Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
Neurosci Biobehav Rev. 2023 Sep;152:105250. doi: 10.1016/j.neubiorev.2023.105250. Epub 2023 May 30.
Binge-Eating Disorder (BED) involves anticipatory craving and urges, subjective loss-of-control during binge-eating episodes, and post-feeding psychological distress and guilt. Evidence indicates neurocognitive dysfunctions contribute to BED onset, maintenance, and treatment response. However, an integrated understanding of how cognitive processes underpin BED symptomology is lacking. We utilised a multi-stage decision-making model defining ten cognitive processes underpinning Preference Formation, Choice Implementation, Feedback Processing, and Flexibility/Shifting, to comprehensively review research published since 2013. We used preregistered PICOS criteria to assess 1966 articles identified from PubMed, PsycInfo, and Scopus database searches. This yielded 50 studies reporting behavioural cognitive tasks outcomes, comparing individuals with BED to controls with normal and higher weight. Meta-analyses revealed a unique profile of cognitive dysfunctions that spanned all decision-making stages. Significant deficits were evident in Uncertainty Evaluation, Attentional Inhibition, Choice Consistency, and Cognitive Flexibility/Set-shifting. We propose a novel model of dysfunctional decision-making processes in BED and describe their role in binge-eating behaviour. We further highlight the potential for cognitive interventions to target these processes and address the significant treatment gap in BED.
暴食障碍（BED）涉及到暴食发作前的渴望和冲动、暴食发作期间的主观失控感、以及进食后的心理困扰和内疚感。有证据表明，神经认知功能障碍与 BED 的发病、维持和治疗反应有关。然而，人们对于认知过程如何构成 BED 症状的综合理解仍然缺乏。我们利用一个多阶段决策模型，定义了支持偏好形成、选择实施、反馈处理和灵活性/转换的十个认知过程，全面回顾了自 2013 年以来发表的研究。我们使用预先注册的 PICOS 标准，评估了从 PubMed、PsycInfo 和 Scopus 数据库搜索中确定的 1966 篇文章。这产生了 50 项研究报告了行为认知任务的结果，将 BED 患者与体重正常和超重的对照组进行了比较。荟萃分析显示，所有决策阶段都存在认知功能障碍的独特模式。在不确定性评估、注意力抑制、选择一致性和认知灵活性/转换方面存在明显缺陷。我们提出了 BED 中功能失调的决策过程的新模型，并描述了它们在暴食行为中的作用。我们还强调了认知干预的潜力，以针对这些过程，并解决 BED 中的显著治疗差距。
