title: On Weight and Waiting: Delay Discounting in Anorexia Nervosa Pretreatment and Posttreatment.
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.
authors: Sackler Institute of Developmental Psychobiology, Weill Cornell Medical College, New York, New York. Electronic address: js1124@columbia.edu.
authors: Johannes Hugo
authors: JH
authors: Decker
authors: Behavioural Science Institute and Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, Netherlands; Center for Decision Sciences , Columbia University.
authors: Bernd
authors: B
authors: Figner
authors: Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, New York.
authors: Joanna E
authors: JE
authors: Steinglass
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D015992:Body Mass Index; D001835:Body Weight; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D065786:Delay Discounting / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D012201:Reward; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anorexia nervosa; Decision-making; Delay discounting; Eating disorders; Imaging; Longitudinal
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