Abstract
Binge eating has been usually viewed as a loss of control and an impulsive behavior. But, little is known about the actual behavior of binging patients (prevalently women) in terms of basic decision-making under risk or under uncertainty. In healthy women, stressful cues bias behavior for safer options, raising the question of whether food cues that are perceived as threatening by binging patients may modulate patients’ behaviors towards safer options. A cross-sectional study was conducted with binging patients (20 bulimia nervosa (BN) and 23 anorexia nervosa binging (ANB) patients) and two control groups (22 non-binging restrictive (ANR) anorexia nervosa patients and 20 healthy participants), without any concomitant impulsive disorder. We assessed decisions under risk with a gambling task with known probabilities and decisions under uncertainty with the balloon analog risk taking task (BART) with unknown probabilities of winning, in three cued-conditions including neutral, binge food and stressful cues. In the gambling task, binging and ANR patients adopted similar safer attitudes and coherently elicited a higher aversion to losses when primed by food as compared to neutral cues. This held true for BN and ANR patients in the BART. After controlling for anxiety level, these safer attitudes in the food condition were similar to the ones under stress. In the BART, ANB patients exhibited a higher variability in their choices in the food compared to neutral condition. This higher variability was associated with higher difficulties to discard irrelevant information. All these results suggest that decision-making under risk and under uncertainty is not fundamentally altered in all these patients.
Highlights
Reviewed by: Bernd Weber, Rheinische-Friedrich-Wilhelms Universität, Germany Silvia U
Binge eating episodes are periods of large food intake within short time. They are commonly viewed as a failure of the strict self-control over food/caloric intake exerted by patients with bulimia nervosa (BN), anorexia nervosa binging subtype (ANB) and eating disorders not otherwise specified (EDNOS; Fairburn and Harrison, 2003)
We investigated the decision-making process involved in risky situations in binging (BN and ANB) patients when primed by neutral, food and stressful cues and compared their performances to those of non-binging (ANR) patients and healthy participants
Summary
Reviewed by: Bernd Weber, Rheinische-Friedrich-Wilhelms Universität, Germany Silvia U. Studies investigating risky choices in binging patients have led to inconsistent results: some claim that binging patients choose more often risky options with small outcome expectancies (Brand et al, 2007; Tchanturia et al, 2007; Brogan et al, 2010) while other studies with larger sample sizes have not found any differences between binging patients and healthy controls (Cavedini et al, 2004; Van den Eynde et al, 2012; Wu et al, 2013) These discrepancies might be due to different levels of attention (Hare et al, 2011; Lim et al, 2011) and cognitive interferences such as preoccupations toward food and weight (Fairburn and Harrison, 2003; Starcke et al, 2011; Aïte et al, 2013) at assessment. A meta-analysis, performed on studies that did not involve any food condition, showed that the preference for risky options is stronger in patients with restrictive anorexia nervosa (ANR), who do not binge, than in binging patients, suggesting that such a preference is not specific to binge eating (Guillaume et al, 2015)
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