Goal Directed and Self-Control Systems in Bulimia Nervosa: An fMRI Study

Abstract

BackgroundBinge eating is apparently the opposite of the strict control over food intake typically set by “maladaptive dieters”. Using functional magnetic resonance imaging (fMRI), we investigated the role of goal-directed behaviors, and the related use of self-control, in binge-related food choices in patients with Bulimia Nervosa (BN).MethodWhile undergoing fMRI, women aged 18–35 with BN (N = 35) and healthy control women (N = 26) rated foods for healthiness and tastiness and then made food choices on a 5 points Likert scale between two conflicting options: one food with lower healthiness and higher tastiness (defined as uncontrolled choice) than the other food (defined as controlled choice).ResultsBN and healthy participants made more uncontrolled than controlled choices (63% vs 24% and 65% vs 18% respectively). While healthy participants used only food tastiness (chose tastier foods more often) to make food choices (p < .001), BN patients used both food healthiness (chose unhealthy food more often, p < .001) and food tastiness (p < .001) to make binge-related food choices. Activity in the ventromedial prefrontal cortex (vmPFC), which correlated with food choices (pFWE = 0.02), reflected this difference in the integration of food healthiness and food tastiness into a decision value. Functional connectivity analysis showed that the activity in the dorsolateral prefrontal cortex was coupled with vmPFC activity in uncontrolled food choices (pFWE = 0.03).InterpretationContrary to what might be expected, not only food tastiness but also unhealthiness (a more abstract cognitive-based attribute than food tastiness) plays a role in uncontrolled choices in BN. These choices are likely goal-directed behaviors and recruit self-control.

A review of the relationship between eating behavior, obesity and functional brain network organization

“…Similarly, another study found that subthreshold BN was associated with increased amygdala connectivity with the insula and putamen during anticipation of tasting a milkshake, highlighting the importance of the insula in binge eating pathology ( Bohon and Stice, 2012 ). Finally, greater connectivity between the dlPFC and vmPFC was associated with more frequent selection of unhealthy calorie dense foods among individuals with BN, a relationship that was not apparent among healthy individuals ( Neveu et al , 2018 ). Together, these findings suggest that binge eating psychopathology is associated with differences in network organization and regions that support reward valuation and salience detection during the processing of food cues.…”

A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism

“…A growing literature is investigating brain processes in BN compared to HC alone or in conjunction with AN subtypes. For example, compared to HC, BN exhibit (a) higher medial PFC activation to overweight body images (Spangler & Allen, ); (b) lower anterior cingulate cortex (ACC), occipital, and orbitofrontal activation to desirable food cues following a stress induction (Collins et al, ); and (c) lower health appraisal of food despite similar ventromedial PFC activation and tastiness appraisals when making desirable food choices (Neveu et al, ). Taken together, these findings are consistent with heightened brain resources devoted to social comparison in BN as well as lowered food‐related conflict in the face of stress.…”

Persepsi Tubuh dan Bulimia Nervosa pada Remaja Putri

“…Makan berlebihan tersebut merupakan istirahat dalam kontrol ketat atas asupan makanan penderita bulimia nervosa (13).…”