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Russman Block SR, Klump KL, Beltz AM, Burt SA, Moser JS. Ovarian hormones reduce the negative association between worry and cognitive control: A combined neural and behavioral investigation. Psychoneuroendocrinology 2024; 161:106947. [PMID: 38183865 DOI: 10.1016/j.psyneuen.2023.106947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Increased reactivity to response conflict and errors, processes governed by the dorsal anterior cingulate cortex (dACC), have both been implicated in anxiety. Anxiety is also more common in females than males. Importantly, natural changes in ovarian hormones levels are related to fluctuations in anxiety symptoms in healthy and clinical populations, and ovarian hormones likely modulate prefrontal cortex structure and function. No studies, however, have examined the role of fluctuating ovarian hormones in the association between anxiety and cognitive control across the menstrual cycle. METHODS In this multimodal proof-of-concept study, naturally cycling females (N = 30 twins from 14 complete twin pairs and 2 participants whose co-twin was not in the final sample; age 18-29) provided saliva samples to assay for estradiol and progesterone and completed the Penn State Worry Questionnaire for 35 consecutive days. At two time points, during projected pre-ovulatory and post-ovulatory phases, they also completed the Flanker task while undergoing functional magnetic resonance imaging to probe cognitive control-related dACC activity. Multilevel modeling was used to examine within- and between-person effects of hormones and worry on cognitive-control indices. RESULTS On days when estradiol and progesterone were low relative to a female's own average (i.e., within-subjects effect), worry was associated with greater flanker interference. In females with higher estradiol and progesterone levels compared to other females (i.e., between-subject effects), worry was associated with less error-related dACC activity, irrespective of the day that dACC activity was assessed. CONCLUSION Findings suggest a protective effect of ovarian hormones on the link between worry and cognitive control. Associations between worry and conflict-monitoring were sensitive to daily hormonal fluctuations (within-person states), whereas associations between worry and error-monitoring were sensitive to mean hormone levels (between-person traits), suggesting that ovarian hormones are critical to consider in studies examining associations between anxiety and cognitive control in females.
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2
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Moser JS, Munia TTK, Louis CC, Anderson GE, Aviyente S. Errors elicit frontoparietal theta-gamma coupling that is modulated by endogenous estradiol levels. Int J Psychophysiol 2024; 197:112299. [PMID: 38215947 PMCID: PMC10922427 DOI: 10.1016/j.ijpsycho.2024.112299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
Cognitive control-related error monitoring is intimately involved in behavioral adaptation, learning, and individual differences in a variety of psychological traits and disorders. Accumulating evidence suggests that a focus on women's health and ovarian hormones is critical to the study of such cognitive brain functions. Here we sought to identify a novel index of error monitoring using a time-frequency based phase amplitude coupling (t-f PAC) measure and examine its modulation by endogenous levels of estradiol in females. Forty-three healthy, naturally cycling young adult females completed a flanker task while continuous electroencephalogram was recorded on four occasions across the menstrual cycle. Results revealed significant error-related t-f PAC between theta phase generated in fronto-central areas and gamma amplitude generated in parietal-occipital areas. Moreover, this error-related theta-gamma coupling was enhanced by endogenous levels of estradiol both within females across the cycle as well as between females with higher levels of average circulating estradiol. While the role of frontal midline theta in error processing is well documented, this paper extends the extant literature by illustrating that error monitoring involves the coordination between multiple distributed systems with the slow midline theta activity modulating the power of gamma-band oscillatory activity in parietal regions. They further show enhancement of inter-regional coupling by endogenous estradiol levels, consistent with research indicating modulation of cognitive control neural functions by the endocrine system in females. Together, this work identifies a novel neurophysiological marker of cognitive control-related error monitoring in females that has implications for neuroscience and women's health.
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Affiliation(s)
- Jason S Moser
- Department of Psychology, Michigan State University, United States of America.
| | - Tamanna T K Munia
- Department of Electrical and Computer Engineering, Michigan State University, United States of America
| | - Courtney C Louis
- Department of Psychology, Michigan State University, United States of America
| | - Grace E Anderson
- Department of Psychology, Michigan State University, United States of America
| | - Selin Aviyente
- Department of Electrical and Computer Engineering, Michigan State University, United States of America
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3
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Klump KL, Culbert KM, Johnson AW, Sisk CL. Ovarian Hormones and Binge Eating in Adulthood: Summary of Findings and Implications for Individual Differences in Risk in Women. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2023; 32:471-478. [PMID: 38313831 PMCID: PMC10836831 DOI: 10.1177/09637214231192835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Ovarian hormone influences on general food intake have been studied in animals for 60+ years. Yet, extensions of these data to key eating disorder symptoms in humans (e.g., binge eating (BE)) have only recently occurred. In this article, we summarize findings from studies examining the effects of ovarian hormones on BE. Findings suggest ovarian hormones contribute to BE in animals and humans, although studies are few in number, and effects are not present in all women or all animals exposed to high-risk hormonal milieus. Differences in susceptibility may be due to gene x hormone interactions that can explain why some, but not all, women/females develop BE in the presence of risky hormonal environments.
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Affiliation(s)
| | | | - Alexander W. Johnson
- Department of Psychology, Michigan State University
- Neuroscience Program, Michigan State University
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4
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Gloe LM, Russman Block S, Klump KL, Beltz AM, Moser JS. Determining menstrual cycle phase: An empirical examination of methodologies and recommendations for improvement in behavioral and brain sciences. Horm Behav 2023; 155:105421. [PMID: 37666081 PMCID: PMC10714354 DOI: 10.1016/j.yhbeh.2023.105421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
The recent decade has brought an exciting proliferation of behavioral, psychological and neuroscientific research involving the menstrual cycle. However, the reliability and validity of many popular methodologies for determining menstrual cycle phase lack empirical examination. These under-investigated methods include: (1) predicting menstrual cycle phase using self-report information only (e.g., "count" methods), (2) utilizing ovarian hormone ranges to determine menstrual cycle phase, and (3) using ovarian hormone changes from limited measurements (e.g., two time points) to determine menstrual cycle phase. In the current study, we examine the accuracy of these methods for menstrual cycle phase determination using 35-day within-person assessments of circulating ovarian hormones from 96 females across the menstrual cycle. Findings indicate that all three common methods are error-prone, resulting in phases being incorrectly determined for many participants, with Cohen's kappa estimates ranging from -0.13 to 0.53 indicating disagreement to only moderate agreement depending on the comparison. Such methodological challenges are surmountable through careful study design, more frequent hormone assays (when possible), and utilization of sophisticated statistical methods. With increased methodological rigor in behavioral, psychological and neuroscientific research, the field will be poised to detect biobehavioral correlates of ovarian hormone fluctuations for the betterment of the mental health and wellbeing of millions of females.
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Affiliation(s)
- Lilianne M Gloe
- Department of Psychology, Michigan State University, East Lansing, MI 48823, USA; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Stefanie Russman Block
- Department of Psychology, Michigan State University, East Lansing, MI 48823, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, MI 48823, USA
| | - Adriene M Beltz
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jason S Moser
- Department of Psychology, Michigan State University, East Lansing, MI 48823, USA
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5
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Guevarra DA, Louis CC, Gloe LM, Block SR, Kashy DA, Klump KL, Moser JS. Examining a window of vulnerability for affective symptoms in the mid-luteal phase of the menstrual cycle. Psychoneuroendocrinology 2023; 147:105958. [PMID: 36332274 DOI: 10.1016/j.psyneuen.2022.105958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
Particular phases of the menstrual cycle may exacerbate affective symptoms for females with a diagnosed mental health disorder. However, there are mixed findings regarding whether affective symptoms change across the menstrual cycle in females without a clinical diagnosis. The window of vulnerability model proposes that natural increases in ovarian hormones in the mid-luteal phase of the menstrual cycle lead to systematic changes in brain networks associated with affective processing. Consequently, the model posits that females may experience stress more intensely and remember negative events more readily in the mid-luteal phase, increasing their risk for higher affective symptoms. Using a 35-day longitudinal study design, we tested the window of vulnerability model in a non-clinical sample. We tracked naturally cycling females' daily stress and three types of affective symptoms: anxious apprehension, anxious arousal, and anhedonic depression. Using multilevel modeling, we simultaneously modeled within- and between-person associations among stress and menstrual phase for each affective symptom. We found increased anhedonic depression in the mid-luteal phase but not anxious apprehension or anxious arousal. Moreover, we detected a positive association between within- and between-person stress and anxious apprehension and anhedonic depression, but not anxious arousal. These associations were not stronger in the mid-luteal phase. Overall, we provide weak evidence for a window of vulnerability for affective symptoms in the mid-luteal phase of the menstrual cycle. Our findings suggest that stress is a better predictor of fluctuations in affective symptoms than the menstrual cycle. Moreover, our findings highlight the importance of measuring multiple negative affective symptoms because they may be differentially related to stress and the menstrual cycle.
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Affiliation(s)
- Darwin A Guevarra
- Michigan State University, United States; University of California, San Francisco, United States.
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6
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Klump KL, Di Dio AM. Combined oral contraceptive use and risk for binge eating in women: Potential gene × hormone interactions. Front Neuroendocrinol 2022; 67:101039. [PMID: 36181777 PMCID: PMC9679583 DOI: 10.1016/j.yfrne.2022.101039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022]
Abstract
Extant animal and human data suggest endogenous ovarian hormones increase risk for binge eating in females, possibly via gene × hormone interactions and hormonally induced increases in genetic influences. Approximately 85 % of women will take combined oral contraceptives (COCs) that mimic the riskiest hormonal milieu for binge eating (i.e., post-ovulation when both estrogen and progesterone are present). The purpose of this narrative review is to synthesize findings of binge eating risk in COC users. Few studies have been conducted, but results suggest that COCs may increase risk for binge eating and related phenotypes (e.g., craving for sweets), particularly in genetically vulnerable women. Larger, more systematic human and animal studies of COCs and binge eating are needed. The goal of this work should be to advance personalized medicine by identifying the extent of COC risk as well as the role of gene × hormone interactions in susceptibility.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, 316 Physics Road - Room 107B, East Lansing, MI 48824-1116, United States.
| | - Alaina M Di Dio
- Department of Psychology, Oberlin College, South Hall, 121 Elm Street, Oberlin, OH 44074, United States
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O’Connor SM, Mikhail M, Anaya C, Haller LL, Burt SA, McGue M, Iacono WG, Klump KL. Exploring the possibility of parents' broad internalizing phenotype acting through passive gene-environment correlations on daughters' disordered eating. Dev Psychopathol 2022; 34:1-12. [PMID: 35983803 PMCID: PMC9938845 DOI: 10.1017/s0954579422000608] [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] [Indexed: 02/05/2023]
Abstract
Twin studies demonstrate significant environmental influences and a lack of genetic effects on disordered eating before puberty in girls. However, genetic factors could act indirectly through passive gene-environment correlations (rGE; correlations between parents' genes and an environment shaped by those genes) that inflate environmental (but not genetic) estimates. The only study to explore passive rGE did not find significant effects, but the full range of parental phenotypes (e.g., internalizing symptoms) that could impact daughters' disordered eating was not examined. We addressed this gap by exploring whether parents' internalizing symptoms (e.g., anxiety, depressive symptoms) contribute to daughters' eating pathology through passive rGE. Participants were female twin pairs (aged 8-14 years; M = 10.44) in pre-early puberty and their biological parents (n = 279 families) from the Michigan State University Twin Registry. Nuclear twin family models explored passive rGE for parents' internalizing traits/symptoms and twins' overall eating disorder symptoms. No evidence for passive rGE was found. Instead, environmental factors that create similarities between co-twins (but not with their parents) and unique environmental factors were important. In pre-early puberty, genetic factors do not influence daughters' disordered eating, even indirectly through passive rGE. Future research should explore sibling-specific and unique environmental factors during this critical developmental period.
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Affiliation(s)
| | - Megan Mikhail
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Carolina Anaya
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Leora L. Haller
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - S. Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Matt McGue
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - William G. Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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8
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Mikhail ME, Anaya C, Culbert KM, Sisk CL, Johnson A, Klump KL. Gonadal Hormone Influences on Sex Differences in Binge Eating Across Development. Curr Psychiatry Rep 2021; 23:74. [PMID: 34613500 PMCID: PMC8576863 DOI: 10.1007/s11920-021-01287-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Binge eating is a transdiagnostic symptom that disproportionately affects females. Sexually dimorphic gonadal hormones (e.g., estradiol, testosterone) substantially impact eating behavior and may contribute to sex differences in binge eating. We examine recent evidence for the role of gonadal hormones in binge eating risk across development. RECENT FINDINGS Both organizational (long-lasting impact on the central nervous system (CNS)) and activational (transient influences on the CNS) hormone effects may contribute to sex differences in binge eating. Gonadal hormones also impact within-sex variability in binge eating, with higher estradiol levels in females and higher testosterone levels in males protective across development. Emerging evidence suggests that the impact of gonadal hormones may be greatest for people with other risk factors, including genetic, temperamental (e.g., high negative affect), and psychosocial (e.g., exposure to weight-based teasing) risk. Gonadal hormones contribute to sex differences and within-sex variability in binge eating across development.
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Affiliation(s)
- Megan E. Mikhail
- Department of Psychology, Michigan State University, 316 Physics Rd., Room 107B, East Lansing, MI, 48824-1116, USA
| | - Carolina Anaya
- Department of Psychology, Michigan State University, 316 Physics Rd., Room 107B, East Lansing, MI, 48824-1116, USA
| | - Kristen M. Culbert
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Cheryl L. Sisk
- Neuroscience Program, Michigan State University, East Lansing, MI, USA
| | - Alexander Johnson
- Neuroscience Program, Michigan State University, East Lansing, MI, USA
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, 316 Physics Rd., Room 107B, East Lansing, MI, 48824-1116, USA,Corresponding author:
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9
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Vo PT, Fowler N, Rolan EP, Culbert KM, Racine SE, Burt SA, Klump KL. The effects of puberty on associations between mood/personality factors and disordered eating symptoms in girls. Int J Eat Disord 2021; 54:1619-1631. [PMID: 34165208 PMCID: PMC8609476 DOI: 10.1002/eat.23572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Negative and positive urgency, anxiety, and depressive symptoms are significant factors of disordered eating (DE) symptoms in early adolescence through young adulthood. However, it is unclear how puberty-a critical developmental milestone that is associated with increased risk for DE symptoms-affects the relationship between these factors and DE symptoms, given that the role of pubertal status has rarely been considered in relation to these associations. Thus, the present study examined whether puberty moderates associations between mood/personality factors and DE in pre-adolescent and adolescent girls. METHOD Participants included 981 girls (aged 8-16 years) from the Michigan State University Twin Registry. Mood/personality factors, pubertal status, and DE were assessed with self-report questionnaires. RESULTS Puberty significantly moderated associations between several factors (negative urgency, positive urgency, trait anxiety, depressive symptoms) and the cognitive symptoms of DE (e.g., shape/weight concerns, body dissatisfaction). Associations between mood/personality factors and cognitive DE were stronger in girls with more advanced pubertal status. By contrast, no significant moderation effects were detected for mood/personality-dysregulated eating (e.g., binge eating, emotional eating) associations. DISCUSSION Findings identify pubertal development as an important moderator of mood/personality-DE symptom associations, especially for cognitive DE symptoms that are known to predict the later onset of clinical pathology.
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Affiliation(s)
- Phuong T. Vo
- Department of Psychology, Michigan State University
| | | | | | - Kristen M. Culbert
- Department of Family Medicine and Public Health Sciences, Wayne State University
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10
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Gloe LM, Kashy DA, Jacobs EG, Klump KL, Moser JS. Examining the role of ovarian hormones in the association between worry and working memory across the menstrual cycle. Psychoneuroendocrinology 2021; 131:105285. [PMID: 34090137 PMCID: PMC8405555 DOI: 10.1016/j.psyneuen.2021.105285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/25/2022]
Abstract
Previous research indicates that worry is associated with poorer working memory performance. Moreover, prior work demonstrates that estradiol relates to both worry and working memory performance. In the present study, we sought to further examine interrelations between worry, estradiol and working memory by testing whether estradiol moderates the association between worry and working memory in females. We hypothesized that worry would be associated with poorer working memory performance at higher levels of estradiol. We also conducted exploratory analyses to examine the role of progesterone as a moderator of the association between worry and working memory. Participants were 97 naturally-cycling females who attended four lab sessions across their menstrual cycles. Consistent with predictions, higher average levels of worry were associated with lower working memory accuracy on particularly difficult trials when average levels of estradiol were also high. The same association between higher worry and lower working memory accuracy emerged when average levels of progesterone were high. Findings highlight the importance of considering ovarian hormones in future studies and current theories of anxiety and cognition.
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11
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Mikhail ME, Keel PK, Burt SA, Sisk CL, Neale M, Boker S, Klump KL. Trait negative affect interacts with ovarian hormones to predict risk for emotional eating. Clin Psychol Sci 2021; 9:114-128. [PMID: 33758690 PMCID: PMC7983867 DOI: 10.1177/2167702620951535] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ovarian hormones significantly influence dysregulated eating in females. However, most women do not develop appreciable disordered eating, suggesting that ovarian hormones may not affect all women equally. We examined whether individual differences in trait negative affect (NA) moderate ovarian hormone-dysregulated eating associations in 446 women who provided saliva samples for hormone measurements and ratings of NA and emotional eating daily for 45 consecutive days. Women were at greatest risk for emotional eating when they had high trait NA and experienced a hormonal milieu characterized by low estradiol or high progesterone. While effects were evident in all women, the combination of high trait NA and high progesterone was particularly risky for women with a history of clinically significant binge eating episodes. These findings provide initial evidence that affective and hormonal risk interact to promote emotional eating, and that effects may be amplified in women with clinically significant binge eating.
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Affiliation(s)
- Megan E. Mikhail
- Department of Psychology, Michigan State University, East Lansing, MI 48824-1116
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL 32306-4301
| | - S. Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, MI 48824-1116
| | - Cheryl L. Sisk
- Neuroscience Program, Michigan State University, East Lansing, MI 48824-1116
| | - Michael Neale
- Departments of Psychiatry, Human Genetics, and Psychology, Virginia Commonwealth University, Richmond, VA 23298
| | - Steven Boker
- Department of Psychology, University of Virginia, Charlottesville, VA 22904-4400
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI 48824-1116
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12
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Culbert KM, Sisk CL, Klump KL. A Narrative Review of Sex Differences in Eating Disorders: Is There a Biological Basis? Clin Ther 2021; 43:95-111. [PMID: 33375999 PMCID: PMC7902379 DOI: 10.1016/j.clinthera.2020.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Eating disorders and their core symptoms (eg, binge eating, body weight/shape concerns) disproportionately affect females, and these sex-differentiated effects become prominent during and after puberty. Although psychosocial influences such as heightened sociocultural pressures for thinness in girls and women contribute to this sex imbalance, biological factors could also play an important role. METHODS This narrative review summarizes evidence of biological factors underlying the sex-differentiated prevalence of eating pathology as well as within-sex variability in risk. FINDINGS There are sex differences in the pubertal emergence of genetic effects on eating pathology (adrenarche in males; gonadarche in females), and at least some genetic contributions to eating pathology seem to vary between the sexes. Furthermore, sex steroid hormones (eg, testosterone, estradiol, progesterone) are leading contributors to differential risk for eating pathology in males and females across the life span. Emerging data suggest that between-sex and within-sex variability in risk might occur via hormone-driven modulation (activation/deactivation) of genetic influences and neural responsiveness to food-related cues. IMPLICATIONS There is a biological basis to heightened risk for eating pathology in females, relative to males, as well as unique biological influences within each sex. Findings from this review highlight the importance of studying both sexes and considering sex-specific biological mechanisms that may underlie differential risk for eating pathology.
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Affiliation(s)
- Kristen M Culbert
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Cheryl L Sisk
- Neuroscience Program, Michigan State University, East Lansing, MI, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Abstract
Conventional longitudinal behavioral genetic models estimate the relative contribution of genetic and environmental factors to stability and change of traits and behaviors. Longitudinal models rarely explain the processes that generate observed differences between genetically and socially related individuals. We propose that exchanges between individuals and their environments (i.e., phenotype-environment effects) can explain the emergence of observed differences over time. Phenotype-environment models, however, would require violation of the independence assumption of standard behavioral genetic models; that is, uncorrelated genetic and environmental factors. We review how specification of phenotype-environment effects contributes to understanding observed changes in genetic variability over time and longitudinal correlations among nonshared environmental factors. We then provide an example using 30 days of positive and negative affect scores from an all-female sample of twins. Results demonstrate that the phenotype-environment effects explain how heritability estimates fluctuate as well as how nonshared environmental factors persist over time. We discuss possible mechanisms underlying change in gene-environment correlation over time, the advantages and challenges of including gene-environment correlation in longitudinal twin models, and recommendations for future research.
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14
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O’Connor SM, Culbert KM, Mayhall LA, Burt SA, Klump KL. Differences in genetic and environmental influences on body weight and shape concerns across pubertal development in females. J Psychiatr Res 2020; 121:39-46. [PMID: 31759219 PMCID: PMC7099836 DOI: 10.1016/j.jpsychires.2019.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/12/2019] [Accepted: 11/07/2019] [Indexed: 02/08/2023]
Abstract
The heritability of disordered eating increases during puberty; however, prior studies have largely examined a composite score of disordered eating, rather than specific symptoms. Body weight and shape concerns cut across all eating disorder diagnoses and are some of the strongest prospective risk factors for the development of eating disorders. Yet, little is known about potential developmental increases or decreases in genetic and environmental influences for these key symptoms. This study examined differences in genetic and environmental effects on a range of body weight and shape concerns during puberty and compared results to findings for overall levels of disordered eating symptoms. Participants were 926 same-sex female twins (ages 8-16) from the Michigan State University Twin Registry. Well-validated questionnaires were used to examine pubertal maturation, overall levels of disordered eating, and a range of cognitive body weight/shape constructs: body dissatisfaction, weight/shape concerns, and weight preoccupation. Findings for overall levels of disordered eating were very similar to those obtained in previous work, with significantly increased genetic effects in girls at more advanced pubertal development. Importantly, these same pubertal increases in genetic influences were observed for body dissatisfaction and weight/shape concerns. However, no pubertal moderation of genetic effects was observed for weight preoccupation; instead, pubertal moderation of nonshared and shared environmental effects was observed. Our findings point to differences in the extent to which genetic and environmental factors contribute to various cognitive body weight and shape symptoms during puberty.
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Affiliation(s)
- Shannon M. O’Connor
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Kristen M. Culbert
- Department of Family Medicine and Public Health, Wayne State University School of Medicine, Detroit, MI, USA
| | - Laura A. Mayhall
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA
| | - S. Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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15
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Abstract
PURPOSE OF REVIEW Females experience eating disorders at substantially higher rates than males. Although sociocultural factors have traditionally been thought to underlie this sex disparity, accumulating evidence implicates differential exposure to gonadal hormones early in life. Gonadal hormones also impact within-sex variability in disordered eating, helping to explain why not all women develop an eating disorder, and some men do. We review recent findings regarding these gonadal hormone effects and their implications for the etiology of eating disorders. RECENT FINDINGS Males are exposed to significantly higher testosterone levels than females perinatally, and this exposure appears to protect against later binge eating in males relative to females. Within-sex, higher estradiol levels among females and higher testosterone levels among males appear to be protective. Progesterone exhibits minimal direct phenotypic effects on disordered eating but appears to counteract the protective effects of estrogen in adult females. Importantly, gonadal hormone effects may be moderated by psychosocial factors. SUMMARY Evidence suggests that gonadal hormones play a critical role in the etiology of disordered eating. Overall, higher testosterone and estrogen appear to be protective across development. Additional research is needed to identify mechanisms underlying these effects and further explore interactions between hormonal and psychosocial risk.
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The Role of Puberty and Ovarian Hormones in the Genetic Diathesis of Eating Disorders in Females. Child Adolesc Psychiatr Clin N Am 2019; 28:617-628. [PMID: 31443879 DOI: 10.1016/j.chc.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Puberty is a critical risk period for eating disorders (EDs). ED incidence increases across the pubertal period and becomes female predominant, and genetic influences on disordered eating significantly increase. Surges of ovarian hormones, particularly estrogen, may drive this increasing genetic effect for EDs in pubertal girls and contribute to differential phenotypic presentations beyond puberty. In this article, we explain phenotypic associations between puberty and disordered eating and present evidence showing underlying genetic and hormonal influence. Potential benefits of communicating roles of genetic influence to people with or at risk for EDs are also discussed.
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Fowler N, Vo PT, Sisk CL, Klump KL. Stress as a potential moderator of ovarian hormone influences on binge eating in women. F1000Res 2019; 8. [PMID: 30854192 PMCID: PMC6396839 DOI: 10.12688/f1000research.16895.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/30/2022] Open
Abstract
Previous research has demonstrated significant associations between increased levels of ovarian hormones and increased rates of binge eating (BE) in women. However, whereas all women experience fluctuations in ovarian hormones across the menstrual cycle, not all women binge eat in response to these fluctuations, suggesting that other factors must contribute. Stress is one potential contributing factor. Specifically, it may be that hormone-BE associations are stronger in women who experience high levels of stress, particularly as stress has been shown to be a precipitant to BE episodes in women. To date, no studies have directly examined stress as a moderator of hormone-BE associations, but indirect data (that is, associations between BE and stress and between ovarian hormones and stress) could provide initial clues about moderating effects. Given the above, the purpose of this narrative review was to evaluate these indirect data and their promise for understanding the role of stress in hormone-BE associations. Studies examining associations between all three phenotypes (that is, ovarian hormones, stress, and BE) in animals and humans were reviewed to provide the most thorough and up-to-date review of the literature on the potential moderating effects of stress on ovarian hormone-BE associations. Overall, current evidence suggests that associations between hormones and BE may be stronger in women with high stress levels, possibly via altered hypothalamic-pituitary-adrenal axis response to stress and increased sensitivity to and altered effects of ovarian hormones during stress. Additional studies are necessary to directly examine stress as a moderator of ovarian hormone-BE associations and identify the mechanisms underlying these effects.
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Affiliation(s)
- Natasha Fowler
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
| | - Phuong T Vo
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
| | - Cheryl L Sisk
- Neuroscience Program, Michigan State University, 293 Farm Lane, East Lansing, MI, 48824-1116, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
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Fowler N, Keel PK, Burt SA, Neale M, Boker S, Sisk CL, Klump KL. Associations between ovarian hormones and emotional eating across the menstrual cycle: Do ovulatory shifts in hormones matter? Int J Eat Disord 2019; 52:195-199. [PMID: 30648266 PMCID: PMC6394872 DOI: 10.1002/eat.22985] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/18/2018] [Accepted: 10/28/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Elevated ovarian hormone levels are associated with increased risk for binge eating (BE) and emotional eating (EE) during the midluteal phase of the menstrual cycle. However, past studies have not examined whether pronounced hormonal changes that precede the midluteal phase (i.e., the dramatic decrease in estradiol and increase in progesterone during/after ovulation) also influence midluteal increases in binge-related symptoms. Past theories and studies of phenotypes strongly related to BE (e.g., depression) suggest that these pronounced hormonal changes may also contribute. This study examined this possibility in 375 female twins (aged 15-25 years) from the Michigan State University Twin Registry. METHODS Daily ratings of EE (assessed with the Dutch Eating Behavior Questionnaire) and daily saliva samples of estradiol and progesterone were collected for 45 consecutive days. RESULTS No significant associations were found between pronounced changes in estradiol or progesterone across ovulation and changes in EE scores in the midluteal phase. Results remained unchanged after controlling for body mass index and negative affect and examining participants with clinical BE episodes or more extreme hormonal fluctuations. DISCUSSION In aggregate, the current findings and past data suggest that hormone levels are more significant predictors of EE than pronounced hormonal changes across the menstrual cycle.
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Affiliation(s)
- Natasha Fowler
- Department of Psychology, Michigan State University, East Lansing, MI, 48824
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL, 32306
| | - S. Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, MI, 48824
| | - Michael Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, 23284
| | - Steven Boker
- Department of Psychology, University of Virginia, Charlottesville, VA, 22903
| | - Cheryl L. Sisk
- Department of Psychology, Michigan State University, East Lansing, MI, 48824,Neuroscience Program, Michigan State University, East Lansing, MI, 48824
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI, 48824
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Sex steroid hormones and differential risk for eating pathology: a review of genetic and phenotypic effects across development. Curr Opin Behav Sci 2018. [DOI: 10.1016/j.cobeha.2018.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Beltz AM, Moser JS, Zhu DC, Burt SA, Klump KL. Using person-specific neural networks to characterize heterogeneity in eating disorders: Illustrative links between emotional eating and ovarian hormones. Int J Eat Disord 2018; 51:730-740. [PMID: 30132946 PMCID: PMC6186182 DOI: 10.1002/eat.22902] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/23/2018] [Accepted: 05/26/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Emotional eating has been linked to ovarian hormone functioning, but no studies to-date have considered the role of brain function. This knowledge gap may stem from methodological challenges: Data are heterogeneous, violating assumptions of homogeneity made by between-subjects analyses. The primary aim of this paper is to describe an innovative within-subjects analysis that models heterogeneity and has potential for filling knowledge gaps in eating disorder research. We illustrate its utility in an application to pilot neuroimaging, hormone, and emotional eating data across the menstrual cycle. METHOD Group iterative multiple model estimation (GIMME) is a person-specific network approach for estimating sample-, subgroup-, and individual-level connections between brain regions. To illustrate its potential for eating disorder research, we apply it to pilot data from 10 female twins (N = 5 pairs) discordant for emotional eating and/or anxiety, who provided two resting state fMRI scans and hormone assays. We then demonstrate how the multimodal data can be linked in multilevel models. RESULTS GIMME generated person-specific neural networks that contained connections common across the sample, shared between co-twins, and unique to individuals. Illustrative analyses revealed positive relations between hormones and default mode connectivity strength for control twins, but no relations for their co-twins who engage in emotional eating or who had anxiety. DISCUSSION This paper showcases the value of person-specific neuroimaging network analysis and its multimodal associations in the study of heterogeneous biopsychosocial phenomena, such as eating behavior.
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Affiliation(s)
| | | | - David C Zhu
- Michigan State University, East Lansing, Michigan
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21
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Klump KL, Fowler N, Mayhall L, Sisk CL, Culbert KM, Burt SA. Estrogen moderates genetic influences on binge eating during puberty: Disruption of normative processes? JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:458-470. [PMID: 29927265 DOI: 10.1037/abn0000352] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Puberty is a critical period for changes in genetic effects for binge eating in girls. Previous twin studies show increases in genetic influences on binge eating from prepuberty (∼0%) to midpuberty and beyond (∼50%). However, little is known about the factors that drive these shifts in genetic effects. A small pilot study showed that pubertal activation of estrogen may contribute to increases in genetic influences, possibly via hormonally induced changes in gene expression. However, large-scale studies investigating hormone effects on genetic risk are lacking. Thus, the purpose of the present study was to examine the effects of estrogen on genetic influences for binge eating in 964 female twins (ages 8-16 years) from the Michigan State University Twin Registry. Binge eating was assessed with the Minnesota Eating Behaviors Survey, whereas afternoon saliva samples were assayed for estradiol levels using standard enzyme immunoassays. Twin moderation models showed substantial differences in genetic influences on binge eating across estradiol levels. Stronger genetic effects were observed at lower (rather than higher) estradiol levels, even when controlling for the effects of age, body mass index, the physical changes of puberty, and the onset of menses. Overall, findings suggest that comparatively lower levels of estradiol during this critical period may disrupt normative developmental processes and enhance genetic influences on binge eating. (PsycINFO Database Record
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Grotzinger AD, Mann FD, Patterson MW, Herzhoff K, Tackett JL, Tucker-Drob EM, Harden KP. Twin models of environmental and genetic influences on pubertal development, salivary testosterone, and estradiol in adolescence. Clin Endocrinol (Oxf) 2018; 88:243-250. [PMID: 29161770 PMCID: PMC5771835 DOI: 10.1111/cen.13522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Research on sources of variation in adolescent's gonadal hormone levels is limited. We sought to decompose individual differences in adolescent testosterone, estradiol, and pubertal status, into genetic and environmental components. DESIGN A sample of male and female adolescent twins from the greater Austin and Houston areas provided salivary samples, with a subset of participants providing longitudinal data at 2 waves. PARTICIPANTS The sample included 902 adolescent twins, 49% female, aged 13-20 years (M = 15.91) from the Texas Twin Project. Thirty-seven per cent of twin pairs were monozygotic; 30% were same-sex dizygotic (DZ) pairs; and 33% were opposite-sex DZ pairs. MEASUREMENTS Saliva samples were assayed for testosterone and estradiol using chemiluminescence immunoassays. Pubertal status was assessed using self-report. Biometric decompositions were performed using multivariate quantitative genetic models. RESULTS Genetic factors contributed substantially to variation in testosterone in males and females in the follicular phase of their menstrual cycle (h2 = 60% and 51%, respectively). Estradiol was also genetically influenced in both sexes, but was predominately influenced by nonshared environmental factors. The correlation between testosterone and estradiol was mediated by a combination of genetic and environmental influences for males and females. Genetic and environmental influences on hormonal concentrations were only weakly correlated with self-reported pubertal status, particularly for females. CONCLUSIONS Between-person variability in adolescent gonadal hormones and their interrelationship reflects both genetic and environmental processes, with both testosterone and estradiol containing sizeable heritable components.
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Affiliation(s)
| | - Frank D. Mann
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Megan W. Patterson
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Kathrin Herzhoff
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | | | - Elliot M. Tucker-Drob
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - K. Paige Harden
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
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Culbert KM, Burt SA, Klump KL. Expanding the developmental boundaries of etiologic effects: The role of adrenarche in genetic influences on disordered eating in males. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:593-606. [PMID: 28691847 PMCID: PMC5505185 DOI: 10.1037/abn0000226] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Genetic influences on disordered eating (DE) increase across age and puberty in girls, an effect that is at least partially due to ovarian hormone activation. However, development shifts in genetic effects have not been detected in boys; genetic influences have been found to be relatively constant from prepuberty to adulthood, suggesting that gonadal hormones may be less important. One caveat is that studies have examined males ages 10 or older. Genetic effects on DE may emerge earlier in boys, such as during adrenarche, when androgens begin to increase but the physical changes of puberty are not yet observable. The current study investigated this hypothesis in 1,212 male twins (ages 6-28) from the Michigan State University Twin Registry. Results supported a potential role of adrenarche, as genetic influences on DE increased during middle childhood, prior to the external physical changes of puberty. Specifically, genetic influences on DE were negligible (0%) in twins during pre- to early adrenarche, but increased incrementally across advancing adrenarche (17% to 44%) and into early puberty (57%). Genetic effects then remained stable into midpuberty and postpuberty (58%), suggesting that nearly all of the genetic effects on DE become prominent during adrenarche in males. Findings suggest that genetic effects on DE emerge sooner in boys than the midpubertal activation that is consistently found in girls. These data highlight a potentially important role for adrenarche in the genetic diathesis for DE in males and a need to examine younger ages in studies of developmental effects. (PsycINFO Database Record
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Klump KL, Culbert KM, Sisk CL. Sex Differences in Binge Eating: Gonadal Hormone Effects Across Development. Annu Rev Clin Psychol 2017; 13:183-207. [PMID: 28301762 DOI: 10.1146/annurev-clinpsy-032816-045309] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Eating disorders are highly sexually differentiated disorders that exhibit a female predominance in risk. Most theories focus on psychosocial explanations to the exclusion of biological/genetic influences. The purpose of this descriptive review is to evaluate evidence from animal and human studies in support of gonadal hormone effects on sex differences in binge eating. Although research is in its nascent stages, findings suggest that increased prenatal testosterone exposure in males appears to protect against binge eating. Although pubertal testosterone may exert additional protective effects, the prenatal period is likely critical for the decreased risk observed in males. By contrast, studies indicate that, in females, it is the lack of prenatal testosterone coupled with the organizational effects of pubertal ovarian hormones that may lead to increased binge eating. Finally, twin data suggest that changes in genetic risk may underlie these hormone influences on sex differences across development.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan 48824;
| | - Kristen M Culbert
- Department of Psychology, University of Nevada, Las Vegas, Nevada 89154;
| | - Cheryl L Sisk
- Department of Psychology, Michigan State University, East Lansing, Michigan 48824; .,Neuroscience Program, Michigan State University, East Lansing, Michigan 48825;
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Klump KL, O'Connor SM, Hildebrandt BA, Keel PK, Neale M, Sisk CL, Boker S, Burt SA. Differential Effects of Estrogen and Progesterone on Genetic and Environmental Risk for Emotional Eating in Women. Clin Psychol Sci 2016; 4:895-908. [PMID: 27747142 DOI: 10.1177/2167702616641637] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Recent data show shifts in genetic and environmental influences on emotional eating across the menstrual cycle, with significant shared environmental influences during pre-ovulation, and primarily genetic effects during post-ovulation. Factors driving differential effects are unknown, although increased estradiol during pre-ovulation and increased progesterone during post-ovulation are thought to play a role. We indirectly investigated this possibility by examining whether overall levels of estradiol and progesterone differentially impact genetic and environmental risk for emotional eating in adult female twins (N = 571) drawn from the MSU Twin Registry. Emotional eating, estradiol levels, and progesterone levels were assessed daily and then averaged to create aggregate measures for analysis. As predicted, shared environmental influences were significantly greater in twins with high estradiol levels, whereas additive genetic effects increased substantially across low versus high progesterone groups. Results highlight significant and differential effects of ovarian hormones on etiologic risk for emotional eating in adulthood.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Shannon M O'Connor
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | | | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Michael Neale
- Departments of Psychiatry, Human Genetics, and Psychology, Virginia Commonwealth University, Charlottesville, VA, USA
| | - Cheryl L Sisk
- Department of Psychology, Michigan State University, East Lansing, MI, USA; Neuroscience Program, Michigan State University, East Lansing, MI, USA
| | - Steven Boker
- Department of Psychology, University of Virginia, Richmond, VA, USA
| | - S Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Abstract
This review summarizes the current state of the literature regarding hormonal correlates of, and etiologic influences on, eating pathology. Several hormones (e.g., ghrelin, CCK, GLP-1, PYY, leptin, oxytocin, cortisol) are disrupted during the ill state of eating disorders and likely contribute to the maintenance of core symptoms (e.g., dietary restriction, binge eating) and/or co-occurring features (e.g., mood symptoms, attentional biases). Some of these hormones (e.g., ghrelin, cortisol) may also be related to eating pathology via links with psychological stress. Despite these effects, the role of hormonal factors in the etiology of eating disorders remains unknown. The strongest evidence for etiologic effects has emerged for ovarian hormones, as changes in ovarian hormones predict changes in phenotypic and genetic influences on disordered eating. Future studies would benefit from utilizing etiologically informative designs (e.g., high risk, behavioral genetic) and continuing to explore factors (e.g., psychological, neural responsivity) that may impact hormonal influences on eating pathology.
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