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A debate on current eating disorder diagnoses in light of neurobiological findings: is it time for a spectrum model?

Brooks SJ, Rask-Andersen M, Benedict C, Schiöth HB - BMC Psychiatry (2012)

Bottom Line: Sixty percent of eating disorders do not meet criteria for anorexia- or bulimia nervosa, as defined by the Diagnostic and Statistical Manual version 4 (DSM-IV).Instead they are diagnosed as 'eating disorders not otherwise specified' (EDNOS).Here we debate the classification issues, and discuss how brain imaging and genetic discoveries might be interwoven into a model of eating disorders to provide better classification and treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neuroscience, University of Uppsala, Box 593, Uppsala, Sweden. samantha.brooks@neuro.uu.se

ABSTRACT

Background: Sixty percent of eating disorders do not meet criteria for anorexia- or bulimia nervosa, as defined by the Diagnostic and Statistical Manual version 4 (DSM-IV). Instead they are diagnosed as 'eating disorders not otherwise specified' (EDNOS). Discrepancies between criteria and clinical reality currently hampering eating disorder diagnoses in the DSM-IV will be addressed by the forthcoming DSM-V. However, future diagnoses for eating disorders will rely on current advances in the fields of neuroimaging and genetics for classification of symptoms that will ultimately improve treatment.

Discussion: Here we debate the classification issues, and discuss how brain imaging and genetic discoveries might be interwoven into a model of eating disorders to provide better classification and treatment. The debate concerns: a) current issues in the classification of eating disorders in the DSM-IV, b) changes proposed for DSM-V, c) neuroimaging eating disorder research and d) genetic eating disorder research.

Summary: We outline a novel evidence-based 'impulse control' spectrum model of eating disorders. A model of eating disorders is proposed that will aid future diagnosis of symptoms, coinciding with contemporary suggestions by clinicians and the proposed changes due to be published in the DSM-V.

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Impulse-control spectrum model of eating disorders.
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Figure 1: Impulse-control spectrum model of eating disorders.

Mentions: Conversely, in those who exhibit binge eating behavior (e.g. BN, BED), previous research summarises a neural pattern to rewarding stimuli that is somewhat reversed, with a reduced or sporadic response in PFC regions, combined with hyperactivation in mesolimbic areas. In further support, a recent fMRI study that directly compared neural activation to food images in women with AN and BN found a clear PFC vs. striatum response to images of food [33]. However, it is also plausible that binge eating might coincide with hypofunctioning of the reward system [34], prompting the hypothesis that during binge eating, like an addict, a person must consume greater quantities of food to achieve the feeling of satiation. Furthermore, there appears to be a differential pattern of activation in binge eaters, when consuming versus anticipating food consumption during fMRI (e.g. [35]), suggesting that the model proposed here might be more applicable to anticipation of food intake, and cognitive biases towards food stimuli. It is also often observed that people who binge (e.g. those with BN) have a strong desire to restrain their intake, and recent evidence suggests that restraining one’s appetite increases the chances of binge eating in those with a genetic risk for binge eating [36]. Moreover, recent evidence suggests that artificial stimulation of the DLPFC using repetitive Transcranial Magnetic Stimuluation (rTMS) reduces craving in those prone to binge-eat [37]. Thus, the neurobiological interactions underpinning restrained and binge eating behaviour are complex. It is proposed here that, in response to appetitive food stimuli that may underlie responses to food, a specific neural signature, with sporadic dominance of restraint versus binge eating can be mapped onto a single model with the support of recent neuroimaging findings. See Figure 1.


A debate on current eating disorder diagnoses in light of neurobiological findings: is it time for a spectrum model?

Brooks SJ, Rask-Andersen M, Benedict C, Schiöth HB - BMC Psychiatry (2012)

Impulse-control spectrum model of eating disorders.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475111&req=5

Figure 1: Impulse-control spectrum model of eating disorders.
Mentions: Conversely, in those who exhibit binge eating behavior (e.g. BN, BED), previous research summarises a neural pattern to rewarding stimuli that is somewhat reversed, with a reduced or sporadic response in PFC regions, combined with hyperactivation in mesolimbic areas. In further support, a recent fMRI study that directly compared neural activation to food images in women with AN and BN found a clear PFC vs. striatum response to images of food [33]. However, it is also plausible that binge eating might coincide with hypofunctioning of the reward system [34], prompting the hypothesis that during binge eating, like an addict, a person must consume greater quantities of food to achieve the feeling of satiation. Furthermore, there appears to be a differential pattern of activation in binge eaters, when consuming versus anticipating food consumption during fMRI (e.g. [35]), suggesting that the model proposed here might be more applicable to anticipation of food intake, and cognitive biases towards food stimuli. It is also often observed that people who binge (e.g. those with BN) have a strong desire to restrain their intake, and recent evidence suggests that restraining one’s appetite increases the chances of binge eating in those with a genetic risk for binge eating [36]. Moreover, recent evidence suggests that artificial stimulation of the DLPFC using repetitive Transcranial Magnetic Stimuluation (rTMS) reduces craving in those prone to binge-eat [37]. Thus, the neurobiological interactions underpinning restrained and binge eating behaviour are complex. It is proposed here that, in response to appetitive food stimuli that may underlie responses to food, a specific neural signature, with sporadic dominance of restraint versus binge eating can be mapped onto a single model with the support of recent neuroimaging findings. See Figure 1.

Bottom Line: Sixty percent of eating disorders do not meet criteria for anorexia- or bulimia nervosa, as defined by the Diagnostic and Statistical Manual version 4 (DSM-IV).Instead they are diagnosed as 'eating disorders not otherwise specified' (EDNOS).Here we debate the classification issues, and discuss how brain imaging and genetic discoveries might be interwoven into a model of eating disorders to provide better classification and treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neuroscience, University of Uppsala, Box 593, Uppsala, Sweden. samantha.brooks@neuro.uu.se

ABSTRACT

Background: Sixty percent of eating disorders do not meet criteria for anorexia- or bulimia nervosa, as defined by the Diagnostic and Statistical Manual version 4 (DSM-IV). Instead they are diagnosed as 'eating disorders not otherwise specified' (EDNOS). Discrepancies between criteria and clinical reality currently hampering eating disorder diagnoses in the DSM-IV will be addressed by the forthcoming DSM-V. However, future diagnoses for eating disorders will rely on current advances in the fields of neuroimaging and genetics for classification of symptoms that will ultimately improve treatment.

Discussion: Here we debate the classification issues, and discuss how brain imaging and genetic discoveries might be interwoven into a model of eating disorders to provide better classification and treatment. The debate concerns: a) current issues in the classification of eating disorders in the DSM-IV, b) changes proposed for DSM-V, c) neuroimaging eating disorder research and d) genetic eating disorder research.

Summary: We outline a novel evidence-based 'impulse control' spectrum model of eating disorders. A model of eating disorders is proposed that will aid future diagnosis of symptoms, coinciding with contemporary suggestions by clinicians and the proposed changes due to be published in the DSM-V.

Show MeSH
Related in: MedlinePlus