Abstract
Bulimia nervosa (BN) and obsessive-compulsive disorder (OCD) co-occur at greater rates than chance and may have shared mechanisms of dysfunction. One of these proposed mechanisms is a hyper-responsive aversive system as indicated by heightened startle response to aversive stimuli. The present study examined this hypothesis using 2 types of aversive stimuli: disorder specific (e.g., high-caloric food pictures for BN, contamination pictures for OCD) and nondisorder specific (e.g., knife). Temporal parameters of aversive responding were also examined by assessing startle response in anticipation of and following picture presentation. The sample consisted of 114 undergraduate women selected to have a broad range of BN and/or OCD symptomatology. OCD symptoms were associated with increased startle potentiation during the anticipation and presentation of contamination pictures, and BN symptoms were associated with increased startle potentiation during disorder-related contamination pictures (e.g., sink, toilet). BN symptoms were also associated with increased startle potentiation during and following the presentation of food pictures (though the former effect was only a trend). Additionally, the interaction of BN and OCD symptoms was associated with elevated startle responding during the presentation of contamination and threat stimuli. Overall, the present study provides evidence that BN and OCD symptoms are associated with heightened aversive responding to disorder-specific stimuli, and comorbid BN and OCD symptoms are associated with heightened aversive responding across disorder-specific and nonspecific aversive stimuli. Clinical and theoretical implications are discussed.
Highlights
Bulimia nervosa (BN) and obsessive-compulsive disorder (OCD) co-occur at significantly greater rates than chance in both clinical and community samples (Angst et al, 2004; Hudson et al, 2007) and share many common phenotypic features (Godart, Flament, Perdereau, & Jeammet, 2002; Lilenfeld et al, 1998; see Altman & Shankman, 2009 for review)
The present study examined the association between BN and/or OCD symptoms and startle response to disorder-specific and non-specific aversive stimuli in a sample of college-aged females
Disorder-Specific Aversiveness BN and Food Pictures: Aversive System, Reward System, or Both? In partial support of our hypotheses, BN symptoms were associated with increased startle potentiation and negative valence ratings of high-caloric food pictures
Summary
Bulimia nervosa (BN) and obsessive-compulsive disorder (OCD) co-occur at significantly greater rates than chance in both clinical and community samples (Angst et al, 2004; Hudson et al, 2007) and share many common phenotypic features (Godart, Flament, Perdereau, & Jeammet, 2002; Lilenfeld et al, 1998; see Altman & Shankman, 2009 for review). The present study examined whether one potential mechanism – heightened aversive system activation – may contribute to the heightened comorbidity between BN and OCD. OCD can be characterized by high aversive motivation (e.g., individuals with OCD may avoid germs). Heightened aversive system activation may be a shared mechanism of BN and OCD that contributes to their high co-occurrence. Lang (1995) proposes that aversive system activation is associated with increased defensive responding, such as the startle response. Startle is an ideal tool for examining the specificity and/or commonality of aversive motivation in BN and OCD, because it potentiates when the individual is in an aversive state (i.e., fear-potentiated startle) and can be used to measure in-the-moment responses to stimuli.
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