Are Sensitivity to Punishment, Sensitivity to Reward and Effortful Control Transdiagnostic Mechanisms Underlying the Eating Disorder/Obesity Spectrum?

Abstract

Although it has been postulated that eating disorders (EDs) and obesity form part of a broad spectrum of eating- and weight-related disorders, this has not yet been tested empirically. In the present study, we investigated interindividual differences in sensitivity to punishment, sensitivity to reward, and effortful control along the ED/obesity spectrum in women. We used data on 286 patients with eating disorders (44.6% AN-R, 24.12% AN-BP, and 31.82% BN), 126 healthy controls, and 640 Class II/III obese bariatric patients (32.81% Class II and 67.19% Class III) with and without binge eating. Participants completed the behavioral inhibition and behavioral activation scales, as well as the effortful control scale, to assess sensitivity to punishment and reward and effortful control. Results showed that patients with EDs scored significantly higher on punishment sensitivity (anxiety) compared to healthy controls and Class II/III obese patients; the different groups did not differ significantly on reward sensitivity. Patients with binge eating or compensatory behaviors scored significantly lower on effortful control than patients without binge eating. Differences in temperamental profiles along the ED/obesity spectrum appear continuous and gradual rather than categorical. This implies that it may be meaningful to include emotion regulation and impulse regulation training in the treatment of both EDs and obesity.

Impulsivity and reward and punishment sensitivity among patients admitted to a specialized inpatient eating disorder treatment program

“…We did not find significant differences between diagnostic groups on punishment sensitivity (BIS) in this study consistent with findings by Beck et al. ( 26 ) but in contrast to other studies reporting greater BIS in AN-R compared to AN-BP or BN ( 14 , 61 ). One possible explanation for the discrepancy in findings is that the current study includes a wider range of ED diagnoses and therefore captures more variability in ED symptom profiles than prior studies.…”

What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas

“…The reduced levels of effortful control found in people with EDs has been well established, particularly in patients with binging/purging EDs who report lower levels of effortful control than those with restrictive EDs (Claes et al, 2010(Claes et al, , 2021. Considering that low effortful control is a risk factor for EDs (Verschueren et al, 2020) and is consistently found in ED samples (Gulliksen et al, 2017;Turner et al, 2014), the relationship between effortful control and ED symptoms found in this study appears well-founded.…”

“…Although negative affectivity has both genetic and environmental components (Mikolajewski et al, 2013), this trait may be particularly impacted by unmet emotional needs in childhood associated with EMS in the disconnection and rejection domain (Basile et al, 2021). The reduced levels of effortful control found in people with EDs has been well established, particularly in patients with binging/purging EDs who report lower levels of effortful control than those with restrictive EDs (Claes et al, 2010, 2021). Considering that low effortful control is a risk factor for EDs (Verschueren et al, 2020) and is consistently found in ED samples (Gulliksen et al, 2017; Turner et al, 2014), the relationship between effortful control and ED symptoms found in this study appears well‐founded.…”

Intrusive images, autobiographical memories, and core beliefs of patients with an eating disorder

“…The AN‐R subtype and AN‐BP subtype have differences in eating disorder symptoms, but may also have other important differences (e.g., personality or cognitive characteristics; Bollen & Wojciechowski. 2005; Claes et al, 2021). Therefore, further research with larger samples is necessary to test for differences among the AN‐subtypes which we were unable to do.…”