Binge-Eating Disorder: Reward Sensitivity and Brain Activation to Images of Food

Background: The underlying neurobiological mechanisms that account for the onset and maintenance of binge-eating disorder (BED) are not sufficiently understood. This functional magnetic resonance imaging (fMRI) study explored the neural correlates of visually induced food reward and loathing. Method: Sixty-seven female participants assigned to one of four groups (overweight BED patients, overweight healthy control subjects, normal-weight healthy control subjects, and normal-weight patients with bulimia nervosa) participated in the experiment. After an overnight fast, the participants' brain activation was recorded during each of the following three conditions: visual exposure to high-caloric food, to disgust-inducing pictures, and to affectively neutral pictures. After the fMRI experiment, the participants rated the affective value of the pictures. Results: Each of the groups experienced the food pictures as very pleasant. Relative to the neutral pictures, the visual food stimuli provoked increased activation in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and insula across all participants. The BED patients reported enhanced reward sensitivity and showed stronger medial OFC responses while viewing food pictures than all other groups. The bulimic patients displayed greater arousal, ACC activation, and insula activation than the other groups. Neural responses to the disgust-inducing pictures as well as trait disgust did not differ between the groups. Conclusions: This study provides first evidence of differential brain activation to visual food stimuli in patients suffering from BED and bulimia nervosa.