Altered Neural Efficiency of Decision Making During Temporal Reward Discounting in Anorexia Nervosa.
The ability of individuals with anorexia nervosa (AN) to resist hunger and restrict caloric intake is often believed to reflect an unusual amount of self-control. However, the underlying neural substrate is poorly understood, especially in adolescent patients.



Functional magnetic resonance imaging was used during an intertemporal choice task to probe the hemodynamic correlates of a common measurement of self-control-delayed (monetary) reward discounting-in a sample of acutely ill, predominately adolescent female patients with AN (n = 31) and age-matched healthy controls (n = 31).



Delayed discounting rates did not differ between the groups, but decision making was consistently faster in the AN group. Although no group differences in the neural correlates of reward valuation were evident, activation associated with decision making was decreased in the AN group, most notably in the lateral prefrontal and posterior parietal regions implicated in executive control. Follow-up analysis of difficult decisions showed decreased activation in the AN group in a region of the dorsal anterior cingulate cortex.



Decreased activation in frontoparietal regions involved in decision making, but faster and more consistent choice behavior, suggests that the altered efficiency of neural resource allocation might underlie an increased level of self-control in AN. This pattern of neural activation and behavior might reflect an ingrained "habit" to sustain high-level proactive (anticipatory) cognitive control in AN, which in turn might compromise reactive control mechanisms needed to adapt to changing cognitive demands, such as when difficult decisions must be made.
Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany.
Joseph A
JA
King
Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany.
Daniel
D
Geisler
Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany.
Fabio
F
Bernardoni
Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany.
Franziska
F
Ritschel
Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany.
Ilka
I
Böhm
Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany.
Maria
M
Seidel
Neuroimaging Center, TU Dresden.
Eva
E
Mennigen
Neuroimaging Center, TU Dresden.
Stephan
S
Ripke
Neuroimaging Center, TU Dresden.
Michael N
MN
Smolka
Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany.
Veit
V
Roessner
Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany. Electronic address: stefan.ehrlich@tu-dresden.de.
Stefan
S
Ehrlich
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002648:Child; D065786:Delay Discounting / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012201:Reward; D055815:Young Adult
anorexia nervosa; decision making; functional magnetic resonance imaging; intertemporal choice; reward processing