reward abnormalities among women with bulimia nervosa

83 Pages·2010·0.92 MB·English

REWARD ABNORMALITIES AMONG WOMEN WITH BULIMIA NERVOSA:
A FUJ\JCTIONAL MAGNETIC RESONANCE IMAGING STUDY
by
CARABOHON
A DISSERTATION
Presented to the Department ofPsychology
and the Graduate School ofthe University ofOregon
in partial fulfillment ofthe requirements
for the degree of
Doctor ofPhilosophy
June 2010
11
University ofOregon Graduate School
Confirmation ofApproval and Acceptance ofDissertation prepared by:
Cara Bohon
Title:
"REWARD ABNORMALITIES AMONG WOMEN WITH BULIMIANERVOSA: A
FUNCTIONAL MAGNETIC RESONANCE IMAGING STUDY"
This dissertation has been accepted and approved inpartial fulfillment ofthe requirements for
the degree in the Department ofPsychologyby:
Jeffrey Measelle, Chairperson, Psychology
Jennifer Ablow, Member, Psychology
DonTucker, Member, Psychology
Eric Stice, Member, Not from U of0
William Harbaugh, Outside Member, Economics
and Richard Linton, Vice Presidentfor Research and Graduate Studies/Dean ofthe Graduate
School for the University ofOregon.
June 14,2010
Original approval signatures are onfile withthe Graduate School and the University ofOregon
Libraries.
An Abstract ofthe Dissertation of
Cara Bohon for the degree of Doctor ofPhilsosophy
in the Department ofPsychology to be taken June 2010
Title: REWARD ABNORMALITIES AMONG WOMEN WITH BULIMIA NERVOSA:
A FUNCTIONAL MAGNETIC RESONANCE IMAGING STUDY
Approved: _
Dr. Jeffrey Measelle
The current study measured BOLD brain response using functional magnetic
resonance imaging (fMRI) to explore the hypothesis that women with bulimia nervosa
have ahyper-responsivity ofthe mesolimbic reward system. Women with bulimia
nervosa and healthy controls (N = 24) completed an fMRI paradigm involving anticipated
and actual receipt ofchocolate milkshake and a tasteless control solution. Women with
bulimia nervosa showed less activation than healthy controls in the right anterior insula in
response to anticipatory food reward and in the leftmedial orbitofrontal cortex, right
posterior insula, right precentral gyrus, and right mid dorsal insula in response to
consummatory food reward. Covariates related to bulimia diagnosis accounted for some
ofthese effects, but not all. Results suggestthat bulimia nervosa may be related to hypo
functioning ofthe brain reward system rather than hyper-functioning. Implications for
intervention and future research are discussed.
IV
CURRICULUM VITAE
NAME OF AUTHOR: CaraBohon
GRADUATE AND UNDERGRADUATE SCHOOLS ATTENDED:
University ofOregon, Eugene, Oregon
Vanderbilt University, Nashville, Tennessee
DEGREES AWARDED:
Doctor ofPhilosophy, Psychology, 2010, University ofOregon
Master ofScience, Psychology, 2006, University ofOregon
BachelorofScience, Psychology, 2004, Vanderbilt University
AREAS OF SPECIAL INTEREST:
Clinical Psychology
Eating Disorders and Obesity
PROFESSIONAL EXPERIENCE:
Therapist, Direction Service Counseling Center, 2008-2009
Graduate Teaching Fellow, University ofOregon, 2005-2008
Research Assistant, Oregon Research Institute, 2005-2008
GRANTS, AWARDS, AND HONORS:
RuthL. KirschsteinNational Research Service Award for Predoctoral Fellows,
2008-2011
ABCT Obesity and Eating Disorders SIG StudentResearcher Award, 2007
Academy ofEating DisorderslNational Institute ofMental HealthJunior
Investigator Travel Fellowship, 2007
v
PUBLICATIONS:
c.,
Stice, E, Shaw, H., Bohon, Marti, C. N., & Rohde, P. (in press). A meta
analytic review ofdepression prevention programs for children and
adolescents: Factors that predict magnitude ofintervention effects.
Journal ofConsulting andClinical Psychology.
Bohon, c., Stice, E, & Spoor, S. (2009). Female emotional eaters show
abnormalities in consummatory and anticipatory food reward: A
functional magnetic resonance imaging study. InternationalJournal of
Eating Disorders, 42, 210-221.
c.,
Bohon, Stice, E, & Burton, E. (2009). Maintenance factors for persistence of
bulimic pathology: A prospective natural history study. International
Journal ofEating Disorders, 42, 173-178.
c.,
Stice, E, Spoor, S., Bohon, Veldhuizen, M., & Small, D. (2008). Relation of
reward from food intake and anticipatedfood intake to obesity: A
functional magnetic resonance imaging study. Journal ofAbnormal
Psychology, 117,924-935.
c.,
Stice, E, Bohon, Marti, C. N., & Fischer, K. (2008). Subtyping women with
bulimia nervosa along dietary and negative affect dimensions: Further
evidence ofreliability and validity. Journal ofConsulting andClinical
Psychology, 76, 1022-1033.
c.,
Stice, E, Spoor, S., Bohon, & Small, D. (2008). Relation between obesity and
blunted striatal response to food is moderated byTaqlAl DRD2 gene.
Science, 322,449-452.
Bohon, C., Stice, E., Burton, E., Fudell, M., & Nolen-Hoeksema, S. (2008). A
prospective test ofcognitive vulnerability models ofdepression with
adolescent girls. Behavior Therapy, 39, 79-90.
Spoor, S. T. P., Stice, E, Burton, E, & Bohon, C. (2007). Relations ofbulimic
symptomfrequency and intensity to psychosocial impairment and health
care utilization: Results from a community-recruited sample. International
Journal ofEating Disorders, 40, 505-514.
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal
relations betweenruminationand bulimic, substance abuse, and depressive
symptoms in adolescent females. Journal ofAbnormalPsychology, 116,
198-207.
c.,
Bohon, Garber, 1., & Horowitz, 1. L. (2007). Predicting school dropout and
adolescent sexual behavior inoffspring ofdepressed and nondepressed
mothers. Journal ofthe AmericanAcademyofChildandAdolescent
Psychiatry, 46, 15-24.
VI
ACKNOWLEDGEMENTS
Iwant to thank Dr. Eric Stice for all ofhis invaluable guidance and supportover
the course ofmy training. I also wantto thank everyone who aided in the collection and
analysis ofthese data, including butnotlimitedto Jason Ellis, Scott Watrous and
everyone atthe Lewis Centerfor Neuroimaging, and Dr. Sonja Spoor. Finally, I wantto
thank Dr. Jeffrey Measelle for serving as my advisor after my initial advisor leftthe
university. This research was supported inpartby aRuth L. KirschsteinNational
Research ServiceAward (Award Number F31MH081588 from the National Institute of
Mental Health). The content is solelythe responsibility ofthe author and does not
necessarily representthe official views ofthe National Institute ofMental Healthofthe
National Institutes ofHealth.
VB
TABLE OF CONTENTS
Chapter Page
I. INTRODUCTION 1
BulimiaNervosa: Diagnostic Features and Epidemiology 1
Subthreshold BulimiaNervosa 2
Statement ofthe Problem 3
II. BACKGROUND 4
Motivation for Normal Eating Behavior 4
Similarities Between BulimiaNervosa and DrugAddiction 8
Heightened Reward Sensitivity in Bulimia Nervosa 10
Implications ofReward Sensitivity and Abnonna1 Reward Circuitry on
Intervention Development 17
Summary ofBackground and Aims ofPresent Study 17
III. METHOD 20
Participants 20
Procedure 20
fMRI Scanner and DataAcquisition 23
Measures 25
DataAnalysis 33
viii
Chapter Page
IV. RESlTLTS 36
Descriptive Statistics and Self-report Data 36
Anticipatory Food Reward Group Differences 37
Consummatory Food Reward Group Differences 37
Post-hoc Analyses 38
V. DISCUSSION 41
General Summary 41
Implications 45
Limitations 46
Conclusion 48
APPENDIX: TABLES AND FIGURES 50
REFERENCES 60
IX
LIST OF TABLES
Table Page
1. Means, standard deviations, and independent sample t-tests on self-report
measures 51
2. Significantbrain regions, clusterZ-score, p-value, and effects size for each
contrast 52
3. Significantbrain regions, clusterZ-score, p-value for effect ofbulimianervosa group
on group anticipatory reward when covariates included 53
4. Significantbrain regions, cluster Z-score, p-value for effect ofbulimianervosa group
on consummatory reward when covariates included 55
x
LIST OF FIGURES
Figure Page
1. Results from ANOYA model ofanticipatory food reward 58
2. Results from ANOYA model ofconsummatory food reward 59