Title | On Weight and Waiting: Delay Discounting in Anorexia Nervosa Pretreatment and Posttreatment. |
Publication Type | Journal Article |
Year of Publication | 2015 |
Authors | Decker JHugo, Figner B, Steinglass JE |
Journal | Biol Psychiatry |
Volume | 78 |
Issue | 9 |
Pagination | 606-14 |
Date Published | 2015 Nov 01 |
ISSN | 1873-2402 |
Keywords | Adult, Anorexia Nervosa, Body Mass Index, Body Weight, Brain, Brain Mapping, Delay Discounting, Female, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Neuropsychological Tests, Reward, Treatment Outcome, Young Adult |
Abstract | BACKGROUND: Individuals with anorexia nervosa (AN) override the drive to eat, forgoing immediate rewards in favor of longer-term goals. We examined delay discounting and its neural correlates in AN before and after treatment to test a potential mechanism of illness persistence. METHODS: Inpatients with AN (n = 59) and healthy control subjects (HC, n = 39) performed a delay discounting task at two time points. A subset (n = 30 AN, n = 22 HC) participated in functional magnetic resonance imaging scanning during the task. The task consisted of a range of monetary choices with variable delay times, yielding individual discount rates-the rate by which money loses value over time. RESULTS: Before treatment, the AN group showed a preference for delayed over earlier rewards (i.e., less steep discount rates) compared with HC; after weight restoration, AN did not differ from HC. Underweight AN showed slower response times for earlier versus delayed choices; this reversed with treatment. Underweight AN showed abnormal neural activity in striatum and dorsal anterior cingulate; normalization of behavior was associated with increased activation in reward regions (striatum and dorsal anterior cingulate) and decision-making regions (dorsolateral prefrontal cortex and parietal cortex). CONCLUSIONS: The undernourished state of AN may amplify the tendency to forgo immediate rewards in favor of longer-term goals. The results suggest that behavior that looks phenotypically like excessive self-control does not correspond with enhanced prefrontal recruitment. Rather, the results point to alterations in cingulostriatal circuitry that offer new insights on the potential role of abnormalities in decision-making neural systems in the perpetuation of AN. |
DOI | 10.1016/j.biopsych.2014.12.016 |
Alternate Journal | Biol. Psychiatry |
PubMed ID | 25641636 |
PubMed Central ID | PMC4478277 |
Grant List | K23 MH076195 / MH / NIMH NIH HHS / United States T32 GM007739 / GM / NIGMS NIH HHS / United States K23MH076195 / MH / NIMH NIH HHS / United States T32GM007739 / GM / NIGMS NIH HHS / United States |
Submitted by kej2006 on June 6, 2018 - 4:11pm