Thursday, October 17, 2013

Impaired Brain Activity Underlies Impulsive Behaviors in Women with Bulimia

Here’s an article I found that is near and dear to my heart (yanno, in a sarcastic kind of way). Surprisingly one of the things I haven’t looked into is less obvious psychological origins of eating disorders. It's exceptionally relevant though because what we're talking about is Impulsive Behavior in one of the criteria designated as an impulsive qualifier for Borderline Personality Disorder. I do wish it took men into consideration, but what can you do.

Science Update • January 12, 2009

Women with bulimia nervosa (BN), when compared with healthy women, showed different patterns of brain activity while doing a task that required self-regulation. This abnormality may underlie binge eating and other impulsive behaviors that occur with the eating disorder, according to an article published in the January 2009 issue of the Archives of General Psychiatry.


In the first study of its kind, Rachel Marsh, Ph.D., Columbia University, and colleagues assessed self-regulatory brain processes in women with Bulimia without using disorder-specific cues, such as pictures of food.

In this study, 20 women with Bulimia and 20 healthy controls viewed a series of arrows presented on a computer screen. Their task was to identify the direction in which the arrows were pointing while the researchers observed their brain activity using functional magnetic resonance imaging (fMRI).

People generally complete such tasks easily when the direction of the arrow matches the side of the screen it is on—an arrow on the left side pointing to the left—but respond more slowly and with more errors when the two do not match. In such cases, healthy adults activate self-regulatory processes in the brain to prevent automatic responses and to focus greater attention on resolving the conflicting information.

Results of the Study 

Women with Bulimia tended to be more impulsive during the task, responding faster and making more mistakes when presented with conflicting information, compared with healthy controls.

Patterns in brain activity also differed between the two groups. Even when they answered correctly to conflicting information, women with Bulimia generally did not show as much activity in brain areas involved in self-regulation as healthy controls did. Women with the most severe cases of the disorder showed the least amount of self-regulatory brain activity and made the most errors on the task.


Altered patterns of brain activity may underlie impaired self-regulation and impulse control problems in women with Bulimia. These findings increase the understanding of causes of binge eating and other impulsive behaviors associated with bulimia and may help researchers to develop better targeted treatments.

What’s Next 

The researchers are currently conducting further studies on brain functioning in teens with Bulimia, which would offer a closer look at the beginnings of the illness. They also recommend studying people in remission from an eating disorder. Comparison studies with impulsive people who have healthy weight and eating habits could also provide more information about which patterns of brain activity are most directly related to eating disorders.

fMRI data showing self-regulatory brain activity in healthy controls (left) and women with Bulimia (right). Red areas show increases in activity while answering correctly when given conflicting information. Blue areas show increases in activity while answering correctly when given matching information. In both cases, women with Bulimia showed less activity than healthy controls.

These differences in brain activity patterns may account for problems with impulse control and similar behaviors related to Bulimia.

Source: Rachel Marsh, Ph.D., Columbia University
Marsh R, Steinglass JE, Gerber AJ, Graziano O’Leary K, Wang Z, Murphy D, Walsh BT, Peterson BS. Deficient Activity in the Neural Systems That Mediate Self-regulatory Control in Bulimia Nervosa. Arch Gen Psychiatry. 2009 Jan;66(1):51–63.

I found this to be spectacularly interesting. First, this is why eating disorders are classified as Impulsive Behaviors in the DSM portion of Borderline Personality Disorder. Then again, I don’t think anyone that has struggled with bulimia would argue with the intense feelings of needing to consume to fill that void, or eat our feelings, or distract our mind…. And then the inevitable instantaneous panic and need to get rid of the shame we just consumed. Both aspects are impulsive. The inability to regulate the intake, and the inability to not purge are impulsive.

For me, regulating my intake is incredibly difficult. Unless I fall into almost obsessive compulsive levels of regulation (which is how I typically live my life in order to keep myself healthy and NOT binging and purging), I easily fall into unhealthy patterns. This is also why holidays and parties are so bad for those of us fighting with bulimia and other eating disorders. The ability to regulate isn’t there.

I imagine this translates into other aspects of an eating disordered persons life as well. In general it’s safe to say that people with bulimia nervosa and other binge eating disorders are often more impulsive in other areas.

I’d be extremely interested in seeing studies done on recovered bulimics. Hell, I’d be interested in participating. It’s been months (yay me!) since me last bulimic episode. I don’t think brain imagine will see much improvement though. Honestly I imagine it would be triggering. To recover from bulimia takes a concerted decision can be a nearly constant battle. It’s not so simple as, “well just stop eating so much and throwing up.” Even when we have been able to successful change our bulimic behaviors, that doesn’t necessarily mean that the mindset has gone away. It just means that we have learned to recognize the triggers of those impulsive cues that make us want to binge, and are able to mentally step in and stop ourselves. So the origins of the behavior are still there, and maybe even the desire is still there. I’ll be honest, I still think about it quite often, even when I haven’t eaten nearly enough to warrant a purge! But that doesn’t mean I allow myself to engage in that behavior. So I wonder if the results of the fMRI would be any different. Curioser and curioser.

What do you think? 

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