Jennifer Svaldi

Background Binge eating disorder (BED) is associated with obesity as well as behavioral and neurobiological changes in the reward and cognitive control systems of the brain. To better dissociate neural mechanisms of pathological eating behavior, functional connectivity (FC) analyses have shown promise. However, there is currently no replicable signature of BED derived from fMRI. Methods We investigated FC in 61 women with varying symptoms of binge eating. The three groups included 21 women with BED, 20 women with subsyndromal BED (subBED), and 20 controls without binge eating (noBE) matched in body mass index (BMI) and age. To identify neural signatures of BED and BMI, we used seed-based FC fingerprints (nucleus accumbens, NAcc, for reward and dorsolateral prefrontal cortex, dlPFC, for cognitive control) to predict group or BMI based on resting state and task-based (food bidding) FC. Furthermore, we explored spatial patterns of FC to quantify associations with BED and BMI. Results Both seeds of the reward and cognitive control networks robustly predicted BMI (rs = .33 - .46). The dlPFC seed predicted BMI across conditions (resting state: p=.002; task: p=.012) while the NAcc seed only predicted BMI based on task-based FC (p=.007). In contrast, FC failed to classify binge eating groups better than chance. Conclusions FC within reward and cognitive control networks primarily reflect obesity-related changes. Despite pronounced differences in eating behavior, BED could not be reliably dissociated from subBED or noBE using FC fingerprints. These results highlight challenges in identifying BED-specific functional markers.

Food cues can activate sensory and motor representations that may challenge inhibitory control. Implementation intentions (if-then plans) can support goal-directed behaviour, but it remains unclear whether the representational format of these plans (modal, i.e., sensory-grounded, versus amodal, i.e., abstract, such as imagining the food cue shrinking) shapes their impact on food-related inhibitory control. The study used a six-condition between-subjects food-related stop-signal task varying representational content and instruction structure. Neutral and modal content were implemented as goal intentions and if-then plans, whereas the amodal format was implemented only as if-then plans. Modal instructions asked participants to imagine food as already eaten on a plate, whereas amodal strategies involved imagining it shrinking or framed as a picture (N = 94). Pooling the neutral, shrinking, and framing if-then-plan conditions did not improve inhibitory control relative to the neutral goal-intention control. Modal if-then plans likewise did not impair inhibitory control, and if-then plans did not outperform goal intentions. In a secondary analysis of the amodal shrinking and framing plans, SSRTs were descriptively about 30 ms shorter than in the neutral goal-intention control (265.73 vs. 296.06 ms), although this difference was not statistically reliable. Despite high commitment (M = 3.01/4), adherence varied substantially; 76.9% in the shrinking condition reported applying the strategy less often, compared with 27.3% in the framing condition. Overall, although representational format did not reliably alter inhibitory control, the descriptive amodal pattern and adherence differences warrant further investigation of representational content and strategy enactment in food-related self-regulation.

Background: Anorexia nervosa (AN) is associated with substantial psychological and physical impairment and low recovery rates. A deeper understanding of its underlying mechanisms is therefore crucial. Cognitive models of eating disorders emphasize the role of attentional biases in the processing of food stimuli. However, only a few studies to date have examined the temporal dynamics of food-related attentional bias in adolescents with AN. Methods: The present study combined the high temporal resolution of event-related potentials with the behavioral measure of the attentional blink in a rapid serial visual presentation task in order to disentangle the temporal processing stages that underlie food-related attentional biases in female adolescents with AN ( n = 33) compared to age-matched healthy controls ( n = 36). Results: Behavioral results revealed an increased attentional engagement with food in AN, but no impairment in attentional disengagement . Additionally, high-calorie food distractors elicited reduced early electrocortical processing followed by enhanced later processing in AN. These AN-specific attentional biases were no longer evident for target processing. Conclusions: The findings suggest that attention allocation to food in AN is a temporally dynamic process rather than a unitary mechanism. They further suggest that these biases are not entirely autonomous but rather depend on the availability of attentional resources.

Purpose: Body image disturbances (BID) are central to anorexia nervosa (AN), influencing its development, maintenance and relapse. While mirror exposure (ME) has been shown to reduce BID in adults, research in adolescents is limited. This pilot randomized controlled trial examined the feasibility and effects of ME, added to treatment as usual (TAU), in adolescent inpatients with AN. In addition, we explored changes in body-related attentional bias as a potential mechanism of change. Methods: Adolescent female inpatients with AN were randomized to receive either 12 ME sessions over 4 weeks (ME group, n = 11) or TAU ( n = 13) in a pre-post design. Primary outcomes were global measures of BID and eating disorder (ED) pathology. Attentional bias was assessed using two eye-tracking paradigms. Results: Relative to TAU, ME did not improve BID or ED pathology. Both groups showed reductions in BID over time. Exploratory post-hoc analyses indicated reductions in body control and avoidance behaviors in the ME but not the TAU group. An attentional bias toward self-defined unattractive body parts was present but did not change over time in either group. Discussion: In this pilot trial, ME did not provide additional benefits over TAU in improving global BID or ED pathology in adolescent inpatients with AN. Improvements in BID may reflect general therapeutic effects of inpatient treatment. Exploratory analyses indicated potential effects on specific body-related behaviors but require cautious interpretation due to limited power. Future research should examine for whom and at what stage body image–focused interventions may be beneficial. Level of evidence: Level I, randomized controlled trial. Trial registration: The study is registered on the German Clinical Trial Register (DRKS; registration number: DRKS0019104).

Background: Body image dissatisfaction in childhood is linked to psychopathological risks, such as increased vulnerability to eating disorders. While cognitive-behavioral models suggest body-related cognitions and self-schemas contribute to body dissatisfaction, these mechanisms remain understudied in children. We hypothesized that children with body dissatisfaction would report higher public body awareness and show stronger body- and appearance-related attributions in negative scenarios, particularly when self-referenced.Methods: 431 children aged 8 to 13 years filled in questionnaires on body-related cognitions. Results: Children with body dissatisfaction showed significantly greater public body awareness and made more appearance- and body-related attributions under self-reference, but not under other-reference.Conclusion: These findings support cognitive models of body image dissatisfaction in preadolescents and highlight early-emerging cognitive distortions as potential targets for prevention and intervention.

Objective: Binge eating disorder (BED) is maintained by increased food‐related incentive salience, which is reflected by an attentional bias for food. Oxytocin acutely attenuates this bias in patients with anorexia nervosa and reduces food intake in males with normal or increased body weight. However, results in individuals with BED have been inconclusive. We assessed the acute effect of oxytocin on food stimulus processing and reward‐driven eating behavior in females with or without BED in a double‐blind, placebo‐controlled cross‐over study. Method: Females with BED ( n = 48) and female control participants with overweight ( n = 46) or normal weight ( n = 40) received intranasal oxytocin (24 IU) and, respectively, placebo, after an overnight fast and a standardized breakfast. In participants with a natural menstrual cycle, sessions were scheduled during consecutive luteal phases. Participants completed a food‐related dot‐probe task with concurrent eye tracking and a bogus taste test measuring snack intake. Results: Oxytocin compared to placebo increased dwell time bias on food stimuli in the BED relative to the overweight control group, in which this effect was reversed. Contrary to our hypothesis, oxytocin increased calorie intake across groups. Exploratory analyses indicated that the latter effect focused on females taking hormonal contraception. Discussion: These results indicate disorder‐ and, respectively, sex‐specific effects of oxytocin on food‐related incentive salience and food intake and point to a role of oxytocin in binge eating pathology. They moreover suggest that sex hormones determine the acute effect of oxytocin on eating behavior in females.

Background: Binge eating disorder (BED) is characterized by repeated episodes of binge eating accompanied by a loss of control. Although it remains unknown which factors drive binge eating (BE) episodes, there are indications that variability in nucleus accumbens (NAcc) responses could lead to increased variability in food intake. Methods: Here, we assessed whether BED is associated with higher intra-individual variability in behavioral and neuroimaging indices of reward responses. To this end, patients with BED ( n = 35, M _BMI = 33.2 kg/m ² ± 6.8), participants with subsyndromal BED ( n = 21, M _BMI = 29.0 kg/m ² ± 7.2), and individuals without symptoms of binge eating ( n = 23, M _BMI = 32.3 kg/m ² ± 6.5) completed an effort allocation task with concurrent functional magnetic resonance imaging. Results: In line with our hypothesis, we found that patients with BED had higher variability in subjective wanting ratings of food ( F _34,21 =1.48, p _boot = .024), but not effort exertion ( F _{34 ,21} = 1.13, p _boot = .30). Crucially, trial-by-trial variability in NAcc responses during the presentation of cues was associated with a higher BMI ( b =0.11, 95%CI [0.03, 0.19], BF ₁₀ =11.1) and disinhibited eating ( b =0.19, 95%CI [0.01, 0.36], BF ₁₀ =4.0) across groups, whereas NAcc variability was only marginally elevated in patients with BED ( b =0.12, 95%CI [−0.04, 0.29], BF ₁₀ =1.2, P>0|data = 88%). Conclusions: Our results support the idea that BMI and disinhibited eating are associated with more variable NAcc responses, which may contribute to the symptoms of BED. However, this association is only weakly indicative of clinical severity of BED.