本文選題：暴食癥 + 沖動(dòng)性�。� 參考：《西南大學(xué)》2016年博士論文

【摘要】：暴食(Binge eating,BE)通常是指在短時(shí)間內(nèi)進(jìn)食大量食物,并伴隨失去控制的感覺。每周發(fā)生一次暴食并持續(xù)三個(gè)月就滿足了暴食癥(Binge eating disorder,BED)的診斷標(biāo)準(zhǔn)。暴食癥通常是指反復(fù)的暴食發(fā)作,并伴隨失去控制、痛苦的感覺,但與貪食癥(Bulimia nervosa,BN)不同,暴食癥不會(huì)發(fā)生為維持體重的不恰當(dāng)補(bǔ)償行為,如過度節(jié)食或運(yùn)動(dòng)等。根據(jù)最近的研究,有許多因素影響暴食癥的發(fā)作和維持,主要包括應(yīng)激,負(fù)性情緒,沖動(dòng)性,身體不滿意,節(jié)食,人際關(guān)系以及父母的喂養(yǎng)方式。一般認(rèn)為沖動(dòng)性是暴食和暴食癥發(fā)生和維持的主要因素。沖動(dòng)性由兩個(gè)因素構(gòu)成:獎(jiǎng)賞敏感性和自發(fā)沖動(dòng)行為。前者力求欲望或獎(jiǎng)賞刺激(如食物線索),而后者不計(jì)后果的放縱行動(dòng)。刺激敏化理論解釋了暴食行為形成和持續(xù)的原因。易感個(gè)體反復(fù)暴露于獎(jiǎng)賞刺激會(huì)加劇獎(jiǎng)賞反應(yīng)。因此暴露于獎(jiǎng)賞刺激會(huì)激活大腦的獎(jiǎng)賞系統(tǒng),導(dǎo)致個(gè)體生理喚醒及渴求的感覺,特別是在抑制控制失敗的時(shí)候,最終會(huì)導(dǎo)致暴食發(fā)作。關(guān)于暴食癥對(duì)食物線索的獎(jiǎng)賞敏感性和抑制控制缺陷研究并不全面。在獎(jiǎng)賞敏感性方面的研究還沒有確定暴食是否與特定類型食物(如高熱量食物與低熱量食物)的反應(yīng)增加有關(guān)。此外,已有研究主要關(guān)注的是肥胖或超重的暴食癥群體,但是有很大一部分暴食個(gè)體在正常體重范圍內(nèi),特別是在亞洲國(guó)家,這里集中了世界上的大部分人口�；谶^去的研究范式,關(guān)于暴食抑制控制缺陷的研究結(jié)果并不一致,一些研究發(fā)現(xiàn)這種缺陷是普遍的,而另外一些研究卻認(rèn)為這種缺陷是針對(duì)食物線索的,還有一些研究并沒有發(fā)現(xiàn)暴食個(gè)體具有抑制控制方面的缺陷。已經(jīng)有研究開始關(guān)注暴食的神經(jīng)機(jī)制。在暴食群體中,對(duì)食物線索的獎(jiǎng)賞和抑制神經(jīng)反應(yīng)的重要性并不清楚,如目前還沒有研究使用低頻振幅(the amplitude of low frequency fluctuations,ALFF)來評(píng)估暴食組和控制組在獎(jiǎng)賞和抑制控制區(qū)域的大腦活動(dòng)上的差異。此外,雖然應(yīng)激和負(fù)性情緒常常促進(jìn)暴食發(fā)作,但是在這些條件下的進(jìn)食增加是否是由于對(duì)外界食物的獎(jiǎng)賞反應(yīng)增加還是由于抑制控制的減少,原因并不清楚。為了解決這些問題,本論文設(shè)計(jì)了六個(gè)研究來考察獎(jiǎng)賞敏感性和抑制控制對(duì)正常體重的暴食個(gè)體行為和神經(jīng)反應(yīng)的影響。研究1和研究2使用不同的實(shí)驗(yàn)室范式考察暴食個(gè)體的行為反應(yīng)。在研究1中,主要考察了有暴食行為的女性(33人)與控制組女性(31人)的注意脫離偏向。被試完成一個(gè)空間線索任務(wù),此任務(wù)中她們首先需要觀察高熱量食物、低熱量食物或中性圖片,然后快速判斷隨后目標(biāo)(一個(gè)圓點(diǎn))出現(xiàn)的位置。對(duì)兩組被試來說,在有效線索試次(即目標(biāo)出現(xiàn)在線索的同側(cè))中,被試的反應(yīng)時(shí)要顯著長(zhǎng)于無效線索試次(即目標(biāo)出現(xiàn)在線索的對(duì)側(cè)),這反應(yīng)了抑制返回效應(yīng)(inhibition of return effect,IOR)。然而,在反應(yīng)時(shí)中也發(fā)現(xiàn),與控制組相比,有暴食行為的女性對(duì)高熱量食物表現(xiàn)出更強(qiáng)的脫離困難,而在其他類型刺激上卻沒有這種差異。對(duì)高熱量食物的注意脫離困難意味著對(duì)這類線索的獎(jiǎng)賞敏感性增加,這也增加了暴食行為發(fā)生的風(fēng)險(xiǎn)。在研究2中,有暴食行為的正常體重女性(31人)和無暴食行為的女性(31人)在禁食12小時(shí)候后,完成一個(gè)與食物有關(guān)的Go/No-Go任務(wù)。該任務(wù)刺激包含高熱量食物、低熱量食物和中性圖片。任務(wù)完成后,被試要在實(shí)驗(yàn)室自由進(jìn)食食物(巧克力和面包)。有暴食行為的女性報(bào)告了更高的特質(zhì)沖動(dòng),更多的進(jìn)食食物。雖然在整體的虛報(bào)(當(dāng)“No-Go”刺激出現(xiàn)時(shí)被試錯(cuò)誤按鍵)上差異不顯著,但是暴食個(gè)體對(duì)高熱量食物線索反應(yīng)比控制組更快,同時(shí)在正確率上,暴食組對(duì)高熱量食物線索反應(yīng)的正確率要高于低熱量食物,而控制組不存在這種差異。此外,被試在“Go”試次上的反應(yīng)時(shí)與任務(wù)完成后的進(jìn)食量呈負(fù)相關(guān),而虛報(bào)率與進(jìn)食量呈正相關(guān)�？傊�,暴食個(gè)體對(duì)食物線索存在獎(jiǎng)賞敏感性,而抑制控制可能沒有受損。在研究3中,考察了暴食癥個(gè)體和控制組在暴食癥狀、獎(jiǎng)賞敏感性和抑制控制、對(duì)食物圖片的大腦反應(yīng)以及進(jìn)食量之間的關(guān)系。在f MRI實(shí)驗(yàn)過程中,19名符合暴食癥診斷標(biāo)準(zhǔn)的被試和27名控制組被試觀看食物圖片,包括高熱量食物、低熱量食物和中性圖片。隨后被試完成一些列問卷,包括暴食行為,食物渴望、普通獎(jiǎng)賞敏感性和行為抑制、情緒狀態(tài),然后進(jìn)食零食。研究結(jié)果發(fā)現(xiàn),與控制組相比,暴食癥個(gè)體報(bào)告了更多的暴食行為、進(jìn)食失控、食物渴望以及邊緣顯著的獎(jiǎng)賞敏感性和抑制控制。掃描結(jié)束后,暴食癥組個(gè)體也進(jìn)食了更多的巧克力。在觀看食物圖片時(shí),暴食癥個(gè)體的額下回、額中回和顳中回有較多的激活,而楔前葉、扣帶回有較少的激活。巧克力的消耗則與額中回、楔前葉的激活呈顯著負(fù)相關(guān)�？傊�,這些結(jié)果顯示,對(duì)暴食癥個(gè)體而言,沖動(dòng)控制的特定腦區(qū)在對(duì)外界食物食物刺激和進(jìn)食發(fā)揮中重要作用。在研究4中,用Go/No-Go任務(wù)考察了抑制反應(yīng)的相關(guān)神經(jīng)活動(dòng),在這個(gè)任務(wù)中,“No-Go”或抑制控制測(cè)試由高熱量食物圖片構(gòu)成�；诮Y(jié)構(gòu)性面談,17名女性滿足DSM-V中暴食癥的診斷標(biāo)準(zhǔn),17名沒有進(jìn)食障礙的女性作為控制組。所有被試完成Go/No-Go任務(wù)并進(jìn)行f MRI掃描,然后完成相關(guān)問卷。在問卷測(cè)量上,暴食癥個(gè)體報(bào)告了高水平的沖動(dòng)性、進(jìn)食失控,更多的節(jié)食和對(duì)體型、體重、進(jìn)食的關(guān)注。同時(shí)暴食癥個(gè)體也有較高的抑郁,焦慮和壓力。在Go/No-Go任務(wù),暴食癥個(gè)體有較多的虛報(bào),反應(yīng)了其抑制控制的缺陷。在高熱量食物圖片線索的“No-Go”反應(yīng)中,暴食癥個(gè)體在腦島上有較多的激活。腦島包含初級(jí)味覺皮層,也涉及對(duì)食物的預(yù)期和進(jìn)食。同時(shí)暴食癥個(gè)體在中央前回和中央后回也有更多的激活。這些區(qū)域涉及味知覺加工,同時(shí)個(gè)體暴露于食物線索時(shí),這些區(qū)域也會(huì)激活。這些結(jié)果顯示,暴食癥個(gè)體可能由于對(duì)高熱量食物線索的獎(jiǎng)賞敏感性增加導(dǎo)致較差的抑制控制,在抑制反應(yīng)的時(shí)候需要較多的控制力。在研究5中,采用靜息態(tài)功能磁共振探討了研究4中暴食癥個(gè)體和控制組自發(fā)腦信號(hào)的低頻振幅。研究結(jié)果發(fā)現(xiàn)暴食癥個(gè)體在楔前葉、額中回、額上回有較高的活動(dòng),而在顳中回有較低的活動(dòng)。進(jìn)一步分析發(fā)現(xiàn)在暴食癥個(gè)體上,身體質(zhì)量指數(shù)(BMI)與眶額葉皮層(orbitofrontal cortex,OFC)的活動(dòng)成正相關(guān),而沖動(dòng)性特質(zhì)分?jǐn)?shù)與背外側(cè)前額葉皮層(dorsal-lateral prefrontal cortex,DLPFC)的活動(dòng)成正相關(guān)。同時(shí)眶額葉皮層與背外側(cè)前額葉皮層的功能連接要顯著大于控制組。這些結(jié)果顯示,眶額葉皮層和背外側(cè)前額葉皮層功能連接的增加在暴食癥的病理生理中發(fā)揮著重要的作用。在研究6中,主要探討了暴食癥個(gè)體和控制組對(duì)食物圖片的腦活動(dòng)及其隨后的進(jìn)食行為中,急性應(yīng)激對(duì)其的影響。19名符合暴食癥診斷標(biāo)準(zhǔn)的被試和控制組被隨機(jī)分配到應(yīng)激組(完成冷壓痛任務(wù),并給予負(fù)性反饋)和中性組(完成非疼痛感覺辨別任務(wù)并給予積極反饋)。隨后他們觀看食物圖片和中性圖片,并進(jìn)行功能磁共振掃描。完成掃描后,被試填寫問卷并進(jìn)食零食。研究結(jié)果發(fā)現(xiàn),暴食癥個(gè)體在應(yīng)激條件下更喜歡高熱量食物,同時(shí)在海馬上有較少的激活。應(yīng)激條件下的暴食癥個(gè)體進(jìn)食了更多的巧克力。更重要的是,在所有被試中,觀看高熱量食物圖片時(shí)海馬的激活與進(jìn)食巧克力的數(shù)量成負(fù)相關(guān)。本研究的結(jié)果顯示負(fù)性急性應(yīng)激可以減少控制區(qū)域的激活,而這些區(qū)域在暴食癥個(gè)體中與食物線索和進(jìn)食有關(guān)。綜上有以下幾個(gè)發(fā)現(xiàn):有暴食行為的女性對(duì)高熱量食物表現(xiàn)出高水平獎(jiǎng)賞敏感性,且抑制控制能力越差,進(jìn)食量越多;在暴食癥個(gè)體對(duì)食物線索反應(yīng)和進(jìn)食中,獎(jiǎng)賞和抑制控制的特定腦區(qū)發(fā)揮著重要的作用;獎(jiǎng)賞區(qū)域(OFC)和抑制控制區(qū)域(DLPFC)功能連接的增加可能導(dǎo)致了暴食癥的發(fā)生和維持;負(fù)性應(yīng)激減少抑制控制區(qū)域的活動(dòng),可能會(huì)導(dǎo)致進(jìn)食失控。本論文的發(fā)現(xiàn)為暴食癥的刺激敏化理論提供了證據(jù)。
[Abstract]:Binge eating (BE) usually refers to eating a large amount of food in a short period of time and with the sense of loss of control. A binge eating and lasting three months a week meets the diagnostic criteria for Binge eating disorder (BED). Unlike Bulimia nervosa (BN), BH does not occur as an improper compensation behavior for maintaining weight, such as overeating or exercise. According to recent studies, many factors affect the attack and maintenance of binge, including stress, negative emotion, impulsiveness, body dissatisfaction, dieting, interpersonal relationships, and parental feeding. Impulsivity is the main factor in the occurrence and maintenance of binge eating and overeating. Impulsivity consists of two factors: reward sensitivity and spontaneous impulsiveness. The former strives for desire or reward stimulation (such as food clues), and the latter does not count the consequences of the indulgence. The repeated exposure to reward stimulation exacerbates the reward response. Therefore, exposure to the reward stimulation activates the reward system of the brain that causes the feeling of individual physiological arousal and craving, especially during the inhibition of control failure. Not comprehensive. Research on the reward sensitivity has not yet been determined whether or not the response to specific types of food (such as high calorie food and low calorie food) is increased. In addition, research has focused mainly on obese or overweight binge eating groups, but a large portion of the overeating individuals are within the normal weight range, especially in subtropical regions. The continent, which concentrates most of the population in the world, is based on past research paradigms, and some studies have found that the defects are common, while some studies have found that the defects are common to food clues, and some studies have not found a binge eating individual. There has been a lack of control. Research has begun to focus on the nervous mechanism of overeating. In a population, the importance of reward for food clues and the inhibition of neural responses is not clear, for example, the the amplitude of low frequency fluctuations (ALFF) has not been studied to evaluate the bulge group and the control group at the prize. In addition, although stress and negative emotions often promote binge eating, it is not clear whether the increase in food intake in these conditions is due to the increase in the reward response to the outside food or the decrease in control. Six studies were conducted to examine the effects of reward sensitivity and inhibition control on individual behavior and neural responses to normal weight loss. Study 1 and Study 2 used different laboratory paradigms to examine the behavioral responses of individuals with binge eating. In the study 1, the main investigation was that women (33) who had binge eating behavior were divorced from the control group (31). The subjects completed a space clue task in which they first needed to observe the high calorie food, low calorie food or neutral pictures, and then quickly judge the position of the subsequent target (a round point). For the two groups, the test was significantly longer than no one in the effective clue test (that is, on the same side of the online cable). Inhibition of return effect (IOR) was reacted to the effect of an effective clue (i.e. the target appears on the opposite side of the online cable). However, in response to the control group, women with binge eating behavior showed greater difficulty in disengagement from high calorie foods, but there was no difference in other types of stimulation. The disengagement of food attention meant an increase in the reward sensitivity of these clues, which also increased the risk of overeating. In Study 2, the normal weight women (31) with binge eating behavior and women without eating behavior (31) finished a food related Go/No-Go task after the fasting. The task was stimulated. Including high calorie food, low calorie food and neutral pictures. After the task was completed, the subjects were free to eat food (chocolate and bread) in the laboratory. Women who had bun reported higher idiosyncratic impulses and more food. Although the difference was not significant in the overall false report (when the "No-Go" stimulus appeared). However, the rate of cue response to high calorie food was faster than that of the control group. At the correct rate, the correct rate of high calorie food cue reaction was higher than that of low calorie food at the correct rate, while the control group did not have this difference. In addition, the response of the subjects on the "Go" trial was negatively correlated with the amount of food after the task was completed, and the false rate rate was also reported. In the study 3, the relationship between binge eating symptoms, reward sensitivity and inhibitory control, the relationship between the brain response to food pictures and the amount of food was examined in the study 3, 19 in the f MRI experiment. Participants and 27 control groups were tested for food pictures, including high calorie food, low calorie food, and neutral pictures. Then some questionnaires were completed, including binge eating, food cravings, common reward sensitivity and behavioral inhibition, emotional state, and then snack food. The group reported more binge eating behavior, eating out of control, food craving, and marginal significant reward sensitivity and inhibition. After the scan, the binge eating group also fed more chocolates. The lower frontal gyrus, the middle frontal gyrus and the middle temporal gyrus were more active while watching the picture of the food, and the wedge was more active. In the anterior leaf, the cingulate gyrus was less activated. The consumption of chocolate was significantly negatively correlated with the middle frontal gyrus and the activation of the front of the wedge. In conclusion, these results showed that the specific brain area of impulse control was important for food food stimulation and feeding in bingia individuals. In study 4, the inhibition reaction was examined with the Go/No-Go task. In this task, "No-Go" or control tests were made up of high calorie food images. Based on structural interviews, 17 women met the diagnostic criteria for binge eating in DSM-V, and 17 women without eating disorders were used as control groups. All subjects completed the Go/ No-Go task and performed a f MRI scan, then completed the related questions. In the questionnaire survey, the individuals reported high levels of impulsiveness, eating out of control, more diet and attention to body weight, body weight, eating, and higher depression, anxiety and stress in individuals with binge eating disorder. In the Go/No-Go task, more asthenia in binge eating individuals responded to their control defects. In high calorie food maps In the "No-Go" response, binge eating individuals have more activation on the insula. The insula contains the primary taste cortex, also involves anticipation and eating of food. At the same time, binge eating individuals also have more activation in the precentral and central back. These areas involve sensory perception, while individuals are exposed to food clues. The region also activates. These results suggest that individuals with binge eating disorder may be less controlled by the increase in the reward sensitivity to high calorie food cues, and require more control during inhibition. In study 5, resting state functional magnetic resonance (fMRI) was used to study the spontaneous brain signals in individuals and control groups of binge eating disorders in 4. Low frequency amplitude. The results showed that individuals in the prefrontal lobe, middle frontal gyrus, and upper frontal gyrus had higher activity and lower activity in the temporal gyrus. Further analysis found that the body mass index (BMI) was positively related to the activity of the orbitofrontal cortex, OFC, and the impulsivity score and the dorsolateral. The activity of the dorsal-lateral prefrontal cortex (DLPFC) is positively correlated. The functional connection between the orbital prefrontal cortex and the dorsolateral prefrontal cortex is significantly greater than that of the control group. These results suggest that the increase in the functional connection between the frontal cortex and the dorsolateral prefrontal cortex plays an important role in the pathophysiology of the disease. Use. In study 6, the brain activity and subsequent eating behavior of food images were discussed mainly in individuals and control groups of binge eating disorder. The effects of acute stress on the food were studied. The.19 names of the subjects and control groups were randomly assigned to the stress group (the task of cold pressure pain, negative feedback) and the neutral group (non pain). Then they looked at the task and gave positive feedback. Then they watched pictures of food and neutral pictures and performed functional magnetic resonance (fMRI). After the completion of the scans, the subjects filled out questionnaires and fed snacks. The results showed that individuals who were more likely to enjoy high calorie foods under stress conditions were less activated in the hippocampus and under stress conditions. More importantly, more importantly, more importantly, in all subjects, the hippocampus activation was negatively related to the number of chocolates when watching high calorie foods. The results of this study showed that negative acute stress could reduce the activation of control areas, and these areas were associated with food clues and advances in individuals with binge eating disease. Food related. In a summary of the following findings: women with binge eating behavior showed high level of reward sensitivity to high calorie food, and the less control ability, the more eating; in the food cue response and eating, food clues and food, reward and suppression of specific brain areas play an important role; the reward area (OFC) and inhibition. The increase in the functional connection of the control area (DLPFC) may lead to the occurrence and maintenance of binge eating disorder; negative stress reduction inhibits the activity of control areas and may lead to eating out of control. The findings of this paper provide evidence for the irritation sensitization theory of binge eating disorder.

【學(xué)位授予單位】：西南大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：B842
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本文編號(hào)：1882563