Basic HTML Version
EDRS 2012
16
5
Eating Disorders in DSM-5: The End Approaches
B. Timothy Walsh
NY State Psychiatric Institute, New York, NY, USA
The formal process to develop DSM-5 began in 2006, and
is now nearing its conclusion. Although there have been
minor changes in the last 18 months, the recommendations
for the Feeding and Eating Disorders section have been
largely unchanged since they were first proposed in 2010.
This presentation will review the status of the proposed
DSM-5 criteria for Feeding and Eating Disorders as the end
of the process nears. As of this writing, the recommendation
to formally recognize Binge Eating Disorder has been
approved by the Board of Trustees of the American
Psychiatric Association, as have the suggested changes to
Pica, Rumination Disorder, Anorexia Nervosa, and Bulimia
Nervosa. The recommendation to formally recognize
Avoidant/Restrictive Food Intake Disorder (ARFID) is
currently under review. Data that have supported the
recommendations will be briefly summarized, including
information from field trials, and the final steps leading to
the publication of DSM-5 will be described. Until DSM-5 is
actually published, all recommendations for change must be
viewed as tentative.
6
A LONGITUDINAL STUDY OF CHANGES IN GENETIC
AND ENVIRONMENTAL INFLUENCES ON WEIGHT AND
SHAPE CONCERN ACROSS ADOLESCENCE
Tracey D Wade
1
, Narelle K Hansell
2
, Rachel Bryant-Waugh
3
,
Janet Treasure
4
, Reginald Nixon
1
, Susan Byrne
5
, Nicholas M
Martin
2
1
Flinders University, Adelaide, Australia,
2
Queensland Institute
of Medical Research, Brisbane, Australia,
3
University of
London, London, United Kingdom,
4
King’s College, London,
United Kingdom,
5
University of Western Australia, Perth,
Australia
Purpose: The goal of the current study was to examine
whether genetic and environmental influences on an
important risk factor for disordered eating, weight and shape
concern, remains stable over adolescence or whether
developmental shifts in these influences occur over time.
Method: We examined an 8-item weight and shape concern
sub-scale derived from the Eating Disorder Examination
using telephone interviews with female adolescents. There
were three waves of data from female-female same sex twin
pairs from the Australian Twin Registry, where the first wave
included 699 twins, representing 377 monozygotic twins
(187 complete pairs and 3 incomplete pairs), 308 dizygotic
twins (154 complete pairs), with 7 pairs where zygosity was
unknown. The mean age at the first wave was 14 years,
where follow up occurred at mean ages of 15 (N=669) and 17
years (N=499). Results: Biometric model fitting controlling for
the effects of age and body mass index showed a negligible
contribution of the shared environment to weight and
shape concern. Testing of sub-models showed that neither
genetic influences nor non-shared environmental influences
could be constrained to be the same across adolescence.
Conclusion: An initial increase in latent genetic risk followed
by a decrease was observed indicating a greater role of latent
environmental impact on weight and shape concern between
the ages of 15 and 19 years.
7
BINGE EATING DISORDER (BED) AND ‘FOOD
ADDICTION’: A MULTILOCUS GENETIC-PROFILE STUDY
Caroline Davis
1
, Robert D Levitan
2
, Jacqueline C Carter
3
,
Allan S Kaplan
2
, James L Kennedy
2
1
York University, Toronto, ON, Canada,
2
The Centre for
Addiction and Mental Health, Toronto, ON, Canada,
3
University Health Network, Toronto, ON, Canada
The clinical symptoms and psycho-behavioural traits that
describe BED have many similarities to those of drug abuse
– findings that converge well with the recent and compelling
evidence of sugar/fat addiction in rats. The current study
extends this research by testing whether genetic markers
associated with brain dopamine signaling are linked to BED,
as they are to other addiction disorders. A sample of obese
adults with (n=87) and without (n=170) BED were recruited
from the community. Using DNA extracted from blood
samples, we calculated a multilocus genetic profile score
(MGP) for each subject based on 6 dopamine-regulating gene
(DRD2, DAT1, ANKK1, COMT) polymorphisms. This method
reflects the cumulative effect of multiple polymorphic loci – of
known functionality – on a specific signaling mechanism. Our
neural target was responsiveness of the ventral striatum,
which regulates appetitive behaviours like eating. Increased
dopamine signaling would imply greater reward sensitivity.
Results indicated a significantly stronger signal in the brain’s
reward pathway in those with BED (p=0.038) and a greater
hedonic response to food (p<0.0001) compared to their
non-BED counterparts. We also found that BED participants
had more symptoms of ‘Food Addiction’ as assessed by
the well-validated
Yale Food Addiction
Scale (p<0.0001),
more addictive personality traits (p=0.002), greater food
cravings (p<0.0001), and they tended to engage in more
‘legal’ addictive behaviours such as smoking and alcohol
consumption (p=0.071). This represents the first MGP study
of BED and supports the view that this syndrome reflects a
hyper-sensitivity to rewarding stimuli - what we might describe
as a
Reward Surfeit Syndrome
– and has close psycho-
genetic parallels to other addictions.
8
PLANNING A BINGE IS REINFORCING FOR WOMEN
WITH BULIMIA NERVOSA: A FUNCTIONAL MAGNETIC
RESONANCE IMAGING (fMRI) STUDY
Carolyn M Pearson, Anders Anderson, David Powell, Gregory
T Smith
University of Kentucky, Lexington, KY, USA
Introduction.
Negative reinforcement (NR) theory posits that
binge eating (BE) in women with bulimia nervosa (BN) is
maintained, despite its negative effects, in part because it
distracts individuals from the source of their distress, thus
providing reduction of distress. However, recent findings
indicate that BN women are still distressed after BE. Perhaps
BN women experience the NR of distress reduction as they
plan their binges, not after the binge is completed (when
they are no longer distracted, feel regret, and feel physically
uncomfortable). It may also be that one cannot assess NR
via distraction by asking individuals how they feel (which
undermines the distraction). Thus, we used fMRI technology
to assess activation in brain regions associated with reward
and with distress as BN women plan a binge.
Methods.
We
induced negative mood in six non-treatment seeking women
with BN and then utilized fMRI to compare blood oxygen
level dependent (BOLD) activation changes when they plan
a binge versus when they engage in a neutral task.
Results.
Greater activation of the VmPFC/VLPFC while planning a
binge versus a neutral task was noted, consistent with the
theory that planning a binge is reinforcing through reduction
of negative mood. We found no evidence of increased
activation in areas of the brain associated with reward.
Conclusions.
BE planning is associated with brain indications
of reduced distress: BE may provide NR through distraction
from distress for women with BN.
PLENARY/ORAL ABSTRACTS