Examining Behavioral Markers of Reward Processing Dysfunction in Individuals With Anorexia Nervosa and Suicidal...

Suicidal thoughts and behaviors (STBs) are common in individuals with anorexia nervosa (AN), including those who are weight-restored. Dysfunction in reward processing has been proposed as a mechanism linking AN to STBs; however, little research has interrogated putative reward links between these phenomena. The present study examined behavioral markers associated with STBs in weight-restored AN using two reward-related decision-making tasks.

Participants included individuals with weight-restored AN (n = 33) with STBs (AN+STB, n = 19) or without STBs (AN-only; n = 14) and healthy controls (HCs; n = 28). Using two behavioral tasks (Food Choice and Web-Surf Tasks), we examined group differences in anticipatory and consummatory reward processing across general and disorder-specific cues, as well as the discrepancy between anticipatory and consummatory responses.

No group differences were observed in average responsivity to either general rewards (pleasant videos) or disorder-specific rewards (low-calorie food cues; ps > 0.05). However, the AN+STB group made fewer high-calorie food choices (lower anticipatory reward; p = 0.030), despite comparable tastiness ratings across groups (similar consummatory reward; p = 0.331), resulting in a greater discrepancy between high-calorie food taste ratings and choice (p = 0.035). Across the full sample, fewer high-calorie food choices and larger taste-choice discrepancies were associated with greater self-reported reward/compulsivity for self-starvation (ps < 0.01).

Reward processing associated with STBs in weight-restored AN may be characterized by diminished anticipatory responses but preserved consummatory responses to disorder-relevant hedonic stimuli, particularly high-calorie foods. Future work clarifying the mechanisms underlying this discrepancy may improve our understanding of, and ability to target, a transdiagnostic dysfunction underlying both eating disorders and co-occurring suicidality.