Impulsivité alimentaire et troubles du comportement alimentaire : de la neuropsychologie à la psychologie clinique

Abstract

Food-related impulsivity, defined as the action of eating on a whim in response to immediate stimuli, is a real therapeutic challenge for therapists. However, this psychological component is frequently found in patients suffering from bulimia, Binge Eating Disorder or overweight or obesity. Research in neuropsychology shows a link between a deficit of response inhibition and the intensity of binge eating. In addition, patients with bulimia and binge eating disorder would have impaired executive functions compared to healthy subjects. Indeed, they would have difficulties in decision-making, and set-shifting, also termed cognitive flexibility, less important than healthy subjects. Moreover, weak central coherence, a bias towards local processing at the expense of global meaning seems to be linked to cognitive traits found in subjects with eating disorders: perfectionism, fear of making mistakes and resistance to change. According to the model of Impulsive Behavior UPPS, patients suffering from binge eating would have a tendency to express fast, direct and strong reactions, often in the presence of negative affects (negative urgency) but also in a positive environment (positive urgency). They would also have inability to sustain attention and motivation to complete tasks and would be sensitive to ruminations (lack of perseverance), a tendency to act without thinking (lack of premeditation), and a tendency to seek excitement and adventure as well as openness to new experiences (that generates emotions that can lead to binge eating). These results provide insight into the clinical pathways currently used in the management of eating disorders. First, specific training for go/no-go tasks would give encouraging results. According to a recent meta-analysis, single-session inhibitory control training led to significant decreases in food choices or consumption in a laboratory study. Secondly, Acceptance and Commitment Therapy, ACT develops psychological flexibility in order to reach the acceptance of mental events or physical sensations that it cannot change sustainably, to reinvest the energy of struggle in actions towards what is important for the patient (his values). The question is if patients should accept their emotions or their desire to eat. If the goal is not to eat for emotional reasons, is it not a struggle? And if all cravings to eat are satisfied, the patient is not likely to automate the behavior and move towards a behavioral addiction? Finally, mindfulness-based meditation, usually used in management of eating disorder, increase emotional tolerance. The patient is led to observe his emotions with curiosity rather than trying to avoid it, especially by food intake. With a daily training of observation and acceptance of what is there, including the emotions and unpleasant thoughts, the mindfulness increases the tolerance to discomfort situations. In conclusion, impulsivity is a real challenge for therapists and it seems important to combine all our resources to improve the effective management of patients: research with the clinical practice, neuropsychology with clinical psychology…