Cobbers on the Brain – Page 137 – Student Commentary on the Neurological Sciences

Bulimia: From Impulsive to Compulsive Behavior

Posted on March 16, 2016 by / 0 Comment

What is Bulimia?
Bulimia Nervosa (BN) is an eating disorder characterized by a period of binge eating followed by a period of purging. Binge eating is defined as eating a lot of food in very little time. Purging is the attempt to get rid of that food. The most common form of purging is vomiting
Impulsive Behavior
There are many situations in which humans make impulse decisions. Often times impulsive action takes place in the face of danger or following intense negative emotion. Research agrees that during times of intense negative emotion people are more likely to make rash impulsive decisions. A psychology/nuerochemistry review paper I recently read made the argument that the initial binge eating episode that can lead to BN is the result of impulsive action. Often this impulsive action is brought on by negative emotion. The act of binge eating is an immediate relief of this negative emotion. The writers of this paper also make the argument that the purge episode to follow is brought on by a number of factors including resentment following the impulsive decision. This resentment the writers believe can mostly be attributed to the “expectancy that thinness leads to overgeneralized life improvement.”
Compulsive Behavior
The path from impulsive binge eating and purging to compulsive binge eating and purging begins in the dopaminergic reward centers of the brain. People with BN show a similar reaction in this part of the brain during a binge episode as drug addicts do during drug use. The continued reward in this portion of the brain leads to a tolerance build up. You see dopamine is the chemical responsible for this reward feeling and in order for dopamine to do its job it has to bind with a dopamine receptor. However if dopamine gets release more often than normal, the brain responds by decreasing the number of dopamine receptors. This means in order to get the same reward feeling, it takes more dopamine than normal. However this reaction from the brain only happens after repeated use. Therefore the initial impulsive decision to binge eat does not exactly cause BN it would be the repeated binge eating and purging episodes that lead to BN.

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The Major Concerns of Bulimia Nervosa

Posted on March 16, 2016 by / 0 Comment

Body image is a topic that many adolescent girls and boys struggle with in the modern society. Wherever you go, there are unrealistic and hurtful images posted in magazine, newspapers, and websites. Not only are these images inappropriate, they also give vulnerable and impressionable adolescents impractical expectations for how they should look. These images, in combination with under developed emotional regulation can lead to serious mental health issues in this population and other men and women. Most commonly, the mental illness that manifests from this combination is Bulimia Nervosa (BN).

Characterized by episodes of binging following by purging, BN is a major source of mental health concern in the adolescent female population. With all of the societal pressures put on these young women to be thin, some of these people go to extreme measures to ensure that they will be looked upon by society with favor. However, these binging and purging episodes are extremely unhealthy and can lead to numerous physiological complications. One such concern is that excessive exposure of stomach acid to the mouth causes the degradation of tooth enamel. Commonly, people that purge consistently loose their teeth and can have other heart burn related issues.

The other major area of concern for these people is the recurrence and compulsive nature of this illness. There is more than a 30% chance that BN victims will relapse six months after treatment. This may be impart to the negative reinforcement of combating this illness. Studies have shown that people with bulimic tendencies also have lower resting metabolic rates. This means that when these people try to get start to eat healthy again, they will inevitably gain weight due to their slowed metabolism. This gain in weight following treatment negatively reinforces the action of eating healthy and can cause these people to revert to old tendencies.
Overall, it is imperative that when discussing this illness we analyze the emotional, psychological, and physiological aspect of these individuals. Additionally, it is also important to recognize that some people are at a higher risk to develop this disease given their social environments and neurological dispositions, such as impulsive behavior and risk taking personality traits.
While psychologists are working on developing new treatment models to help reverse the affects of BN, I think that the best form of care is to work on preventing it from evolving. I think that we need to continue to make the public aware of these dangerous images and teach kids the importance of eating healthy, exercising, and being physically fit, not skinny. If we are able to raise public awareness and education, I think that the amount of people affect by BN will significantly decrease and we can slowly combat the rising prevalence of this disease.

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What is Bulimia Nervosa?

Posted on March 15, 2016 by / 0 Comment

Bulimia Nervosa is an eating disorder characterized by a cycle of bingeing and compensatory behaviors, such as vomiting, abuse of laxatives, and over exercising. It is a severe disorder that affects 1-2% of adolescent and young adult women. Highlighting the neural mechanisms involved in the outset and maintenance of the disease is of great importance, in order to develop efficient treatments to help those suffering with the disease.
Some studies revealed a connection between Bulimia and Serotonin, a type neurotransmitter (molecules found in the brain, responsible of maintain the communication between neurons) often related with mood. The findings are still unclear, but some patients are currently treated with a combination of therapy and medications, that interact with Serotonin levels in the brain.
Unfortunately, the relapse rates for Bulimia are still high: in one study, a relapse rate of 31% was observed during the 2-year follow-up period of recovery, and the vast majority of relapses occurred within the first 6 months after treatment. Thus, the development of novel and more effective treatment is necessary.
The efforts to find new types of treatment must join forces with those who make efforts to change the pattern of ultra-thin ideal body, that has been spread all over the world. Evidence indicates that the maintenance of Bulimia is sustained by many factors, including genetic predisposition, personality traits such as impulsivity, social environment that overvalues body image, and environmental stressors.

It is impossible to know if the disease would still exist if we did not have such skinny standards of beauty, but it is certain that the ultra-thin ideal body plays a role in the maintenance of not only Bulimia, but other eating disorders, as Anorexia.

Disease/Health

Uncovering Bulimia Nervosa

Posted on March 15, 2016 by / 0 Comment

For our topic this week, it was bulimia nervosa (BN). The article we discussed was written by Dr. Stephen Wonderlich, a Concordia Alumni, and the inaugural speaker for our Nornes Lectureship in Neuroscience.
BN is eating large amounts of food, and then purging or trying to get rid of the calories in an unhealthy way. These methods include vomiting, laxatives, diuretics or enemas after bingeing.
According to the Mayo Clinic, risk factors for BN are being a female, age, biology, psychological and emotional issues, media and sports pressure.
In Dr. Wonderlich’s review, his team designed a treatment based on how BN changes from an impulsive action to compulsive behavior. Their plan of approach is called the Integrative Cognitive-Affective Therapy (ICAT). As in the title, it focuses on the cognitive behavioral therapy aspect of psychotherapy. It helps a patient recognize their unhealthy, negative behaviors and replacing them with more healthy and positive ones.
The term negative urgency was present in Dr. Wonderlich’s review. The term is defined as the tendency to engage in rash action in response to extreme negative emotions, so it is a genetic factor for some people with BN. Negative urgency is the only trait that can consistently predict binge eating and purging. By understanding how some patients are genetically at risk for BN, and then incorporating the media idea of a “perfect” body image shows a recipe for an increase in BN patients.

By understanding how some people are at risk for BN, and decreasing the media’s “ideal” body as well as other risk factors will help reduce the number of bulimics. If a person does become diagnose with BN, but then incorporating Dr. Wonderlich’s and colleagues treatment plan of ICAT. It will help treat one the most severe eating disorders.

Disease/Health

Reducing the Stigma of Mental Illness: Bulimia Nervosa

Posted on March 15, 2016 by / 0 Comment

Psychological illness are a difficult thing to deal with, and make living and doing everyday activities difficult for sufferers. While there are many different distinct mental illnesses that are characterized, many of them seem to be linked to similar root causes, and two of those linked diseases now include Bulimia Nervosa (BN) and Obsessive Compulsive Disorder (OCD). These diseases have been recently thought to involve some of the same pathological characteristics both related to psychological manifestations and with respect to brain chemistry.

Bulimia nervosa is a vicious cycle in which the person affected binges on food after a period of starving themselves, followed by throwing up the food because of feelings of guilt and shame. This is done in order to lose weight. This seems to ultimately come from the stigma against being overweight; people try to lose weight in order to feel better about themselves and live a better life. Unfortunately, environmental situations or genetic factors can make a person more susceptible to developing a mental illness, and often more than one will occur together. Bulimia and depression are very strongly linked: about 79% of people with bulimia also have depression.
It is important for society to look at mental illness not as a choice or weakness, but as a physical disease, to reduce the stigma associated with it. The chemical makeup of the brain is changed in specific ways that cause people to behave in ways that they do not truly have control over. In fact, with bulimia and OCD, the parts of the brain that are responsible for exerting control over our actions are dysfunctional, causing the disease in the first place. The idea of self-control is traditionally something that people are inherently born with, but it is actually more of a resource. This “resource” is actually a complicated system in the brain that uses neurotransmitters such as serotonin to control immediate emotion-based impulses that brain-healthy people take for granted.
This “resource” for effortful control is found as a linking system from the amygdala (responsible for experiencing emotions) to the prefrontal cortex. This signaling happens via dopamine. The prefrontal cortex then determines what to do with the information that the amygdala, and compares the demands from the emotional signaling to long-term goals. The prefrontal cortex can only inhibit these emotional responses with sufficient amounts of serotonin present. High levels of dopamine in these areas increase the power of the emotional signaling, while low levels of serotonin decrease the ability to inhibit the emotional signaling.

Emotional impulse regulation in the brain

Binge eating stems from the prolonged effortful control that is required to maintain the intense dieting the precedes it. Once the self-control resources such as serotonin in the brain are used up, a bulimic person will binge eat, satisfy their hunger, but then feel bad for failing their weight-loss or dieting ideal. In the end, they purge the food and continue the cycle.
Treating these diseases permanently is very difficult, although relief is often achieved. The recovery depends on the severity of the symptoms and how ingrained the compulsive behaviors are for each individual person. Usually both of these diseases are treated with Selective Serotonin Reuptake Inhibitors (SSRIs) that increase the amount of serotonin in the brain. The importance of this treatment comes from increasing serotonin in specific areas of the brain responsible for controlling emotions that lack serotonin.
By understanding how bulimia and other mental illnesses develop, hopefully awareness of the disease as a physical illness (rather than some kind of weakness of the person’s soul) will make sufferers more likely to seek professional help.

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Emotional Regulation and Bulimia Nervosa

Posted on March 15, 2016 by / 0 Comment

Monday, March 14^th is a big day for the Concordia College Neuroscience Community. Dr. Steve Wonderlich, a Cobber Alumni, is going to hold a lecture about his new Bulimia Nervosa treatment model. Because of this, the Neurochemistry class focused on the topic Bulimia and worked together to break down Wonderlich’s 2014 paper discussing his model.

Bulimia Nervosa is serious and sometimes life-threatening disorder in which an individual undergoes a cycle of binge eating and then purging through vomiting, laxadives, or excessive exercise.
Dr. Wonderlich’s model focused on the importance of targeting the patient’s emotional regulation and working with them on an individual basis so that they are able to overcome their need for binging and purging.
The role of emotion plays a very critical role in bulimia because it is not solely about body image; it is about one’s inability to control their impulsiveness when in an emotional vulnerable state, according to Dr. Wonderlich. His new method is called interactive cognitive affective therapy (ICAT).
What is really interesting about this model is that it’s primary focus is on emotional regulation whereas some other forms of treatment focus primarily on the patient’s way of thinking cognitively. It target’s the patients emotional understanding, self-awareness, and triggers for episodes.
Dr. Wonderlich talked about how the brain plays a role in this disorder. The two main brain areas that are involved in emotion are the striatum and the amygdala, which are parts of the brain’s limbic system.

The amygdala is also essential for the brain’s reward pathway, which is activated during a bulimic episode, as well as with drug use.
During a bulimic episode, the individual wants to avoid negative feelings, so they resort to binge-eating (which can also be triggered after starvation with anorexia nervosa). The food acts as a reward and an escape from the negative aspects of their life, meaning that it acts as both positive and negative reinforcement.

After their binge episode, the individual may feel guilty and want to avoid the weight gain, so they go through a purge episode, which, again, acts as negative reinforcement.

This vicious cycle has made bulimia very hard to treat because, more often than not, it is about a lot more than just body image; it is about gaining control and avoiding the negative in one’s life. Although it is difficult to treat, Dr. Wonderlich’s breakthrough with emotional regulation shows promising results for a promising future of those suffering from bulimia nervosa.

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Integrative Cognitive Affective Therapy – The Future of Bulimia Nervosa Treatment

Posted on March 15, 2016 by / 0 Comment

I recently got the opportunity to listen to Dr. Stephen Wonderlich, a Concordia graduate and distinguished clinical psychologist, speak on campus. He began his talk by explaining that his research is focused on the science of eating disorders, specifically bulimia nervosa (BN). BN is a disorder that includes recurrent episodes of binge eating, a subsequent purge episode that those suffering do to rid themselves of the binge they just did, a sense of lack of self-control, and typically a deficit in positive self image. Furthermore, he explained that BN affects predominately females, with about 90% of cases being female.
Dr. Wonderlich offered a couple personal stories of people who suffered from BN, discussing how they often experienced negative childhood events or extreme social pressures to lose weight or obtain a “thin” image. To further explain, he talked about the current excepted treatment theory for BN – Cognitive Behavioral Treatment (CBT). This model begins with focusing on the patient’s low self esteem, which in turn leads to extreme concerns about weight, strict dieting, and eventually binge eating. He then discussed the theory he and his colleagues have been developing – Integrative Cognitive Affective Theory (ICAT) – and its mechanisms of action. He explained how ICAT focuses on the emotions of the subjects by analyzing the subjective experience, physiological reaction, expressive component, and behavioral reaction of the subject. Furthermore, he mentioned that many published articles explain that negative emotions precipitate eating disorders. These aspects provide the groundwork of ICAT.
Dr. Wonderlich then explained the role of the brain in emotion generation and regulation, with the dorsal system of the brain being responsible for emotional generation, and the ventral system being responsible for regulating and managing emotion. The two emotional circuits work in accordance – and in people suffering from BN, these two systems may not work as effectively as they could. From extensive testing and research, it has been found that with increased negative emotion comes increased activation of the brain’s reward center in BN patient. Additionally, when bulimic people plan a future binge, their amygdala calms down. Therefore, the thought of food for bulimic people leads to a reward response. This phenomenon is what drives Dr. Wonderlich’s work in the connection between negative emotional states and the induction of a bulimic episode.
Lastly, Dr. Wonderlich talked about the treatments for BN and how he and his team have developed a manual using ICAT that is being disseminated around the world. He explained that the treatment first works to increase positive emotions and then to find a way for patients to tolerate the negative emotional states. The results of the study showed that integrating ICAT and CBT had profoundly positive outcomes, and that the the large majority of the subjects involved continued with the treatment. This, to me, is amazing – a novel treatment for a very serious disorder can now be implemented in order to improve the lives of those that suffer from BN.
Getting the chance to hear the leader of this potentially groundbreaking research was undoubtedly enjoyable, and I am very intrigued to learn of what the future holds for ICAT and Dr. Wonderlich’s team. I also really appreciated Dr. Wonderlich’s ability to integrate the effects a Concordia College education had on him and his future. For me, I feel even more thankful to be given the opportunity to go into the community and influence the affairs of the world. Luckily, I had the chance to talk with Dr. Wonderlich about his work and the road he took to get to where he is today. I found myself further interested in neuroscience and medicine, and I hope I can continue to integrate the two areas in my future career.

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Bulimia a Drug?

Posted on March 15, 2016 by / 0 Comment

Bulimia Nervosa is of concern among adolescents and can be extremely hard to identify. Along with the difficulty in identification many side effects accompany bulimia. Some include the erosion of the enamel from teeth, popped blood vessels, digestive complications, and reproductive impairments. When talking about bulimia more models are suggesting similarities between bulimia and drug addiction.
The new theory describes impulsive versus compulsive behaviors and how they lead into each other especially when looking at bulimia. Impulsive actions lead into compulsions by repetitively taking part in an activity where a reward is being earned but then turns into a compulsion when that individual needs to take part in the activity to avoid a more negative effect from occurring.
Bulimia is usually initiated in adolescents and there are certain individuals that are at higher risk than others, the two main risks for impulsive behaviors are state-based and trait-based. When talking about state-based a lack of self control is being had by the individual. Trait-based is when negative urgency takes place and negative urgency is defined as the tendency to act rashly when distressed, is characterized by high neuroticism, low conscientiousness, and low agreeableness.
Bulimic actions are then reinforced by distraction and negative reinforcement which is very similar to what occurs with drug addiction and can be the reason why it is difficult to stop.
Now knowing the similarities between the addictiveness of drugs and bulimia we as a society will be more informed and aware of the signs of bulimia to help individuals who are struggling with the disease.

Disease/Health

Could Meghan Trainor Actually Save the United States from Bulimia Nervosa?

Posted on March 15, 2016 by / 0 Comment

Meghan Trainor—along with many other celebrities and companies in the United States—has boldly proclaimed her support of the body image acceptance movement.
She’s “All About That Base,” and is encouraging others to accept the bodies they have.
Her aim is to decrease the negative body image that so many young adolescents and adults have developed growing up in a culture that idealizes and idolizes ultra-thinness. By encouraging the acceptance of our bodies, the advocates like Meghan Trainor likely hope to see a decrease in eating disorders—such as bulimia nervosa (BN).
However, there is curious research into the psychology and chemistry of BN that happens to suggest a lot more than just a negative body image factor at play.
The True Predispositions
First off, some people are more predisposed to developing BN than others—we all have to eat, we all like to eat junk food, and we all want to lose weight, but not all of us develop BN.
This predisposition seems to be the beginning of a complex development process.
Predisposition can be genetic, and can be determined based on how much self-control one has—which is somewhat determined chemically through serotonin and dopamine regulatory measurements.
The predisposition also is linked to a person’s attitude. If a person has a negative affect—meaning they are very likely to be in a negative mood—they are more likely to develop BN as well.
With these predispositions, when a person is placed in the right environment, BN develops.
The True Development
In this development process, the person first acts on impulse. Likely the person is in a “bad mood” maybe due to negative body image, or maybe due to stresses in life. They are also likely on a diet. When they have reached the point of exhausting their self-control and/or ability to deal with negative stressors, they binge eat.
This binge eating, in the impulsive stage, acts as a positive reinforcement reward. The brain is given what it wants and the person feels satisfied.
After the binge, the person will feel they have undone what they have desired to accomplish and purge their binge. This begins the cycle again. The cycle eventually leads to more compulsive actions.
The compulsive stage is similar to drug addiction. The patient seeks out the binge in the same way a heroin addict seeks out heroin.
The binge now provides more of a negative reinforcement. The binge takes away negative stressors in life via distraction, and/or satisfies the body of foods it has been deprived of during a diet.
The True Perpetuation

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The interesting thing about BN is not the negative self-image and strive for a perfect body, but the way in which the disease perpetuates.
Because the disease adopts reward functions that mimic drug addiction, the ideal body image becomes a secondary reason for the disease.
If the negative self-image was taken away—like Meghan Trainor and others are trying to do—it is likely that people who suffer from BN would still suffer from addictive and harmful behaviors. This is due to their predisposition to these types of behaviors with low self-control complexes in combination with high negative affect.
Yes, the negative affect that results from negative body image would be removed—but the negative affect caused by other stressors in life would not be, and could result in the same reward seeking cycles with other diagnosis—such as drug addiction, alcoholism, or gambling.
The impulsivity of these patients and their lack of ability to deal with negative emotions will likely persist and lead them to other harmful behaviors if negative body image is eradicated in this culture.
The True Promising Solutions
So, in getting to the root of Meghan Trainor’s likely goal—no, she is not going to rid the world of bulimic-like tendencies. She may succeed in lowering the rates of eating-disorders, but in the case of patients suffering from BN, it will likely take shape in a different harmful behavior.
While her songs are catchy and her intentions are good, Meghan’s ideas are not going to solve the problem. What is? Further research into cognitive functions of bulimic patients and their emotion regulation patterns, as well as further research into the regulatory roles of both dopamine and serotonin in decreasing impulsivity.

Disease/Health

The Addictive Nature of Bulimia Nervosa

Posted on March 13, 2016 by / 0 Comment

In the United States, we have some real problems with our bodies. It become a bit obvious when you look at the constant deluge of advertisements thrown at us saying that we are too fat, too thin, too scrawny, too puffy, too wrinkled, too young, too old, too medicated, or not medicated enough. It’s no wonder that our national self image is in the tank.
But beyond making it easier for corporations to pick our collective pocket, there is a real danger to our national health that comes with hating how we look. The number of eating disorders in the United States has risen to affect almost 20 million women and 10 million men at some point during their lives. This means that almost 10% of the current population will have struggled or is currently struggling with some form of eating disorder.
Once an eating disorder has developed it becomes incredibly difficult to be cured. As seen in bulimia nervosa, the brain chemistry of the afflicted person is warped to accommodate the disorder. In bulimia, the initial susceptibility to the disorder is triggered by a number of possible factors including personal stressors, general anxiety, and negative body image.

In order to feel some relief, the person makes an impulsive decision to binge eat which activates dopamine receptors in their brain and provides a euphoric feeling. However, after binging, the person regrets overeating and feels compelled to eliminate the excess calories consumed leading to a purging episode. By exercising control over this one aspect of their lives, people in the throes of the binge/purge cycle are comforted and actually rewarded for this behavior by a positive neurochemical response to their actions including dopamine activation and serotonin inhibition.

The impulsive act quickly become compulsive because brain chemistry adapts to the increased dopamine signaling by decreasing active dopamine receptors. This means that these people now have a higher threshold for normal dopamine signaling are because of this are more at risk for developing depression. Thus the cycle of binging and purging becomes a requisite aspect of everyday life as people with eating disorders experience symptoms very similar to drug addiction.
To escape the cycle, certain types of cognitive or emotional regulatory treatment have been utilized but with limited success. One of the best ways to help a person struggling with an eating disorder is to establish a supportive network that they can rely on. So until our society wises up to the dangers that are quietly infiltrating our lives, make sure to be aware of the signs and symptoms of eating disorders and take care of your loved ones.