Preference for Safe Over Risky Options in Binge Eating

Abstract

Binge eating has been usually viewed as a loss of control and an impulsive behavior. But, little is known about the actual behavior of binging patients (prevalently women) in terms of basic decision-making under risk or under uncertainty. In healthy women, stressful cues bias behavior for safer options, raising the question of whether food cues that are perceived as threatening by binging patients may modulate patients’ behaviors towards safer options. A cross-sectional study was conducted with binging patients (20 bulimia nervosa (BN) and 23 anorexia nervosa binging (ANB) patients) and two control groups (22 non-binging restrictive (ANR) anorexia nervosa patients and 20 healthy participants), without any concomitant impulsive disorder. We assessed decisions under risk with a gambling task with known probabilities and decisions under uncertainty with the balloon analog risk taking task (BART) with unknown probabilities of winning, in three cued-conditions including neutral, binge food and stressful cues. In the gambling task, binging and ANR patients adopted similar safer attitudes and coherently elicited a higher aversion to losses when primed by food as compared to neutral cues. This held true for BN and ANR patients in the BART. After controlling for anxiety level, these safer attitudes in the food condition were similar to the ones under stress. In the BART, ANB patients exhibited a higher variability in their choices in the food compared to neutral condition. This higher variability was associated with higher difficulties to discard irrelevant information. All these results suggest that decision-making under risk and under uncertainty is not fundamentally altered in all these patients.

The influence of oxytocin on risk‐taking in the balloon analogue risk task among women with bulimia nervosa and binge eating disorder

“…On the whole, however, the general pattern of responding on the BART in samples with subclinical binge eating behaviour has indicated greater levels of risk‐taking behaviour, which is in line with studies finding greater risk‐taking tendencies on other measures in populations with clinical levels of binge eating behaviour . In the present study, we therefore aimed to investigate whether participants with clinical levels of recurrent binge eating behaviour would indeed be found to exhibit greater risk‐taking tendencies on the BART given the greater sample size combined with a greater number of BART trials compared to previous investigations …”

“…Manasse et al, for example, found no differences on the BART between obese individuals with and without BED. Neveu et al found that individuals with BN tend to exhibit less risky behaviour in the BART following exposure to food vs neutral images but did not exhibit overall differences in behaviour compared to control participants. The study conducted by Neveu et al, however, was limited by low sample size, and the study conducted by Manasse et al administered only 10 trials in the BART, whereas the BART was originally validated across 30 trials of balloons with the same probability of explosion.…”

Intolerance of Uncertainty in Eating Disorders: A Systematic Review and Meta‐Analysis

“…Across nine studies of AN, there was evidence of elevated IU and impaired decision‐making related to cognitive bias towards less risk in acute AN (Abbate‐Daga et al , ; Adoue et al , ; Frank et al , ; McFadden et al , ; Merwin et al , ; Moskovich, ; Neveu et al , ; Sternheim, Konstantellou, Startup, & Schmidt, ; Sternheim et al , ). Levels of IU in AN were higher than in OCD and psychosis, and similar to GAD (Sternheim, et al , ).…”

“…Of five studies of BN, some evidence of elevated IU was found (Celone, ; Frank et al , ; Giménez, ; Neveu et al , ; Sternheim, et al , ). However, there was inconsistent evidence of differences between AN and BN; similar levels to AN were found in one study (Frank et al , ) and lower levels in another (Sternheim et al , ).…”

The Sequential Binge, a New Therapeutic Approach for Binge Eating: A Pilot Study

“…These processes facilitate a subsequent restriction of binge foods and reinforce binge occurrence [1]. These processes are i) the excessive food intake, which temporarily reduces the desire to eat these foods through a saturation effect [6–9]; ii) the use of planning and other cognitive control abilities during the binge to reduce long-term binge food attractiveness [10,11]; and iii) the overall feeling of loss of control at the end of the binge which is consecutive to the excessive food intake, feeling that strengthens subsequent binge food restriction [1]. …”