Emotional food-cue-reactivity in anorexia nervosa and bulimia nervosa: An electroencephalography study.

OBJECTIVE: Food-cue-reactivity entails neural and experiential responses to the sight and smell of attractive foods. Negative emotions can modulate such cue-reactivity and this might be central to the balance between restrictive versus bulimic symptomatology in Anorexia Nervosa (AN) and Bulimia Nervosa (BN). METHOD: Pleasantness ratings and electrocortical responses to food images were measured in patients with AN (n = 35), BN (n = 32) and matched healthy controls (HC, n = 35) in a neutral state and after idiosyncratic negative emotion induction while electroencephalography (EEG) was recorded. The EEG data were analyzed using a mass testing approach. RESULTS: Individuals with AN showed reduced pleasantness for foods compared to objects alongside elevated widespread occipito-central food-object discrimination between 170 and 535 ms, indicative of strong neural cue-reactivity. Food-object discrimination was further increased in the negative emotional condition between 690 and 1200 ms over centroparietal regions. Neither of these effects was seen in individuals with BN. DISCUSSION: Emotion modulated food-cue-reactivity in AN might reflect a decreased appetitive response in negative mood. Such specific (emotion-)regulatory strategies require more theoretical work and clinical attention. The absence of any marked effects in BN suggests that emotional cue-reactivity might be less prominent in this group or quite specific to certain emotional contexts or food types. PUBLIC SIGNIFICANCE: Negative affectivity is a risk factor for the development of eating disorders and individuals with eating disorders experience problems with emotion regulation. To better understand the effects of negative emotions, the present study investigated how they affected neural correlates of food perception in anorexia nervosa and bulimia nervosa.

I change my mind to get better: Process tracing-based microanalysis of food choice processes reveals differences between anorexia nervosa and bulimia nervosa during inpatient treatment.

Food choice and its underlying processes is understudied in bulimia nervosa (BN) and anorexia nervosa (AN). Thus, we examined cognitive processes during food choice through mouse tracing in AN (n = 36) and BN (n = 27) undergoing inpatient treatment. Both patient groups and matched healthy controls (HC, n = 59) made 153 binary food choices before rating all foods on their liking and calorie density. Choice outcomes and corresponding mouse movements were modelled as a function of inpatient treatment stage in our analyses. Compared to patients with BN and HC, those with AN showed a clear calorie avoidance on most trials. Yet, mouse paths in AN patients early in treatment, revealed a late direction reversal ('change of mind', CoM) on high-calorie choices. AN patients later in treatment, by contrast, showed fewer CoM alongside more choices for - and liking of - high-calorie foods. Patients with BN showed more CoM trials during low-calorie choices and low-calorie choices were more frequent in patients later in treatment. Thus, relative to patients early in treatment, patients who are later in treatment show less of the overall group pattern of consistently choosing low-calorie food (AN) or high-calorie food (BN). Less cognitive regulation (fewer CoM trials) went along with higher liking for high-calorie foods in AN. These cross-sectional differences between AN early and late in treatment might reflect the formation of healthier habits. In addition, clear patient group differences suggest more specific treatment strategies.

(Mouse cursor)-Tracking food decisions in binge eating disorder reveals preference for high-energy foods and a role of BMI.

Binge Eating Disorder (BED) has been associated with deficits in cognitive control and decision-making. Yet, no study has yet investigated the characteristics of food choice and the involved choice conflict in this disorder. In the present study individuals with BED (N = 22) and without BED (N = 61), with a body mass index (BMI) between 21 and 44 completed 153 binary food decisions among foods varying in palatability and energy density. To assess conflict during choice we recorded computer mouse paths and reaction times. Subsequently, participants rated all foods on liking and energy content. Finally, participants completed a bogus taste test with the same foods to measure actual consumption. Predictors were modelled continuously using Bayesian mixed-effects modelling. Individuals with BED liked foods with higher energy content more and chose them more often in the choice task. Yet, actual consumption in the taste test did not differ between groups, neither regarding total consumption, nor of foods with higher energy. Mouse cursor-tracking revealed that control participants with higher BMIs showed more choice conflict than those with lower BMIs. This pattern was reversed in those with BED. The high-energy preference in ratings and food choice represent the first evidence in a controlled laboratory context for disorder-congruent food choice in BED. The fact that this was not reflected in actual consumption might have methodological implications for measuring laboratory eating behaviour. Mouse cursor-tracking gave further insights into choice processes and showed a less conflicted food choice in those with BED with higher BMI compared to those with lower BMI.

Bad mood food? Increased versus decreased food cue reactivity in anorexia nervosa and bulimia nervosa during negative emotions.

OBJECTIVE: Emotion regulation difficulties in anorexia nervosa (AN) and bulimia nervosa (BN) might underlie bingeing and purging in BN, extreme fasting in AN, or combinations of these symptoms in binge-purge type AN. In this study, we tested for decreased food cue reactivity in response to negative emotions in AN, and the opposite pattern for BN. Furthermore, we explored subgroup differences (restrictive vs. binge-purging AN; history of AN in BN). METHOD: Patients with AN (n = 41), BN (n = 39), and matched controls (n = 70) completed an emotional eating questionnaire. In a laboratory experiment, we induced negative emotions and measured food cue reactivity (pleasantness, desire to eat (DTE), and corrugator muscle activity). RESULTS: AN reported emotional undereating, while BN reported emotional overeating. In the laboratory task, BN showed increased DTE and an appetitive corrugator response during negative emotions, selectively towards high-calorie foods. AN showed generalized reduced cue reactivity to high-calorie food regardless of emotional state. This pattern appears to be characteristic of restrictive AN, while cue reactivity of both BN subgroups pointed towards emotional overeating. CONCLUSIONS: The emotional over- versus undereating framework might help to explain bingeing and restricting along the anorectic-bulimic disorder spectrum, which calls for novel transdiagnostic theories and subgroup-specific treatments.

Mood-induced changes in the cortical processing of food images in bulimia nervosa.

BACKGROUND: Negative mood often triggers binge eating in bulimia nervosa (BN). We investigated motivational salience as a possible underlying mechanism using event-related potentials (ERPs) as indicators of motivated attention allocation (P300) and sustained processing (LPP). METHODS: We collected ERPs (P300: 350-400 ms; LPP: 600-1000 ms) from 21 women with full-syndrome or partially remitted BN and 21 healthy women (HC), matched for age and body mass index. Idiosyncratic negative and neutral situations were used to induce corresponding mood states (counterbalanced), before participants viewed images of high- and low-calorie foods and neutral objects, and provided ratings for pleasantness and desire to eat. RESULTS: P300 was larger for foods than objects; LPP was largest for high-calorie foods, followed by low-calorie foods, then objects. The BN group showed an increased desire to eat high-calorie foods under negative mood and stronger mood induction effects on ERPs than the HC group, with generally reduced P300 and a small increase in LPP for high-calorie foods. Effects were limited to circumscribed electrode positions. Exploratory analyses showed clearer effects when comparing high vs. low emotional eaters. CONCLUSION: We argue that negative mood decreased the availability of cognitive resources (decreased P300) in BN, thereby facilitating disinhibition and food cravings (increased desire-to-eat ratings). Increased sustained processing might be linked to emotional eating tendencies rather than BN pathology per se, and reflect approach motivation, conflict, or regulatory processes. Negative mood appears to induce complex changes in food image processing, whose understanding may contribute to the development of tailored interventions in the future.

Fight, Flight, - Or Grab a Bite! Trait Emotional and Restrained Eating Style Predicts Food Cue Responding Under Negative Emotions.

In today's society, obesity rates are rising as food intake is no longer only a response to physiological hunger signals that ensure survival. Eating can represent a reward, a response to boredom, or stress reduction and emotion regulation. While most people decrease food intake in response to stress or negative emotions, some do the opposite. Yet, it is unclear who shows emotional overeating under which circumstances. Emotion regulation theories describe emotional overeating as a learned strategy to down-regulate negative emotions. Cognitive theories, by contrast, attribute emotional overeating to perceived diet breaches in individuals who chronically attempt to diet. After consuming "forbidden foods", they eat more than individuals who do not restrict their food intake. This laboratory study investigated emotional overeating by exposing individuals to a personalized emotion induction while showing images of palatable foods. Outcome variables indexed cue reactivity to food images through picture ratings (valence, desire to eat), facial expressions (electromyography of the corrugator supercilii muscle), and brain reactivity by detecting event-related potentials (ERPs) by means of electroencephalography (EEG). The influence of emotion condition (negative, neutral) and individual differences (self-reported trait emotional and restrained eating) on outcome variables was assessed. Valence ratings and appetitive reactions of the corrugator muscle to food pictures showed a relative increase in the negative condition for individuals with higher emotional eating scores, with the opposite pattern in lower scores. Desire to eat ratings showed a similar pattern in individuals who showed a strong response to the emotion induction manipulation, indicative of a dose-response relationship. Although no differences between conditions were found for ratings or corrugator activity with restrained eating as a predictor, an ERP at P300 showed increased activation when viewing food compared to objects in the negative condition. Findings support emotion regulation theories: Emotional eaters showed an appetitive reaction in rating patterns and corrugator activity. EEG findings (increased P300) suggest a motivated attention toward food in restrained eaters, which supports cognitive theories. However, this did not translate to other variables, which might demonstrate successful restraint. Future studies may follow up on these findings by investigating eating disorders with emotion regulation difficulties.

The dynamics of self-control: within-participant modeling of binary food choices and underlying decision processes as a function of restrained eating.

Successful self-control during food choice might require inhibition of impulses to avoid indulging in tempting but calorie-dense foods, and this might particularly apply to individuals restraining their food intake. Adopting a novel within-participant modeling approach, we tested 62 females during a mouse-tracking based binary food choice task. Subsequent ratings of foods on palatability, healthiness, and calorie density were modeled as predictors for both decision outcome (choice) and decision process (measures of self-control conflict) while considering the moderating role of restrained eating. Results revealed that individuals higher on restrained eating were less likely to choose more high-calorie foods and showed less self-control conflict when choosing healthier foods. The latter finding is in contrast with the common assumption of self-control as requiring effortful and conscious inhibition of temptation impulses. Interestingly, restrained eaters rated healthy and low-calorie foods as more palatable than individuals with lower restrained eating scores, both in the main experiment and an independent replication study, hinting at an automatic and rather effortless mechanism of self-control (palatability shift) that obviates effortful inhibition of temptation impulses.

Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa.

Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) show emotion regulation deficits. While individuals with BN use binge eating to regulate negative affect, individuals with restricting-type AN may use self-starvation for this purpose. The current study examined the emotion regulatory function of over- and undereating in response to different emotional states in women with restrictive AN (n = 54), BN (n = 47), and women without eating disorders (n = 68). Participants completed self-report measures assessing the use of emotion regulation strategies and emotional eating. Both patient groups reported using more dysfunctional and less functional emotion regulation strategies than controls. The BN group reported eating more than usual in response to negative emotions but less than usual in response to positive emotions. In contrast, the AN group reported eating more than usual in response to positive emotions and less than usual in response to negative emotions. More dysfunctional emotion regulation related to eating less in response to negative emotions in the AN group. Less functional emotion regulation related to eating less when being happy in the BN group. The current study highlights the need to differentiate between different eating outcomes and different emotional states when examining emotion effects on food intake.

Associations between interoceptive sensitivity, intuitive eating, and body mass index in patients with anorexia nervosa and normal-weight controls.

Reduced perception of bodily signals and low levels of intuitive eating have been reported in patients with anorexia nervosa (AN) compared with normal-weight individuals. However, findings have been inconsistent and treatment progress might account for some of these inconsistencies. Thirty-seven inpatients with AN and 39 normal-weight controls completed a heartbeat perception task and the Intuitive Eating Scale-2. Patients with AN reported lower intuitive eating than controls, whereas interoceptive sensitivity did not differ between groups. Higher interoceptive sensitivity was related to higher intuitive eating across both groups. In patients with AN, both higher interoceptive sensitivity and intuitive eating correlated with the number of days in the hospital and with higher body mass index (BMI), when controlling for BMI at admission. These relationships suggest that interoceptive sensitivity and intuitive eating improve during treatment. Future research should determine whether these improvements promote weight gain or follow it.

Food craving, food choice and consumption: The role of impulsivity and sham-controlled tDCS stimulation of the right dlPFC.

BACKGROUND: Impulsivity has been found to be associated with overeating and obesity. Transcranial direct current stimulation (tDCS) may enhance inhibitory control while reducing food craving and intake. Thus, the aim of the present study was to investigate whether tDCS stimulation modifies food choice, craving and consumption as a function of trait impulsivity. METHODS: Forty-two predominantly healthy-weight women received active tDCS stimulation to the right dorsolateral prefrontal cortex and sham stimulation in a within participant design. Trait impulsivity was measured with a short form of the Barratt Impulsiveness Scale. Participants completed a computerized food-choice task, during which their mouse movements were traced. Current food craving was measured by a modified version of the Food Cravings Questionnaire-State as well as by desire to eat ratings for food pictures. Food intake was measured in a taste test. RESULTS: There were no tDCS effects on any of the dependent variables. Trait impulsivity (and non-planning impulsivity in particular) was positively associated with higher calorie intake in the taste test, irrespective of tDCS stimulation. CONCLUSION: The current findings question the efficacy of single-session tDCS stimulation of the right dLPFC to reduce food craving, high caloric food choice and calorie intake in non-selected, predominantly healthy weight women. However, they do support the idea that trait impulsivity is related to overeating and, therefore, may be a risk factor for obesity. Future research needs to specify which appetitive behaviors can be modulated by brain stimulation and which populations might profit from it the most.

Social Pavlovian conditioning: Short- and long-term effects and the role of anxiety and depressive symptoms.

Today's stressors largely arise from social interactions rather than from physical threat. However, the dominant laboratory model of emotional learning relies on physical stimuli (e.g. electric shock) whereas adequate models of social conditioning are missing, possibly due to more subtle and multilayered biobehavioral responses to such stimuli. To fill this gap, we acquired a broad set of measures during conditioning to negative social unconditioned stimuli, also taking into account long-term maintenance of conditioning and inter-individual differences. Fifty-nine healthy participants underwent a classical conditioning task with videos of actors expressing disapproving (US-neg) or neutral (US-neu) statements. Static images of the corresponding actors with a neutral facial expression served as CS+ and CS-, predicting US-neg and US-neu, respectively. Autonomic and facial-muscular measures confirmed differential unconditioned responding whereas experiential CS ratings, event-related potentials, and evoked theta oscillations confirmed differential conditioned responding. Conditioning was maintained at 1 month and 1 year follow-ups on experiential ratings, especially in individuals with elevated anxiety and depressive symptoms, documenting the efficiency of social conditioning and its clinical relevance. This novel, ecologically improved conditioning paradigm uncovered a remarkably efficient multi-layered social learning mechanism that may represent a risk factor for anxiety and depression.