The Neurocognitive Reward Learning Mechanisms of Binge Eating

Sanford Research North, Fargo ND

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Abstract

Binge-eating disorder (BED) is a serious psychiatric disorder, which is associated with a range of negative outcomes including obesity, psychological impairment, poor quality of life, and premature death. BED is also the most prevalent and most costly eating disorder, impacting over two million Americans each year. As treatments for BED are ineffective for over 50% of patients, there is a critical need to clarify the mechanisms underlying BED maintenance, in order to inform the development of more effective interventions. Reward learning theories propose that reward prediction error (RPE) – the difference between the expected and experienced reward from a behavior – plays a key role in behavior maintenance, and accruing evidence supports this premise in BED. Specifically, research from our group demonstrates that individuals who experience positive (i.e., better than expected) RPE in response to binge eating are more likely to maintain their binge-eating symptoms over time. Importantly, multiple distinct memory systems can underlie this process, and research on other psychiatric disorders has shown that identifying the precise system contributing to disordered behavior can have crucial treatment implications. Currently, it is unknown which memory mechanisms contribute to the influence of RPE on binge-eating behavior. Therefore, this project aims to test how functionally and neuroanatomically distinct memory systems (episodic, procedural, and working memory) contribute to the relationship between RPE and BED maintenance. In a BED sample, at baseline, we will capture (1) naturalistic RPE in response to binge eating using ecological momentary assessment, (2) the neural influence of reward on distinct memory systems using electroencephalography, and (3) the functional connectivity between reward and distinct memory systems using resting state functional magnetic resonance imaging. In addition, at a 6-month follow-up visit, we will assess maintenance of BED symptoms. This will allow examination of how RPE from binge eating and neurocognitive memory mechanisms might interact to maintain binge-eating behavior. Knowledge gained from this study will help guide the development of targeted therapeutic approaches (e.g., neuromodulation, pharmaceutical, psychotherapy) that are designed to directly engage empiricallyidentified disorder-maintaining mechanisms, which will enhance the efficacy and efficiency of treatments for BED.