Bartholdy Savani, Dalton Bethan, Rennalls Samantha J, Kekic Maria, McClelland Jessica, Campbell Iain C, O'Daly Owen G, Schmidt Ulrike
Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Centre for Neuroimaging Sciences, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
J Eat Disord. 2025 Jan 3;13(1):1. doi: 10.1186/s40337-024-01165-y.
There is a need for improved understanding of why 20-30% of individuals with anorexia nervosa (AN) develop a severe and enduring form of illness (SE-AN). Previously, we reported differences in proactive inhibition (a pre-emptive slowing of responses) in individuals with AN compared to healthy controls (after controlling for intolerance of uncertainty). The present study is a preliminary exploration of proactive inhibition in which we compared women with SE-AN with healthy comparison (HC) women and explored its association with restrictive/avoidant eating behaviours.
Thirty-four women with SE-AN (defined by >3 years of illness and a previous unsuccessful course of eating disorder treatment) and 30 HCs completed (a) a cued reaction time task, to assess proactive inhibition, and (b) questionnaires assessing restrictive/avoidant eating behaviours and intolerance of uncertainty.
Both SE-AN and HC participants showed slower reaction times under conditions of uncertainty, indicating proactive inhibition in both groups. There was a main effect of group, with SE-AN participants showing significantly slower reaction times compared to HC. There was no interaction between group and condition, suggesting that individuals with SE-AN did not differ in proactive inhibition compared to HCs. However, post-hoc analysis between-group tests for each trial type revealed that group differences were only present under conditions of uncertainty. Proactive inhibition was not significantly associated with self-reported restrictive/avoidant eating behaviours, including when taking intolerance of uncertainty into consideration.
It is unlikely that proactive inhibition contributes to avoidant and restrictive eating behaviours seen in SE-AN. Our findings suggest that the SE-AN group are relatively more cautious when responding under conditions of uncertainty. Longitudinal studies and between-group comparisons of individuals across different stages of illness will be required to elucidate the way in which proactive inhibition is specifically implicated in SE-AN, rather than in AN more generally.
有必要更好地理解为什么20%-30%的神经性厌食症（AN）患者会发展为严重且持久的疾病形式（SE-AN）。此前，我们报告称，与健康对照组相比（在控制了对不确定性的不耐受之后），AN患者在主动抑制（一种对反应的预先减缓）方面存在差异。本研究是对主动抑制的初步探索，我们将患有SE-AN的女性与健康对照（HC）女性进行了比较，并探讨了其与限制/回避性饮食行为的关联。
34名患有SE-AN的女性（定义为病程超过3年且之前有过饮食失调治疗未成功的经历）和30名HC完成了（a）一项线索反应时任务，以评估主动抑制，以及（b）评估限制/回避性饮食行为和对不确定性不耐受的问卷。
在不确定条件下，SE-AN组和HC组参与者的反应时均较慢，表明两组均存在主动抑制。存在组间主效应，SE-AN组参与者的反应时显著慢于HC组。组与条件之间没有交互作用，这表明与HC组相比，SE-AN组在主动抑制方面没有差异。然而，对每种试验类型进行的组间事后分析显示，组间差异仅在不确定条件下存在。主动抑制与自我报告的限制/回避性饮食行为没有显著关联，包括在考虑对不确定性的不耐受时。
主动抑制不太可能导致SE-AN中出现的回避性和限制性饮食行为。我们的研究结果表明，SE-AN组在不确定条件下做出反应时相对更为谨慎。需要进行纵向研究以及对处于不同疾病阶段的个体进行组间比较，以阐明主动抑制具体是如何与SE-AN相关联的，而不是更普遍地与AN相关联。
