Study Will Analyze Brain Mechanisms Behind Binge-Eating Disorder

A new study will look at the behavioral and biological factors behind Binge-Eating Disorder (BED), including the brain circuits and chemistry that may help explain the condition, according to a paper in BMC Psychiatry.

Anorexia and bulimia nervosa get more clinical attention than BED, but the latter affects a broader range of individuals and is known to be a long-term disorder with a mean lifetime duration of more than 14 years. The unknown pathophysiology of BED significantly limits potential therapeutic interventions.

Despite the severity associated with BED, there are limited treatment options available for it. Most treatment centers around cognitive behavioral therapy (CBT), but the study authors note that the impact of psychological interventions for BED is limited, and medications used to treat weight gain have significant adverse event challenges.

The study posits that brain mechanisms underlying drug and food craving may be similar; both are reported to be associated with increased neural activity in the orbitofrontal and anterior cingulate cortex and a diminished regulatory influence from lateral prefrontal circuits. Individuals with effective dietary self-control have increased activity in the left dorsolateral prefrontal cortex when making decisions about food ingestions, suggesting that that part of the brain may be important for controlling food consumption.

In particular, the study will look at the potential therapeutic benefits of repetitive transcranial magnetic stimulation (rTMS), which has been studied previously with mixed results. One earlier study suggested that rTMS applied to the left pre-frontal cortex might inhibit food craving in “strong cravers,” but a smaller study found no benefit for the use of rTMS to control bingeing or purging behaviors in bulimic subjects.

The study will analyze 60 eligible obese females with binge eating disorder, who will be randomly allocated to receive 20 sessions of TMS intervention (n = 30) or the sham transcranial magnetic stimulation intervention (n = 30) over 3 days per week. Thirty eligible controls will complete the baseline assessment. The primary outcome will be the number of binge eating episodes and will be assessed at each treatment sessions and two months after intervention completion.

The research will also look at the psychological aspects of abnormalities in the food reward system for BED patients and its connection to emotional and physiological stress, and the potential role of estrogen, progesterone, and leptin in appetite regulation.

“Functional approaches, such as the evaluation of resting state connectivity and task-induced activation, have great potential to identify targeted neurocognitive diagnostic markers and may indicate illness severity and prognosis with increased accuracy,” the study authors note. “In response to the current shortcomings in knowledge of BED etiology and the limited treatments available, we hope to support innovation in the development of more targeted and effective evidence-based treatments.”