Impaired Flexible Reward-Based Decision-Making in Binge Eating Disorder: Evidence from Computational Modeling and Functional Neuroimaging

Abstract

Despite its clinical relevance and the recent recognition as a diagnostic category in the DSM-5, binge eating disorder (BED) has rarely been investigated from a cognitive neuroscientific perspective targeting a more precise neurocognitive profiling of the disorder. BED patients suffer from a lack of behavioral control during recurrent binge eating episodes and thus fail to adapt their behavior in the face of negative consequences, eg, high risk for obesity. To examine impairments in flexible reward-based decision-making, we exposed BED patients (n = 22) and matched healthy individuals (n = 22) to a reward-guided decision-making task during functional resonance imaging (fMRI). Performing fMRI analysis informed via computational modeling of choice behavior, we were able to identify specific signatures of altered decision-making in BED. On the behavioral level, we observed impaired behavioral adaptation in BED, which was due to enhanced switching behavior, a putative deficit in striking a balance between exploration and exploitation appropriately. This was accompanied by diminished activation related to exploratory decisions in the anterior insula/ventro-lateral prefrontal cortex. Moreover, although so-called model-free reward prediction errors remained intact, representation of ventro-medial prefrontal learning signatures, incorporating inference on unchosen options, was reduced in BED, which was associated with successful decision-making in the task. On the basis of a computational psychiatry account, the presented findings contribute to defining a neurocognitive phenotype of BED.

Differential expression of deltaFosB in reward processing regions between binge eating prone and resistant female rats

“…We therefore conclude that the activity of ΔFosB-expressing neurons in both the mPFC and VTA would also decrease, and this decrease is greater in BEP than in BER rats. Our results extend the findings of neuroimaging studies which revealed a reduction of activity in the mPFC [11, 12, 14], VTA [42, 43], and Acb [10] in BED patients. Furthermore, a decrease in mPFC activity is associated with compulsivity [44].…”

“…Furthermore, a decrease in mPFC activity is associated with compulsivity [44]. BED patients display compulsive behavior, which is associated with a loss of inhibitory control due to hypoactivity in the mPFC [11, 12]. Our light/dark box test showed that BEP rats spent more time in the zone of sucrose and consumed more sucrose than BER rats despite the exposure to the aversive light zone, as was previously shown [16].…”

Food addiction and impaired executive functions in women with obesity

“…In terms of decision‐making, our IGT results indicate that increased food addiction severity in the OB group was positively associated with poorer overall performance, suggesting that a deficit in making adaptive decisions could be underpinned by addictive symptomatology in some individuals with OB. Patients with binge ED and OB alike often report suffering from a lack of behavioural control during recurrent overeating episode and thus fail to adjust behaviour in the face of negative consequences (Fagundo et al, ; Reiter, Heinze, Schlagenhauf, & Deserno, ). Other studies have identified a link between decision‐making impairment and binge eating severity (Danner et al, ), and it is plausible that similar impairments are present in subthreshold binge ED patients who present food addiction symptoms.…”

General Habit Propensity Relates to the Sensation Seeking Subdomain of Impulsivity But Not Obesity

“…Moreover, abnormalities in habit formation might be a specific issue of certain obese subtypes as opposed to applying generally to obesity. Especially individuals with a diagnosis of binge eating (Voon et al, 2015; Reiter et al, 2016) or food addiction (Gearhardt et al, 2009; Davis et al, 2011; Davis, 2013; Meule and Gearhardt, 2014; Murphy et al, 2014) may be prone to stimulus-guided behavior, which should be clarified in future studies.…”