23
Bethesda, Maryland | September 19-21, 2013
SYMPOSIUM
Friday, 3:15 - 4:45 PM
Waterford/Lalique
Eating Disorders and Cognitive Neuroscience: Implications for the
Developmental Progression of Dysfunction
36
COGNITIVE NEUROSCIENCE AND THE PERSISTENCE OF ANOREXIA
NERVOSA
B. Timothy Walsh
Columbia University, New York State Psychiatric Institute
Food restriction, the salient behavioral feature of Anorexia Nervosa,
typically begins during adolescence and becomes extremely
entrenched over time, and resistant to change via either psychological
or pharmacological treatment. Cognitive neuroscience has described
two related but distinct processes that underlie the acquisition of new
patterns of behavior, action-outcome (instrumental) and stimulus-response
learning. It is likely that both processes are involved in the development
of Anorexia Nervosa, and that stimulus-response learning, i.e. habit
formation, is critical to the persistence of the dieting behavior.
This presentation will describe a formulation (Walsh, in press), based
on recent advances in cognitive neuroscience, that the food restriction
characteristic of Anorexia Nervosa is acquired via action-outcome
learning, as initial weight loss for adolescent females is perceived as
highly rewarding. As the behavior continues over months and years,
food restriction becomes entrained via mechanisms responsible for
stimulus-response learning. In parallel, the neural systems responsible
for the behavior shift from ventral to dorsal striatum and ventromedial
to dorsolateral prefrontal cortex. This formulation provides a potential
hypothesis to account for the process by which dieting, a behavior
engaged in by most young women, in some evolves into a life-threatening
and extremely persistent illness.
37
FROM IMPULSIVITY TO COMPULSIVITY
Carolyn Pearson
University of Kentucky
We argue there is a developmental process in which binge eating and
purging initially represent impulsive actions designed to reduce distress
and become, over time, compulsive behaviors. Negative urgency (NU) is
the tendency to respond to distress with impulsive actions. Measured in
5
th graders, it predicts subsequent learning that eating alleviates distress
(
EE) and thinness leads to overgeneralized life improvement (TE). The
learning predicts binge eating and purging (Pearson et al., 2012a). The
two behaviors are negatively reinforced and thus become increasingly
common responses to distress over time, despite their harmful effects. In
perhaps the early developmental stages of this process, we found that EE
and TE measured in elementary school predicted stable binge eating and
purging, respectively, across the following three years of middle school.
The regular reliance on these behaviors may be the first step toward
compulsive use of them to alleviate immediate distress.
38
TESTING OF THE COGNITIVE NEUROSCIENCE MODEL OF
ANOREXIA NERVOSA: HABIT LEARNING
Joanna Steinglass
Columbia University, New York State Psychiatric Institute
Learning and memory likely play a role in the development and
persistence of anorexia nervosa (AN) and, more specifically, in patients’
difficulties changing behaviors. Habit learning refers to a type of learning
that is more resistant to change, and is thought to be mediated by dorsal
striatum. Building on advances in cognitive neuroscience, we measured
learning using tasks known to rely on dorsal striatum. Individuals
with Anorexia Nervosa (AN) and healthy controls (HC) completed a
neuropsychological battery including converging measures of basal
ganglia cognitive functioning. Individuals with AN participated before and
after weight restoration; HC were also tested twice. The Ice Cream Task
relies on the dorsal striatum to improve accuracy in an implicit learning
task. The “Acquired Equivalence” Task measures both striatal-based
learning and hippocampal-based learning. Data from 46 patients (n=24
AN binge purge subtype; 22 AN-restricting subtype) and 24 HC at two time
points indicate impairment specific to basal ganglia learning. These results
suggest there may be a disturbance in CNS systems that mediate habitual
behaviors. The relationship of such abnormalities to the core behavioral
features and persistence of AN will be discussed.
39
NEGATIVE REINFORCEMENT MODELS AND NEW TREATMENTS FOR
BULIMIA NERVOSA
Stephen Wonderlich
University of North Dakota School, Neuropsychiatric Research Institute
This presentation will review studies testing the idea that bulimia nervosa
may be maintained through a combination of positive and negative
reinforcement processes. There is increasing evidence that bulimic
individuals exhibit significant deficits in terms of emotion regulation and,
furthermore, that bulimic individuals expect that binge eating will reduce
negative emotional experience. Supporting this observation, field studies
will be reviewed which indicate that both binge eating and purging
behaviors significantly reduce negative affect in bulimic individuals.
The presentation will also introduce Integrative Cognitive-Affective
Therapy (ICAT), which is based on emotion regulation principles and
negative reinforcement conditioning processes. ICAT has recently been
compared to CBT-E in a randomized control trial, which indicated that both
treatments have significant effects on bulimic behavior. These findings
provide further support for a model of bulimic behavior based on emotion
regulation and negative reinforcement which has direct clinical utility.
TOP ABSTRACTS/AWARDS PAPER SESSION
Saturday, 8:30 - 9:30 AM
Waterford/Lalique
40
THE INTERGENERATIONAL EFFECTS OF MATERNAL EATING
DISORDERS AND PSYCHIATRIC DISORDERS ON OFFSPRING
CHILDHOOD AND EARLY ADOLESCENT PSYCHIATRIC DISORDERS
Nadia Micali
1
,
Bianca De Stavola
2
,
George Ploubidis
2
,
Emily Simonoff
3
,
Janet Treasure
4
1
University College London (UCL) Institute of Child Health, London, United
Kingdom,
2
London School of Hygiene and Tropical Medicine, London,
United Kingdom,
3
London School of Hygiene and Tropical Medicine,
London, United Kingdom,
4
Department of Child and Adolescent Psychiatry,
Institute of Psychiatry, King’s College London, London, United Kingdom,
5
Eating Disorders research unit, Psychological Medicine, Institute of
Psychiatry, King’s College London, London, United Kingdom
Introduction
:
There is evidence that parental psychiatric disorders
increase the risk of offspring psychiatric disorder. We aimed to investigate
psychiatric disorders at age 7, 10 and 13 years in offspring of women with
pre-conception eating disorders (ED) and other psychiatric disorders.
Methods
:
Women (N=12,035) from a large population-based longitudinal
cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC).
A brief pre-pregnancy psychiatric history was obtained at enrollment
to determine exposure. Offspring psychiatric disorder was measured
using the Developmental and Well-being Assessment at ages 7, 10 and
13.
Results
:
Maternal ED were associated with a psychiatric diagnosis
across ages, particularly emotional disorders (Odds ratio=2.3, 95%CI:
1.3-3.8,
p=0.001); this was particularly true for maternal AN. Maternal
psychiatric disorders other than ED predicted psychiatric diagnoses across
ages, and acted in an additive fashion with maternal ED.
Conclusions
:
Maternal ED pre-conception together with comorbid psychopathology
increase the risk for psychiatric disorders in childhood and early
adolescence, in particular for emotional disorders. This has important
implications for prevention and our understanding of the overlap between
ED and emotional disorders.
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NEUROPSYCHOLOGICAL ASSESSMENT IN ANOREXIA NERVOSA-
CLUSTER ANALYSIS OF 332 PATIENTS
Mark Rose
1,2
,
Ian Frampton
1,4
,
Beth Watkins
1
,
Bryan Lask
1,3
1
Great Ormond Street Hospital for Children NHS Foundation Trust,
London, United Kingdom,
2
The Huntercombe Group, Maidenhead, United
Kingdom,
3
Care UK, London, United Kingdom,
4
College of Life and
Environmental Sciences, Exeter, United Kingdom
To investigate whether specific neuropsychological impairments
consistently identified in Anorexia Nervosa (AN) group together to form
distinct cognitive profiles. Sample - 332 patients with a clinical diagnosis of
AN, mean age 17.6 years (SD= 4.6), mean BMI 15.9 (SD= 1.9). Analysis-
Hierarchical cluster analysis identified the optimum number of clusters.
K
means cluster analysis assigned membership to the specified number of
clusters. Children and adolescents were analysed separately from adults
to avoid masking subtle developmental effects. Four clusters emerged
in children and adolescents. Group 1 (40%) showed no weaknesses
and strengths in global central coherence, verbal fluency, inhibition and
flexibility. Group 2 (24%) showed weakness in visuo-spatial memory,
flexibility and inhibition. Group 3 (30%) showed weakness in visuo-spatial
memory and strength in verbal fluency. Group 4 (4%) showed weakness
in verbal fluency, flexibility and inhibition and strength in global central
coherence. Two clusters emerged in adults. Group 1 (41%) showed
weakness in visuo-spatial memory, local central coherence and poor
ORAL ABSTRACTS
