Cognitive Neuroscience of Eating Disorders

Steinglass, Joanna E.; Berner, Laura A.; Attia, Evelyn

doi:10.1016/j.psc.2018.10.008

Cited by 55 publications

(35 citation statements)

References 125 publications

(136 reference statements)

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“…Importantly, however, the fMRI analysis targeting brain regions involved in executive decision-making (regessor 1) revealed less deactivation in the core nodes of the "task-negative" DMN at follow-up relative to baseline (TP2 > TP1). This finding is relevant not only to the literature on reward-based decision-making (including DD) in AN [7,60,61], but also to the greater functional neuroimaging literature in the disorder [10,[62][63][64], for at least three reasons. First, the "task-negative" DMN regions in which longitudinal changes were observed (medial prefrontal cortex, posterior cingulate/precuneus, inferior parietal lobule) highly overlapped those in which we previously found abnormally decreased activation (i.e., greater deactivation) in acAN-T1, in comparison to HC, using the same analysis [40].…”

Section: Discussionmentioning

confidence: 85%

“…The unusual capacity of people with AN to resist hunger, postpone eating, and forgo food is often thought to be an expression of "too much" self-control [4,5]. Excessive self-control has long been recognized as an important clinical characteristic of AN [6], which together with altered reward sensitivity [7][8][9][10], might contribute to disorder maintenance and therapy resistance [11].…”

Section: Introductionmentioning

confidence: 99%

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Strengthened Default Mode Network Activation During Delay Discounting in Adolescents with Anorexia Nervosa After Partial Weight Restoration: A Longitudinal fMRI Study

Doose

King

Bernardoni

et al. 2020

JCM

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The capacity of patients with anorexia nervosa (AN) to resist food-based rewards is often assumed to reflect excessive self-control. Previous cross-sectional functional magnetic resonance imaging (fMRI) studies utilizing the delay discounting (DD) paradigm, an index of impulsivity and self-control, suggested altered neural efficiency of decision-making in acutely underweight patients (acAN) and a relative normalization in long-term, weight-recovered individuals with a history of AN (recAN). The current longitudinal study tested for changes in functional magnetic resonance imaging (fMRI) activation during DD associated with intensive weight restoration treatment. A predominately adolescent cohort of 22 female acAN patients (mean age—15.5 years) performed an established DD paradigm during fMRI at the beginning of hospitalization and again after partial weight restoration (≥12% body mass index (BMI) increase). Analyses investigated longitudinal changes in both reward valuation and executive decision-making processes. Additional exploratory analyses included comparisons with data acquired in aged-matched healthy controls (HC) as well as probes of functional connectivity between empirically identified nodes of the “task-positive” frontoparietal control network (FPN) and “task-negative” default-mode network (DMN). While treatment was not associated with changes in behavioral DD parameters or activation, specific to reward processing, deactivation of the DMN during decision-making was significantly less pronounced following partial weight restoration. Strengthened DMN activation during DD might reflect a relative relaxation of cognitive overcontrol or improved self-referential, decision-making. Together, our findings present further evidence that aberrant decision-making in AN might be remediable by treatment and, therefore, might constitute an acute effect rather than a core trait variable of the disorder.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Strengthened Default Mode Network Activation During Delay Discounting in Adolescents with Anorexia Nervosa After Partial Weight Restoration: A Longitudinal fMRI Study

Doose

King

Bernardoni

et al. 2020

JCM

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“…Finally, given our cross-sectional design, it is unclear whether NEAT deficits are a cause or a consequence of ED symptoms. Some biological consequences of EDs (e.g., malnutrition) can have considerable neurocognitive consequences [81]; thus, longitudinal analyses are needed to confirm that impaired negative emotional response inhibition precedes worsening ED symptoms.…”

Section: Discussionmentioning

confidence: 99%

Emotional Response Inhibition: A Shared Neurocognitive Deficit in Eating Disorder Symptoms and Nonsuicidal Self-Injury

et al. 2020

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Eating disorder (ED) symptoms often co-occur with non-suicidal self-injury (NSSI). This comorbidity is consistent with evidence that trait negative urgency increases risk for both of these phenomena. We previously found that impaired late-stage negative emotional response inhibition (i.e., negative emotional action termination or NEAT) might represent a neurocognitive mechanism for heightened negative urgency among people with NSSI history. The current study evaluated whether relations between negative urgency and ED symptoms similarly reflect deficits in this neurocognitive process. A total of 105 community adults completed an assessment of ED symptoms, negative urgency, and an emotional response inhibition task. Results indicated that, contrary to predictions, negative urgency and NEAT contributed independent variance to the prediction of ED symptoms, while controlling for demographic covariates and NSSI history. Worse NEAT was also uniquely associated with restrictive eating, after accounting for negative urgency. Our findings suggest that difficulty inhibiting ongoing motor responses triggered by negative emotional reactions (i.e., NEAT) may be a shared neurocognitive characteristic of ED symptoms and NSSI. However, negative urgency and NEAT dysfunction capture separate variance in the prediction of ED-related cognitions and behaviors, distinct from the pattern of results we previously observed in NSSI.Brain Sci. 2020, 10, 104 2 of 17 of diverse self-injurious behaviors [12][13][14][15][16] and a putative non-specific marker of general vulnerability for psychopathology [17,18]. Consistent with this notion, the most commonly reported function of NSSI and ED behaviors is to reduce negative affect [19][20][21][22][23][24][25]. Ecological momentary assessment corroborates the idea that direct and indirect self-injury are both motivated by a desire to alleviate unpleasant emotional states, as increased negative affect proximally predicts episodes of NSSI, dysregulated eating, and compensatory behaviors [26][27][28][29][30][31][32].Much like emotion dysregulation, impulsivity is implicated in various psychiatric disorders and self-injurious behaviors. This multifaceted construct encompasses several subfactors, including impulsive personality traits and impulsive behavior, or motor impulsivity. Impulsive behavior can be further divided into impulsive action and impulsive choice, which reflect inhibitory control and decision-making deficits, respectively. Impaired inhibitory control and consequently, impulsive action, are aspects of altered neurocognition broadly involved in suicidal thoughts and behaviors [12]. Impulsive personality traits, especially negative urgency, are also associated with NSSI [11,[33][34][35][36] and dysregulated eating [36][37][38][39][40]. Negative urgency is a transdiagnostic personality characteristic that refers to individual differences in the tendency to act impulsively in response to negative affect [41]. Heightened negative urgency among people who engage in self-injurious behaviors s...

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“…With daily repetition, the actions become automatic and entrenched until they are activated with no conscious effort in response to a stimulus or cue [56]. A recent cognitive neuroscience model of AN proposes that habitual behaviours are mediated within dorsal frontostriatal circuits [57][58][59]. In line with this, techniques from habit reversal therapy with inpatients led to significant reductions in eating disorder symptoms and self-reported habit strengths [60].…”

Section: Behavioural Consequences Of Anorexia Nervosamentioning

confidence: 95%

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

149

122

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The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

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Cognitive Neuroscience of Eating Disorders

Cited by 55 publications

References 125 publications

Strengthened Default Mode Network Activation During Delay Discounting in Adolescents with Anorexia Nervosa After Partial Weight Restoration: A Longitudinal fMRI Study

Strengthened Default Mode Network Activation During Delay Discounting in Adolescents with Anorexia Nervosa After Partial Weight Restoration: A Longitudinal fMRI Study

Emotional Response Inhibition: A Shared Neurocognitive Deficit in Eating Disorder Symptoms and Nonsuicidal Self-Injury

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

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