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Neural Processing of Food and Erotic Cues in Bulimia Nervosa

Delgado-Rodríguez, Rafael PhD; Hernández-Rivero, Isabel MSc; Fernández-Santaella, M. Carmen PhD; Vila, Jaime PhD; Guerra, Pedro PhD; Miccoli, Laura PhD

doi: 10.1097/PSY.0000000000000704

Objective Event-related brain potential (ERP) studies have shown that bulimia nervosa (BN) is associated with facilitated processing of disorder-specific stimuli, visible in altered early components during presentation of food cues and bodies varying in size. Less is known about BN and late ERPs, typically less influenced by perceptual features and regarded as more reliable indices of motivational relevance. The purpose of this study was to use the late positive potential (LPP) to investigate the motivational significance of BN-relevant stimuli.

Methods Highly salient stimuli, such as pictures of personal binge foods and images that are pleasant, neutral, and unpleasant (e.g., human attacks) were presented to 24 women with bulimia and 24 healthy women (19.7 ± 2.1 and 20.5 ± 2.6 years, respectively). Pictures of erotic couples, previously shown to prompt the greatest appetitive reactions in healthy women, were used as pleasant cues. Based on BN aversion to body cues, we hypothesized that the motivational significance of erotic cues could be increased in bulimic women.

Results Consistent with the literature, the LPP was modulated by the salience of the pictures (F(2.8,130.7) = 24.6, p < .001). An additional interaction with diagnostic group (F(2.8,130.7) = 2.8, p = .047) indicated that bulimic women showed a larger LPP than healthy controls during pictures displaying binge foods (p = .037) and erotic couples (p = .031).

Conclusions The findings provide objective evidence that BN is characterized by dysregulated emotional processing that is not limited to food cues. The implications are discussed within a transdiagnostic perspective on food-related disorders.

From the Mind, Brain, and Behavior Research Center (CIMCYC), Universidad de Granada, Granada (Delgado-Rodríguez, Hernández-Rivero, Fernández-Santaella, Vila, Guerra, Miccoli); and Universidad de Almería (Delgado-Rodríguez), Almería, Spain.

Address correspondence to Laura Miccoli, PhD, Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Campus Universitario de Cartuja s/n, 18071, Granada, Spain. E-mail:

Supplemental Content

Received for publication August 30, 2018; revision received December 28, 2018.

Online date: April 25, 2019

Copyright © 2019 by American Psychosomatic Society
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