Academic journal article Journal of Eating Disorders

Neuroimaging in Bulimia Nervosa and Binge Eating Disorder: A Systematic Review

Academic journal article Journal of Eating Disorders

Neuroimaging in Bulimia Nervosa and Binge Eating Disorder: A Systematic Review

Article excerpt

Author(s): Brooke Donnelly[sup.1], Stephen Touyz[sup.1], Phillipa Hay[sup.2], Amy Burton[sup.1], Janice Russell[sup.3] and Ian Caterson[sup.4]

Plain English summary

This paper is a systematic review of research investigating structural and functional differences transdiagnostically; that is, in people who have an eating disorder characterized by binge eating, either Bulimia Nervosa (BN) or Binge Eating Disorder (BED), when compared to healthy people with no eating disorder or other mental illness. Using a set of fixed search terms, we completed a systematic review of published peer-reviewed scientific papers, identifying thirty-two papers that met the inclusion criteria. The majority of papers reviewed used functional Magnetic Resonance Imaging (fMRI) and the rest used one or two other neuroimaging tests. An overview and synthesis of the results of the papers is provided, grouped according to the type of test completed. A small number of findings emerged of individuals with BN or BED when they have clinically significant symptoms, highlighting there are reductions in the overall size of the brain in BN and BED and diminished activity in regions associated with self regulation (frontostriatal circuits). Also, some studies highlight differences in the activity within neural regions associated with emotional processing (amygdala), attention and spatial manipulation (middle frontal gyrus) and visual processing (occipital cortex). We discuss the implications of the results and highlight recommendations for future neurobiological research based on our findings.


Recurrent binge eating is a debilitating symptom that is a core diagnostic criterion for bulimia nervosa (BN) and binge eating disorder (BED); it also occurs in anorexia nervosa-binge purge type (AN-BP), and is a common feature in other specified feeding and eating disorder (OSFED). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1] specifies that individuals are engaging in objective binge episodes (OBEs) at least once per week to reach a diagnosis of BN or BED. This differs from the proposed ICD-11 criterion where the binge episode (BE) is not required to be objectively large and can look like subjective binge episodes (SBEs) [2]. BN involves binge episodes (BEs)1 followed by inappropriate compensatory behaviours to avoid weight gain, such as purging, while BED involves engaging in recurrent binge episodes with no compensatory strategies [1].

BN and BED are disorders with noted social and health consequences that typically arise in later adolescent and young adult years [3]. In a cross-sectional population survey of Australian adults, the three-month prevalence of BN and BED ranged from 1.1-1.5% [4]. In 2014 in the Australian population, the prevalence of recurrent binge eating with or without distress was 10.1% and 13.0% in 2015 [3]. Psychiatric comorbidity, particularly with depression and anxiety disorders, is common [5, 7] and mortality is increased [6]. Over one in five individuals with BN will attempt suicide during their life, with factors relating to emotion dysregulation, lifetime anxiety and depression [7].

Treatments and assessments for BN and BED have been developed based on the current definition of BEs. Cognitive Behavioural Therapy (CBT) is the first-line treatment for BN and BED [8]. Available psychological treatments are moderately effective and medication may offer benefits but longer-term maintenance of effects are unclear [9-12]. Research has demonstrated that the majority of individuals with BN and BED do not seek treatment for their eating disorder, but instead present for weight loss treatment [13, 14].

In recent decades, major advances have taken place in the field of neuroscience, which has increased knowledge of the interrelationship between neurological processes and eating disorders [15]. However, most neuroimaging studies have focused their attention on people with AN rather than BN or BED. …

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