Brucar Leyla R, Rawls Eric, Haynos Ann F, Peterson Carol B, Zilverstand Anna
Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
Department of Psychology, University of North Carolina Wilmington, Wilmington, NC, USA.
Transl Psychiatry. 2025 Jun 6;15(1):193. doi: 10.1038/s41398-025-03408-1.
Binge eating (BE), a transdiagnostic feature that occurs across eating disorders and in the general population, carries significant health risks even in the absence of a full-syndrome diagnosis. The limited efficacy of current treatments for binge-type eating disorders highlights the need to better understand the mechanistic heterogeneity underlying BE to optimize treatment allocation, advance personalized medicine, and ultimately improve outcomes. We hypothesized considerable heterogeneity within three neurofunctional domains prevalent across compulsive behaviors and implicated in BE: approach-related behavior, executive function, and negative emotionality. We analyzed data from 612 participants (ages 18-59, 66% female) from the enhanced Nathan Kline Institute-Rockland Sample, including 461 controls and 151 individuals with BE behaviors. Using data-driven statistical modeling of comprehensive, multimodal measures across the three hypothesized domains, we identified subtypes of BE. Subtypes were validated using assessments of eating pathology, substance use, clinical diagnostics, and resting-state functional magnetic resonance imaging. Three distinct and stable subtypes emerged: a 'Negative Emotionality' subtype characterized by greater negative affect, emotion dysregulation and psychiatric comorbidity, an 'Approach' subtype with higher approach-related and impulsive behaviors, and a 'Restrained' subtype that was overcontrolled and harm avoidant. The Approach and Restrained subtypes further demonstrated unique neurobiological profiles, as determined by graph theory analysis of resting-state functional connectivity. All subtypes showed similar proportions of BE episodes meeting clinical-level threshold (≥4 objective binge episodes/month), and no differences in BMI, indicating functionally distinct expressions of BE, beyond clinical severity and diagnostic classification. This study is the first to explore the mechanistic heterogeneity of BE through a comprehensive multi-modal assessment across three neurofunctional domains in a single sample. Findings highlight the need for updated models of BE etiology that integrate approach/reward-related behaviors, impulsivity and overcontrolled behaviors, and negative emotionality, and suggest the potential of these functionally-derived subtypes to inform the development of personalized, targeted interventions.
暴饮暴食（BE）是一种跨诊断特征，出现在各种饮食失调症以及普通人群中，即使在没有完全综合征诊断的情况下也会带来重大健康风险。目前针对暴饮暴食型饮食失调症的治疗效果有限，这凸显了更好地理解BE背后机制异质性的必要性，以便优化治疗分配、推进个性化医疗并最终改善治疗结果。我们假设在强迫行为中普遍存在且与BE相关的三个神经功能领域内存在相当大的异质性：与趋近相关的行为、执行功能和负性情绪。我们分析了来自增强版内森·克莱因研究所-罗克兰样本的612名参与者（年龄18 - 59岁，66%为女性）的数据，其中包括461名对照者和151名有BE行为的个体。通过对三个假设领域的综合多模态测量进行数据驱动的统计建模，我们确定了BE的亚型。使用饮食病理学、物质使用、临床诊断和静息态功能磁共振成像评估对亚型进行了验证。出现了三种不同且稳定的亚型：一种“负性情绪”亚型，其特征是具有更强的负性情绪、情绪失调和精神共病；一种“趋近”亚型，具有更高的与趋近相关和冲动行为；还有一种“克制”亚型，其过度受控且回避伤害。通过对静息态功能连接性的图论分析确定，趋近和克制亚型进一步表现出独特的神经生物学特征。所有亚型中达到临床水平阈值（每月≥4次客观暴饮暴食发作）的BE发作比例相似，且体重指数无差异，这表明BE在功能上存在不同的表现形式，超越了临床严重程度和诊断分类。本研究首次通过对单个样本中三个神经功能领域进行全面的多模态评估来探索BE的机制异质性。研究结果强调了需要更新BE病因模型，将与趋近/奖励相关的行为、冲动性和过度受控行为以及负性情绪整合进去，并表明这些基于功能的亚型有可能为个性化、靶向干预措施的开发提供信息。
