title: Elevated cognitive control over reward processing in recovered female patients with anorexia nervosa.
abstract: BACKGROUND
  Individuals with anorexia nervosa are thought to exert excessive self-control to inhibit primary drives.
  
  
  METHODS
  This study used functional MRI (fMRI) to interrogate interactions between the neural correlates of cognitive control and motivational processes in the brain reward system during the anticipation of monetary reward and reward-related feedback. In order to avoid confounding effects of undernutrition, we studied female participants recovered from anorexia nervosa and closely matched healthy female controls. The fMRI analysis (including node-to-node functional connectivity) followed a region of interest approach based on models of the brain reward system and cognitive control regions implicated in anorexia nervosa: the ventral striatum, medial orbitofrontal cortex (mOFC) and dorsolateral prefrontal cortex (DLPFC).
  
  
  RESULTS
  We included 30 recovered patients and 30 controls in our study. There were no behavioural differences and no differences in hemodynamic responses of the ventral striatum and the mOFC in the 2 phases of the task. However, relative to controls, recovered patients showed elevated DLPFC activity during the anticipation phase, failed to deactivate this region during the feedback phase and displayed greater functional coupling between the DLPFC and mOFC. Recovered patients also had stronger associations than controls between anticipation-related DLPFC responses and instrumental responding.
  
  
  CONCLUSIONS
  The results we obtained using monetary stimuli might not generalize to other forms of reward.
  
  
  CONCLUSIONS
  Unaltered neural responses in ventral limbic reward networks but increased recruitment of and connectivity with lateral-frontal brain circuitry in recovered patients suggests an elevated degree of selfregulatory processes in response to rewarding stimuli. An imbalance between brain systems subserving bottom-up and top-down processes may be a trait marker of the disorder.
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Stefan
authors.initials: S
authors.lastname: Ehrlich
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Daniel
authors.initials: D
authors.lastname: Geisler
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Franziska
authors.initials: F
authors.lastname: Ritschel
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Joseph A
authors.initials: JA
authors.lastname: King
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Maria
authors.initials: M
authors.lastname: Seidel
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Ilka
authors.initials: I
authors.lastname: Boehm
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Marion
authors.initials: M
authors.lastname: Breier
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Sabine
authors.initials: S
authors.lastname: Clas
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Jessika
authors.initials: J
authors.lastname: Weiss
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Michael
authors.initials: M
authors.lastname: Marxen
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Michael N
authors.initials: MN
authors.lastname: Smolka
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Veit
authors.initials: V
authors.lastname: Roessner
authors.affiliation: From the Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany (Ehrlich, Geisler, Ritschel, King, Seidel, Boehm, Breier, Clas, Weiss, Roessner); the MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA (Ehrlich); the Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Ehrlich); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Marxen, Smolka, Kroemer).
authors.forename: Nils B
authors.initials: NB
authors.lastname: Kroemer
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology*; D001931:Brain Mapping / Q000523:psychology*; D002540:Cerebral Cortex / Q000503:physiopathology; D003071:Cognition; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009042:Motivation; D017397:Prefrontal Cortex / Q000502:physiology*; D012201:Reward; D000068356:Self-Control / Q000523:psychology*; D066328:Ventral Striatum / Q000502:physiology*; D055815:Young Adult