Psychological risk factors, cognitive-contextual approaches and neural correlates in eating disorders: an integrative review

Abstract

Eating disorders (ED) are a significant source of physical and psychosocial impairment, mainly amongst women in adolescence and early adulthood. The development and progression of ED are influenced by a large set of environmental and social factors, but it has also been recognized that ED have important biological and psychological determinants. This article reviews the literature on ED concerning defensive emotion and psychological processes involved in the development and maintenance of ED, but also their neuroimaging/electrophysiological correlates. Furthermore, it also reviews treatment approaches that focused on the improvement of ED patients’ symptomatology. An extensive literature exists regarding neuroimaging/electrophysiological studies associated with clinical features of ED patients in terms of body image and food processing and reward/inhibition processes. However, studies addressing the neural correlates of psychological processes, such as rumination, experiential avoidance, cognitive fusion and self-criticism, and the defensive emotion of shame, which are key components for the development and maintenance of ED, are still scarce if not lacking. In the context of this cognitive set, cognitive-contextual approaches for ED patients, such as mindfulness, acceptance- and compassion-based interventions are promising to change the way individuals relate to their aversive experiences, but still requires a deeper understanding of the mechanisms by which it operates and further testing of its therapeutic efficacy. This review highlights the lack of neuroimaging/electrophysiological studies in ED patients in which concerns shame and other relevant psychological processes, but also the scarce evidence in terms of brain modifications associated with therapeutic efficacy of cognitive-contextual approaches that help to change the way individuals relate to their body, weight and food concerns, reduce maladaptive emotion regulation strategies and improve well-being in patients suffering from ED.