title: Hunger does not motivate reward in women remitted from anorexia nervosa.
abstract: BACKGROUND
  Hunger enhances sensitivity to reward, yet individuals with anorexia nervosa (AN) are not motivated to eat when starved. This study investigated brain response to rewards during hunger and satiated states to examine whether diminished response to reward could underlie food restriction in AN.
  
  
  METHODS
  Using a delay discounting monetary decision task known to discriminate brain regions contributing to processing of immediate rewards and cognitive control important for decision making regarding future rewards, we compared 23 women remitted from AN (RAN group; to reduce the confounding effects of starvation) with 17 healthy comparison women (CW group). Monetary rewards were used because the rewarding value of food may be confounded by anxiety in AN.
  
  
  RESULTS
  Interactions of Group (RAN, CW) × Visit (hunger, satiety) revealed that, for the CW group, hunger significantly increased activation in reward salience circuitry (ventral striatum, dorsal caudate, anterior cingulate cortex) during processing of immediate reward, whereas satiety increased activation in cognitive control circuitry (ventrolateral prefrontal cortex, insula) during decision making. In contrast, brain response in reward and cognitive neurocircuitry did not differ during hunger and satiety in the RAN group. A main effect of group revealed elevated response in the middle frontal gyrus for the RAN group compared with the CW group.
  
  
  CONCLUSIONS
  Women remitted from AN failed to increase activation of reward valuation circuitry when hungry and showed elevated response in cognitive control circuitry independent of metabolic state. Decreased sensitivity to the motivational drive of hunger may explain the ability of individuals with AN to restrict food when emaciated. Difficulties in valuating emotional salience may contribute to inabilities to appreciate the risks inherent in this disorder.
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Wierenga
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bischoff-Grethe
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California.
authors.forename: A James
authors.initials: AJ
authors.lastname: Melrose
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Irvine
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California.
authors.forename: Laura
authors.initials: L
authors.lastname: Torres
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California.
authors.forename: Ursula F
authors.initials: UF
authors.lastname: Bailer
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California.
authors.forename: Alan
authors.initials: A
authors.lastname: Simmons
authors.affiliation: Departments of Neurobiology and Anatomy and Psychiatry, University of Rochester Medical Center, Rochester, New York.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Fudge
authors.affiliation: Department of Psychology, Stanford University, Stanford, California.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: McClure
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California.
authors.forename: Alice
authors.initials: A
authors.lastname: Ely
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, California. Electronic address: wkaye@ucsd.edu.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000503:physiopathology* / Q000523:psychology*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D065786:Delay Discounting / Q000502:physiology; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D006815:Hunger; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009042:Motivation / Q000502:physiology*; D009434:Neural Pathways / Q000503:physiopathology; D009483:Neuropsychological Tests; D012201:Reward; D055815:Young Adult
keywords: Anorexia nervosa; Decision making; Delay discounting; Eating disorders; Functional MRI; Reward processing