Sensitivity to the rewarding effects of food and exercise in the eating disorders

doi:10.1053/comp.2002.32356

Comprehensive Psychiatry

Volume 43, Issue 3, May 2002, Pages 189-194

https://doi.org/10.1053/comp.2002.32356 Get rights and content

Abstract

The diminished capacity to experience pleasure or reward (“anhedonia”) has its biological underpinnings in the mesolimbic dopamine system and is strongly implicated in risk for a variety of addictive behaviors. The present study tested the prediction that patients with anorexia nervosa (AN) would be more anhedonic than those with bulimia nervosa (BN)—a factor that could contribute to their respective avoidance and approach relationship to food. We also tested the idea that anhedonia would be correlated with high-level exercising from the viewpoint that the latter serves as a compensatory behavior for a blunted affect. AN patients of the restrictor subtype (n = 78) and BN patients with no history of AN (n = 76) were included in the regression analyses. Patients were also classified as excessive exercisers or moderate/nonexercisers according to information gathered during a structured clinical interview. Findings were largely supportive of our predictions. AN patients were highly anhedonic compared to BN patients, and excessive exercisers tended to be more anhedonic than those who did not exercise. We discuss the AN-BN differences in capacity for reward/pleasure in the context of the common psychobiological links between the eating disorders and drug and alcohol addiction, and speculate on how these differences might relate to the etiology and pathophysiology of both AN and BN.

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Citation Excerpt :
Along with information on brain volumetric changes, chief information on brain modifications in individuals with EDs has been conveyed by the use of in vivo MRI techniques examining brain functionality. Current theories in the pathophysiology of EDs emerging from MRI studies mostly focus on cortical-striatal-limbic circuits that sustain reward processing and habit formation (Friederich et al., 2010, 2012; Smith and Robbins, 2013; O’Hara et al., 2015; Steward et al., 2018), orbital-frontal and prefrontal networks with respect to cognitive and executive control (Treasure et al., 2012; Berner and Marsh, 2014; Geisler et al., 2017; Kullmann et al., 2014; Steward et al., 2018), self-monitoring networks consisting of the fusiform gyrus, the precuneus, and the prefrontal cortex that are involved in body-image perception (Mohr et al., 2011; Esposito et al., 2016; Steward et al., 2018) and affective-related circuits comprising the amygdala, the insula and regions in the prefrontal cortex (Davis and Woodside, 2002; Kaye et al., 2009; Botvinick, 2007; Bischoff-Grethe et al., 2013; Steward et al., 2018). Bottom-up (BU) and top-down (TD) models have been proposed for EDs functions related to restrictive eating habits (Steward et al., 2018).
Brain imaging studies on eating disorders (EDs) often reported volumetric and functional changes involving the cerebellum. Nevertheless, few studies performed in-depth examinations and suggested a cerebellar role in the EDs’ pathophysiology.
A systematic literature search on volumetric changes and functional alterations involving the cerebellum in individuals with EDs was conducted using PubMed, PsychInfo and Web of Science. This review was conducted according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement and Rayyan web application for screening studies.
Twenty-four papers reporting cerebellar alterations in individuals with EDs were included in the study: 9 assessing brain volumetric changes, 9 investigating task-based functional brain activation and 6 investigating brain functional connectivity at rest. Most studies focused on anorectic-type EDs (n.22), while fewer involved bulimic-type EDs (n.9) and eating disorders not otherwise specified (n.2), revealing subtypes-specific patterns of altered cerebellar volume and functionality.
This review proposes critical arguments to consider the cerebellum as a key structure in the pathophysiology of EDs that requires further forthcoming exploration.
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^☆: Supported by Grant No. 410-97-1149 from the Social Sciences and Humanities Research Council of Canada.

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Sensitivity to the rewarding effects of food and exercise in the eating disorders☆

Abstract