Incentive Processing and Learning in Anorexia Nervosa and Bulimia Nervosa

The purpose of this study is to investigate areas of the brain responsible for 'liking', 'wanting', and learning in adults with eating disorders using brain imaging techniques, computer tasks, a test meal, and self-report questionnaires and interviews. The investigators will study changes in brain activity using a procedure called functional magnetic resonance imaging (fMRI). This study will include 252 women with an eating disorder (63 AN-restricting type (AN-R), 63 AN-binge eating/purging type (AN-BP), 63 bulimia nervosa (BN)) and 63 healthy controls (HC) aged 18-39.

Aim 1: To examine neural differences in 'liking' and 'wanting' in ED relative to HC.

Aim 2: To examine differences in instrumental learning for reward and punishment in ED relative to HC.

Aim 3: To examine how 'liking' and 'wanting' drive instrumental learning in ED and predict clinical symptoms at baseline and 1 year later.

Exploratory Aim: To explore the associations of dopamine function, as measured by neuromelanin MRI (NM-MRI), with ED diagnosis and brain response to 'liking', 'wanting', and learning.

Study Overview

• Status: Recruiting
• Conditions: Anorexia Nervosa; Bulimia Nervosa

• Study Type: Observational
• Enrollment (Estimated): 252

Contacts and Locations

• Study Contact: Name: Christina Wierenga; Phone Number: 858-534-8047; Email: cwierenga@health.ucsd.edu

Study Locations

• United States
  • California
    • La Jolla, California, United States, 92121
      • Recruiting
      • UCSD Eating Disorders Treatment and Research Program
      • Contact: Megan Martinho; Phone Number: 858-210-0318; Email: mamartinho@health.ucsd.edu
      • Principal Investigator: Christina Wierenga
      • Contact: Katherine Gandee; Phone Number: 858-534-0371; Email: kgandee@health.ucsd.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 35 years (Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study will recruit 189 adult women currently ill with ED including anorexia nervosa, restricting type (AN-R, n=63), AN binge eating/purging type (AN-BP, n=63), and bulimia nervosa (BN, n=63) and 63 healthy control (HC) women between the ages of 18 and 39.

Description

Inclusion Criteria:

Eating Disorder Group:

• Between the ages of 18 and 39 years old
• Meet DSM-V criteria for AN-R, AN-BP, or BN

Healthy Control Group:

• Between the ages of 18 and 39 years old
• Have maintained 85% to 120% ideal body weight since menarche

Exclusion Criteria:

All Groups:

• Psychotic illness/other mental illness requiring hospitalization
• Current dependence on drugs or alcohol defined by DSM IV criteria. Additionally, positive test results for drug use on the day of the scan, apart of marijuana, will result in cancelling or rescheduling the scan because acute use will impact MRI measures.
• Physical conditions (e.g. diabetes mellitus, pregnancy) known to influence eating or weight
• Neurological disorder, neurodevelopmental disorder, or history of head injury with >30 min loss of consciousness
• Any contraindication to undergoing an MRI
• Primary obsessive compulsive disorder or primary major depressive disorder

Additional Exclusion Criteria for ED Group:

-If taking other psychotropic medication, any change in dosage in the 2 weeks before scanning

Additional Exclusion Criteria for Healthy Control Group:

• Meet criteria for the diagnosis of any psychiatric disorder currently
• Any history of binge eating or purging behaviors, including self-induced vomiting, laxative or diuretic misuse
• Use of any psychoactive or other medication known to affect mood or concentration in the last 3 months

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort
AN-R; Participants that meet Diagnostic And Statistical Manual Of Mental Disorders (DSM-V) criteria for Anorexia Nervosa restricting subtype.
Healthy Controls; Participants that do not meet DSM-V criteria for any disorder.
AN-BP; Participants that meet DSM-V criteria for Anorexia Nervosa binging/purging subtype
BN; Participants that meet DSM-V criteria for Bulimia Nervosa.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
BOLD response	Brain activity associated with 'liking', 'wanting', and learning	1 Year
Reward and Punishment Learning	Task reinforcement learning rate in reward and punishment trials	1 Year
Connectome-based predictive modeling (CPM)	Functional connectivity maps from task-based fMRI data and clinical data	1 Year

Collaborators and Investigators

• Sponsor: University of California, San Diego

Study record dates

Study Major Dates

• Study Start (Actual): May 26, 2022
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): January 1, 2027

Study Registration Dates

• First Submitted: September 9, 2021
• First Submitted That Met QC Criteria: September 15, 2021
• First Posted (Actual): September 24, 2021

Study Record Updates

• Last Update Posted (Actual): March 12, 2024
• Last Update Submitted That Met QC Criteria: March 11, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Signs and Symptoms, Digestive; Feeding and Eating Disorders; Hyperphagia; Anorexia; Anorexia Nervosa; Bulimia; Bulimia Nervosa
• Other Study ID Numbers: 800775

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No