Negative mood induction effects on problem-solving task in women with eating disorders: a multi-method examination

BACKGROUND

The effects of negative affect on problem-solving and its psychophysiological correlates are poorly understood in eating disorder populations.

METHODS

This study examined respiratory sinus arrhythmia (RSA) and skin conductance responses of women with Binge Eating Disorder (BED: n = 56), Anorexia Nervosa (AN: n = 12), Bulimia Nervosa (BN: n = 32), and 24 healthy controls (HCs) at baseline, and then during: a negative mood induction task, an adapted Means Ends Problem-Solving (MEPS) task, and recovery. The MEPS task included four interpersonal scenarios: (1) binge-eating as a solution to stress, (2) job loss, (3) rejection by friends, and (4) by a significant other.

RESULTS

We found that individuals with eating disorders reported less positive mood than HCs and individuals with BN and BED reported more negative mood and greater urges to binge than HCs. After a negative mood induction, women with BED provided significantly less effective problem-solving strategies compared to HCs and women with BN for the binge-eating MEPS scenario. Relative to baseline and the negative mood induction, all participants exhibited significantly higher skin conductance measures throughout the MEPS scenarios and recovery. BED showed significantly lower respiratory sinus arrhythmia (RSA) levels than individuals with BN and HCs throughout the protocol.

CONCLUSIONS

The multimethod findings suggest individuals with BED are likely to have disorder-specific problem-solving difficulties after a negative mood induction.

Distress tolerance across self-report, behavioral and psychophysiological domains in women with eating disorders, and healthy controls

BACKGROUND AND OBJECTIVES

The tendency to engage in impulsive behaviors when distressed is linked to disordered eating. The current study comprehensively examines emotional responses to a distress tolerance task by utilizing self-report, psychophysiological measures (respiratory sinus arrhythmia [RSA], skin conductance responses [SCRs] and tonic skin conductance levels [SCLs]), and behavioral measures (i.e., termination of task, latency to quit task).

METHODS

26 healthy controls (HCs) and a sample of treatment-seeking women with Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Anorexia Nervosa (AN) (N = 106) completed the Paced Auditory Serial Addition Task- Computerized (PASAT-C). Psychophysiological measurements were collected during baseline, PASAT-C, and recovery, then averaged for each time period. Self-reported emotions were collected at baseline, post-PASAT-C and post-recovery.

RESULTS

Overall, we found an effect of Time, with all participants reporting greater negative emotions, less happiness, lower RSA, more SCRs and higher tonic SCLs after completion of the PASAT-C relative to baseline. There were no differences in PASAT-C performance between groups. There was an effect of Group for negative emotions, with women with BN, BED and AN reporting overall higher levels of negative emotions relative to HCs. Furthermore, we found an effect of Group for greater urges to binge eat and lower RSA values among BED, relative to individuals with BN, AN and HCs.

LIMITATIONS

This study is cross-sectional and lacked an overweight healthy control group.

CONCLUSION

During the PASAT-C, individuals with eating disorders (EDs) compared to HCs report higher levels of negative emotions, despite similar physiological and behavioral manifestations of distress.

The importance of body image concerns in overweight and normal weight individuals with binge eating disorder

Body image concerns in binge eating disorder (BED) have been examined almost exclusively in overweight individuals with BED. The current study extends past research by including overweight and normal weight BED and non-BED groups to assess the multifactorial construct of body image using subscales of the Eating Disorder Examination 16.0 (EDE-16.0) and a Body Comparison Task. Independent of weight status and when controlling for age and race, women with BED are distinguished from those without BED by significantly greater overvaluation of shape and weight on the EDE-16.0 and significantly reduced weight satisfaction after a Body Comparison Task. Both BED diagnosis and weight status were independently associated with Weight Concern and Shape Concern subscales on the EDE-16.0. Taken together, these data provide further support for the consideration of body image concerns in the diagnostic criteria for BED.

Assessment of executive functioning in binge-eating disorder independent of weight status

OBJECTIVE

Executive functioning (EF) problems may serve as vulnerability or maintenance factors for Binge-Eating Disorder (BED). However, it is unclear if EF problems observed in BED are related to overweight status or BED status. The current study extends this literature by examining EF in overweight and normal-weight BED compared to weight-matched controls.

METHOD

Participants were normal-weight women with BED (n = 23), overweight BED (n = 32), overweight healthy controls (n = 48), and normal-weight healthy controls (n = 29). The EF battery utilized tests from the National Institutes of Health (NIH) Toolbox and Delis-Kaplan Executive Function System (D-KEFS).

RESULTS

After controlling for years of education and minority status, overweight individuals performed more poorly than normal-weight individuals on a task of cognitive flexibility requiring generativity (p < .01), and speed on psychomotor performance tasks (p = .01). Normal-weight and overweight BED performed worse on working memory tasks compared to controls (p = .04). Unexpectedly, normal-weight BED individuals out-performed all other groups on an inhibitory control task (p < .01). No significant differences were found between the four groups on tasks of planning.

DISCUSSION

Regardless of weight status, BED is associated with working memory problems. Replication of the finding that normal-weight BED is associated with enhanced inhibitory control is needed.

Taste assessment in normal weight and overweight individuals with co-occurring Binge Eating Disorder

BACKGROUND

Taste perception influences food choice, and may contribute to both weight status and disordered eating. Relatively little work has attempted to disentangle contributions of weight status and Binge Eating Disorder (BED) to human taste perception. We predicted weight status and BED would interact, showing difference in taste perception from non-eating disorder matched groups.

METHODS

The four study groups included: normal weight BED (NW BED), normal weight healthy controls (NW HC), overweight BED (OW BED), and overweight healthy controls (OW HC) (N = 60). Groups were matched for age (±5 years), ethnicity, and weight status. Participants were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders, the Eating Disorder Examination Version 16.0, and the NIH Toolbox Gustatory Assessment with additional taste solutions and taste stimulus delivered with edible taste strips.

RESULTS

Interactions were found between weight status and diagnosis on measures of regional taste intensity for quinine hydrochloride (CI 95% [44.61, 56.31], p = 0.018), sucrose (CI 95% [46.79, 56.45], p = 0.003), and 6-n-propylthiouracil (CI 95% [25.557, 39.269], p = 0.015). OW BED participants perceived these taste stimuli significantly less intensely than OW HC and NW BED. Whole mouth taste intensity tests at suprathreshold amounts did not reveal group differences. All four groups reported similar hedonic response to taste stimuli. Edible taste strips had medium to large significant correlations with NIH Gustatory Assessment taste stimuli.

CONCLUSIONS

There were significant differences in the taste perception of OW BED relative to the other three groups. These findings may provide partial explanation as to why previous studies correlating taste and weight status have mixed results. Replication in larger samples assessed longitudinally is needed to extend this work.

Genetic and neural predictors of behavioral weight loss treatment: A preliminary study

OBJECTIVE

To examine neural mechanisms of action in behavioral weight loss treatment (BWL) and explore neural and genetic predictors of BWL.

METHODS

Neural activation to milkshake receipt and genetics were compared in 17 women with obesity who received 12 weeks of BWL and 17 women who received no intervention. Participants were scanned twice using functional magnetic resonance imaging at baseline and 12 weeks. Weight was assessed at baseline, 12, 36, and 60 weeks.

RESULTS

BWL participants lost more weight than controls at 12 weeks (-4.82% versus -0.70%). After 12 weeks, BWL had greater reduction in right caudate activation response to milk shake receipt than did controls. Among BWL participants, baseline to 12-week reduction in frontostriatal activation to milk shake predicted greater weight loss at 12, 36, and 60 weeks. Possessing the A/A or T/A genotype of the fat mass and obesity-associated (FTO) variant rs9939609 predicted greater weight loss at 12 and 36 weeks.

CONCLUSIONS

These preliminary data reveal that reduction in right caudate activation may be a neural mechanism of weight loss in BWL, and baseline FTO variant and reduction in frontostriatal activation during BWL predict short- and long-term weight loss. These findings require replication in larger samples.

Family-Based Therapy for Young Adults with Anorexia Nervosa Restores Weight

OBJECTIVE

We examined the preliminary acceptability and efficacy of family-based therapy (FBT) for weight restoration in young adults (FBTY) with Anorexia Nervosa (AN).

METHOD

Twenty-two primarily female participants ranging from age 18 to 26, with AN or atypical AN (ICD-10) and their support adults were enrolled in a 6-month open trial of FBTY. Participants were assessed at baseline, after treatment, and at six and 12 month follow-up visits. The primary outcome was BMI and secondary outcomes included eating disorder psychopathology, current eating disorder obsessions, and compulsions, number of other Axis I disorders and global assessment of functioning.

RESULTS

Although FBTY was rated as suitable by participants and their support adults, during FBTY, 9/22 participants dropped out and 3/22 dropped out at follow-up assessments. Despite being offered 18-20 sessions over six months, a mean of 12 FBTY sessions (SD = 6) were attended. After FBTY, 15 of the intent-to-treat sample of 22 were no longer underweight (BMIs ≥ 19 kg/m(2) ) and 12 months after treatment, 13/22 were no longer underweight. The magnitude of the BMI increase during FBTY (Hedges g = 1.20, 95th percentile CI = 0.55-1.85) was comparable to findings for adolescent FBT for AN. Secondary outcomes also improved.

DISCUSSION

FBTY for young adults with AN and atypical AN, which involves support adults participants have chosen, results in weight restoration that is sustained up to a year after treatment. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:701-707).