Abstract
The aim of this meta-analysis was to summarise data from neuropsychological studies on inhibitory control to general and disease-salient (i.e., food/eating, body/shape) stimuli in bulimic-type eating disorders (EDs). A systematic literature search was conducted to identify eligible experimental studies. The outcome measures studied included the performance on established inhibitory control tasks in bulimic-type EDs. Effect sizes (Hedges' g) were pooled using random-effects models. For inhibitory control to general stimuli, 24 studies were included with a total of 563 bulimic-type ED patients: 439 had bulimia nervosa (BN), 42 had anorexia nervosa of the binge/purge subtype (AN-b), and 82 had binge eating disorder (BED). With respect to inhibitory control to disease-salient stimuli, 12 studies were included, representing a total of 218 BN patients. A meta-analysis of these studies showed decreased inhibitory control to general stimuli in bulimic-type EDs (g = −0.32). Subgroup analysis revealed impairments with a large effect in the AN-b group (g = −0.91), impairments with a small effect in the BN group (g = −0.26), and a non-significant effect in the BED group (g = −0.16). Greater impairments in inhibitory control were observed in BN patients when confronted with disease-salient stimuli (food/eating: g = −0.67; body/shape: g = −0.61). In conclusion, bulimic-type EDs showed impairments in inhibitory control to general stimuli with a small effect size. There was a significantly larger impairment in inhibitory control to disease salient stimuli observed in BN patients, constituting a medium effect size.
Highlights
The spectrum of bulimic-type eating disorders (EDs) includes anorexia nervosa of the binge/purge subtype (AN-b), bulimia nervosa (BN), and binge eating disorder (BED)
Because no standardized criteria have been established to assess the quality of neuropsychological studies, we developed a priori a standardized checklist of risk of bias which was based on domains of the Newcastle-Ottawa Scale (NOS: www.ohri.ca/programs/ clinical_epidemiology/oxford.htm) for evaluating risk of bias in case- control and cohort studies
The ‘PRISMA statement’ [39] for reporting a systematic review and meta-analyses was followed. This PRISMA Flow chart highlights the number of articles found at each stage of the search and the final number of studies that were included in the review
Summary
The spectrum of bulimic-type eating disorders (EDs) includes anorexia nervosa of the binge/purge subtype (AN-b), bulimia nervosa (BN), and binge eating disorder (BED). These conditions share the common characteristic of recurrent episodes of binge eating (i.e., overeating of large amounts of food) with (AN-b and BN) or without (BED) compensatory behaviours, e.g., self-induced vomiting. The bulimic-type EDs are mental disorders associated with increased morbidity and all-cause mortality [2,3], the mechanisms underlying bulimic behaviours are largely unknown. Recurrent episodes of binge eating are considered to be a common phenomenon in purging spectrum disorders and are evident in various ED pathologies, including AN (binge/purge subtype), BN and BED. Impaired inhibitory control in bulimic-type ED patients does not appear to be restricted to food intake but may extend to general behaviours, e.g., excessive drinking, substance abuse, sexual disinhibition, and bullying, suggesting a more general dysregulation of inhibitory control in bulimic-type EDs [7,8]
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