Altered reward processing in women recovered from anorexia nervosa.
OBJECTIVE
Individuals with anorexia nervosa are known to be ascetic and able to sustain self-denial of food as well as most comforts and pleasures in life. Building on previous findings of altered striatal dopamine binding in anorexia nervosa, the authors sought to assess the response of the anterior ventral striatum to reward and loss in this disorder.


METHODS
Striatal responses to a simple monetary reward task were investigated using event-related functional magnetic resonance imaging. To avoid the confounding effects of malnutrition, the authors compared 13 healthy comparison women and 13 women who had recovered from restricting-type anorexia nervosa and had 1 year of normal weight and regular menstrual cycles, without binge eating or purging.


RESULTS
Recovered women showed greater hemodynamic activation in the caudate than comparison women. Only the recovered women showed a significant positive relationship between trait anxiety and the percentage change in hemodynamic signal in the caudate during either wins or losses. In contrast, in the anterior ventral striatum, comparison women distinguished positive and negative feedback, whereas recovered women had similar responses to both conditions.


CONCLUSIONS
Individuals who have recovered from anorexia nervosa may have difficulties in differentiating positive and negative feedback. The exaggerated activation of the caudate, a region involved in linking action to outcome, may constitute an attempt at "strategic" (as opposed to hedonic) means of responding to reward stimuli. The authors hypothesize that individuals with anorexia nervosa have an imbalance in information processing, with impaired ability to identify the emotional significance of a stimulus but increased traffic in neurocircuits concerned with planning and consequences.
University of Pittsburgh, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
Angela
A
Wagner
Howard
H
Aizenstein
Vijay K
VK
Venkatraman
Julie
J
Fudge
J Christopher
JC
May
Laura
L
Mazurkewicz
Guido K
GK
Frank
Ursula F
UF
Bailer
Lorie
L
Fischer
Van
V
Nguyen
Cameron
C
Carter
Karen
K
Putnam
Walter H
WH
Kaye
D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D001479:Basal Ganglia / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight; D001931:Brain Mapping; D002421:Caudate Nucleus / Q000098:blood supply / Q000502:physiology; D004192:Discrimination, Psychological / Q000502:physiology; D005071:Evoked Potentials / Q000502:physiology; D005246:Feedback / Q000502:physiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D005715:Gambling / Q000523:psychology; D005717:Games, Experimental; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D009752:Nutritional Status; D010100:Oxygen / Q000097:blood; D012201:Reward; D016896:Treatment Outcome
D010100:Oxygen