Lauren Breithaupt

Impact of the neural correlates of stress and cue reactivity on stress related binge eating in the natural environment

Women with symptoms of bulimia nervosa (BN) exhibit decreased response to visual food cues in several limbic and frontal regions compared to controls. Stress causes decreased blood oxygenation level dependent (BOLD) response in these regions in non-clinical samples; there is a lack of data on this topic in BN. This study examined the impact of individual differences in neural reactivity to palatable food cues following acute stress on stress-binge trajectories in everyday life. 16 women with BN symptoms viewed palatable food cues prior to and immediately following an acute stress induction in the scanner. Participants then responded to a series of prompts assessing daily ratings of stress and binge episodes for a period of two weeks. Decreased BOLD signal was observed in response to food cues pre to post stress in the anterior cingulate cortex (ACC), amygdala, and ventromedial prefrontal cortex (vmPFC). Ecological momentary assessment data collection demonstrated that stress increased prior to binge episodes in the natural environment, and decreased following. Changes in activation in the ACC, precuneus, and dorsolateral prefrontal cortex (dlPFC) significantly moderated the relationship of stress to binge eating in daily life, such that women who exhibited decreased response reported significantly increasing stress prior to binges, while women who did not exhibit decreases reported no significant change in stress prior to binges. Individual differences in neural response to food cues under stress appear to underlie distinct antecedants to binge eating.

REbeL Peer Education: A model of a voluntary, after-school program for eating disorder prevention

Dissonance-based eating disorder prevention leads to decreases in risk factors for these disorders. Although controlled trials have demonstrated that targeted, manualized programs reduce eating disorder risk, concerns regarding implementation and dissemination remain. A primary concern is the difficulty in adapting programs for a high school setting for populations at highest risk: adolescents. This paper describes the REbeL Peer Education model and assesses the initial pilot trials of the intervention. The program is novel in that it utilizes a voluntary, self-selection model that is sustainable in a high school setting, and focuses on empowerment and effective cognitive dissonance based prevention activities. High school peer-educators self-selected into the semi-manualized dissonance based intervention. Group activities were peer led, designed to critique the thin ideal, and designed to empower macro (school and larger community wide) changes in The pilot trial (N=47) assess the effectiveness and feasibility of the intervention. Results of the initial pilot study revealed preliminary support for the feasibility of the program, increases in feelings of empowerment, and decreases in eating disorder cognitions and behaviors with moderate to large effect sizes. Feedback from participants indicated that the intervention was enjoyable, educational, and empowering. This study is the first to adapt dissonance-based prevention models to a semi-manualized, peer-led, prevention program integrated into high school settings.

Body checking as a behavioral link: A preliminary study assessing inhibition and its association to idiosyncratic body checking in anorexia nervosa

Body checking (BC) is a behavioral feature of anorexia nervosa (AN), which is also present in obsessive-compulsive (OC) disorders. This study assessed whether increased body checking in AN patients correlated with deficits in cognitive inhibition. A battery of neuropsychological tests (the Ravello Profile), OC disorder measures, and the Body Checking Questionnaire (BCQ) were administered to nine adolescent females being treated for AN at an in-patient hospital in Scotland, UK. Neuropsychological measures were assessed using composite variables. Body Checking prevalence was split into high and low category to compare across groups. A negative relationship between cognitive inhibition and idiosyncratic body checking was evident. Clinically, increased body-checking symptoms were related to OC symptoms. These findings provide preliminary evidence that idiosyncratic body checking in AN patients may indicate a similar neuropsychological profile found in those with checking behaviors in OCD patients.

Negative urgency and expectancies increase vulnerability to binge eating in bulimia nervosa

ABSTRACT Negative urgency (NU), the tendency to act impulsively when distressed, is associated with binge eating. Women who believe that eating alleviates negative affect are also more likely to binge eat. Thus, it is hypothesized that the individuals with high levels of NU, and who endorse these eating expectancies, will binge eat the following acute distress. This study tested these hypotheses using ecological momentary assessment. Sixteen women with the symptoms of BN completed clinical assessments, and were asked to report on distress and binges multiple times daily for two weeks. NU moderated the temporal relationship of negative affect to binges, such that women with lower scores on NU experienced a sharper increase in affect prior to binges. Individual differences in eating expectancies also moderated the relationship of affect to binge eating. Results suggest that women with high levels of NU and expectancy endorsement are triggered to binge by smaller shifts in negative affect than women who do not endorse these traits.

A Double-Blind, Randomized Pilot Trial of Chromium Picolinate for Overweight Individuals with Binge-Eating Disorder: Effects on Glucose Regulation

ABSTRACT Purpose: Chromium treatment has been shown to improve glucose regulation in some populations. The purpose of this study was to evaluate whether chromium picolinate (CrPic) supplementation improves glucose regulation in overweight individuals with binge-eating disorder (BED). Methods: In this double-blinded randomized pilot trial, participants (N = 24) were randomized to high (HIGH, 1000 mcg/day, n = 8) or moderate (MOD, 600 mcg/day, n = 9) dose of CrPic or placebo (PL, n = 7) for 6 months. Participants completed an oral glucose tolerance test (OGTT) at baseline, 3 months, and 6 months. Fixed effects models were used to estimate mean change in glucose area under the curve (AUC), insulinAUC, and insulin sensitivity index (ISI). Results: Results revealed a significant group and time interaction (p < 0.04) for glucoseAUC, with glucoseAUC increasing significantly in the PL group (p < 0.02) but decreasing significantly in the MOD group (p < 0.03) at 6 months. InsulinAUC increased significantly over time (main effect, p < 0.02), whereas ISI decreased significantly over time (main effect, p < 0.03). Conclusion: As anticipated, a moderate dose of CrPic was associated with improved glycemic control, whereas PL was associated with decreased glycemic control. It was unexpected that the improved glycemic control seen in the MOD dose group was not seen in the HIGH dose group. However, although participants randomized to the HIGH dose group did not have improved glycemic control, they had better glycemic control than participants randomized to the PL group. These findings support the need for larger trials.

The impact of acute stress on the neural processing of food cues in bulimia nervosa: Replication in two samples.

The impact of acute stress on the neural processing of food cues in bulimia nervosa (BN) is unknown, despite theory that acute stress decreases cognitive control over food and hence increases vulnerability to environmental triggers for binge eating. Thus, the goals of this manuscript were to explore the impact of acute stress on the neural processing of food cues in BN. In Study 1, 10 women with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) BN and 10 healthy controls participated in an fMRI paradigm examining the neural correlates of visual food cue processing pre and post an acute stress induction. Whole brain analysis indicated that women with BN exhibited significant decreases in activation in the precuneus, associated with self-referential processing, the paracingulate gyrus, and the anterior vermis of the cerebellum. Healthy controls exhibited increased activation in these regions in response to food cues poststress. In Study 2, 17 women with DSM–5 BN or otherwise specified feeding and eating disorder with BN symptoms participated in the same paradigm. A region of interest analysis replicated findings from Study 1. Replication of imaging findings in 2 different samples suggests the potential importance of these regions in relation to BN. Decreased activation in the precuneus, specifically, is consistent with models of BN that posit that binge eating serves as a concrete distraction from aversive internal stimuli.

Sweet taste preference in binge-eating disorder: A preliminary investigation

Research suggests that individuals with high liking for sweets are at increased risk for binge eating, which has been minimally investigated in individuals with binge-eating disorder (BED). Forty-one adults (85% female, 83% white) with binge eating concerns completed a sweet taste test and measures of eating disorder behaviors and food cravings. A subset of participants with BED completed an oral glucose tolerance test (OGTT; N=21) and a 24-hour dietary recall (N=26). Regression models were used to compare highest sweet preferers (HSP [N=18]) to other sweet preferers (OSP [N=23]) and were used to assess associations between sweet taste preference and outcome variables. Effect sizes (ηp2) for differences between HSP and OSP ranged from small (≤0.01) to large (≥0.24); group differences were statistically nonsignificant except for 24-hour caloric intake (ηp2=0.16, p=0.04), protein intake (ηp2=0.16, p=0.04), and insulin sensitivity index (ηp2=0.24, p=0.04), which were higher in HSP, and postprandial insulin, which was smaller in HSP (ηp2=0.27, p=0.03). Continuous analyses replicated postprandial insulin response. Compared with OSP, HSP reported numerically higher binge-eating frequency (ηp2=0.04), over-eating frequency (ηp2=0.06), and carbohydrate intake (ηp2=0.14), and they exhibited numerically smaller postprandial glucose AUC (ηp2=0.16). Sweet taste preference may have implications for glucose regulation, binge-eating frequency, and nutrient intake in BED.

Enhancing empowerment in eating disorder prevention: Another examination of the REbeL peer education model

Previously validated eating disorder (ED) prevention programs utilize either a targeted or universal approach. While both approaches have shown to be efficacious, implementing either style of program within a school setting remains a challenge. The current study describes an enhanced version of REbeL, a module based, continuous ED prevention program which utilizes a self-selection model of prevention in high school settings. The purpose of this study was to determine if an enhanced empowerment model of REbeL could increase feelings of empowerment and reduce eating disorder risk. We also aimed to assess the feasibility and acceptability of the intervention. High school peer-educators self-selected into the semi-manualized dissonance based intervention. Following feedback from a pilot trailed, enhanced peer-led group activities, designed to critique the thin ideal and designed to empower macro-changes in societal structures that emphasize the thin ideal, were added. The study (N=83) indicates that the program appears to be effective at reducing eating disorder risk factors and increasing empowerment. Participants reported reductions in body checking and internalization of the thin ideal.

Rumination and self-control interact to predict bulimic symptomatology in college students.

Recent studies suggest that a ruminative response style may contribute to the development and maintenance of Bulimia nervosa. However it is not clear what factors may contribute to the relationship between rumination and BN. One factor may be self-control, as studies suggest that BN symptomatology relates to deficits in self-control. In the present study, we hypothesized that the association between rumination and BN symptomatology would be the strongest among individuals with lower self-control relative to those with higher self-control. Participants were 353 students at a large university. Participants completed measures of self-control, rumination, and eating disorder symptomology as part of an online study. A hierarchical regression supported an interaction between rumination and self-control predicting bulimic symptomatology, controlling for BMI. Individuals with higher levels of rumination presented more bulimic symptoms if they also had lower levels of self-control, supporting our hypothesis. Based on these findings, assessing rumination in conjunction with self-control among individuals who present with eating concerns may help to direct treatment. Additionally, clinical interventions increasing self-control may also alleviate some BN symptoms in ruminators.

The impact of neural responses to food cues following stress on trajectories of negative and positive affect and binge eating in daily life

Stress and affect have been implicated in the maintenance of binge eating for women with symptoms of bulimia nervosa (BN). Neuroimaging and ecological momentary assessment (EMA) have separately examined how these variables may contribute to eating disorder behavior. Though both methodologies have their own strengths, its unclear how either methodology might inform the other. This study examined the impact of individual differences in neural reactivity to food cues following acute stress on the trajectories of positive affect (PA) and negative affect (NA) surrounding binge eating. Women (n = 16) with BN symptoms viewed palatable food cues before and after a stress induction in the scanner. For two weeks, participants responded to prompts assessing affect and binge episodes several times a day. EMA data revealed NA increased and PA decreased before binge episodes in the natural environment. Additionally, NA decreased while PA increased following binge episodes. Changes in activation in the ACC, amygdala, and the vmPFC significantly moderated the relationship of affect to binge eating. However, lateral differences of each brain region uniquely moderator the trajectory of PA, NA, or both to binge eating. Specifically, those with less change in BOLD response reported significantly increasing NA and decreasing PA prior to binges, while women with greater decreases reported no change in affect. Following binge eating, individuals with decreased change in BOLD response reported decreasing NA and increasing PA. This may suggest individual differences in neural response to food cues under stress appear to underlie affect driven theory on the antecedents to binge eating.