Reactivity to 35% carbon dioxide in bulimia nervosa and panic disorder

Woznica, Andrea; Vickers, Kristin S.; Koerner, Naomi; Fracalanza, Katie

doi:10.1016/j.psychres.2015.05.050

Cited by 12 publications

(14 citation statements)

References 43 publications

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“…While this is the first study to explicitly examine suffocation fear in transdiagnostic EDs as well as in AN, previous studies documenting abnormal respiratory processing in ED can be interpreted as providing evidence of suffocation alarm misfires. For example, there are heightened reports of choking following loaded breathing in AN as compared to HC [ 68 ], elevated panic attack rates in BN similar to individuals with panic disorder after breathing 35% CO 2 enriched air [ 9 ], and heightened ratings of dyspnea intensity in AN vs. HC during administration of isoproterenol, an adrenaline analogue [ 10 ]. In contrast, Perna et al, 2004 [ 72 ] found that in response to 35% CO 2 inhalation, individuals with transdiagnostic EDs responded more similarly to HCs than to panic disorder patients with respect to panic-related sensations (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Supporting this notion are findings that individuals with bulimia nervosa (BN) experience heightened stomach fullness after a standardized non-nutrient water load [ 7 ] and individuals with anorexia nervosa (AN) exhibit increased activation of the insular cortex during interoceptive attention to stomach sensations [ 8 ]. BN individuals report higher symptoms of anxiety and panic than healthy comparisons (HC) in response to breathing 35% carbon dioxide (CO 2 )-enriched air, but at similar levels as individuals with panic disorder, suggesting that amplifications of interoceptive processing might also extend to respiratory signals [ 9 ]. In previous interoceptive processing using the adrenaline analogue isoproterenol, we found that individuals with AN reported a greater intensity of cardiorespiratory sensations relative to HC during meal anticipation, an effect that was particularly pronounced for sensations of dyspnea [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders

et al. 2020

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Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample ( n = 51) that was individually matched to MA individuals ( n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa ( n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders

et al. 2020

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“…The CO 2 challenge has traditionally been studied in clinical populations, as characterized by the provocation of panic-like symptoms in individuals with a history of panic or anxiety disorders [14, 18] or other psychiatric conditions [23]. The variable responses of individuals to the CO 2 test may be attributed to differences in cognitive appraisal and tolerance of physiological symptoms between healthy populations and clinical populations with a history of anxiety or panic disorders.…”

Section: Discussionmentioning

confidence: 99%

Re-conceptualizing stress: Shifting views on the consequences of stress and its effects on stress reactivity

et al. 2017

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BackgroundThe consequences of stress are typically regarded from a deficit-oriented approach, conceptualizing stress to be entirely negative in its outcomes. This approach is unbalanced, and may further hinder individuals from engaging in adaptive coping. In the current study, we explored whether negative views and beliefs regarding stress interacted with a stress framing manipulation (positive, neutral and negative) on measures of stress reactivity for both psychosocial and physiological stressors.MethodNinety participants were randomized into one of three framing conditions that conceptualized the experience of stress in balanced, unbalanced-negative or unbalanced-positive ways. After watching a video on stress, participants underwent a psychosocial (Trier Social Stress Test), or a physiological (CO2 challenge) method of stress-induction. Subjective and objective markers of stress were assessed.ResultsMost of the sampled population regarded stress as negative prior to framing. Further, subjective and objective reactivity were greater to the TSST compared to the CO2 challenge. Additionally, significant cubic trends were observed in the interactions of stress framing and stress-induction methodologies on heart rate and blood pressure. Balanced framing conditions in the TSST group had a significantly larger decrease in heart rate and diastolic blood pressure following stress compared to the positive and negative framing conditions.ConclusionFindings confirmed a deficit-orientation of stress within the sampled population. In addition, results highlighted the relative efficacy of the TSST compared to CO2 as a method of stress provocation. Finally, individuals in framing conditions that posited stress outcomes in unbalanced manners responded to stressors less efficiently. This suggests that unbalanced framing of stress may have set forth unrealistic expectations regarding stress that later hindered individuals from adaptive responses to stress. Potential benefits of alternative conceptualizations of stress on stress reactivity are discussed, and suggestions for future research are made.

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“…One study found comparable rates of reactivity (i.e., subjective anxiety and panic symptoms) in an eating disordered group (AN and BN) and a HC group (Perna et al, 2004); panic attack rates were not measured. However, limitations of this heterogeneous eating disordered group prompted researchers to conduct another CO2 challenge test in a group of participants with BN only (Woznica et al, 2015). Contrary to Perna et al's findings, reactivity in the BN group was significantly greater than that in the HC group; and furthermore, reactivity was comparable in the BN group and a PD group (see Appendix C for effect sizes).…”

Section: How Do People With Bn Respond To 35% Co2?mentioning

confidence: 80%

“…Experimentally investigating stress response in individuals with BN provides significant insight into factors that maintain the disorder. Indeed, researchers have used both naturalistic and laboratory stressors to investigate stress response in BN, and results generally suggest that individuals within this diagnostic group experience heightened reactivity to stressors (e.g., Monteleone et al, 2012;Woznica, Vickers, Koerner, & Fracalanza, 2015). However, no study to date has directly examined psychological and physiological stress reactivity in individuals with BN while considering the potential effects of comorbid symptoms and disorders, including those that are social anxiety related (and known to be linked to BN, as demonstrated above).…”

Section: Stress Reactivity In Bnmentioning

confidence: 99%

An examination of responses to laboratory stressors in individuals with bulimia nervosa compared to those without a history of eating disorders

Linett¹

2021

Preprint

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The association between perceived interpersonal stress and symptoms of bulimia nervosa (BN) has been well documented. In line with this association, recent research is focused on better understanding common factors of BN and social anxiety (SA; e.g., fear of negative evaluation, perfectionism) that might contribute to the maintenance of BN symptomatology. Thus far, the extent to which stress affects individuals with BN and co-occurring SA has not been extensively studied, despite the high comorbidity of these two disorders. Using an experimental paradigm, the present study explored the effects of different stressor-types on individuals with BN, as well as the potential impact of SA symptoms and related factors on stress response in this population. A total of 56 females participated in this study: 28 diagnosed with BN, and 28 controls without a history of eating disorders. All participants completed self-report measures and underwent three laboratory stressors: a modified version of the Trier Social Stress Test (a psychosocial stressor), a carbon dioxide challenge (a physiological stressor), and a body image stressor (an eating disorder specific stressor developed for use in this study). Subjective and cardiovascular responses were measured. Contrary to hypotheses, significant between-group differences in stressor response were not consistently revealed. An examination of Cohen’s d values, however, suggested that the magnitude of group differences represented practically significant effects. Notably, participants within both groups reported decreased levels of hunger and desire to eat in response to each stressor. Also inconsistent with hypotheses was that neither SA symptoms nor associated factors consistently predicted stress reactivity in either group. Moreover, in the BN group, similar magnitudes of response were revealed across the three stressors. Implications and suggestions for further research are discussed. Although binge eating was not behaviourally measured, the finding that different stressor-types did not lead directly to increased hunger and desire to eat is notable and consistent with the cognitive behavioural theory of BN. With continued study of SA-related factors in association with BN symptomatology-- particularly in the context of stressful events-- further insight into the maintenance of this disorder might be revealed for a subset of individuals with comorbid BN and SAD.

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Reactivity to 35% carbon dioxide in bulimia nervosa and panic disorder

Cited by 12 publications

References 43 publications

Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders

Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders

Re-conceptualizing stress: Shifting views on the consequences of stress and its effects on stress reactivity

An examination of responses to laboratory stressors in individuals with bulimia nervosa compared to those without a history of eating disorders

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