Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
J Int Neuropsychol Soc. 2024 Aug;30(7):651-659. doi: 10.1017/S1355617724000237. Epub 2024 Sep 18.
Anorexia nervosa (AN) is characterized by severe restriction of calorie intake, which persists despite serious medical and psychological sequelae of starvation. Several prior studies have identified impaired feedback learning among individuals with AN, but whether it reflects a disturbance in learning from positive feedback (i.e., reward), negative feedback (i.e., punishment), or both, and the extent to which this impairment is related to severity and duration of illness, has not been clarified.
Participants were female adolescents with AN ( = 76) and healthy teen volunteers (HC; = 38) between the ages of 12-18 years who completed a probabilistic reinforcement learning task. A Bayesian reinforcement learning model was used to calculate separate learning rates for positive and negative feedback. Exploratory analyses examined associations between feedback learning and duration of illness, eating disorder severity, and self/parent reports of reward and punishment sensitivity.
Adolescents with AN had a significantly lower rate of learning from positive feedback relative to HC. Patients and HC did not differ in learning from negative feedback or on overall task performance measures. Feedback learning parameters were not significantly associated with duration of illness, eating disorder severity, or questionnaire-based reports of reward and punishment sensitivity.
Adolescents with AN showed a circumscribed deficit in learning from reward that was not associated with duration of illness or reported sensitivity to reward or punishment. Subsequent longitudinal research should explore whether differences in learning from positive feedback relate to course of illness in youth with AN.
神经性厌食症（AN）的特征是严重限制热量摄入，尽管饥饿会导致严重的医学和心理后果，但仍持续存在。先前的几项研究已经确定了厌食症患者的反馈学习受损，但它是否反映了对正反馈（即奖励）、负反馈（即惩罚）的学习障碍，以及这种损伤与疾病的严重程度和持续时间的关系，尚未得到明确。
参与者为年龄在 12 至 18 岁之间的患有 AN 的女性青少年（n = 76）和健康的青少年志愿者（HC；n = 38），他们完成了一个概率强化学习任务。使用贝叶斯强化学习模型计算正负反馈的单独学习率。探索性分析考察了反馈学习与疾病持续时间、饮食障碍严重程度以及自我/父母报告的奖励和惩罚敏感性之间的关联。
与 HC 相比，患有 AN 的青少年从正反馈中学习的速度明显较慢。患者和 HC 在从负反馈中学习或在整体任务表现方面没有差异。反馈学习参数与疾病持续时间、饮食障碍严重程度或基于问卷的奖励和惩罚敏感性报告均无显著相关性。
患有 AN 的青少年在从奖励中学习方面存在特定的缺陷，而这种缺陷与疾病持续时间或报告的奖励和惩罚敏感性无关。随后的纵向研究应探讨从正反馈中学习的差异是否与青少年 AN 的病程有关。
