From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka).
J Psychiatry Neurosci. 2020 Mar 1;45(2):108-116. doi: 10.1503/jpn.180252.
Extreme restrictive food choice in anorexia nervosa is thought to reflect excessive self-control and/or abnormal reward sensitivity. Studies using intertemporal choice paradigms have suggested an increased capacity to delay reward in anorexia nervosa, and this may explain an unusual ability to resist immediate temptation and override hunger in the long-term pursuit of thinness. It remains unclear, however, whether altered delay discounting in anorexia nervosa constitutes a state effect of acute illness or a trait marker observable after recovery.
We repeated the analysis from our previous fMRI investigation of intertemporal choice in acutely underweight patients with anorexia nervosa in a sample of weight-recovered women with anorexia nervosa (n = 36) and age-matched healthy controls (n = 36) who participated in the same study protocol. Follow-up analyses explored functional connectivity separately in both the weight-recovered/healthy controls sample and the acute/healthy controls sample.
In contrast to our previous findings in acutely underweight patients with anorexia nervosa, we found no differences between weight-recovered patients with anorexia nervosa and healthy controls at either behavioural or neural levels. New analysis of data from the acute/healthy controls sample sample revealed increased coupling between dorsal anterior cingulate cortex and posterior brain regions as a function of decision difficulty, supporting the hypothesis of altered neural efficiency in the underweight state.
This was a cross-sectional study, and the results may be task-specific.
Although our results underlined previous demonstrations of divergent temporal reward discounting in acutely underweight patients with anorexia nervosa, we found no evidence of alteration in patients with weight-recovered anorexia nervosa. Together, these findings suggest that impaired valuebased decision-making may not constitute a defining trait variable or “scar” of the disorder.
厌食症患者对食物的极端限制选择被认为反映了过度的自我控制和/或异常的奖励敏感性。使用跨期选择范式的研究表明，厌食症患者延迟奖励的能力增强，这可能解释了他们在长期追求消瘦的过程中抵抗即时诱惑和抑制饥饿的异常能力。然而，厌食症患者中改变的延迟折扣是否构成急性疾病的状态效应或可在康复后观察到的特征标志物尚不清楚。
我们在一组体重恢复的厌食症女性患者（n = 36）和年龄匹配的健康对照组（n = 36）中重复了我们之前关于厌食症患者跨期选择的 fMRI 研究中的分析，这些患者在研究方案中参与了相同的研究。后续分析分别在体重恢复/健康对照组样本和急性/健康对照组样本中探索了功能连接。
与我们之前在急性体重不足的厌食症患者中的发现相反，我们在体重恢复的厌食症患者和健康对照组之间在行为或神经水平上均未发现差异。对急性/健康对照组样本数据的新分析显示，随着决策难度的增加，背侧前扣带皮层和后脑区域之间的耦合增加，支持了在体重不足状态下改变神经效率的假设。
这是一项横断面研究，结果可能是特定于任务的。
尽管我们的结果强调了之前在急性体重不足的厌食症患者中观察到的不同的时间奖励折扣，但我们没有发现体重恢复的厌食症患者有任何改变的证据。这些发现表明，受损的基于价值的决策制定可能不构成该疾病的特征变量或“痕迹”。
