Reward In Anorexia Nervosa Research Articles

Increased self-reported delay of gratification in acutely underweight, but not remitted anorexia nervosa.

Laboratory experiments using delay discounting tasks have delivered some evidence of an increased capacity to delay reward in anorexia nervosa (AN). Overall, however, findings have been inconclusive and no comprehensive studies of self-reported tendency to forgo immediate gratification in favor of long-term rewards exist in AN. A total of 71 acutely underweight female inpatients with AN (acAN); 52 women long-term weight-recovered from AN (recAN); and 120 healthy control women completed the Delaying Gratification Inventory (DGI). Fifty-two acAN were reassessed after short-term weight rehabilitation. Separate cross-sectional and longitudinal group comparisons tested for differences in DGI subscales (food, physical pleasure, social interaction, money, and achievement) and total scores. DGI scores were elevated in acAN even after removing food-related items and accounting for comorbid symptoms. DGI scores remained relatively elevated following short-term weight rehabilitation, but no differences were evident between recAN and HC. This study delivers self-report evidence supporting the notion of an increased propensity to delay gratification in individuals acutely ill with AN which does not appear to change with partial weight restoration alone. A reduction in the tendency to delay reward may thus be an important cognitive correlate of long-term recovery in AN.

Heightened self-reported punishment sensitivity, but no differential attention to cues signaling punishment or reward in anorexianervosa.

This study examined whether adolescents with anorexia nervosa (AN) are more sensitive to punishment and less sensitive to reward than a non-eating disorder comparison group. Both self-report and performance measures were used to index reward and punishment sensitivity. Participants were adolescents with AN (n = 69) and an individually matched comparison group with healthy weight (n = 69). They completed the Behavioral Inhibition Scale/Behavioral Activation Scale and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire to index self-reported reward and punishment sensitivity, and performed the Spatial Orientation Task to index attention to cues signaling reward and punishment. There was extremely strong evidence (BF10 > 100), that adolescents with AN reported higher sensitivity to punishment than adolescents without an eating disorder. However, adolescents with AN did not differ from the comparison group on self-reported reward sensitivity, and attention to cues signaling reward or punishment. Adolescents with AN clearly show heightened punishment sensitivity, yet this was not paralleled by a heightened proneness to detect signals of punishment. An important next step would be to examine whether punishment sensitivity is a reliable risk factor for the development or maintenance of AN.

Intact value-based decision-making during intertemporal choice in women with remitted anorexia nervosa? An fMRI study

Extreme restrictive food choice in anorexia nervosa is thought to reflect excessive self-control and/or abnormal reward sensitivity. Studies using intertemporal choice paradigms have suggested an increased capacity to delay reward in anorexia nervosa, and this may explain an unusual ability to resist immediate temptation and override hunger in the long-term pursuit of thinness. It remains unclear, however, whether altered delay discounting in anorexia nervosa constitutes a state effect of acute illness or a trait marker observable after recovery. We repeated the analysis from our previous fMRI investigation of intertemporal choice in acutely underweight patients with anorexia nervosa in a sample of weight-recovered women with anorexia nervosa (n = 36) and age-matched healthy controls (n = 36) who participated in the same study protocol. Follow-up analyses explored functional connectivity separately in both the weight-recovered/healthy controls sample and the acute/healthy controls sample. In contrast to our previous findings in acutely underweight patients with anorexia nervosa, we found no differences between weight-recovered patients with anorexia nervosa and healthy controls at either behavioural or neural levels. New analysis of data from the acute/healthy controls sample sample revealed increased coupling between dorsal anterior cingulate cortex and posterior brain regions as a function of decision difficulty, supporting the hypothesis of altered neural efficiency in the underweight state. This was a cross-sectional study, and the results may be task-specific. Although our results underlined previous demonstrations of divergent temporal reward discounting in acutely underweight patients with anorexia nervosa, we found no evidence of alteration in patients with weight-recovered anorexia nervosa. Together, these findings suggest that impaired valuebased decision-making may not constitute a defining trait variable or “scar” of the disorder.

Food vs money? Effects of hunger on mood and behavioral reactivity to reward in anorexia nervosa

BackgroundPrevious studies using neuroimaging and behavioral measures reported altered reward processing in anorexia nervosa (AN). In addition, anhedonia states are frequently reported in AN, potentially due to the physiological stress produced by the permanent starvation. We investigated the effect of fasting and satiety on mood and reaction times to monetary rewards in AN patients and healthy controls. MethodsTwenty-four participants with acute AN (BMI 14.4 (11.9–15.5) Kg/m2) and 17 age and gender matched healthy, normal weight subjects (HW) (BMI 21.8 (18.9–24.9) Kg/m2) performed a reward task (the wheel of fortune) involving uncertain (50/50 probability of winning high and low rewards), safe and risky (30/70 and 10/90 probabilities) categories in fasted (after an 8-h fasting period) and fed (after intake of a standardized meal) states. Data analysis was done with linear mixed models. ResultsAN reacted slower than HW when maximum uncertainty (50/50) was involved. Positive mood in response to winning was higher when fasting especially for HW, while negative mood in response to not winning was higher in the fed state for both groups. Still, HW were more reactive than AN to not winning a highly predictable monetary reward (10/90 safe). ConclusionThe data on the reaction times indicate an impaired motor response to uncertainty in AN. Mood reactivity to winning a monetary reward does not seem to be impaired in AN, however, our results suggest that negative mood in response to not winning is less adaptive in AN. Implications to clinical psychotherapy are discussed.

A focus on reward in anorexia nervosa through the lens of the activity-based anorexia rodent model.

Patients suffering anorexia nervosa (AN) become anhedonic, unable or unwilling to derive normal pleasures and tend to avoid rewarding outcomes, most profoundly in food intake. The activity-based anorexia model recapitulates many of the pathophysiological and behavioural hallmarks of the human condition, including a reduction in food intake, excessive exercise, dramatic weight loss, loss of reproductive cycles, hypothermia and anhedonia, and therefore it allows investigation into the underlying neurobiology of anorexia nervosa. The use of this model has directed attention to disruptions in central reward neurocircuitry, which may contribute to disease susceptibility. The purpose of this review is to demonstrate the utility of this unique model to provide insight into the mechanisms of reward relevant to feeding and weight loss, which may ultimately help to unravel the neurobiology of anorexia nervosa and, in a broader sense, the foundation of reward-based feeding.

Hungry for reward: How can neuroscience inform the development of treatment for Anorexia Nervosa?

Dysfunctional reward from the pursuit of thinness presents a major challenge to recovery from Anorexia Nervosa (AN). We explore the neuroscientific basis of aberrant reward in AN, with the aim of generating novel hypotheses for translational investigation, and elucidate disease mechanisms to inform the development of targeted interventions. Relevant neuroimaging and behavioural studies are reviewed. These suggest that altered eating in AN may be a consequence of aberrant reward processing combined with exaggerated cognitive control. We consider evidence that such aberrant reward processing is reflected in the compulsive behaviours characterising AN, with substantial overlap in the neural circuits implicated in reward processing and compulsivity. Drawing on contemporary neuroscientific theories of substance dependence, processes underpinning the shift from the initially rewarding pursuit of thinness to extreme and compulsive weight control behaviours are discussed. It is suggested that in AN, weight loss behaviour begins as overtly rewarding, goal-directed and positively reinforced, but over time becomes habitual and increasingly negatively reinforced. Excessive habit formation is suggested as one underlying mechanism perpetuating compulsive behaviour. Ongoing research into the behavioural and neural basis of aberrant reward in AN is required to further elucidate mechanisms. We discuss clinical and transdiagnostic implications, and propose that future treatment innovation may benefit from the development of novel interventions targeting aberrant reward processing in AN.

Heightened sensitivity to punishment and reward in anorexia nervosa

Objective: The aim of this study was to investigate reinforcement sensitivity in anorexia nervosa (AN). It was tested whether self-reported punishment (PS) and reward sensitivity (RS) differed between adolescents with AN and healthy controls, and/or between AN-subtypes. In addition, the predictive validity of PS and RS was examined for AN symptoms one year later. Method: In total, 165 female adolescents admitted for treatment of AN or eating disorder not otherwise specified resembling AN and 72 controls participated in the study. Participants completed measurements for eating disorder severity and the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ). Percentage of underweight and severity of AN symptoms were measured again after one year in individuals with AN. Results: Individuals with AN scored higher on PS and RS than controls. In addition, the AN purging type showed higher PS than the AN restrictive type, whereas there were no differences in RS between AN-subtypes. Regression analyses indicated that PS and RS were independently associated with the degree of eating disorder symptoms, whereas only PS was related to percentage underweight. Yet, neither RS nor PS were related to percentage of underweight and AN symptoms after one year. Discussion: Although the present study clearly demonstrated that heightened punishment and reward sensitivity are both linked to AN, there was no evidence that these characteristics are also involved in the course of AN symptoms.

Increased Capacity to Delay Reward in Anorexia Nervosa

Individuals with anorexia nervosa (AN) are often characterized as possessing excessive self-control and are unusual in their ability to reduce or avoid the consumption of palatable foods. This behavior promotes potentially life-threatening weight loss and suggests disturbances in reward processing. We studied whether individuals with AN showed evidence of increased self-control by examining the tendency to delay receipt of a monetary, non-food related, reward. Underweight AN (n = 36) and healthy controls (HC, n = 28) completed a monetary intertemporal choice task measuring delay discounting factor. Individuals with AN reduced the value of a monetary reward over time significantly less than HC (F[1,61] = 5.03; p = 0.029). Secondary analyses indicated that the restricting subtype of AN, in particular, showed significantly less discounting than HC (F[1,46] = 8.3; p = 0.006). These findings indicate that some individuals with AN show less temporal discounting than HC, suggestive of enhanced self-control that is not limited to food consumption. This is in contrast to other psychiatric disorders, for example, substance abuse, which are characterized by greater discounting. Though preliminary, these findings suggest that excessive self-control may contribute to pathological processes and individuals with AN may have neuropsychological characteristics that enhance their ability to delay reward and thereby may help to maintain persistent food restriction.

Altered social reward and attention in anorexia nervosa

Dysfunctional social reward and social attention are present in a variety of neuropsychiatric disorders including autism, schizophrenia, and social anxiety. Here we show that similar social reward and attention dysfunction are present in anorexia nervosa (AN), a disorder defined by avoidance of food and extreme weight loss. We measured the implicit reward value of social stimuli for female participants with (n = 11) and without (n = 11) AN using an econometric choice task and also tracked gaze patterns during free viewing of images of female faces and bodies. As predicted, the reward value of viewing bodies varied inversely with observed body weight for women with anorexia but not control women, in contrast with their explicit ratings of attractiveness. Surprisingly, women with AN, unlike control women, did not find female faces rewarding and avoided looking at both the face and eyes – independent of observed body weight. These findings suggest comorbid dysfunction in the neural circuits mediating gustatory and social reward in anorexia nervosa.

Increased Dopamine D2/D3 Receptor Binding After Recovery from Anorexia Nervosa Measured by Positron Emission Tomography and [ 11C]Raclopride

Several lines of evidence support the possibility that disturbances of dopamine (DA) function could contribute to alterations of weight, feeding, motor activity, and reward in anorexia nervosa (AN). To assess possibly trait-related disturbances but avoid confounding effects of malnutrition, 10 women who were recovered from AN (REC AN) were compared with 12 healthy control women (CW). Positron emission tomography with [(11)C]raclopride was used to assess DA D2/D3 receptor binding. The women who were recovered from AN had significantly higher [(11)C]raclopride binding potential in the antero-ventral striatum than CW. For REC AN, [(11)C]raclopride binding potential was positively related to harm avoidance in the dorsal caudate and dorsal putamen. These data lend support for the possibility that decreased intrasynaptic DA concentration or increased D2/D3 receptor density or affinity is associated with AN and might contribute to the characteristic harm avoidance or increased physical activity found in AN. Most intriguing is the possibility that individuals with AN might have a DA related disturbance of reward mechanisms contributing to altered hedonics of feeding behavior and their ascetic, anhedonic temperament.