Temporal discounting across three psychiatric disorders: Anorexia nervosa, obsessive compulsive disorder, and social anxiety disorder

Abstract

Background Temporal discounting refers to the tendency for rewards to lose value as the expected delay to receipt increases. Individuals with anorexia nervosa (AN) have been found to show reduced temporal discounting rates, indicating a greater preference for delayed rewards compared to healthy peers. Obsessive–compulsive disorder (OCD) and social anxiety disorder (SAD) commonly co-occur with AN, and anxiety has been related to development and prognosis of AN. We examined whether reduced temporal discounting is present across these potentially related disorders, and explored the relationship between temporal discounting and anxiety trans-diagnostically. Methods One hundred ninety six individuals (75 healthy controls (HC); 50 OCD; 27 AN; 44 SAD) completed two temporal discounting tasks in which they chose between smaller-sooner and larger-later monetary rewards. Two measures of discounting—discount rate and discount factor—were compared between diagnostic groups, and associations with anxious traits were examined. Results Individuals with AN showed decreased temporal discounting compared to HC. OCD and SAD groups did not differ significantly from HC. Across the sample, anxiety was associated with decreased discounting; more anxious individuals showed a greater preference for delayed reward. Conclusions We replicated the findings that individuals with AN show an increased preference for delayed reward relative to HC and that individuals with OCD do not differ from HC. We also showed that individuals with SAD do not differ from HC in discounting. Across this large sample, two measures of anxious temperament were associated with temporal discounting. These data raise new questions about the relationship between this dimensional trait and psychopathology.

Delay Discounting of Reward and Impulsivity in Eating Disorders: From Anorexia Nervosa to Binge Eating Disorder

“…Contrastingly, AN‐R patients presented less steep discounting rates than the other ED groups. This result coincides with past studies identifying more conservative decision making in AN patients (Decker et al ., ; Steinglass et al ., , ). Clinically, patients with AN‐R are often described as being more prone to excessive self‐control than their AN‐BP counterparts, who are characterized as being more undercontrolled (Lavender et al ., ; Wildes et al ., ).…”

“…EDs characterized by higher levels of impulsivity, namely, BN and BED, are associated with a preference for immediate rewards, regardless of whether the reward is monetary (Davis, Patte, Curtis, & Reid, ; Kekic et al ., ) or a food reward (Manwaring, Green, Myerson, Strube, & Wilfley, ). On the other hand, being overly cautious and choosing delayed rewards more than is expected has been linked to AN (Decker, Figner, & Steinglass, ; Steinglass et al ., , ). This tendency is thought to reflect the unusually elevated level of self‐control found in AN patients and possibly reflects a vulnerability marker for the disorder (Kanakam, Krug, Collier, & Treasure, ; Stojek & MacKillop, ).…”

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

“…9 Consistent with the clinical presentation of anorexia nervosa suggestive of excessive self-control, 4 studies of acutely underweight patients have reported decreased (i.e., less steep) discounting relative to healthy controls. [9][10][11][12] However, these findings were in predominantly chronic adult samples, and intertemporal choice Background: 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.…”

“…Given the importance of distinguishing between state and trait factors associated with anorexia nervosa, 25,26 we sought to clarify whether divergent behavioural and/or neural correlates of delay discounting in anorexia nervosa are characteristic only of acute undernutrition (state marker), as suggested by previous studies, [9][10][11][12]18 or may also be present in long-term weight-recovered women with a history of anorexia nervosa (trait marker). To this end, we repeated our previous analysis focused on acutely underweight patients with anorexia nervosa 18 in a sample of weight-recovered women and age-matched healthy controls who participated in the same study protocol.…”

Computational psychiatry of impulsivity and risk: how risk and time preferences interact in health and disease

“…Choice impulsivity, in particular, has broad clinical importance. Individuals diagnosed with schizophrenia [5], bipolar disorder [6], impulse control disorders [7], bulimia nervosa [8,9], ADHD [10] and substance use and addictive disorders [11] have all been found to have increased choice impulsivity, while those diagnosed with obsessive compulsive disorder (OCD) and anorexia nervosa may show the converse pattern [12]. The relationship between choice impulsivity and at least a few of these disorders seems to be prospective [13,14], suggesting this & 2018 The Author(s) Published by the Royal Society.…”