark Rutgers University, Newark, New Jersey, USA
| | - Philip Gorwood
- GHU Paris Psychiatrie et Neurosciences (CMME, Hospital Sainte-Anne), Institute of Psychiatry and Neuroscience of Paris (INSERM UMR1266), Paris, France
| | - Marco Am Prado
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Vania F Prado
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Salah El Mestikawy
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Sorbonne Universités, Université Pierre et Marie Curie UM 119 - CNRS UMR 8246 - INSERM U1130, Neurosciences Paris Seine - Institut de Biologie Paris Seine, Paris, France
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16
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Reward Learning Through the Lens of RDoC: a Review of Theory, Assessment, and Empirical Findings in the Eating Disorders. Curr Psychiatry Rep 2021; 23:2. [PMID: 33386514 DOI: 10.1007/s11920-020-01213-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Reward-related processes may represent important transdiagnostic factors underlying eating pathology. Using the NIMH Research Domain Criteria as a guide, the current article reviews theories, behavioral and self-report assessments, and empirical findings related to reward learning in the eating disorders. RECENT FINDINGS Data from behavioral tasks suggest deficits in reinforcement learning, which may become more pronounced with increasing disorder severity and duration. Self-report data strongly implicate positive eating and thinness/restriction expectancies (an element of reward prediction error) in the onset and maintenance of eating pathology. Finally, self-report measures of habit strength demonstrate relationships with eating pathology and illness duration; however, behavioral task data do not support relationships between eating pathology and a propensity towards general habit development. Existing studies are limited, but provide preliminary support for the presence of abnormal reward learning in eating disorders. Continued research is needed to address identified gaps in the literature.
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17
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Musolino CM, Warin M, Gilchrist P. Embodiment as a Paradigm for Understanding and Treating SE-AN: Locating the Self in Culture. Front Psychiatry 2020; 11:534. [PMID: 32595537 PMCID: PMC7304294 DOI: 10.3389/fpsyt.2020.00534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
There has been a growing call for sociologically engaged research to better understand the complex processes underpinning Severe and Enduring Anorexia Nervosa (SE-AN). Based on a qualitative study with women in Adelaide, South Australia who were reluctant to seek help for their disordered eating practices, this paper draws on anthropological concepts of embodiment to examine how SE-AN is experienced as culturally grounded. We argue that experiences of SE-AN are culturally informed, and in turn, inform bodily perception and practice in the world. Over time, everyday rituals and routines became part of participants' habitus', experienced as taken-for-granted practices that structured life-worlds. Here, culture and self are not separate, but intimately entangled in and through embodiment. Approaching SE-AN through a paradigm of embodiment has important implications for therapeutic models that attempt to move anorexia nervosa away from the body and separate it from the self in order to achieve recovery. Separating experiences-literally disembodying anorexia nervosa-was described by participants as more than the loss of an identity; it would dismantle their sense of being-in-the-world. Understanding how SE-AN is itself a structure that structures every aspect of daily life, helps us to understand the fear of living differently, and the safety that embodied routines bring. We conclude by asking what therapeutic treatment might look like if we took embodiment as one orientation to SE-AN, and focused on quality of life and harm minimization.
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Affiliation(s)
- Connie Marguerite Musolino
- College of Medicine and Public Health, Southgate Institute for Health, Society and Equity, Flinders University, Bedford Park, SA, Australia
| | - Megan Warin
- Faculty of Arts, School of Social Sciences, University of Adelaide, Adelaide, SA, Australia
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18
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Di Lodovico L, Gorwood P. The relationship between moderate to vigorous physical activity and cognitive rigidity in anorexia nervosa. Psychiatry Res 2020; 284:112703. [PMID: 31813596 DOI: 10.1016/j.psychres.2019.112703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
A drive for physical activity despite underweight is a core feature of anorexia nervosa. This pilot study detects which aspect of physical activity, if any, could be related to cognitive rigidity in anorexia nervosa. Twenty-eight outpatients with anorexia nervosa and 24 healthy participants were assessed for cognitive flexibility with the Trail Making Test (TMT) and for multiple dimensions of physical activity by subjective and objective assessments. Correlation analysis was conducted to disentangle the relationship between cognitive rigidity and the different aspects of physical activity, then, the moderating effect of anorexia nervosa on this relationship was assessed. A principal component analysis was performed to incorporate all variables of physical activity in (a) global factor(s) reflecting the multidimensional nature of this construct. Cognitive rigidity (TMT b - a score) was significantly correlated to the amount of objectively assessed physical activity estimated, only in the sample of patients with anorexia nervosa. The principal component analysis confirms the correlation between a single construct of "physical activity" and cognitive rigidity in anorexia nervosa only. This pilot study suggests a relationship between cognitive rigidity and physical activity that could help explain the persistence of the latter despite ongoing malnutrition in patients with anorexia nervosa.
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Affiliation(s)
- Laura Di Lodovico
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, 1 Rue Cabanis, Paris 75014, France; INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Université de Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
| | - Philip Gorwood
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, 1 Rue Cabanis, Paris 75014, France; INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Université de Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
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19
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Vogel V, Dittrich M, Horndasch S, Kratz O, Moll GH, Erim Y, Paslakis G, Rauh E, Steins‐Loeber S. Pavlovian‐to‐instrumental transfer in Anorexia Nervosa: A pilot study on conditioned learning and instrumental responding to low‐ and high‐calorie food stimuli. Eur J Neurosci 2019; 51:1794-1805. [DOI: 10.1111/ejn.14592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/08/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Verena Vogel
- Department of Clinical Psychology and Psychotherapy University of Bamberg Bamberg Germany
| | - Marie Dittrich
- Department of Clinical Psychology and Psychotherapy University of Bamberg Bamberg Germany
| | - Stefanie Horndasch
- Department of Child and Adolescent Mental Health University of Erlangen‐Nuremberg Erlangen Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health University of Erlangen‐Nuremberg Erlangen Germany
| | - Gunther H. Moll
- Department of Child and Adolescent Mental Health University of Erlangen‐Nuremberg Erlangen Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy University of Erlangen‐Nuremberg Erlangen Germany
| | - Georgios Paslakis
- Department of Psychosomatic Medicine and Psychotherapy University of Erlangen‐Nuremberg Erlangen Germany
| | | | - Sabine Steins‐Loeber
- Department of Clinical Psychology and Psychotherapy University of Bamberg Bamberg Germany
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20
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Steding J, Boehm I, King JA, Geisler D, Ritschel F, Seidel M, Doose A, Jaite C, Roessner V, Smolka MN, Ehrlich S. Goal-directed vs. habitual instrumental behavior during reward processing in anorexia nervosa: an fMRI study. Sci Rep 2019; 9:13529. [PMID: 31537862 PMCID: PMC6753148 DOI: 10.1038/s41598-019-49884-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022] Open
Abstract
Previous studies have proposed that altered reward processing and elevated cognitive control underlie the etiology of anorexia nervosa (AN). A newly debated notion suggests altered habit learning and an overreliance on habits may contribute to the persistence of AN. In weight-recovered AN patients, we previously found neuroimaging-based evidence for unaltered reward processing, but elevated cognitive control. In order to differentiate between state versus trait factors, we here contrast the aforementioned hypotheses in a sample of acutely underweight AN (acAN) patients. 37 acAN patients and 37 closely matched healthy controls (HC) underwent a functional MRI while performing an established instrumental motivation task. We found no group differences with respect to neural responses during the anticipation or receipt of reward. However, the behavioral response data showed a bimodal distribution, indicative for a goal-directed (gAN) and a habit-driven (hAN) patient subgroup. Additional analyses revealed decreased mOFC activation during reward anticipation in hAN, which would be in line with a habit-driven response. These findings provide a new perspective on the debate regarding the notion of increased goal-directed versus habitual behavior in AN. If replicable, the observed dissociation between gAN and hAN might help to tailor therapeutic approaches to individual patient characteristics.
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Affiliation(s)
- Julius Steding
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ilka Boehm
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Joseph A King
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Daniel Geisler
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Franziska Ritschel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Arne Doose
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, TU Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany. .,Translational Developmental Neuroscience Section, Department of Child and Adolescent Psychiatry, Eating Disorders Research and Treatment Center, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
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21
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Steinglass JE, Glasofer DR, Walsh E, Guzman G, Peterson CB, Walsh BT, Attia E, Wonderlich SA. Targeting habits in anorexia nervosa: a proof-of-concept randomized trial. Psychol Med 2018; 48:2584-2591. [PMID: 29455696 DOI: 10.1017/s003329171800020x] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Habits are behavioral routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa (AN), behaviors that promote the starved state appear habitual, and this is the foundation of a recent neurobiological model of AN. In this proof-of-concept study, we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines. METHODS The primary intervention target was habit strength; we also measured clinical impact via eating disorder psychopathology and actual eating. Twenty-two hospitalized patients with AN were randomly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aimed at cues for maladaptive behavioral routines, Regulating Emotions and Changing Habits (REaCH). RESULTS Covarying for baseline, REaCH was associated with a significantly lower Self-Report Habit Index (SRHI) score and significantly lower Eating Disorder Examination-Questionnaire (EDE-Q) global score at the end-of-treatment. The end-of-treatment effect size for SRHI was d = 1.28, for EDE-Q was d = 0.81, and for caloric intake was d = 1.16. CONCLUSIONS REaCH changed habit strength of maladaptive routines more than an active control therapy, and targeting habit strength yielded improvement in clinically meaningful measures. These findings support a habit-based model of AN, and suggest habit strength as a mechanism-based target for intervention.
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Affiliation(s)
- Joanna E Steinglass
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Deborah R Glasofer
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Emily Walsh
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Gabby Guzman
- Rutgers Graduate School of Applied and Professional Psychology
| | | | - B Timothy Walsh
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Evelyn Attia
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute/Department of Psychiatry and Behavioral Science University of North Dakota School of Medicine and Health Sciences
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22
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Haynos AF, Hall LMJ, Lavender JM, Peterson CB, Crow SJ, Klimes-Dougan B, Cullen KR, Lim KO, Camchong J. Resting state functional connectivity of networks associated with reward and habit in anorexia nervosa. Hum Brain Mapp 2018; 40:652-662. [PMID: 30251758 DOI: 10.1002/hbm.24402] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/27/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
Neurobiological disturbances associated with reward and/or habit learning are theorized to maintain symptoms of anorexia nervosa (AN). Although research has investigated responses in brain regions associated with reward and habit to disorder-specific cues (e.g., food) and presumed rewards (e.g., money), little is known about the functional organization of the circuits underlying these constructs independent of stimulus. This study aimed to provide initial data on the synchrony of networks associated with reward and habit in AN by comparing resting-state functional connectivity (RSFC) patterns between AN and healthy control (HC) participants in these circuits and delineating how these patterns relate to symptoms. Using theoretically selected seeds in the nucleus accumbens (NAcc), ventral caudate, and dorsal caudate, reflecting a continuum from reward- to habit- oriented regions, RSFC patterns were compared between AN restricting subtype (n = 19) and HC (n = 19) participants (cluster threshold: p < .01). Exploratory correlations between RSFC z-scores and Eating Disorder Examination (EDE) scores, BMI, and illness duration were conducted. The AN group demonstrated lower RSFC between the NAcc and superior frontal gyrus, between the ventral caudate and frontal and posterior regions, and between the dorsal caudate and frontal, temporal, and posterior regions. In the AN group, lower NAcc- superior frontal gyrus RSFC correlated with greater EDE Global scores (r = -.58, CI: -.83, -.13). These resting-state synchrony disruptions of the ventral and dorsal frontostriatal circuits, considered in context of the broader literature, support the utility of further investigating possible reward and habit disturbances supporting symptoms in AN.
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Leah M J Hall
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota.,Eastern Oklahoma VA Medical Center, Tulsa, Oklahoma
| | - Jason M Lavender
- Department of Psychiatry, University of California, San Diego, California
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota.,The Emily Program, St. Paul, Minnesota
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota.,The Emily Program, St. Paul, Minnesota
| | | | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Jazmin Camchong
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
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23
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Khalsa SS, Hassanpour MS, Strober M, Craske MG, Arevian AC, Feusner JD. Interoceptive Anxiety and Body Representation in Anorexia Nervosa. Front Psychiatry 2018; 9:444. [PMID: 30298026 PMCID: PMC6160545 DOI: 10.3389/fpsyt.2018.00444] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/28/2018] [Indexed: 12/31/2022] Open
Abstract
Individuals with anorexia nervosa (AN) typically display anxious traits prior to the onset of food avoidance and weight loss that characterize the disorder. Meal associated anxiety is an especially common clinical feature in these patients, and heightened sensitivity to sympathetically mediated interoceptive sensations has also been observed. However, it remains unclear how heightened interoceptive sensitivity relates to experiences of anxiety before and after meals. To investigate this relationship, we experimentally induced anxiety and panic symptoms with isoproterenol, a peripheral sympathetic agonist similar to adrenaline, across several different conditions: during panic provocation, during anticipation of a 1,000 Calorie meal, and after meal consumption. Fifteen AN and 15 age- and sex-matched healthy comparisons received bolus infusions of isoproterenol and saline in a double-blinded, randomized design. Participants rated anxiety symptoms after each infusion, completed panic rating scales, and traced the location of perceived palpitations on a manikin to index interoceptive "body map" representation. The AN group reported significantly elevated anxiety relative to healthy comparisons during infusions before and after the meal, but surprisingly, not during panic provocation. These symptoms were accompanied by geographical differences in patterns of perceived heartbeat sensations across each condition. In particular, the AN group localized heartbeat sensations disproportionately to the chest during meal related saline infusions, when no cardiorespiratory modulation actually occurred. The AN group also showed a trend toward higher panic attack rates during the meal anticipation period. Correcting for anxiety levels reported during saline infusions abolished group differences in anxiety change across all conditions, suggesting a significant contribution of anxious traits in AN. The observation of meal related "visceral illusions" provides further evidence that AN is associated with abnormal interoceptive representation of the heartbeat and suggests that meal consumption, particularly when anticipated, preferentially alters the processing of interoception related signals in AN.
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Affiliation(s)
- Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| | | | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle G. Craske
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Armen C. Arevian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jamie D. Feusner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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24
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Abstract
PURPOSE OF REVIEW This review delineates issues in the conceptualization and operationalization of eating disorder recovery, highlights recent findings about recovery (since 2016), and proposes future directions. RECENT FINDINGS A longstanding problem in the field is that there are almost as many different definitions of recovery in eating disorders as there are studies on the topic. Yet, there has been a general shift to accepting that psychological/cognitive symptoms are important to recovery in addition to physical and behavioral indices. Further, several operationalizations of recovery have been proposed over the past two decades, and some efforts to validate operationalizations exist. However, this work has had limited impact and uptake, such that the field is suffering from "broken record syndrome," where calls are made for universal definitions time and time again. It is critical that proposed operationalizations be compared empirically to help arrive at a consensus definition and that institutional/organizational support help facilitate this. Themes in recent recovery research include identifying predictors, examining biological/neuropsychological factors, and considering severe and enduring anorexia nervosa. From qualitative research, those who have experienced eating disorders highlight recovery as a journey, as well as factors such as hope, self-acceptance, and benefiting from support from others as integral to the process of recovery. The field urgently needs to implement a universal definition of recovery that is backed by evidence, that can parsimoniously be implemented in clinical practice, and that will lead to greater harmonization of scientific findings.
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25
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Uniacke B, Walsh BT, Foerde K, Steinglass J. The Role of Habits in Anorexia Nervosa: Where We Are and Where to Go From Here? Curr Psychiatry Rep 2018; 20:61. [PMID: 30039342 PMCID: PMC6550313 DOI: 10.1007/s11920-018-0928-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The persistent maladaptive eating behavior characteristic of anorexia nervosa (AN) can be understood as a learned habit. This review describes the cognitive neuroscience background and the existing data from research in AN. RECENT FINDINGS Behavior is habitual after it is frequently repeated and becomes nearly automatic, relatively insensitive to outcome, and mediated by dorsal frontostriatal neural systems. There is evidence for such behavior in AN, in which restrictive intake has been related to dorsal frontostriatal systems. Other neural and neurocognitive data provide mixed findings, some of which suggest disturbances in habit systems in AN. There are compelling behavioral and neural data to suggest that habit systems may underlie the persistence of AN. The habit model needs further research, via more direct behavioral hypothesis testing and probes of the development of habitual behavior. Investigation of the habit-centered model of AN may open avenues for the development of novel treatments.
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Affiliation(s)
- Blair Uniacke
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA. .,Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA
| | - Karin Foerde
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA
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26
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de Wit S, Kindt M, Knot SL, Verhoeven AAC, Robbins TW, Gasull-Camos J, Evans M, Mirza H, Gillan CM. Shifting the balance between goals and habits: Five failures in experimental habit induction. J Exp Psychol Gen 2018; 147:1043-1065. [PMID: 29975092 PMCID: PMC6033090 DOI: 10.1037/xge0000402] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/20/2017] [Accepted: 11/30/2017] [Indexed: 12/28/2022]
Abstract
Habits are repetitive behaviors that become ingrained with practice, routine, and repetition. The more we repeat an action, the stronger our habits become. Behavioral and clinical neuroscientists have become increasingly interested in this topic because habits may contribute to aspects of maladaptive human behavior, such as compulsive behavior in psychiatry. Numerous studies have demonstrated that habits can be induced in otherwise healthy rats by simply overtraining stimulus-response behaviors. However, despite growing interest in this topic and its application to psychiatry, a similar body of work in humans is absent. Only a single study has been published in humans that shows the effect of extensive training on habit expression. Here, we report five failed attempts to demonstrate that overtraining instrumental behavior leads to the development of inflexible habits in humans, using variants of four previously published outcome devaluation paradigms. Extensive training did not lead to greater habits in two versions of an avoidance learning task, in an appetitive slips-of-action task, or in two independent attempts to replicate the original demonstration. The finding that these outcome devaluation procedures may be insensitive to duration of stimulus-response training in humans has implications for prior work in psychiatric populations. Specifically, it converges with the suggestion that the failures in outcome devaluation in compulsive individuals reflect dysfunction in goal-directed control, rather than overactive habit learning. We discuss why habits are difficult to experimentally induce in healthy humans, and the implications of this for future research in healthy and disordered populations. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | - Julia Gasull-Camos
- Department of Neurochemistry and Neuropharmacology, Institute of Biomedical Research Barcelona
| | | | - Hira Mirza
- Department of Psychology, New York University
| | - Claire M Gillan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin
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27
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Smeets T, van Ruitenbeek P, Hartogsveld B, Quaedflieg CWEM. Stress-induced reliance on habitual behavior is moderated by cortisol reactivity. Brain Cogn 2018; 133:60-71. [PMID: 29807661 DOI: 10.1016/j.bandc.2018.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 11/28/2022]
Abstract
Instrumental learning, i.e., learning that specific behaviors lead to desired outcomes, occurs through goal-directed and habit memory systems. Exposure to acute stress has been shown to result in less goal-directed control, thus rendering behavior more habitual. The aim of the current studies was to replicate and extend findings on stress-induced prompting of habitual responding and specifically focused on the role of stress-induced cortisol reactivity. Study 1 used an established outcome devaluation paradigm to assess goal-directed and habitual control. Study 2 utilized a modified version of this paradigm that was intended to establish stronger habitual responding through more extensive reward training and applying a relevant behavioral devaluation procedure (i.e., eating to satiety). Both studies failed to replicate that stress overall, i.e., independent of cortisol reactivity, shifted behavior from goal-directed to habitual control. However, both studies found that relative to stress-exposed cortisol non-responders and no-stress controls, participants displaying stress-induced cortisol reactivity displayed prominent habitual responding. These findings highlight the importance of stress-induced cortisol reactivity in facilitating habits.
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Affiliation(s)
- T Smeets
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
| | - P van Ruitenbeek
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - B Hartogsveld
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Conny W E M Quaedflieg
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
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28
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Park RJ, Scaife JC, Aziz TZ. Study Protocol: Using Deep-Brain Stimulation, Multimodal Neuroimaging and Neuroethics to Understand and Treat Severe Enduring Anorexia Nervosa. Front Psychiatry 2018; 9:24. [PMID: 29681866 PMCID: PMC5898619 DOI: 10.3389/fpsyt.2018.00024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/22/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Research suggests that altered eating and the pursuit of thinness in anorexia nervosa (AN) are, in part, a consequence of aberrant reward circuitry. The neural circuits involved in reward processing and compulsivity overlap significantly, and this has been suggested as a transdiagnostic factor underpinning obsessive compulsive disorder, addictions and eating disorders. The nucleus accumbens (NAcc) is central to both reward processing and compulsivity. In previous studies, deep-brain stimulation (DBS) to the NAcc has been shown to result in neural and symptomatic improvement in both obsessive compulsive disorder and addictions. Moreover, in rats, DBS to the NAcc medial shell increases food intake. We hypothesise that this treatment may be of benefit in severe and enduring anorexia nervosa (SE-AN), but first, feasibility and ethical standards need to be established. The aims of this study are as follows: (1) to provide feasibility and preliminary efficacy data on DBS to the NAcc as a treatment for SE-AN; (2) to assess any subsequent neural changes and (3) to develop a neuroethical gold standard to guide applications of this treatment. METHOD This is a longitudinal study of six individuals with SE-AN of >7 years. It includes an integrated neuroethical sub-study. DBS will be applied to the NAcc and we will track the mechanisms underpinning AN using magnetoelectroencephalography, neuropsychological and behavioural measures. Serial measures will be taken on each intensively studied patient, pre- and post-DBS system insertion. This will allow elucidation of the processes involved in symptomatic change over a 15-month period, which includes a double-blind crossover phase of stimulator on/off. DISCUSSION Novel, empirical treatments for SE-AN are urgently required due to high morbidity and mortality costs. If feasible and effective, DBS to the NAcc could be game-changing in the management of this condition. A neuroethical gold standard is crucial to optimally underpin such treatment development. CLINICAL TRIAL REGISTRATION The study is ongoing and registered with www.ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT01924598, 22 July, 2013. It has full ethical and HRA approval (Project ID 128658).
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Affiliation(s)
- Rebecca J. Park
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jessica C. Scaife
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Tipu Z. Aziz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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29
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30
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Schaumberg K, Welch E, Breithaupt L, Hübel C, Baker JH, Munn-Chernoff MA, Yilmaz Z, Ehrlich S, Mustelin L, Ghaderi A, Hardaway AJ, Bulik-Sullivan EC, Hedman AM, Jangmo A, Nilsson IAK, Wiklund C, Yao S, Seidel M, Bulik CM. The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:432-450. [PMID: 28967161 PMCID: PMC5711426 DOI: 10.1002/erv.2553] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In 2015, the Academy for Eating Disorders collaborated with international patient, advocacy, and parent organizations to craft the 'Nine Truths About Eating Disorders'. This document has been translated into over 30 languages and has been distributed globally to replace outdated and erroneous stereotypes about eating disorders with factual information. In this paper, we review the state of the science supporting the 'Nine Truths'. METHODS The literature supporting each of the 'Nine Truths' was reviewed, summarized and richly annotated. RESULTS Most of the 'Nine Truths' arise from well-established foundations in the scientific literature. Additional evidence is required to further substantiate some of the assertions in the document. Future investigations are needed in all areas to deepen our understanding of eating disorders, their causes and their treatments. CONCLUSIONS The 'Nine Truths About Eating Disorders' is a guiding document to accelerate global dissemination of accurate and evidence-informed information about eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Katherine Schaumberg
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elisabeth Welch
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lauren Breithaupt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Christopher Hübel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica H Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Linda Mustelin
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Public Health and Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andrew J Hardaway
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emily C Bulik-Sullivan
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Jangmo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ida A K Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Camilla Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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31
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Lloyd EC, Frampton I, Verplanken B, Haase AM. How extreme dieting becomes compulsive: A novel hypothesis for the role of anxiety in the development and maintenance of anorexia nervosa. Med Hypotheses 2017; 108:144-150. [PMID: 29055388 DOI: 10.1016/j.mehy.2017.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/22/2017] [Accepted: 09/03/2017] [Indexed: 02/07/2023]
Abstract
The US National Institute of Mental Health's Research Domain Criteria (NIMH RDoC) advocates the study of features common to psychiatric conditions. This transdiagnostic approach has recently been adopted into the study of anorexia nervosa (AN), an illness that can be considered compulsive in nature. This has led to the development of an account of AN that identifies key roles for the heightened reinforcement of starvation, leading to its excessive repetition, and goal-directed system dysfunction. Considering models of illness in other compulsive disorders, we extend the existing account to explain the emergence of reinforcement and goal-directed system abnormalities in AN, proposing that anxiety is central to both processes. As such we emphasise the particular importance of the anxiolytic effects of starvation, over other reinforcing outcomes, in encouraging the continuation of starvation within a model that proposes a number of mechanisms by which anxiety operates in the development and maintenance of AN. We suggest the psychopathology of AN mediates the relationship between the anxiolytic effects of starvation and excessive repetition of starvation, and that compulsive starvation has reciprocal effects on its determinants. We thus account for the emergence of symptoms of AN other than compulsive starvation, and for the relationship between different features of the disorder. By extending and adapting an existing explanation of AN, we provide a richer aetiological model that invites new research questions and could inform novel approaches to prevention and treatment.
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Affiliation(s)
- E C Lloyd
- School of Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - I Frampton
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry Road, Prince of Wales Road, Exeter EX4 4QG, UK.
| | - B Verplanken
- Department of Psychology, 10 West, University of Bath, Bath BA2 7AY, UK.
| | - A M Haase
- School of Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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32
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Won't stop or can't stop? Food restriction as a habitual behavior among individuals with anorexia nervosa or atypical anorexia nervosa. Eat Behav 2017; 26:144-147. [PMID: 28388511 DOI: 10.1016/j.eatbeh.2017.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 11/20/2022]
Abstract
Food restriction among individuals with anorexia nervosa (AN) is regarded as a goal-directed behavior. However, Walsh (2013) theorized that, although restriction is initially maintained by operant conditioning (with successful weight loss and external praise as salient rewards), it ultimately becomes a classically conditioned habit, persisting regardless of the presence of these once-salient rewards. Understanding food restriction as a well-ingrained habit may provide insight into treatment resistance. Further, it is not clear whether habitual food restriction is present among individuals with atypical AN (i.e. who engage in food restriction but are not low-weight). This study evaluated whether strength of habit predicted self-reported restriction above and beyond cognitive restraint. Seventy-eight individuals with AN or atypical AN completed the Eating Pathology Symptoms Inventory Restriction (EPSI-R) and Cognitive Restraint (EPSI-CR) subscales and the Self-Report Habit Index (SRHI) adapted for food restriction. We used a hierarchical multiple regression model to test whether habit strength predicted food restriction above and beyond cognitive restraint. After adding illness duration (step 1) and diagnosis (step 2) to the model, cognitive restraint (step 3) was not significant in explaining variation in restriction, whereas adding habit strength to the model (step 4) explained 27.9% of the variance in restriction (p<0.001). This is the first study to test a key component of Walsh's theory. Results provide support for food restriction maintenance through habit, rather than through effortful cognitive restraint. Because current models of AN characterize food restriction as purposeful, further research is needed to better understand habitual restriction in AN.
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