Patients suffering anorexia nervosa (AN) become anhedonic, unable or unwilling to derive normal pleasures and tend to avoid rewarding outcomes, most profoundly in food intake. The activity-based anorexia model recapitulates many of the pathophysiological and behavioural hallmarks of the human condition, including a reduction in food intake, excessive exercise, dramatic weight loss, loss of reproductive cycles, hypothermia and anhedonia, and therefore it allows investigation into the underlying neurobiology of anorexia nervosa. The use of this model has directed attention to disruptions in central reward neurocircuitry, which may contribute to disease susceptibility. The purpose of this review is to demonstrate the utility of this unique model to provide insight into the mechanisms of reward relevant to feeding and weight loss, which may ultimately help to unravel the neurobiology of anorexia nervosa and, in a broader sense, the foundation of reward-based feeding.
K E Y W O R D Sactivity-based anorexia, animal models, anorexia nervosa, dopamine, mesolimbic reward pathways
| ANOREXIA NERVOSA AS A NEUROBIOLOGICAL DISORDERAnorexia nervosa (AN) is a debilitating psychiatric disorder of complex aetiology that is characterised by a relentless pursuit of weight loss through extreme food restriction and excessive exercise, as well as high rates of chronicity, morbidity and mortality.1 AN is accompanied by physiological, biochemical and behavioural disturbances, including a diminished capacity to experience pleasure or reward. Figure 1A). A core aspect of this hypothesis is that "top-down" cognitive modulatory mechanisms exert control over "bottom-up" ap-
| NEUROCIRCUITRY MODULATING REWARD AND INHIBITIONIt is likely that AN behaviours are encoded in limbic and cognitive circuits that fall into two categories. The first may be described as "limbic" and involves the amygdala and ventral striatum, as well as regions of the cerebral cortex, including the insula, anterior cingulate and prefrontal regions, which collectively coordinate the affective response to stimuli including food and feeding. The current terminology introduced by Berridge and Kringelbach 11 is that "liking" is the actual pleasure component of reward and "wanting" is the measure of motivation or incentive salience for a reward. The microstructure of neural circuits and transmitters coding for pleasure can be subdivided, in simplistic terms, into (i) those dopaminergic projections originating in the ventral tegmental area (VTA) and extending to the nucleus accumbens (NAc) which account for "wanting" and (ii) the activation of μ-opioid, In addition to the interaction between these two broad determinants of anorexic behaviour, mesolimbic reward and cortical control, there are clearly modulatory influences form other regions that impinge on such circuits. One of these involves serotonin released from neurones originating in the midbrain raphe nuclei, which can influence reward processing and anhedonic behaviours via actions directly on the VTA, indire...