Hunger Does Not Motivate Reward in Women Remitted from Anorexia Nervosa



      Hunger enhances sensitivity to reward, yet individuals with anorexia nervosa (AN) are not motivated to eat when starved. This study investigated brain response to rewards during hunger and satiated states to examine whether diminished response to reward could underlie food restriction in AN.


      Using a delay discounting monetary decision task known to discriminate brain regions contributing to processing of immediate rewards and cognitive control important for decision making regarding future rewards, we compared 23 women remitted from AN (RAN group; to reduce the confounding effects of starvation) with 17 healthy comparison women (CW group). Monetary rewards were used because the rewarding value of food may be confounded by anxiety in AN.


      Interactions of Group (RAN, CW) × Visit (hunger, satiety) revealed that, for the CW group, hunger significantly increased activation in reward salience circuitry (ventral striatum, dorsal caudate, anterior cingulate cortex) during processing of immediate reward, whereas satiety increased activation in cognitive control circuitry (ventrolateral prefrontal cortex, insula) during decision making. In contrast, brain response in reward and cognitive neurocircuitry did not differ during hunger and satiety in the RAN group. A main effect of group revealed elevated response in the middle frontal gyrus for the RAN group compared with the CW group.


      Women remitted from AN failed to increase activation of reward valuation circuitry when hungry and showed elevated response in cognitive control circuitry independent of metabolic state. Decreased sensitivity to the motivational drive of hunger may explain the ability of individuals with AN to restrict food when emaciated. Difficulties in valuating emotional salience may contribute to inabilities to appreciate the risks inherent in this disorder.


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      Linked Article

      • Valuation and Cognitive Circuitry in Anorexia Nervosa: Disentangling Appetite from the Effort to Obtain a Reward
        Biological PsychiatryVol. 77Issue 7
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          Motivation is classically defined as the amount of effort one is willing to expend to acquire a reward. In humans, rewards may range from basic or primary (e.g., drugs of abuse, sex, money, palatable food) to more complex, personal ones (e.g., social engagement or reciprocity, entertainment, hobbies), and working toward those rewards, whether immediate or distant, often guides the choices we make daily. Findings in healthy populations have identified key neural regions involved in anticipation, evaluation, and decision making during reward processing and demonstrated the impact of internal states modulating these, including stress (1) and sleep (2), among others.
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