Prefrontal Responses during Proactive and Reactive Inhibition Are Differentially Impacted by Stress in Anorexia and Bulimia Nervosa.

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Westwater, Margaret L  ORCID logo
Gorka, Adam X 
Shapleske, Jane 
Serfontein, Jaco 

Binge eating is a distressing, transdiagnostic eating disorder symptom associated with impulsivity, particularly in negative mood states. Neuroimaging studies of bulimia nervosa (BN) report reduced activity in frontostriatal regions implicated in self-regulatory control, and an influential theory posits that binge eating results from self-regulation failures under stress. However, there is no direct evidence that psychological stress impairs self-regulation in binge-eating disorders, or that any such self-regulatory deficits generalize to binge eating in underweight individuals (i.e., anorexia nervosa bingeing/purging subtype; AN-BP). We therefore determined the effect of acute stress on inhibitory control in 85 women (BN, 33 women; AN-BP, 22 women; 30 control participants). Participants underwent repeated functional MRI scanning during performance of the Stop-signal anticipation task, a validated measure of proactive (i.e., anticipation of stopping) and reactive (outright stopping) inhibition. Neural and behavioral responses to induced stress and a control task were evaluated on 2 consecutive days. Women with BN had reduced proactive inhibition, while prefrontal responses were increased in both AN-BP and BN. Reactive inhibition was neurally and behaviorally intact in both diagnostic groups. Both AN-BP and BN groups showed distinct stress-induced changes in inferior and superior frontal activity during both proactive and reactive inhibition. However, task performance was unaffected by stress. These results offer novel evidence of reduced proactive inhibition in BN, yet inhibitory control deficits did not generalize to AN-BP. Our findings identify intriguing alterations of stress responses and inhibitory function associated with binge eating, but they counsel against stress-induced failures of inhibitory control as a comprehensive explanation for loss-of-control eating.SIGNIFICANCE STATEMENT Binge eating is a common psychiatric syndrome that feels uncontrollable to the sufferer. Theoretically, it has been related to reduced self-regulation under stress, but there remains no direct evidence for this link in binge-eating disorders. Here, we examined how experimentally induced stress affected response inhibition in control participants and women with anorexia nervosa and bulimia nervosa. Participants underwent repeated brain scanning under stressful and neutral conditions. Although patient groups had intact action cancellation, the slowing of motor responses was impaired in bulimia nervosa, even when the likelihood of having to stop increased. Stress altered brain responses for both forms of inhibition in both groups, yet performance remained unimpaired. These findings counsel against a simple model of stress-induced disinhibition as an adequate explanation for binge eating.

Adult, Anorexia Nervosa, Bulimia Nervosa, Female, Humans, Magnetic Resonance Imaging, Prefrontal Cortex, Reactive Inhibition, Stress, Psychological, Young Adult
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J Neurosci
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Wellcome Trust (100574/Z/12/Z)
Wellcome Trust (206368/Z/17/Z)
Wellcome Trust (100574/B/12/Z)
MRC (MR/T010614/1)
Funding was provided by the Bernard Wolfe Health Neuroscience Fund to PCF and HZ and a Wellcome Trust Investigator Award to PCF (Reference No. 206368/Z/17/Z). MLW was supported through the NIH-Oxford-Cambridge Scholars Program and a Cambridge Trust fellowship. FM was supported by research grants from Versus Arthritis, the Experimental Psychological Society and a Career Development Award from the Medical Research Council (MR/T010614/1). AG, CG and ME were supported by the Intramural Research Program of the NIMH (Ref. ZIAMH002798). The Wellcome Trust/NIHR Clinical and Translational Research Facilities and the Wolfson Brain Imaging Centre provided equipment and support staff for the study. This research was supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).