Behavioral Responses to Uncertainty in Weight-Restored Anorexia Nervosa - Preliminary Results.

Mayron Piccolo,Chantal Martin-Soelch,Christoph Mueller-Pfeiffer,Sonja Schumacher,Gabriella Franca Milos,Monique Ernst,Michael Fried,Sena Bluemel

doi:10.3389/fpsyg.2019.02492

Abstract

Impaired decision-making under conditions of uncertainty seems to contribute to the expression and maintenance of anorexia nervosa (AN), but it is not clear whether this impairment is a disease state that would remit with treatment, or a persisting trait in patients with AN. To examine this question, a longitudinal study was conducted in 12 female inpatients with AN (age M = 22.2, SE = 1.36), before (Time-1) and after reaching a body mass index of >17.5 kg/m2 (Time-2). Intolerance of uncertainty (IU) was assessed via a decision-making task, the wheel of fortune (WOF). Weight gain at Time-2 was accompanied with significant changes in uncertainty-related performance compared to Time-1 [(Time × Uncertainty), p < 0.05]. At Time-1, reaction times (RTs) varied in function of uncertainty, while at Time-2, uncertainty did not modulate RTs. These findings support a change in decision-making under uncertainty with successful weight-rehabilitation in AN. While IU was present in underweight patients, it became non-significant after weight restoration.

Highlights

The mechanisms underlying anorexia nervosa (AN), a life-threatening condition, are still unclear (American Psychiatric Association, 2013)
Body mass index - BMI, depression level assessed by the Beck Depression Inventory (BDI), and anxiety level assessed by the State-Trait Anxiety Inventory (STAI) after admission (Time-1) and after weight rehabilitation (Time-2) in inpatients with anorexia nervosa
This study tested whether behavioral intolerance of uncertainty (IU) remains present after weight-restoration in patients with AN

Summary

INTRODUCTION

The mechanisms underlying anorexia nervosa (AN), a life-threatening condition, are still unclear (American Psychiatric Association, 2013). Decision-making under uncertainty and IU have been studied both using self-report and behavioral measures (Jacoby et al, 2014; Kesby et al, 2017; Piccolo et al, 2019). Desire for predictability is mostly associated with the anticipation of uncertain situations, while uncertainty paralysis represents a freezing behavior in the face of uncertainty (Kesby et al, 2017) These questionnaires were created to reflect both prospective and inhibitory IU (Berenbaum et al, 2008). While mostly measured with self-report questionnaires, responses to uncertainty have recently been examined by using experimental tasks (Sternheim et al, 2011b; Jacoby et al, 2014; Piccolo et al, 2019). As a potential vulnerability factor, behavioral IU would be expected to remain present after weight restoration, but as a symptomatic expression of AN, IU would be expected to decrease along with other symptoms

METHODS

RESULTS

Findings

ETHICS STATEMENT