Anorexia nervosa, neuroimaging research, and the contextual salience of food cues: The food approach–avoidance conundrum

Abstract

Anorexia nervosa (AN) is characterized by an avoidance and marked apprehension around food intake, yet paradoxically, those with AN often display approach behaviors to food, engaging in food shopping or preparation activities which are described as rewarding. This approach–avoidance conundrum is of much importance as neuroimaging studies continue to probe mechanisms relating to core AN psychopathology. This Idea Worth Researching discusses the notion that neuroimaging studies relying on food cue presentation paradigms may be methodologically flawed without specifying the contextual salience of the food cues presented in paradigms. The appraisal of food cues may diverge as a function of one’s intent-to-eat, and thus, neuroimaging studies not specifying the contextual salience of food cues (i.e., intent-to-eat or not) may confound two distinctly different processes.

Reward System Abnormalities in Anorexia Nervosa

“…However, the paradigm to date has not tested—in animal models, healthy individuals, or patients with AN—whether passive learning and prediction error response is actually associated with eating behavior. Although the authors suggest that an association with illness-related phenomena is present based on self-reported assessments (primarily harm avoidance, which is ostensibly a trait measure), translational research in eating disorders would be strengthened by getting closer to measurement of actual behavior (eg, direct measurement of restrictive food intake) …”

“…Although the authors suggest that an association with illness-related phenomena is present based on self-reported assessments (primarily harm avoidance, which is ostensibly a trait measure), translational research in eating disorders would be strengthened by getting closer to measurement of actual behavior (eg, direct measurement of restrictive food intake). 8 The challenge in understanding the meaning of neural activation patterns is a pervasive conundrum in neuroimaging research; therefore, cognitive neuroscience studies often include manipulations that aim to constrain the interpretation. The prediction error paradigm is essentially a passive learning task, with no instrumental response component.…”

No effect of very brief exposure to masked food pictures on fear of food in anorexia nervosa

“…While spider images are clearly representations of the core fear in spider phobia, the feared outcome of food exposure in AN is not yet well understood (Murray, Loeb et al., 2016). A potential feared outcome for many patients with AN might be weight gain which could mean that food images only elicit fear when they are associated with potential weight gain, that is, in the context of eating (Murray & Strigo, 2018), which they were not in our study (as we only used pictures of food for the exposure). In patients with AN, food avoidance tendencies seem to conflict with approach tendencies (Giel et al., 2011; Murray & Strigo, 2018), given that food stimuli are considered a primary reward (Skinner, 1953).…”

The influence of homeostatic mechanisms on neural regulation of food craving in anorexia nervosa

“…Additionally, the distraction from visually presented food stimuli may not be suitable for triggering reactions related to the psychopathology of AN. According to Murray and Strigo (Murray & Strigo, 2018 ), neuroimaging food cue paradigms should be situated in the context most salient to the psychopathology of AN, which refers mainly to food consumption and the intention to eat, rather than passive exposure to food stimuli. Given that patients with AN often display paradoxical approach towards as well as avoidance behavior away from food, future studies should aim at designing a more naturalistic approach by examining patients' intention to eat.…”