Altered brain response to reward and punishment in adolescents with Anorexia nervosa

Abstract

Adults recovered from anorexia nervosa (AN) have altered reward modulation within striatal limbic regions associated with the emotional significance of stimuli, and executive regions concerned with planning and consequences. We hypothesized that adolescents with AN would show similar disturbed reward modulation within the striatum and the anterior cingulate cortex, a region connected to the striatum and involved in reward-guided action selection. Using functional magnetic resonance imaging, twenty-two adolescent females (10 restricting-type AN, 12 healthy volunteers) performed a monetary guessing task. Time series data associated with monetary wins and losses within striatal and cingulate regions of interest were subjected to a linear mixed effects analysis. All participants responded more strongly to wins versus losses in limbic and anterior executive striatal territories. However, AN participants exhibited an exaggerated response to losses compared to wins in posterior executive and sensorimotor striatal regions, suggesting altered function in circuitry responsible for coding the affective context of stimuli and action selection based upon these valuations. As AN individuals are particularly sensitive to criticism, failure, and making mistakes, these findings may reflect the neural processes responsible for a bias in those with AN to exaggerate negative consequences.

Altered Medial Frontal Feedback Learning Signals in Anorexia Nervosa

“…For example 224 adolescent AN patients exhibited an elevated neural response to punishment in the "cognitive" zone 225 of the dACC relative to HC in a monetary guessing task. (21). Conversely, Zastrow et al (24) found 226 decreased pMFC activation specifically on "shift" trials of a target detection task in AN.…”

“…Suggesting that AN patients may be particularly 17 hypersensitive to punishment, patients have been also found to make less risky choices than healthy 18 controls (HC) in another decision-making paradigm, the Balloon Analogue Risk Task (13). Further 19 evidence comes from neuroimaging studies which found altered reward processing in response to 20 disorder-related stimuli like food or taste (16)(17)(18) and secondary reinforcers (19)(20)(21)(22)(23). For example, 21 neural response to punishment (monetary loss) has been found to be elevated in acutely ill 22 adolescents in corticostriatal regions involved in valuation and action selection (21).…”

“…Further 19 evidence comes from neuroimaging studies which found altered reward processing in response to 20 disorder-related stimuli like food or taste (16)(17)(18) and secondary reinforcers (19)(20)(21)(22)(23). For example, 21 neural response to punishment (monetary loss) has been found to be elevated in acutely ill 22 adolescents in corticostriatal regions involved in valuation and action selection (21). Alteration in 23 motivational and executive corticostriatal circuitry may also be associated with an impaired ability to 24 flexibly adapt to change (24) and an apparently excessive amount of self-control (5,25).…”

Abnormal functional global and local brain connectivity in female patients with anorexia nervosa

“…Based on the clinical presentation, several functional neuroimaging studies have focused on the processing of food/taste and other appe titive stimuli. [4][5][6][7][8][9] Results suggest that patients may have an al tered sensitivity for sensory interoceptive and/or reward processes as well as an impaired awareness of homeostatic needs. 10 However, published reports revealed considerable inconsistencies, which may be explained by substantial vari ability among studies, including issues with task design, stimulus selection and varying cognitive abilities of the starv ing participants.…”

Elevated cognitive control over reward processing in recovered female patients with anorexia nervosa

“…Based on self-report or behavioural data, some researchers have suggested reduced reward sensitivity in patients with anorexia nervosa, 42,43 but others have reported no group differences. 44 While an fMRI study in recovered patients 10 using a guessing game pointed to a general dysfunction of the reward system in patients with anorexia nervosa, this finding could not be verified in acutely underweight adolescents with anorexia nervosa, 45 suggesting that the abnormalities may not represent a trait effect. Using disease-relevant stimuli, such as food or thin body images, other studies have reported a hyposensitivity 17 or hypersensitivity of the brain reward system in recovered adults 12,43 and in adults 13 and adolescents 46 with acute anorexia nervosa.…”