Dopamine, Fear, and Food: How the Brain Links Anxiety, Eating, and Extinction

Understanding Dopamine: How it Connects Fear, Anxiety, and Disordered Eating. Explore how dopamine imbalances influence anorexia, binge eating, and bulimia, and discover emerging therapies aimed at rewiring brain responses to food and fear

Dopamine is best known for its role in pleasure and motivation, but research over the past 65 years has shown its critical role in fear conditioning and extinction (1). These processes shape how we learn from threats and regulate anxiety, playing a crucial role in conditions like post-traumatic stress disorder (PTSD), phobias, and eating disorders. A systematic review by Hamati et al. (1) consolidates decades of research, offering insights into how dopamine influences fear-related learning and how this knowledge can be applied to mental health treatments, including psychedelic-assisted therapy.

Dopamine’s Role in Fear Learning and Extinction

Fear conditioning is a learning process where a neutral stimulus (e.g., a sound) becomes associated with an aversive event (e.g., a shock), leading to a fear response. Extinction occurs when repeated exposure to the conditioned stimulus without the aversive event gradually reduces fear (1).

Dopamine is essential in both processes, acting in key brain regions:

• Amygdala – Processes emotional responses and fear memories. Dopamine strengthens the link between stimuli and fear but also plays a role in updating fear memories during extinction (1).

• Prefrontal Cortex (PFC) – Regulates fear responses and is crucial for extinction learning. Dopamine helps override old fear memories and promotes flexibility in behavior (1,2).

• Striatum – Integrates fear learning with habit formation, influencing how we react to fear-related stimuli over time (1,3).

By regulating these regions, dopamine affects how we acquire, maintain, and extinguish fear responses—processes that directly impact anxiety disorders and eating behaviors.

Fear, Food, and Eating Disorders

Fear conditioning mechanisms extend beyond physical threats, shaping emotional responses to food. Eating disorders like anorexia nervosa, bulimia nervosa, and binge-eating disorder (BED) involve dopamine dysfunction, which can lead to heightened anxiety around food, compulsive behaviors, and difficulties in breaking harmful eating patterns (3).

• Anorexia Nervosa – Dopamine abnormalities reinforce restrictive eating by associating food with anxiety rather than pleasure. Extinction deficits may contribute to persistent food-related fears (3).

• Binge-Eating Disorder – An overactive dopamine response to high-calorie foods strengthens compulsive eating behaviors, making it difficult to extinguish cravings (3).

• Bulimia Nervosa – Impaired dopamine regulation contributes to impulsivity, reinforcing cycles of binging and purging (3).

By understanding dopamine’s role in fear learning and reward, we gain insights into why eating disorder behaviors persist and how therapies targeting dopamine could help.

Clinical Implications: Expanding Treatment Options

Since dopamine regulates both fear and reward, treatments aimed at balancing its activity could benefit those with anxiety disorders and eating disorders.

• Cognitive Behavioral Therapy (CBT) – Techniques like exposure therapy could be improved by integrating dopamine-modulating strategies, including psychedelics (4,5).

• Pharmacological Approaches – Dopamine-based drugs, such as D1/5 receptor agonists, may help enhance extinction learning and reduce compulsive eating behaviors (2,3).

• Psychedelic Therapy – Emerging evidence suggests that combining psychedelics with therapy can improve fear extinction, emotional regulation, and behavior change (4,5).

• Nutritional Strategies – Dietary interventions that support dopamine balance, such as adequate protein intake and omega-3 fatty acids, may complement psychological treatments (3).

Conclusion

Dopamine is a central player in both fear learning and reward-based behaviors, linking anxiety and eating disorders through shared neural pathways. The research by Hamati et al. (1) highlights how dopamine influences fear conditioning and extinction, offering insights into innovative treatments such as psychedelic therapy. As research progresses, integrating dopamine-targeted approaches with psychotherapy, medication, and nutrition may provide more effective, long-lasting solutions for individuals struggling with anxiety and eating disorders.

References

1. Hamati R, Ahrens J, Shvetz C, Holahan MR, Tuominen L. 65 years of research on dopamine’s role in classical fear conditioning and extinction: A systematic review. Eur J Neurosci. 2024 Mar;59(6):1099-1140. doi: 10.1111/ejn.16157. Epub 2023 Oct 17. PMID: 37848184.

2. Abraham AD, Neve KA, Lattal KM. Activation of D1/5 dopamine receptors: A common mechanism for enhancing extinction of fear and reward-seeking behaviors. Neuropsychopharmacology. 2016 Jul;41(8):2072-81. doi: 10.1038/npp.2016.5. Epub 2016 Jan 14. PMID: 26763483; PMCID: PMC4893725.

3. Salinas-Hernández XI, Vogel P, Betz S, et al. Dopamine neurons drive fear extinction learning by signaling the omission of expected aversive outcomes. eLife. 2018 Nov 6;7:e38818. doi: 10.7554/eLife.38818. PMID: 30395015; PMCID: PMC6226002.

4. Mithoefer MC, Mithoefer AT, Feduccia AA, et al. MDMA-assisted psychotherapy for PTSD: A randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021 Jun;27(6):1025-1033. doi: 10.1038/s41591-021-01336-3. PMID: 33972795.

5. Carhart-Harris RL, Roseman L, Bolstridge M, et al. Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Sci Rep. 2017 Oct 13;7(1):13187. doi: 10.1038/s41598-017-13282-7. PMID: 29038542.