Neural Processing of Food and Erotic Cues in Bulimia Nervosa

Abstract

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.

Emotional Reactivity to Binge Food and Erotic Cues in Women With Bulimia Nervosa Symptoms

“…It has been shown that personally signi cant stimuli, such as faces of loved ones or cues of personal phobias, are associated with high levels of physiological reactivity (38,39). In our previous study (6), the presentation of personal binge food cues successfully prompted subjective feelings of arousal that were higher than those observed using nonpersonal high-calorie food cues. Thus, during a telephone interview, participants reported their six personal binge foods, describing them meticulously and giving at least two descriptors of each food (e.g., lasagna with meat, cheese, and bechamel).…”

“…Patients with this debilitating disorder are characterized by binge eating, inappropriate compensatory behaviors, undue in uence of body weight and/or shape on self-esteem (4). These symptoms appear to be related to altered food cue responses, although it recently emerged that erotic stimuli also tend to be processed differently in patients with BN, at least in terms of subjective emotional reactivity (5,6).…”

“…However, not all foods have the same emotional meaning for people with food-related problems (12,13), since binge-food preferences are highly idiosyncratic (14,15). Thus, the present study individually selected binge food images for each participant (see also (6,14). Exploring subjective and psychophysiological reactivity to speci c binge food cues has implications for clinical practice, since binge foods are the cue target of exposure therapy (16)(17)(18), through which BN patients can develop a more adaptive emotional pattern and prevent binge-purge cycles (19).…”

A Systematic Review of Electrophysiological Findings in Binge-Purge Eating Disorders: A Window Into Brain Dynamics

“…More recently, Delgado-Rodríguez et al ( 2019 ) conducted an ERP study to evaluate the LPP response to food and erotic cues in individuals with BN. The authors hypothesized that as these individuals exhibit aversion to body cues, the motivational significance of erotic images could be increased in women with BN.…”

“…The 15 included studies scored from 5 to 9 on the modified Newcastle-Ottawa Quality Assessment Scale. Two studies (Rodriguez et al, 2007 ; Blechert et al, 2011a ) reached scores of 5 or 6, nine studies (Léonard et al, 1998 ; Otagaki et al, 1998 ; Tammela et al, 2010 ; Kuehnpast et al, 2012 ; Merlotti et al, 2013 ; Mai et al, 2015 ; Wolz et al, 2017 ; Leehr et al, 2018 ) 7 or 8, and four studies (Blechert et al, 2011b ; Imperatori et al, 2015 ; Schienle et al, 2017 ; Delgado-Rodríguez et al, 2019 ) scored 9. The major weaknesses found in the studies included (1) absence of sample size calculation, (2) comparability of the groups (e.g., large differences between subgroup characteristics, such as BMI) and (3) the absence of a standardized and paired stimulus used in the tasks.…”