Abstract
BackgroundAnorexia Nervosa (AN) is a debilitating, sometimes fatal eating disorder (ED) whereby restraint of appetite and emotion is concomitant with an inflexible, attention-to-detail perfectionist cognitive style and obsessive-compulsive behaviour. Intriguingly, people with AN are less likely to engage in substance use, whereas those who suffer from an ED with a bingeing component are more vulnerable to substance use disorder (SUD).DiscussionThis insight into a beneficial consequence of appetite control in those with AN, which is shrouded by the many other unhealthy, excessive and deficit symptoms, may provide some clues as to how the brain could be trained to exert better, sustained control over appetitive and impulsive processes. Structural and functional brain imaging studies implicate the executive control network (ECN) and the salience network (SN) in the neuropathology of AN and SUD. Additionally, excessive employment of working memory (WM), alongside more prominent cognitive deficits may be utilised to cope with the experience of negative emotions and may account for aberrant brain function.SummaryWM enables mental rehearsal of cognitive strategies while regulating, restricting or avoiding neural responses associated with the SN. Therefore, high versus low WM capacity may be one of the factors that unites common cognitive and behavioural symptoms in those suffering from AN and SUD respectively. Furthermore, emerging evidence suggests that by evoking neural plasticity in the ECN and SN with WM training, improvements in neurocognitive function and cognitive control can be achieved. Thus, considering the neurocognitive processes of excessive appetite control and how it links to WM in AN may aid the application of adjunctive treatment for SUD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0714-z) contains supplementary material, which is available to authorized users.
Highlights
Anorexia Nervosa (AN) is a debilitating, sometimes fatal eating disorder (ED) whereby restraint of appetite and emotion is concomitant with an inflexible, attention-to-detail perfectionist cognitive style and obsessive-compulsive behaviour
A person suffering from anorexia nervosa is sometimes conscious of compulsively over-exerting self-control despite the risk of debilitating and/or fatal consequences
A person with substance use disorder (SUD) is sporadically aware that negative emotions are only temporarily substituted by the compulsive consumption of a rewarding substance
Summary
Anorexia Nervosa (AN) is a debilitating, sometimes fatal eating disorder (ED) whereby restraint of appetite and emotion is concomitant with an inflexible, attention-to-detail perfectionist cognitive style and obsessive-compulsive behaviour. If we take the viewpoint that WM functions to toggle between cognitive-emotion interactions in the brain, providing as a by-product a sense of conscious selfregulation, we may form a hinge model of the mind from which excessive, cognitive control and excessive engagement in appetitive processes swings This viewpoint does not presuppose that WM is synonymous with consciousness or cognitive control (which introduces the infinite regress problem of homunculus management), but rather that the subjective experience of varying degrees of cognitive control, or self-regulation, automatically arises from the neural capacity to flexibly toggle between not mutually exclusive cognitive and affective states
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