Abstract
The capacity of patients with anorexia nervosa (AN) to resist food-based rewards is often assumed to reflect excessive self-control. Previous cross-sectional functional magnetic resonance imaging (fMRI) studies utilizing the delay discounting (DD) paradigm, an index of impulsivity and self-control, suggested altered neural efficiency of decision-making in acutely underweight patients (acAN) and a relative normalization in long-term, weight-recovered individuals with a history of AN (recAN). The current longitudinal study tested for changes in functional magnetic resonance imaging (fMRI) activation during DD associated with intensive weight restoration treatment. A predominately adolescent cohort of 22 female acAN patients (mean age—15.5 years) performed an established DD paradigm during fMRI at the beginning of hospitalization and again after partial weight restoration (≥12% body mass index (BMI) increase). Analyses investigated longitudinal changes in both reward valuation and executive decision-making processes. Additional exploratory analyses included comparisons with data acquired in aged-matched healthy controls (HC) as well as probes of functional connectivity between empirically identified nodes of the “task-positive” frontoparietal control network (FPN) and “task-negative” default-mode network (DMN). While treatment was not associated with changes in behavioral DD parameters or activation, specific to reward processing, deactivation of the DMN during decision-making was significantly less pronounced following partial weight restoration. Strengthened DMN activation during DD might reflect a relative relaxation of cognitive overcontrol or improved self-referential, decision-making. Together, our findings present further evidence that aberrant decision-making in AN might be remediable by treatment and, therefore, might constitute an acute effect rather than a core trait variable of the disorder.
Highlights
Anorexia nervosa (AN) is a serious eating disorder characterized by extreme energy-intake restriction, significantly low body weight, intense fear of weight gain, and disturbances in body image [1]
We found no longitudinal changes in functional magnetic resonance imaging (fMRI) activation associated with subjective reward valuation
When considered in conjunction with our previous cross-sectional findings that were suggestive of relatively intact value-dependent processing in both acutely underweight patients (acAN) and recovered individuals with a history of AN (recAN) as compared to healthy controls (HC) [23,40], this finding delivered further evidence that monetary delay discounting (DD) tasks such as ours might not be well-suited to capture clinically-relevant alterations, specific to reward sensitivity in AN
Summary
Anorexia nervosa (AN) is a serious eating disorder characterized by extreme energy-intake restriction, significantly low body weight, intense fear of weight gain, and disturbances in body image [1]. The unusual capacity of people with AN to resist hunger, postpone eating, and forgo food is often thought to be an expression of “too much” self-control [4,5]. A growing number of studies have employed delay discounting (DD; or “intertemporal choice”) tasks in AN samples in an attempt to quantify reward-based decision-making in the disorder [12,13]. In a typical DD task, participants make a series of choices between an immediate monetary reward (smaller sooner, SS) and a larger one to be delivered after a certain delay (larger later, LL). While steeper DD (i.e., a greater preference for immediate rewards) is generally taken to reflect more impulsive reward-related decision-making, shallower DD (i.e., greater propensity to delay gratification) is thought to indicate relatively self-controlled value-based choice [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
