Theoretical perspective on anorexia nervosa: The conflict of reward

Altered Medial Frontal Feedback Learning Signals in Anorexia Nervosa

“…Although the model 245 did not uncover a group difference in a feedback sensitivity parameter, the finding that patients 246 tended to base their decisions on recent experience is commensurate with our finding of increased 247 learning rate in AN. The current evidence of altered decision-making in response to negative 248 feedback is in line with notion of altered reinforcement learning in AN (1)(2)(3)(4)(5)8) and, considered in 249 light of similar recent findings (13), is suggestive of a particular sensitivity to punishment. Decision-250 making may be intact, however, in paradigms that don't include negative feedback, at least in 251 adolescents (19,59).…”

“…Nonetheless, these findings were made in predominately restrictive AN and 252 future studies are needed to clarify potential subtype differences in reward and punishment 253 sensitivity (10,11). Furthermore, given the presumption that AN is characterized by altered general 254 reward-related decision-making (4,8,19) and the lack of group differences in this respect in both the 255 current study and other recent ones (21,51), future research is also needed to clarify under which 256 conditions the neural substrates of reward processing are aberrant in AN. 257…”

“…Aberrant reward-based learning in AN may reflect an entrenched "habit" of restrictive food choice 6 (6,7). Similarly, it has been proposed that primary rewards (food) become conditioned as punishing, 7 and aversive stimuli (hunger) as rewarding in the brain reward system of individuals with AN (8). 8 However, the precise mechanisms underlying response to and learning from reward and punshiment 9 in AN are still poorly understood.…”

“…Similarly, it has been proposed that primary rewards (food) become conditioned as punishing, 7 and aversive stimuli (hunger) as rewarding in the brain reward system of individuals with AN (8). 8 However, the precise mechanisms underlying response to and learning from reward and punshiment 9 in AN are still poorly understood. 10 AN is consistently associated with low reward reactivity and high punishment sensitivity on 11 clinical scales although important differences between subtypes (restrictive vs. binge-purging) may 12 exist (9-13).…”

Oestrogen: an overlooked mediator in the neuropsychopharmacology of treatment response?

“…The diagnostic relevance of amenorrhoea is highly questionable (Abraham et al 2005 ;Dalle Grave et al 2008 ;Garfinkel et al 1996 ;Keating, 2009). However, from a treatment perspective there may be important implications for the hormonal milieu of the patient and their capacity to respond to pharmacotherapy.…”