Dissociable hormonal profiles for psychopathology and stress in anorexia and bulimia nervosa

BackgroundAnorexia nervosa (AN) and bulimia nervosa (BN) are complex psychiatric conditions, in which both psychological and metabolic factors have been implicated. Critically, the experience of stress can precipitate loss-of-control eating in both conditions, suggesting an interplay between mental state and metabolic signaling. However, associations between psychological states, symptoms and metabolic processes in AN and BN have not been examined.MethodsEighty-five women (n = 22 AN binge/purge subtype, n = 33 BN, n = 30 controls) underwent remote salivary cortisol sampling and a 2-day, inpatient study session to examine the effect of stress on cortisol, gut hormones [acyl-ghrelin, peptide tyrosine tyrosine (PYY) and glucagon-like peptide-1] and food consumption. Participants were randomized to either an acute stress induction or control task on each day, and plasma hormones were serially measured before a naturalistic, ad libitum meal.ResultsCortisol-awakening response was augmented in AN but not in BN relative to controls, with body mass index explaining the most variance in post-awakening cortisol (36%). Acute stress increased acyl-ghrelin and PYY in AN compared to controls; however, stress did not alter gut hormone profiles in BN. Instead, a group-by-stress interaction showed nominally reduced cortisol reactivity in BN, but not in AN, compared to controls. Ad libitum consumption was lower in both patient groups and unaffected by stress.ConclusionsFindings extend previous reports of metabolic dysfunction in binge-eating disorders, identifying unique associations across disorders and under stress. Moreover, we observed disrupted homeostatic signaling in AN following psychological stress, which may explain, in part, the maintenance of dysregulated eating in this serious illness

Dissociable hormonal responses to symptoms and stress in anorexia and bulimia nervosa

Background: Anorexia nervosa (AN) and bulimia nervosa (BN) are complex psychiatric conditions, in which both psychological and metabolic factors have been implicated. Critically, the experience of stress can precipitate loss-of-control eating in both conditions, suggesting an interplay between mental state and metabolic signaling. However, associations between psychological states, symptoms and metabolic processes in AN and BN have not been examined. Methods: Eighty-five women (n=22 AN binge/purge subtype, n=33 BN, n=30 controls) underwent remote salivary cortisol sampling and a two-day, inpatient study session to examine the effect of stress on cortisol, gut hormones (acyl-ghrelin, PYY, GLP-1) and food consumption. Participants were randomized to either an acute stress induction or control task on each day, and plasma hormones were serially measured before a naturalistic, ad libitum meal.Results: Cortisol awakening response (CAR) was augmented in AN but not BN relative to controls, with body mass index explaining the most variance in CAR (36%). Acute stress increased acyl-ghrelin and PYY in AN compared to controls; however, stress did not alter gut hormone profiles in BN. Instead, a group-by-stress interaction showed nominally reduced cortisol reactivity in BN, but not AN, compared to controls. Ad libitum consumption was lower in both patient groups and unaffected by stress.Conclusions: Findings extend previous reports of metabolic dysfunction in binge-eating disorders, identifying unique associations across disorders and under stress. Moreover, we observed disrupted homeostatic signaling in AN following psychological stress, which may explain, in part, the maintenance of dysregulated eating in this serious illness.</p

Prefrontal responses during proactive and reactive inhibition are differentially impacted by stress in anorexia and bulimia nervosa

Binge eating is a distressing, transdiagnostic eating disorder symptom associated with impulsivity, particularly in negative mood states. Neuroimaging studies of bulimia nervosa (BN) report reduced activity in frontostriatal regions implicated in self-regulatory control, and an influential theory posits that binge eating results from self-regulation failures under stress. However, there is no direct evidence that psychological stress impairs self-regulation in binge-eating disorders, or that any such self-regulatory deficits generalize to binge eating in underweight individuals (i.e., anorexia nervosa bingeing/purging subtype; AN-BP). We therefore determined the effect of acute stress on inhibitory control in 85 women (BN, 33 women; AN-BP, 22 women; 30 control participants). Participants underwent repeated functional MRI scanning during performance of the Stop-signal anticipation task, a validated measure of proactive (i.e., anticipation of stopping) and reactive (outright stopping) inhibition. Neural and behavioral responses to induced stress and a control task were evaluated on 2 consecutive days. Women with BN had reduced proactive inhibition, while prefrontal responses were increased in both AN-BP and BN. Reactive inhibition was neurally and behaviorally intact in both diagnostic groups. Both AN-BP and BN groups showed distinct stress-induced changes in inferior and superior frontal activity during both proactive and reactive inhibition. However, task performance was unaffected by stress. These results offer novel evidence of reduced proactive inhibition in BN, yet inhibitory control deficits did not generalize to AN-BP. Our findings identify intriguing alterations of stress responses and inhibitory function associated with binge eating, but they counsel against stress-induced failures of inhibitory control as a comprehensive explanation for loss-of-control eating

Prefrontal responses during proactive and reactive inhibition are differentially impacted by stress in anorexia and bulimia nervosa

AbstractBackgroundBinge-eating is a distressing, transdiagnostic eating disorder symptom associated with impulsivity, particularly in negative mood states. Neuroimaging studies of bulimia nervosa (BN) report reduced activity in fronto-striatal regions implicated in self-regulatory control. However, it remains unknown if negative affective states, including stress, impair self-regulation, and, if so, whether such self-regulatory deficits generalize to binge-eating in underweight individuals (i.e., the bingeing/purging subtype of anorexia nervosa; AN-BP).MethodsWe determined the effect of acute stress on inhibitory control in 85 women (33 BN, 22 AN-BP, 30 matched controls). Participants underwent repeated functional MRI scanning, during performance of the stop-signal anticipation task, a validated measure of proactive (i.e., anticipation of stopping) and reactive (outright stopping) inhibition. Neural and behavioral responses to induced, psychological stress and a control task were evaluated on two separate days.ResultsWomen with BN had reduced proactive inhibition while prefrontal responses were increased in both AN-BP and BN. Reactive inhibition was neurally and behaviorally intact in both diagnostic groups. Both AN-BP and BN groups showed distinct, stress-induced changes in prefrontal activity during both proactive and reactive inhibition. However, task performance was not significantly affected by stress.ConclusionsThese findings offer novel evidence of reduced proactive inhibition in BN, yet inhibitory control deficits did not generalize to AN-BP. While both groups showed altered neural responses during inhibition following stress, neither group demonstrated stress-induced performance deficits. As such, our findings counsel against a simplistic, stress-induced failure of regulation as a holistic explanation for binge-eating in these conditions.</jats:sec

Food addiction and obesity: unnecessary medicalization of hedonic overeating

The concept of addiction is loaded with connotations and often used for its political as much as its medical utility. The scientific case for ‘food addiction’ as a clinical phenotype currently rests on its association with generic diagnostic criteria for substance-related disorders applied to everyday foods and eating-related problems. This has fused the concept of obesity with addiction regardless of whether it fits the definition. The hedonic/reward system can account for ingestion of foods and drugs, confirming that they share neural substrates that differentiate liking and wanting. These are normal processes recruited for natural homeostatic behaviours and can explain the phenomenon of hedonic overeating as a consequence of human motivation pushed to extremes by an obesogenic environment. Food addiction constitutes a medicalization of common eating behaviour, taking on the properties of a disease. Use of this medical language has implications for the way in which society views overeating and obesity