Investigating Associations Between General and Disorder-Specific Reward and Suicidality in Anorexia Nervosa

Altered reward processing is proposed to be central to the pathology of anorexia nervosa (AN). This study aimed to investigate how aspects of reward dysfunction relate to suicidal thoughts and behaviours (STBs) in AN.

We compared responses on self-report measures of general (i.e., anticipatory, consummatory, and social reward) and disorder-specific (i.e., self-starvation reward) reward between individuals with AN with (AN + STBs; n = 28) or without (AN; n = 31) lifetime active STBs and healthy controls (HC; n = 32). Further, we examined whether interactions between general and disorder-specific reward dysfunction were associated with lifetime active STBs in AN.

Compared to AN and HC groups, the AN + STBs group reported significantly lower anticipatory and social reward; both AN + STBs and AN groups reported higher self-starvation reward than HCs. When accounting for the effects of depression, group differences became non-significant for general rewards but remained significant for disorder-specific reward processing. The interaction between anticipatory and self-starvation reward was significantly associated with STB risk beyond the effects of depression: AN participants reporting high self-starvation reward were at elevated STB risk regardless of anticipatory reward levels, whereas those with low self-starvation reward showed increased STBs only when anticipatory reward was also low.

Our results suggest that the combination of general and disorder-specific reward processes may shape distinct suicidality risk profiles in AN.