BACKGROUND: Recent frameworks for understanding food rewards recognize the role of separable affective and motivational processes (liking and wanting) in driving human eating behavior. Separate assessments of liking and wanting may aid in understanding the complex eating-related behaviors seen in anorexia nervosa (AN). OBJECTIVE: The aim of this study was to examine separately liking and wanting for foods of different energy densities in women at different stages of AN and in healthy volunteers at both an implicit and an explicit level. DESIGN: Explicit liking and wanting responses to high- and low-calorie foods were derived from analog ratings, whereas an implicit "wanting" measure was identified by using reaction time in a forced-choice procedure. Explicit and implicit processes were compared across 3 groups of AN participants (current AN, weight-restored AN, and recovered AN) and healthy volunteers. RESULTS: Currently underweight AN participants explicitly wanted high-calorie foods less than did the other groups. Both current and weight-restored AN groups demonstrated significantly less implicit "wanting" for high-calorie foods and more implicit "wanting" for low-calorie foods-an inverted pattern to never-ill participants. CONCLUSIONS: The aberrant responses to food that characterize AN may be driven more by altered motivational salience ("wanting") than by explicit liking responses. This pattern of aberrant food reward appears to be independent of weight status. Examining the processes that motivate approach or avoidance of low- and high-calorie foods in AN may aid the development of targeted strategies to augment existing interventions.
"Future studies which combine DBS with multimodal imaging strategies such as fMRI which indexes blood flow, DTI which indexes integrity of neural tracts and magnetoencephalography (MEG) which measures neural activity in real time, will offer important new information about the neural dynamics of AN. Investigations of response to experimental interventions such as DBS should optimally include assessment of putative mechanisms underlying AN pathology, in particular compulsivity and food related reward-liking vs wanting (Cowdrey, Finlayson, et al., 2013). "
[Show abstract][Hide abstract] ABSTRACT: Dysfunctional reward from the pursuit of thinness presents a major challenge to recovery from Anorexia Nervosa (AN). We explore the neuroscientific basis of aberrant reward in AN, with the aim of generating novel hypotheses for translational investigation, and elucidate disease mechanisms to inform the development of targeted interventions. Relevant neuroimaging and behavioural studies are reviewed. These suggest that altered eating in AN may be a consequence of aberrant reward processing combined with exaggerated cognitive control. We consider evidence that such aberrant reward processing is reflected in the compulsive behaviours characterising AN, with substantial overlap in the neural circuits implicated in reward processing and compulsivity. Drawing on contemporary neuroscientific theories of substance dependence, processes underpinning the shift from the initially rewarding pursuit of thinness to extreme and compulsive weight control behaviours are discussed. It is suggested that in AN, weight loss behaviour begins as overtly rewarding, goal-directed and positively reinforced, but over time becomes habitual and increasingly negatively reinforced. Excessive habit formation is suggested as one underlying mechanism perpetuating compulsive behaviour. Ongoing research into the behavioural and neural basis of aberrant reward in AN is required to further elucidate mechanisms. We discuss clinical and transdiagnostic implications, and propose that future treatment innovation may benefit from the development of novel interventions targeting aberrant reward processing in AN.
Behaviour Research and Therapy 11/2014; 62. DOI:10.1016/j.brat.2014.07.007 · 3.85 Impact Factor
"These distorted beliefs and perceptions are accompanied by a lack of concern over extreme emaciation, a perpetual drive for thinness and continuous lowering of weight goals (Barbarich-Marsteller et al., 2011; see Figure 1 for DSM-V diagnostic criteria). Characteristic behaviors seen in AN to achieve these goals, such as extreme dietary restriction and driven over-exercise, have been described as evidence of compulsivity and aberrant reward processing (Park et al., 2011, 2012; Cowdrey et al., 2013; Kaye et al., 2013a). Indeed the stereotyped and often ritualistic behaviors seen in AN have been compared to that of obsessive–compulsive disorder (OCD; Steinglass and Walsh, 2006), with the two disorders often being reported as comorbid (Halmi et al., 1991), leading to the suggestion that they may share common underlying neurobiological mechanisms (Steinglass and Walsh, 2006). "
[Show abstract][Hide abstract] ABSTRACT: The compulsive nature of weight loss behaviors central to anorexia nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as obsessive-compulsive disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behavior, and consider evidence of aberrancies in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behavior in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement, and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.
Frontiers in Psychology 07/2014; 5:778. DOI:10.3389/fpsyg.2014.00778 · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been conducted nationwide; the purpose of this study was, therefore, to determine whether such a pattern could be identified. Methods. A total number of 577 analyses were performed during a three-year period on people suspected of non-lethal substance abuse, in more than two-thirds of the counties in Romania. Preliminary tests were conducted using immunoassay tests (blood or urine) and confirmatory tests were carried out using either GC-MS or HPLC. Results. 240 cases (41.6%) were negative while 327 cases (58.4%) tested positive for illegal drugs, central nervous system medication or both. Men represented 89.5% of all cases, while women accounted for only 10.5%. The pattern of substance abuse varied significantly, depending on the geographical area. In most cases, the identified drugs of abuse were cannabinoids and opiates, with a significantly different distribution of cases, depending on the geographical area. The highest number of positive cases was identified in the month of October, whereas the smallest numbers were identified in July and December. The annual trend of consumption revealed a significant decrease in the analysed substances in 2011. Conclusions. Our study has determined the presence of a specific pattern of consumption in different geographical areas - a result that suggests the need for more targeted prevention programmes, addressing local particularities in consumption behaviours. A significant decrease in the identification of drugs of abuse in the third year of our study, combined with data attesting the significant increase in the consumption of legal highs suggests that the forensic toxicology laboratories need to be equipped with apparatus able to detect these newer substances of abuse more efficiently.
Heroin Addiction and Related Clinical Problems 01/2014; 16(3):7-13. · 0.35 Impact Factor
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