Objective Event-related brain potential (ERP) studies have shown that bulimia nervosa (BN) is associated with facilitated processing of disorder-specific stimuli, visible in altered early components during presentation of food cues and bodies varying in size. Less is known about BN and late ERPs, typically less influenced by perceptual features and regarded as more reliable indices of motivational relevance. The purpose of this study was to use the late positive potential (LPP) to investigate the motivational significance of BN-relevant stimuli. Methods Highly salient stimuli, such as pictures of personal binge foods and images that are pleasant, neutral, and unpleasant (e.g., human attacks) were presented to 24 women with bulimia and 24 healthy women (19.7 ± 2.1 and 20.5 ± 2.6 years, respectively). Pictures of erotic couples, previously shown to prompt the greatest appetitive reactions in healthy women, were used as pleasant cues. Based on BN aversion to body cues, we hypothesized that the motivational significance of erotic cues could be increased in bulimic women. Results Consistent with the literature, the LPP was modulated by the salience of the pictures (F(2.8,130.7) = 24.6, p < .001). An additional interaction with diagnostic group (F(2.8,130.7) = 2.8, p = .047) indicated that bulimic women showed a larger LPP than healthy controls during pictures displaying binge foods (p = .037) and erotic couples (p = .031). Conclusions The findings provide objective evidence that BN is characterized by dysregulated emotional processing that is not limited to food cues. The implications are discussed within a transdiagnostic perspective on food-related disorders.
Background: Studies on food cue reactivity have documented that altered responses to high-calorie food are associated with bulimic symptomatology, however, alterations in sexual motivations and behaviors are also associated clinical features for this population, which justify their inclusion as a research target. Here, we study responses to erotic cues – alongside neutral and aversive cues – to gain an understanding of specificity to food vs. a generalized sensitivity to primary reinforcers. Methods: We recorded peripheral psychophysiological indices –the startle reflex, zygomaticus, and corrugator responses– and self-reported emotional responses (valence, arousal, and dominance) in 75 women that were presented with the Spanish version of the Bulimia Test-Revised (BULIT-R). Multiple regression analysis tested whether BULIT-R symptoms were predicted by self-reported and psychophysiological responses to food vs. neutral and erotic vs. neutral images. Results: The results showed that individuals with higher bulimic symptoms were characterized by potentiated eye blink startle response during binge food (vs. neutral images) and more positive valence ratings during erotic (vs. neutral) cues. Conclusions: The results highlight the negative emotional reactivity of individuals with elevated bulimic symptoms toward food cues, which could be related to the risk of progression to full bulimia nervosa and thereby addressed in prevention efforts. Results also point to the potential role of reactivity to erotic content, at least on a subjective level. Theoretical models of eating disorders should widen their conceptual scope to consider reactivity to a broader spectrum of primary reinforcers, which would have implications for cue exposure-based treatments.
Background Studies on food cue reactivity have documented that altered responses to high-calorie food are associated with bulimic symptomatology, however, alterations in sexual motivations and behaviors are also associated clinical features in this population, which justify their inclusion as a research target. Here, we study responses to erotic cues—alongside food, neutral and aversive cues—to gain an understanding of specificity to food versus a generalized sensitivity to primary reinforcers. Methods We recorded peripheral psychophysiological indices –the startle reflex, zygomaticus, and corrugator responses—and self-reported emotional responses (valence, arousal, and dominance) in 75 women completing the Bulimia Test-Revised (BULIT-R). Multiple regression analysis tested whether BULIT-R symptoms were predicted by self-reported and psychophysiological responses to food versus neutral and erotic versus neutral images. Results The results showed that individuals with higher bulimic symptoms were characterized by potentiated eye blink startle response during binge food (vs. neutral images) and more positive valence ratings during erotic (vs. neutral) cues. Conclusions The results highlight the negative emotional reactivity of individuals with elevated bulimic symptoms toward food cues, which could be related to the risk of progression to full bulimia nervosa and thereby addressed in prevention efforts. Results also point to the potential role of reactivity to erotic content, at least on a subjective level. Theoretical models of eating disorders should widen their conceptual scope to consider reactivity to a broader spectrum of primary reinforcers, which would have implications for cue exposure-based treatments. Plain English summary We examined appetitive and aversive cue responses in college women to investigate how bulimic symptoms relate to primary reinforcers such as food and erotic images. We recorded peripheral psychophysiological indices (the startle reflex, zygomaticus, and corrugator responses) and self-reported emotional responses (valence, arousal, and dominance) in 75 college women that were presented with the Spanish version of the Bulimia Test-Revised. The results showed that bulimic symptoms increase both psychophysiological defensiveness toward food cues and subjective pleasure toward erotic cues. The findings suggest a generalized sensitivity to primary reinforcers in the presence of bulimic symptoms, and emphasize the relevance of adopting a wider framework in research and treatment on bulimia nervosa.
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