Evidence that Illness-Compatible Cues Are Rewarding in Women Recovered from Anorexia Nervosa: A Study of the Effects of Dopamine Depletion on Eye-Blink Startle Responses

Abstract

In anorexia nervosa (AN), motivational salience is attributed to illness-compatible cues (e.g., underweight and active female bodies) and this is hypothesised to involve dopaminergic reward circuitry. We investigated the effects of reducing dopamine (DA) transmission on the motivational processing of AN-compatible cues in women recovered from AN (AN REC, n = 17) and healthy controls (HC, n = 15). This involved the acute phenylalanine and tyrosine depletion (APTD) procedure and a startle eye-blink modulation (SEM) task. In a balanced amino acid state, AN REC showed an increased appetitive response (decreased startle potentiation) to illness-compatible cues (underweight and active female body pictures (relative to neutral and non-active cues, respectively)). The HC had an aversive response (increased startle potentiation) to the same illness-compatible stimuli (relative to neutral cues). Importantly, these effects, which may be taken to resemble symptoms observed in the acute stage of illness and healthy behaviour respectively, were not present when DA was depleted. Thus, AN REC implicitly appraised underweight and exercise cues as more rewarding than did HC and the process may, in part, be DA-dependent. It is proposed that the positive motivational salience attributed to cues of emaciation and physical activity is, in part, mediated by dopaminergic reward processes and this contributes to illness pathology. These observations are consistent with the proposal that, in AN, aberrant reward-based learning contributes to the development of habituation of AN-compatible behaviours.

Neural mechanisms of perceptive and affective processing of body stimuli in anorexia nervosa – are there developmental effects?

“…It would also be interesting to acquire longitudinal data in the course of treatment and, in order to further clarify the processes involved, to assess neural activation patterns in the context of e.g. dopamine depletion, as dopamine has been seen to influence reward reactions in AN (54).…”

The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease

“…Individuals with AN demonstrate elevated skin conductance, decreased eye blink startle, and increased electroencephalogram late positive potential in response to underweight stimuli (Clarke, Ramoz, Fladung, & Gorwood, ; Horndasch et al, ; O'Hara et al, ), indicating greater salience and PA responding. This altered dopaminergic functioning and reward response is corroborated by a study showing increased eye blink startle in response to thinness images following dopamine depletion (O'Hara et al, ).…”

Impulsivity and Compulsivity in Anorexia Nervosa: Cognitive Systems Underlying Variation in Appetite Restraint from an RDoC Perspective

“…First, attentional processes are associated with regulatory control and response inhibition, and underlie the conscious and non-conscious processes of attentional bias to food stimuli [15,31]. For example, attention is influenced by incentive salience as reflected in eye-blink startle responses to disorder-specific cues [32], which could drive the cognitive tendency for delayed reporting of disorder-specific stimuli [15]. Second, perception is related to this, and encompasses Bayesian Inference and epistemic foraging, or in AN-related terms, excessive cognitive sampling (e.g.…”