Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America.
Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; The Metis Foundation, San Antonio, TX, United States of America.
Clin Psychol Rev. 2020 Jul;79:101872. doi: 10.1016/j.cpr.2020.101872. Epub 2020 May 27.
Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.
神经性厌食症（AN）的模型假设，症状是通过缺乏奖励和增强惩罚处理来维持的。然而，理论和经验上的不一致性突出表明，需要对这方面的文献进行更细致的概念化。我们的目标是从特定线索的角度全面审查 AN 中关于奖励和惩罚反应的研究，以确定哪些刺激在该人群中引起或抑制奖励和惩罚反应，以及这些奖励和惩罚线索最终可能具有哪些特性。一项针对特定线索的奖励和惩罚反应的系统审查产生了 92 篇文章，这些文章检查了个体对与疾病相关（如食物）和不相关（如金钱）刺激的自我报告、行为和生物学指标的反应。总的来说，在大多数研究中，患有 AN 的个体对表示更高体重、社交环境和金钱损失的线索表现出厌恶反应，对表示减肥行为和消瘦的线索表现出渴望反应。对美味食物和金钱收益的反应则更为复杂。研究结果表明，AN 中的奖励和惩罚反应是特定于情境的，可能受到各种刺激质量（例如，可预测性、可控性、延迟、努力）的影响。未来对 AN 中奖励和惩罚机制的研究中增加特异性将更好地为有针对性的干预措施的发展提供信息。
