Altered anticipation and processing of aversive interoceptive experience among women remitted from bulimia nervosa - PubMed (original) (raw)

Altered anticipation and processing of aversive interoceptive experience among women remitted from bulimia nervosa

Laura A Berner et al. Neuropsychopharmacology. 2019 Jun.

Abstract

Bulimia nervosa (BN) is characterized by dysregulated intake of food, which may indicate homeostatic imbalance. Critically important for homeostatic regulation is interoception, or the sensing and processing of body-relevant information. A well-documented link between avoidance of unpleasant body sensations and BN symptoms suggests that aversive interoceptive experiences may be particularly relevant to BN pathophysiology. This study examined whether individuals with a history of BN show aberrant neural processing of aversive interoceptive stimuli. Using a cued inspiratory breathing load paradigm, we compared women remitted from BN (RBN; n = 24; to reduce the confounding effects of active bulimic symptoms) and control women (CW; n = 25). During breathing load anticipation, the RBN group, relative to CW, showed increased activation in mid-insula, superior frontal gyrus, putamen, dorsal anterior cingulate, posterior cingulate, and amygdala. However, over the course of the aversive experience, neural activation in RBN relative to CW showed an aberrant decline in most of these regions. Exploratory analyses indicated that greater activation during breathing load anticipation was associated with past bulimic symptom severity and the duration of symptom remission. An exaggerated anticipatory response and an abnormally decreasing response during aversive homeostatic perturbations may promote hallmark bulimic behaviors-binge eating, dietary restriction, and purging. Our findings support a role for homeostatic instability in BN, and these altered patterns of brain activation may serve as novel targets for pharmacological, neuromodulatory, and behavioral interventions.

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Figures

Fig. 1

Experimental paradigm. The inspiratory breathing load paradigm has been used to study aversive interoception in healthy and psychiatric populations [, –42]. During fMRI scanning, participants wore a nose clip and were instructed to breathe through a hose that intermittently restricted breathing for 40-s periods via 40 cm H20/L/sec inspiratory loads. Colored rectangles (mean duration 6 s) signaled the likelihood of an upcoming breathing load period (yellow = 25% chance of subsequent breathing load, blue = 0% chance). Overlaid on each rectangle, an arrow pointing left or right cued participants to press a left button or a right button, respectively. Accuracy and reaction time on this continuous performance task measured attention. The post-load period after all breathing load conditions lasted an average of 2 s

Fig. 2

Increased activation during breathing load anticipation in women remitted from bulimia nervosa relative to controls. Corresponding statistics are presented in Table 1. No statistically significant between-group differences were found during or after the breathing load. Amy amygdala, rACC rostral anterior cingulate cortex, Ins insula, Put putamen, PCC posterior cingulate cortex, dACC dorsal anterior cingulate cortex, SFG superior frontal gyrus

Fig. 3

Group differences in activation time course. Group x Time interaction results suggest that the time course of activation in RBN statistically significantly differed from that of CW. Time-course graphs for anticipation, breathing load, and post-breathing load conditions are shown in in light gray and with gray shading the background. Error bars represent standard error of the mean. Additional clusters in which time course differed between groups are shown in Table 2. RBN women remitted from bulimia nervosa, CW healthy control women, MFG middle frontal gyrus, rACC rostral anterior cingulate cortex, PCC posterior cingulate cortex

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Altered anticipation and processing of aversive interoceptive experience among women remitted from bulimia nervosa - PubMed (original) (raw)