Patients with bulimia nervosa do not show typical neurodevelopment of cognitive control under emotional influences.

Bulimia nervosa (BN) emerges in the late teen years and is characterized by binge eating and related compensatory behaviors. These behaviors often co-occur with periods of negative affect suggesting an association between emotions and control over eating behavior. In the current study, we examined how cognitive control and neural processes change under emotional states of arousal in 46 participants with (n=19) and without (n=27) BN from the ages of 18-33 years. Participants performed a go/nogo task consisting of brief negative, positive and neutral emotional cues and sustained negative, positive and neutral emotional states of arousal during functional magnetic resonance imaging (fMRI). Overall task performance improved with age for healthy participants, but not for patients with BN. These age-dependent behavioral effects were paralleled by diminished recruitment of prefrontal control circuitry in patients with BN with age. Although patients with BN showed no difference in performance on the experimental manipulations of negative emotions, sustained positive emotions related to improved performance among patients with BN. Together the findings highlight a neurodevelopmental approach towards understanding markers of psychopathology and suggest that sustained positive affect may have potential therapeutic effects on maintaining behavioral control in BN.

Bulimia nervosa and evidence for striatal dopamine dysregulation: a conceptual review.

OBJECTIVE: This article reviews concepts and evidence, based in particular on the work of Bartley G. Hoebel and colleagues, which suggest that a better understanding of the role of striatal dopamine (DA) in the initiation and/or maintenance of bulimia nervosa (BN) may result in a clearer characterization of mechanisms underlying BN. METHODS: Literature review, using PubMed search. RESULTS: Several lines of evidence, including the work of Bartley G. Hoebel, implicate the importance of striatal DA in feeding behavior, as well as in the disordered eating behaviors relevant to BN. Preclinical models of 'BN-like' eating behaviors have been associated with changes in striatal DA and DA receptor measures. Emerging clinical research also suggests that striatal DA abnormalities exist in individuals with BN. CONCLUSION: Alterations in striatal DA may exist in patients with BN. While the precise relationship between these findings and the etiology and maintenance of bulimic symptomatology remains unclear, further investigation of brain DA systems is a fruitful avenue of future research in BN.

Baclofen for binge eating: an open-label trial.

OBJECTIVE: Baclofen is a GABA-B agonist that may be useful in the treatment of substance use disorders, and also reduces 'binge-like' eating in rodents. We hypothesized that baclofen might be effective in reducing binge eating episodes in binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Seven women with BED (n = 4) or BN (n = 3) took baclofen (60 mg/day) for 10 weeks. RESULTS: Six out of seven patients completed the full 10-week trial. Five out of seven participants (3 BED; 2 BN) demonstrated 50% or greater reduction of frequency of binge eating from beginning to end of the study. Three out of seven participants (2 BED; 1 BN) were free of binge eating at study end. Four out of seven participants elected to continue baclofen at study end. Baclofen was well tolerated by the participants. CONCLUSION: In this open-label trial, baclofen was associated with decreased binge eating frequency in patients with BED and BN.