Reduced activation of a specific prefrontal brain region may directly contribute to binge eating in bulimia nervosa, new study finds


In the news – New York, NY (February 25, 2022) New research led by a researcher at the Icahn School of Medicine at Mount Sinai has revealed a key neural mechanism underlying feelings of being unable to stop eating, the most salient aspect of binge eating episodes in eating disorders such as bulimia nervosa.

The researcher found deficient activation of the medial and lateral prefrontal cortices (brain regions known to play a role in controlling cravings, behaviors and emotions) when inhibiting the specific response to food in affected participants bulimia compared to healthy controls. The conclusions, published on February 25 in Psychological medicineprovide initial evidence that this diminished activation of the prefrontal cortex may directly contribute to more severe, uncontrollable, and maladaptive eating behaviors.

Bulimia nervosa is a serious and common psychiatric disorder that is associated with high rates of disability and mortality. Less than half of adults treated with first-line interventions recover. The neural bases of bulimia nervosa symptoms remain poorly understood, hampering efforts to develop more effective treatments. Decades of previous research suggests that a feeling of loss of control over eating is the most prominent feature of binge eating that characterizes the disorder. Therefore, identifying brain alterations that occur specifically during attempts to control eating could ultimately improve our understanding and targeted treatment of this often chronic disease.

This study, led by Laura Berner, PhD, assistant professor of psychiatry at Icahn Mount Sinai and a leading researcher at the Mount Sinai Center of Excellence in Eating and Weight Disorders and the Center for Computational Psychiatry, is the first to examine brain activation in attempts to control eating behavior in people with eating disorders.

Most studies of how we stop or prevent ourselves from engaging in a behavior ask people to complete a task of remembering responses at the push of a button. But Dr. Berner has developed a new task that asks people to remember their food responses. Using a wearable brain imaging technology called functional near-infrared spectroscopy (fNIRS), the research team measured prefrontal cortex activation in 23 women with bulimia nervosa (BN) and 23 healthy controls during this novel go/no-go task requiring inhibition of food responses and during a standard go/no-go task requiring inhibition of responses by pressing a button.

They found that women with BN made commission errors on both tasks — eating and pressing the button when they weren’t supposed to — more often than women without an eating disorder. Coupled with this reduced ability to control their eating responses, the subsets of women with BN who felt the most severe loss of control over their eating over the past month, and those who felt the most they ate excessively during the task, both showed abnormally reduced activation of the bilateral ventromedial prefrontal cortex (vmPFC) and right ventrolateral (vlPFC) during food response inhibition. Similarly, across the sample, lower food task activation in the right vlPFC was related to more frequent and severe loss of food control, but no difference in activation between groups was found. was detected for either task when this whole sample was compared to healthy controls. Notably, the diagnosis and severity of BN were unrelated to brain activation during button-press inhibition.

“Our patients describe feeling like they just can’t stop themselves from taking the next bite or sip during binge eating episodes, but we haven’t understood the neural mechanisms that might underlie this experience. the first time this method allowed us to measure what happens in the brains of people with bulimia nervosa when they try to inhibit their food responses, but fail to do so,” said Dr. Berner. Our results suggest that diet-specific disturbances in inhibitory control-related activation may serve as a new target for treatment. In fact, we just learned that we received funding from the National Eating Disorders Association to test this idea. We will use fNIRS-based neurofeedback to train women with bulimia to increase their own prefrontal cortex activation while eating, and test the impact of this training on symptoms.

WHO: Laura Berner, PhD, Assistant Professor of Psychiatry, Icahn Mount Sinai and Senior Investigator for the Mount Sinai Center for Computational Psychiatry and the Mount Sinai Center of Excellence in Eating and Weight Disorders.

This work was supported by a grant from the National Institute of Mental Health (F31MH097406), a Dissertation Research Award from the American Psychological Association, and a Student Research Award from the Academy of Eating Disorders awarded to Dr. Berner.

Item: Altered prefrontal activation during inhibition of food responses in women with bulimia nervosa. Psychological medicineFebruary 25, 2022.

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