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Cognitive biases in binge eating disorder: the hijacking of decision making

  • Valerie Voon (a1)

Binge eating disorder (BED) is the most common of eating disorders and is characterized by excessive, out-of-control, rapid food intake. This review focuses on cognitive impairments in BED, which represent an endophenotype that mediates brain function and behavior. Here we focus on reviewing impulsivity, compulsivity, attentional biases to food cues, and executive function. Behavioral regulation in BED appears to be influenced by the context of motivationally salient food cues and the degree of obesity. Deficits in delay discounting and risk taking under ambiguity are impaired in obesity irrespective of BED status. However, in BED subjects with milder obesity, greater risk seeking under explicit probabilistic risk is observed to monetary rewards, whereas this shifts to risk aversion and enhanced delay discounting in more severe obesity. Relative to non-BED obese subjects, BED is characterized by enhanced behavioral inflexibility or compulsivity across multiple domains, with subjects selecting the same choices despite change in relevance (set shifting), being no longer rewarding (habit formation), or irrespective of outcome (perseveration). The context of food cues was associated with multiple attentional and early and late inhibitory impairments and enhanced memory bias, although BED patients also have generalized cognitive interference in working memory. These findings may help explain the phenotype of binge eating. Motivationally salient food cues provoke attentional and memory biases along with impairing response inhibitory processes. Those with BED are also more susceptible to cognitive interference and have impaired decisional impulsivity, with the tendency to inflexibly stick with the same choices irrespective of changes in context. These findings suggest critical cognitive domains that may guide therapeutic interventions.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited
Corresponding author
*Address for correspondence: Valerie Voon, Department of Psychiatry, University of Cambridge, Addenbrookes Hospital, Cambridge CB2 0QQ, UK. (Email:
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1. Hudson, JI, Hiripi, E, Pope, HG Jr, Kessler, RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007; 61(3): 348358.
2. Kessler, RC, Berglund, PA, Chiu, WT, et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry. 2013; 73(9): 904914.
3. Insel, TR, Voon, V, Nye, JS, et al. Innovative solutions to novel drug development in mental health. Neurosci Biobehav Rev. 2013; 37(10 Pt 1): 24382444.
4. Insel, T, Cuthbert, B, Garvey, M, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010; 167(7): 748751.
5. Gearhardt, AN, White, MA, Potenza, MN. Binge eating disorder and food addiction. Curr Drug Abuse Rev. 2011; 4(3): 201207.
6. Hebebrand, J, Albayrak, O, Adan, R, et al. “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior. Neurosci Biobehav Rev. 2014; 47: 295306.
7. Davis, C, Carter, JC. Compulsive overeating as an addiction disorder: a review of theory and evidence. Appetite. 2009; 53(1): 18.
8. Ziauddeen, H, Fletcher, PC. Is food addiction a valid and useful concept? Obes Rev. 2013; 14(1): 1928.
9. Moeller, FG, Barratt, ES, Dougherty, DM, Schmitz, JM, Swann, AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001; 158(11): 17831793.
10. Dalley, JW, Everitt, BJ, Robbins, TW. Impulsivity, compulsivity, and top-down cognitive control. Neuron. 2011; 69(4): 680694.
11. Lipszyc, J, Schachar, R. Inhibitory control and psychopathology: a meta-analysis of studies using the stop signal task. J Int Neuropsychol Soc. 2010; 16(6): 10641076.
12. Smith, JL, Mattick, RP, Jamadar, SD, Iredale, JM. Deficits in behavioural inhibition in substance abuse and addiction: a meta-analysis. Drug Alcohol Depend. 2014; 145: 133.
13. Ersche, KD, Jones, PS, Williams, GB, Turton, AJ, Robbins, TW, Bullmore, ET. Abnormal brain structure implicated in stimulant drug addiction. Science. 2012; 335(6068): 601604.
14. Mobbs, O, Iglesias, K, Golay, A, Van der Linden, M. Cognitive deficits in obese persons with and without binge eating disorder: investigation using a mental flexibility task. Appetite. 2011; 57(1): 263271.
15. Svaldi, J, Naumann, E, Trentowska, M, Schmitz, F. General and food-specific inhibitory deficits in binge eating disorder. Int J Eat Disord. 2014; 47(5): 534542.
16. Wu, M, Giel, KE, Skunde, M, et al. Inhibitory control and decision making under risk in bulimia nervosa and binge-eating disorder. Int J Eat Disord. 2013; 46(7): 721728.
17. Mole, TB, Irvine, MA, Worbe, Y, et al. Impulsivity in disorders of food and drug misuse. Psychol Med. 2015; 45(4): 771782.
18. Noreika, V, Falter, CM, Rubia, K. Timing deficits in attention-deficit/hyperactivity disorder (ADHD): evidence from neurocognitive and neuroimaging studies. Neuropsychologia. 2013; 51(2): 235266.
19. Bickel, WK, Koffarnus, MN, Moody, L, Wilson, AG. The behavioral- and neuro-economic process of temporal discounting: a candidate behavioral marker of addiction. Neuropharmacology. 2014; 76(Pt B): 518527.
20. Davis, C, Patte, K, Curtis, C, Reid, C. Immediate pleasures and future consequences: a neuropsychological study of binge eating and obesity. Appetite. 2010; 54(1): 208213.
21. Manwaring, JL, Green, L, Myerson, J, Strube, MJ, Wilfley, DE. Discounting of various types of rewards by women with and without binge eating disorder: evidence for general rather than specific differences. Psychol Rec. 2011; 61(4): 561582.
22. Danner, UN, Ouwehand, C, van Haastert, NL, Hornsveld, H, de Ridder, DT. Decision-making impairments in women with binge eating disorder in comparison with obese and normal weight women. Eur Eat Disord Rev. 2012; 20(1): e56e62.
23. Aloi, M, Rania, M, Caroleo, M, et al. Decision making, central coherence and set-shifting: a comparison between binge eating disorder, anorexia nervosa and healthy controls. BMC Psychiatry. 2015; 15: 6.
24. Svaldi, J, Brand, M, Tuschen-Caffier, B. Decision-making impairments in women with binge eating disorder. Appetite. 2010; 54(1): 8492.
25. Voon, V, Morris, LS, Irvine, MA, et al. Risk-taking in disorders of natural and drug rewards: neural correlates and effects of probability, valence, and magnitude. Neuropsychopharmacology. 2015; 40(4): 804812.
26. Goldstein, RZ, Parvaz, MA, Maloney, T, et al. Compromised sensitivity to monetary reward in current cocaine users: an ERP study. Psychophysiology. 2008; 45(5): 705713.
27. Goldstein, RZ, Tomasi, D, Alia-Klein, N, et al. Subjective sensitivity to monetary gradients is associated with frontolimbic activation to reward in cocaine abusers. Drug Alcohol Depend. 2007; 87(2–3): 233240.
28. Belin, D, Mar, AC, Dalley, JW, Robbins, TW, Everitt, BJ. High impulsivity predicts the switch to compulsive cocaine-taking. Science. 2008; 320(5881): 13521355.
29. Voon, V. Models of impulsivity with a focus on waiting impulsivity: translational potential for neuropsychiatric disorders. Curr Addict Rep. 2014; 1(4): 281288.
30. Voon, V, Irvine, MA, Derbyshire, K, et al. Measuring “waiting” impulsivity in substance addictions and binge eating disorder in a novel analogue of rodent serial reaction time task. Biol Psychiatry. 2014; 75(2): 148155.
31. Duchesne, M, Mattos, P, Appolinario, JC, et al. Assessment of executive functions in obese individuals with binge eating disorder. Rev Bras Psiquiatr. 2010; 32(4): 381388.
32. Galioto, R, Spitznagel, MB, Strain, G, et al. Cognitive function in morbidly obese individuals with and without binge eating disorder. Compr Psychiatry. 2012; 53(5): 490495.
33. Balodis, IM, Molina, ND, Kober, H, et al. Divergent neural substrates of inhibitory control in binge eating disorder relative to other manifestations of obesity. Obesity. 2013; 21(2): 367377.
34. Wu, M, Hartmann, M, Skunde, M, Herzog, W, Friederich, HC. Inhibitory control in bulimic-type eating disorders: a systematic review and meta-analysis. PLoS One. 2013; 8(12): e83412.
35. Koob, GF, Volkow, ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010; 35(1): 217238.
36. Wu, M, Brockmeyer, T, Hartmann, M, Skunde, M, Herzog, W, Friederich, HC. Set-shifting ability across the spectrum of eating disorders and in overweight and obesity: a systematic review and meta-analysis. Psychol Med. 2014; 44(16): 33653385.
37. Daw, ND, Gershman, SJ, Seymour, B, Dayan, P, Dolan, RJ. Model-based influences on humans’ choices and striatal prediction errors. Neuron. 2011; 69(6): 12041215.
38. Voon, V, Derbyshire, K, Ruck, C, et al. Disorders of compulsivity: a common bias towards learning habits. Mol Psychiatry. 2015; 20(3): 345352.
39. Frank, MJ, Doll, BB, Oas-Terpstra, J, Moreno, F. Prefrontal and striatal dopaminergic genes predict individual differences in exploration and exploitation. Nat Neurosci. 2009; 12(8): 10621068.
40. Morris, LS, Baek, K, Kundu, P, Harrison, NA, Frank, MJ, Voon, V. Biases in the explore-exploit tradeoff in addictions: the role of avoidance of uncertainty. Neuropsychopharmacology. In press. DOI: 10.1038/npp.2015.208.
41. Svaldi, J, Tuschen-Caffier, B, Peyk, P, Blechert, J. Information processing of food pictures in binge eating disorder. Appetite. 2010; 55(3): 685694.
42. Schag, K, Teufel, M, Junne, F, et al. Impulsivity in binge eating disorder: food cues elicit increased reward responses and disinhibition. PLoS One. 2013; 8(10): e76542.
43. Svaldi, J, Schmitz, F, Trentowska, M, Tuschen-Caffier, B, Berking, M, Naumann, E. Cognitive interference and a food-related memory bias in binge eating disorder. Appetite. 2014; 72: 2836.
44. Svaldi, J, Bender, C, Tuschen-Caffier, B. Explicit memory bias for positively valenced body-related cues in women with binge eating disorder. J Behav Ther Exp Psychiatry. 2010; 41(3): 251257.
45. Ziauddeen, H, Chamberlain, SR, Nathan, PJ, et al. Effects of the mu-opioid receptor antagonist GSK1521498 on hedonic and consummatory eating behaviour: a proof of mechanism study in binge-eating obese subjects. Mol Psychiatry. 2013; 18(12): 12871293.
46. Cambridge, VC, Ziauddeen, H, Nathan, PJ, et al. Neural and behavioral effects of a novel mu opioid receptor antagonist in binge-eating obese people. Biol Psychiatry. 2013; 73(9): 887894.
47. Chamberlain, SR, Mogg, K, Bradley, BP, et al. Effects of mu opioid receptor antagonism on cognition in obese binge-eating individuals. Psychopharmacology (Berl). 2012; 224(4): 501509.
48. Pattij, T, Schetters, D, Janssen, MC, Wiskerke, J, Schoffelmeer, AN. Acute effects of morphine on distinct forms of impulsive behavior in rats. Psychopharmacology (Berl). 2009; 205(3): 489502.
49. Wiskerke, J, Schetters, D, van Es, IE, et al. mu-Opioid receptors in the nucleus accumbens shell region mediate the effects of amphetamine on inhibitory control but not impulsive choice. J Neurosci. 2011; 31(1): 262272.
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