Fear, gastrointestinal distress, and interoception: Physiological and psychological mechanisms in eating disorders

7.项目总结/摘要 饮食失调是一种普遍、昂贵和致命的精神疾病。目前， 在大多数患者中，干预措施未能实现症状缓解。胃肠道（GI）不适（例如， 恶心、胃痛）是导致对与膳食相关的干预措施依从性差的一个障碍， 包括循证治疗。拟议的R15学术研究促进奖旨在 测试饮食失调维持中胃肠道不适的因果模型。在这个模型中，对食物的恐惧，吃， 假设体重增加通过两种直接机制引起GI痛苦（即，通过增加 胆囊收缩素和肽YY肠肽反应，并通过增加由于偏见的饱腹感， 内感受）以及通过增强肠道的恐惧相关的饱腹感增加的间接机制 肽反应具体目标1将使用受试者内测试餐测试恐惧作为GI困扰的贡献者 范例，其中参与者食用他们被告知含有高或低脂肪含量的食物，但这些食物 其实是一模一样的具体目标2将测试所提出的胃肠道不适的直接和间接机制。在 此外，将进行一系列多重调解模型，以探讨恐惧作为增强肠道的原因 肽的反应，反过来，增加饱胀，胃肠道不适，并敦促限制食物摄入。解决 为了达到这些目的，152名体重正常的进食障碍妇女报告了餐后胃肠道不适， 将参与一个试验餐范例。采用受试者内交叉设计，在两个不同的早晨， 参与者将吃被描述为“高脂肪”和“低脂肪”的酸奶。虽然“高脂肪”餐的目的是 激活恐惧的食物，吃，体重增加相对于“低脂肪”餐，在现实中的膳食不会有什么不同 每个都含有67%的脂肪这种操作的有效性将使用恐惧的主观评级进行评估 和皮肤电导。此外，肠肽水平和胃肠道痛苦，饱腹感和欲望的主观评级 将在试验餐前、试验餐中和试验餐后评估限制食物摄入的能力。这项研究填补了一个基本的 差距是第一个实验测试的整合恐惧，增强肠道肽反应，和偏见， 进食障碍维持模型中的内感受。这项研究将作出重大贡献， 研究恐惧是胃肠道不适的原因这将提供具体的见解，如何适应经验- 支持的干预措施（即，暴露）的饮食失调患者谁经历胃肠道不适。识别 增强的肠道肽反应是饱胀和胃肠道不适的原因，这将有助于定制心理教育 和基于症状的进食障碍患者的内感受性暴露。这项研究将改变目前 通过确定恐惧、肠肽反应和饱胀感作为潜在的基于胃肠道的治疗的临床实践 目标，有可能通过针对症状体验定制干预措施来改善治疗结果 进食障碍患者的个人资料。与R15的目标一致，本研究将加强研究 俄亥俄州大学学生的经历。

7. Project Summary/Abstract Eating disorders are prevalent, costly, and deadly psychiatric illnesses. Current empirically-supported interventions fail to achieve symptom remission in the majority of patients. Gastrointestinal (GI) distress (e.g., nausea, stomachache) is one barrier that contributes to poor adherence to the meal-related interventions that comprise evidence-based treatments. The proposed R15 Academic Research Enhancement Award seeks to test a causal model of GI distress in eating disorder maintenance. In this model, fear of food, eating, and weight gain are hypothesized to cause GI distress through two direct mechanisms (i.e., by increasing cholecystokinin and peptide YY gut peptide responses and by increasing perceived fullness due to biased interoception) as well as through an indirect mechanism of fear-related increases in fullness via enhanced gut peptide response. Specific Aim 1 will test fear as a contributor to GI distress using a within-subject test meal paradigm wherein participants consume foods that they are told contains high or low fat content, but which are actually identical. Specific Aim 2 will test the proposed direct and indirect mechanisms of GI distress. In addition, a serial multiple mediation model will be conducted to explore fear as a cause of enhanced gut peptide response and in turn, increases in fullness, GI distress, and urges to restrict food intake. To address these aims, 152 women with eating disorders in the normal weight range who report postprandial GI distress will participate in a test meal paradigm. Using a within-subjects crossover design, on two separate mornings, participants will eat yogurt described as “high fat” and “low fat.” Although the “high fat” meal is designed to activate fear of food, eating, and weight gain relative to the “low fat” meal, in actuality the meals will not differ and will each contain 67% fat. Efficacy of this manipulation will be assessed using subjective ratings of fear and skin conductance. In addition, gut peptide levels and subjective ratings of GI distress, fullness, and urges to restrict food intake will be assessed before, during, and after the test meal. This study fills a fundamental gap by being the first to experimentally test an integration of fear, enhanced gut peptide response, and biased interoception in an eating disorder maintenance model. This study will make a significant contribution by examining fear as a cause of GI distress. This will provide specific insight into how to adapt empirically- supported interventions (i.e., exposure) for eating disorder patients who experience GI distress. Identifying enhanced gut peptide response as the cause of fullness and GI distress will facilitate tailoring psychoeducation and interoceptive exposures for eating disorder patients based upon symptoms. This study will shift current clinical practice by identifying fear, gut peptide response, and fullness as potential symptom-based treatment targets, with the potential to improve treatment outcomes by tailoring interventions to the symptom experience of individual eating disorder patients. Consistent with the aims of the R15, this study will enhance the research experiences of Ohio University students.