Set-shifting abilities, mood and loss of control over eating in binge eating disorder: An experimental study
Introduction
Binge eating disorder (BED) has recently been added as a distinct eating disorder category to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013). Binge eating disorder involves the consumption of objectively large amounts of food within a limited period of time with an associated loss of control over eating, but without inappropriate compensatory behaviors (i.e., self-induced vomiting, misuse of laxatives or diuretics, excessive exercising). Binge eating is characterized by eating much more rapidly than usual, eating until feeling uncomfortably full and eating large amounts of food without being physically hungry. Individuals with BED usually go through their binge eating episodes alone because they feel embarrassed. Afterwards they often feel disgusted with themselves, depressed and guilty. Individuals with BED do not enjoy eating during a binge; in fact, they display marked distress regarding binge eating (Dingemans et al., 2002).
Forty-six to 61% of individuals with BED have a lifetime diagnosis of mood disorders (Hudson et al., 2007, Javaras et al., 2008, Grilo et al., 2009). Several cross-sectional, experimental and therapy outcome studies suggested an association between depressive symptoms (trait), acute negative mood (state), and binge eating behavior (Antony et al., 1994, Telch and Agras, 1996, Grilo et al., 2001, Peterson et al., 2005, Masheb and Grilo, 2008, Dingemans et al., 2009a, Dingemans et al., 2009b). These studies indicated that higher levels of depression are related to more severe binge eating. Also, ecological momentary assessment studies have demonstrated that binge eating in BED is preceded by the experience of negative emotions (Hilbert and Tuschen-Caffier, 2007, Stein et al., 2007, Goldschmidt et al., 2012, Munsch et al., 2012). In two experimental studies of our research group (Dingemans et al., 2009a, Dingemans et al., 2009b), we found that patients with BED with depressive symptoms were less able to cope with negative moods than BED patients with no depressive symptoms and were therefore more likely to engage in ineffective coping strategies such as binge eating. More specifically, individuals with BED with depressive symptoms who experienced move severe negative mood changes consumed more calories during a bogus taste task than those who were less affected by a negative movie clip.
The pervasiveness of the link between depressive symptoms, negative emotions and binge eating suggests that the question is not whether but how negative mood leads to binge eating (Tice et al., 2001). The escape from self-awareness model suggests that binge eating is used as a means to escape from negative mood and to help alleviate emotional stress (Heatherton and Baumeister, 1991). According to this model, binge eating episodes can be seen as the result of an individual’s effort to draw attention away from emotional distress by narrowing the focus from an aversive self-perception towards the immediate environment (food). Indeed, negative emotions have found to be associated with (Svaldi et al., 2014a) and preceded by (Agras and Telch, 1998, Goldschmidt et al., 2012) failures in the behavioral control over eating. It has been suggested that loss of control may be the most salient aspect of binge eating (Agras and Telch, 1998, Wolfe et al., 2009, Goldschmidt et al., 2012). A negative mood may lower an individual’s threshold for losing control over eating with binge eating as a result. Individuals with BED frequently lose control over eating especially in the context of negative mood because they fail to regulate their negative mood in a more healthy way. In other words, affect-evoking situations may interact with individuals’ emotion regulation strategies (Dingemans et al., 2009a, Svaldi et al., 2014b, Kittel et al., 2015;).
Executive functions play an important role in mediating self-control, self-regulation and decision-making. Executive functions are intrinsic to the ability to respond to novel situations in an adaptive manner and they form the basis of many cognitive, emotional and social skills (Lezak et al., 2011). Set-shifting is an aspect of executive functioning and concerns the ability to move back and forth between multiple tasks, operations or mental sets; it represents cognitive flexibility. Set-shifting may contribute to rigid mental acts and behaviors that are central to the phenomenology of several mental disorders, particularly obsessive–compulsive disorder and eating disorders but also attention deficit hyperactivity disorder and substance dependence (Robbins et al., 2012). Regarding BED, it has been hypothesized that the inability to control eating in BED may imply deficits in executive functioning (Galioto et al., 2012, Manasse et al., 2014). That is, poorer set-shifting might narrow the number of strategies individuals are capable of using when they have to deal with stress or negative emotions. Indeed, a major finding of a recent meta-analysis (Wu et al., 2014) was that anorexia nervosa, bulimia nervosa, BED and obesity were associated with diminished set-shifting abilities. The number of studies which investigated set-shifting in BED specifically is however limited. A more recent systematic review by Kittel et al. (2015) included more studies than Wu et al. (2014), showing mixed results. Two studies found set-shifting deficits in patients with BED, when compared to matched controls without BED (Duchesne et al., 2010, Svaldi et al., 2010), whereas three other studies found no differences in set-shifting abilities between patients with and without BED (Galioto et al., 2012, Kelly et al., 2013, Manasse et al., 2014). These mixed results may be partly explained by the differences in characteristics of participants in the five studies such as age and BMI and by the different tests that were used to assess set-shifting.
However, the presence of a negative mood might hamper set-shifting, as studies have shown depression to negatively affect executive functioning and decrease initiation and problem solving and impede cognitive flexibility (McClintock et al., 2010, Roberts et al., 2010). In the context of negative mood individuals with poorer set-shifting abilities might have more difficulties regulating their negative mood in a healthy way then individuals with better set-shifting abilities. It can be speculated that as a result of the narrowing of the focus to the immediate environment (food) during a negative mood state (Heatherton and Baumeister, 1991) individuals with BED have difficulties shifting to healthy coping behavior. This might be due to an impairment in the ability to shift attention and behavior from one set to another.
The aim of this experimental study was to test whether there is a causal relationship between set-shifting ability and changes in mood and/or loss of control over eating. Participants diagnosed with BED were randomly assigned to a negative or neutral mood induction. Set-shifting abilities, depressive symptoms, current mood and loss of control over eating were assessed. Our research questions were threefold:
- 1.
Do set-shifting abilities predict changes in mood during an acute mood induction?
- 2.
Is this association affected by the overall level of depressive symptoms?
- 3.
Do set-shifting abilities and changes in mood have an effect on feelings of loss of control over eating?
We hypothesized that individuals with poorer set-shifting abilities are more affected by a negative mood induction and therefore experience more changes in negative mood. We further hypothesized that individuals with moderate to severe depressive symptoms and poorer set-shifting abilities experience more increases in negative mood and loss of control over eating than individuals with no to mild symptoms of depression and better set-shifting abilities. No effects were to be expected in the neutral mood condition. Finally, we hypothesized that set-shifting abilities and changes in negative mood are associated with feelings of loss of control over eating. More specifically, individuals who experience more negative mood and who have more deficits in set-shifting will have more feelings of loss of control over eating.
Section snippets
Participants
Eligible participants were non-pregnant females with a primary diagnosis of BED according to DSM-5 criteria (American Psychiatric Association, 2013). To be included in the study, a participant had to report an average of one binge eating episode a week over the previous 3 months. If participants were on medication, they could participate in the study if their response to and doses of the medication was stable (at least 2 months). Exclusion criteria were current or past self-induced vomiting,
Participant characteristics
The study participants were 75 non-pregnant females aged between 18 and 62 with a primary diagnosis of binge eating disorder (BED) according to DSM-5 criteria (American Psychiatric Association, 2013). About two third (n=52; 69%) of the participants were recruited from three clinics specializing in treating eating disorders at the beginning of treatment. The remainder (n=23; 31%) of the participants were recruited through advertisements in local newspapers and on Internet websites. All
Discussion
The aim of the present study was to examine, by means of a psychological experiment, the causal relationships between set-shifting ability, changes in mood and loss of control over eating in individuals with BED. As expected, individuals with poorer set-shifting abilities were more affected by a negative mood induction and therefore experienced more negative emotions than individuals with better set-shifting abilities. Moreover, more depressive symptoms combined with poorer set-shifting
Acknowledgments
The authors would like to thank Erika Wamsteker (Geerets and Kuypers) and Saskia van Manen (GGZ Rivierduinen, Midden Holland) for their help in the recruitment of eligible participants for the study
References (50)
- et al.
The effects of caloric deprivation and negative affect on binge eating in obese binge-eating disordered women
Behav. Ther.
(1998) - et al.
Psychopathology correlates of binge eating and binge eating disorder
Compr. Psychiatry
(1994) - et al.
Psychometric properties of the Beck Depression Inventory-25 years of evaluation
Clin. Psychol. Rev.
(1988) - et al.
The effect of suppressing negative emotions on eating behavior in Binge Eating Disorder
Appetite
(2009) - et al.
Expectations, mood, and eating behavior in binge eating disorder beware of the bright side
Appetite
(2009) - et al.
Cognitive function in morbidly obese individuals with and without binge eating disorder
Compr. Psychiatry
(2012) - et al.
The prevalence and correlates of eating disorders in the national comorbidity survey replication
Biol. Psychiatry
(2007) - et al.
Prognostic significance of two sub-categorization methods for the treatment of binge eating disorder: negative affect and overvaluation predict, but do not moderate, specific outcomes
Behav. Res. Ther.
(2008) - et al.
Binge eating in binge eating disorder: a breakdown of emotion regulatory process?
Psychiatry Res.
(2012) - et al.
Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry
Trends Cogn. Sci.
(2012)