Joseph A. King, PhD; Fabio Bernardoni, PhD; Daniel Geisler, MSc; Franziska Ritschel, PhD; Arne Doose, MSc; Sophie Pauligk, MSc; Konrad Pásztor, CandMed; Kerstin Weidner, MD; Veit Roessner, MD; Michael N. Smolka, MD; Stefan Ehrlich, MD, PhD
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. 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.
Methods: 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.
Results: 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 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.
Limitations: This was a cross-sectional study, and the results may be task-specific.
Conclusion: 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 value-based decision-making may not constitute a defining trait variable or “scar” of the disorder.
Submitted Dec. 19, 2018; Revised Apr. 29, 2019; Accepted Jun. 13, 2019; Published online Oct. 9, 2019
Acknowledgments: The authors express their gratitude to all associated research assistants for their help with participant recruitment and data collection and thank all participants for their time and cooperation. The authors also thank the Center for Information Services and High Performance Computing (ZIH) at Technische Universität Dresden for generous allocations of computer time.
Affiliations: From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka).
Funding: This work was supported by the Deutsche Forschungsgemeinschaft (EH 367/5-1, SFB 940/1, SM 80/7-2).
Competing interests: V. Roessner has received payment for consulting and writing activities, independent of the current work, from Lilly, Novartis and Shire Pharmaceuticals; lecture honoraria from Lilly, Novartis, Shire Pharmaceuticals and Medice Pharma; and support for research from Shire and Novartis. He has carried out (and is currently carrying out) clinical trials in cooperation with the Novartis, Shire and Otsuka. J. King, F. Bernardoni, D. Geisler, F. Ritschel, A. Doose, S. Pauligk, K. Pásztor, K. Weidner, M. Smolka and S. Ehrlich declare no competing interests.
Contributors: D. Geisler, F. Ritschel, V. Roessner, M. Smolka and S. Ehrlich designed the study. J. King, F. Bernardoni, D. Geisler, F. Ritschel, S. Pauligk, K. Pásztor, K. Weidner and M. Smolka acquired the data, which J. King, F. Bernardoni, D. Geisler, F. Ritschel, A. Doose and S. Ehrlich analyzed. J. King and S. Ehrlich wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.
Correspondence to: S. Ehrlich, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Division of Psychological and Social Medicine and Developmental Neuroscience, Fetscherstrasse 74, 01307 Dresden, Germany; firstname.lastname@example.org