The influence of depressive symptoms on executive functioning in binge eating disorder: A comparison of patients and non-obese healthy controls

Abstract

Executive functions are a set of cognitive processes that are necessary for the cognitive control of behavior. They play a role in mediating self-control, self-regulation and decision-making. It has been suggested that the inability to control eating behavior in binge eating disorder (BED) may indicate deficits in executive functioning. This may be worsened by depressive symptoms. The aim of the present study was to compare executive functioning of patients with BED and no-to-mild depressive symptoms (n = 25), patients with BED and moderate-to-severe depressive symptoms (n = 66), and healthy controls (Body Mass Index <30) (n = 56), matched on age, educational level and gender. The participants were assessed by means of neuropsychological tests and questionnaires. The neuropsychological tests did not show significant differences in executive functioning between the groups. However, eating disorder psychopathology and depressive symptoms are associated with self-reported difficulties in executive functioning in daily life. A self-report questionnaire which evaluates the functional, real-world impact of executive dysfunction expressed in everyday activities seems to be more useful in this population than neuropsychological tests. This study highlights the importance of taking depressive symptoms into account when studying executive functioning in patients with (binge) eating disorders.

Scrutinizing Domains of Executive Function in Binge Eating Disorder: A Systematic Review and Meta-Analysis

“…Qualitative inspection of the literature indicated mixed, inconclusive findings for control inhibition, decision making and cognitive flexibility in individuals with BED compared to controls (obese or normal weight), we will discuss it later. Only one small metaanalysis (n = three studies, 200 participants in total) suggested poorer working memory performance in people with BED compared to obese individuals without BED (29,30,33), with a small effect size.…”

“…Six additional studies not included in the meta-analysis reported mixed findings. In three studies, there was no evidence of altered performance in the BED group compared to obese (18,37,41) or normal weight controls (18,33). In one study (56), individuals with BED showed poorer performance compared to normal weight controls on all indexes of the WCST, apart from perseverative errors.…”

“…People with BED showed higher rates of decision-making impairments compared to normal weight controls in three studies. On the other hand, others reported no significant differences in this domain between BED and obese controls (36,37) and normal weight controls (33).…”

“…Amongst the studies selected for the systematic review (30), 13 were not included in any of the meta-analyses conducted. Reasons for not combining data from these studies were: the use of instruments that provided scores in a different manner from the others (18,39,41,42,(45)(46)(47)51), lack of raw data (means and standard deviation) in published material which was not obtained from authors upon request (50), and studies that compared BED and normal weight control groups (32,33,40,44). This last group of studies (which compared BED and normal weight control groups) could not be included in meta-analyses as there was no domain for which at least 3 studies examined the same function using comparable measures, which would enable aggregation of results.…”

“…Balodis et al (39) used an event-related fMRI Stroop color-word interference task, finding no significant group differences to congruent or incongruent stimuli in individuals with BED compared to obese and normal weight controls. Compared with normal weight controls, individuals with BED showed worse performance on the Hayling Sentence Completion Task (HSCT) in one study (32), but no differences in another 3 studies using the Stroop test (33), the Stop-Signal task (44) and Stroop match-to-sample task (40). Svaldi et al (45) used a Pictorial priming paradigm and found that individuals with BED and obese controls demonstrated poorer performance compared to normal weight controls, but did not differ from one another.…”