S72. Longitudinal Assessment of Impairments in Goal-Directed Reinforcement Learning for Money and Food in Anorexia Nervosa

ABSTRACT Objectives: Anorexia nervosa (AN) is associated with altered sensitivity to reward and punishment. Few studies have investigated whether this results in aberrant learning. The ability to learn from rewarding and aversive experiences is essential for flexibly adapting to changing environments, yet individuals with AN tend to demonstrate cognitive inflexibility, difficulty set-shifting and altered decision-making. Deficient reinforcement learning may contribute to repeated engagement in maladaptive behavior. Methods: This study investigated learning in AN using a probabilistic associative learning task that separated learning of stimuli via reward from learning via punishment. Forty-two individuals with Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 restricting-type AN were compared to 38 healthy controls (HCs). We applied computational models of reinforcement learning to assess group differences in learning, thought to be driven by violations in expectations, or prediction errors (PEs). Linear regression analyses examined whether learning parameters predicted BMI at discharge. Results: AN had lower learning rates than HC following both positive and negative PE (p < .02), and were less likely to exploit what they had learned. Negative PE on punishment trials predicted lower discharge BMI (p < .001), suggesting individuals with more negative expectancies about avoiding punishment had the poorest outcome. Conclusions: This is the first study to show lower rates of learning in AN following both positive and negative outcomes, with worse punishment learning predicting less weight gain. An inability to modify expectations about avoiding punishment might explain persistence of restricted eating despite negative consequences, and suggests that treatments that modify negative expectancy might be effective in reducing food avoidance in AN.

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The Rise and Fall of Dopamine: A Two-Stage Model of the Development and Entrenchment of Anorexia Nervosa

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.799548 ◽

2022 ◽

Vol 12 ◽

Author(s):

Jeff A. Beeler ◽

Nesha S. Burghardt

Keyword(s):

Weight Loss ◽

Anorexia Nervosa ◽

Reinforcement Learning ◽

Behavioral Plasticity ◽

Stage Model ◽

Initial Development ◽

Common Path ◽

Neural Substrate ◽

Two Stages

Dopamine has long been implicated as a critical neural substrate mediating anorexia nervosa (AN). Despite nearly 50 years of research, the putative direction of change in dopamine function remains unclear and no consensus on the mechanistic role of dopamine in AN has been achieved. We hypothesize two stages in AN– corresponding to initial development and entrenchment– characterized by opposite changes in dopamine. First, caloric restriction, particularly when combined with exercise, triggers an escalating spiral of increasing dopamine that facilitates the behavioral plasticity necessary to establish and reinforce weight-loss behaviors. Second, chronic self-starvation reverses this escalation to reduce or impair dopamine which, in turn, confers behavioral inflexibility and entrenchment of now established AN behaviors. This pattern of enhanced, followed by impaired dopamine might be a common path to many behavioral disorders characterized by reinforcement learning and subsequent behavioral inflexibility. If correct, our hypothesis has significant clinical and research implications for AN and other disorders, such as addiction and obesity.

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Strep Throat Can Cause Anorexia Nervosa, OCD

Internal Medicine News ◽

10.1016/s1097-8690(05)72194-6 ◽

2005 ◽

Vol 38 (20) ◽

pp. 64

Author(s):

KATE JOHNSON

Keyword(s):

Anorexia Nervosa ◽

Strep Throat

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Rückfälle im Krankheitsverlauf der Anorexia nervosa

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024//1422-4917.27.3.207 ◽

1999 ◽

Vol 27 (3) ◽

pp. 207-219 ◽

Cited By ~ 10

Author(s):

B. Lay ◽

M. H. Schmidt

Keyword(s):

Anorexia Nervosa

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Eine internationale neuropsychologische Testbatterie für Kinder, Jugendliche und Erwachsene mit Anorexia nervosa – die deutsche Adaptation des Ravello Profils

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000253 ◽

2013 ◽

Vol 41 (6) ◽

pp. 371-381 ◽

Cited By ~ 5

Author(s):

Betteke Maria van Noort ◽

Ernst Pfeiffer ◽

Ulrike Lehmkuhl ◽

Viola Kappel

Keyword(s):

Anorexia Nervosa

Fragestellung: Erwachsene mit Anorexia nervosa (AN) zeigen vor und nach Gewichtsrehabilitation Beeinträchtigungen kognitiver Funktionen. Im Bereich der kindlichen und früh-adoleszenten AN besteht ein großer Bedarf an strukturierten Untersuchungen der kognitiven Funktionen. Bisherige Studien weisen methodische Inkonsistenzen bezüglich der Testauswahl und der Operationalisierung kognitiver Funktionen auf, die die Interpretierbarkeit und Vergleichbarkeit der Befunde deutlich einschränken. Um diese Inkonsistenzen zu verringern, wurde eine neuropsychologische Testbatterie, das sogenannte „Ravello Profil“ entwickelt, das bisher jedoch nicht für den deutschen Sprachraum zur Verfügung steht. Die vorliegende Arbeit stellt daher eine für den deutschen Sprachraum adaptierte Version des Ravello Profils vor und überprüft dessen Anwendbarkeit im Kindes- und Jugendalter. Methodik: Das Ravello Profil wurde für den deutschen Sprachraum adaptiert. Anhand von drei Fallbeispielen wurde die Durchführbarkeit des Ravello Profils bei Kindern und Jugendlichen mit AN überprüft. Ergebnisse und Schlussfolgerungen: Die Fallbeispiele verdeutlichen die Anwendbarkeit des adaptierten Ravello Profils bei Kindern und Jugendlichen mit AN. Das Ravello Profil ermöglicht somit auch im deutschen Sprachraum methodisch konsistente Untersuchungen kognitiver Funktionen bei Kindern, Jugendlichen und Erwachsenen mit AN. Mithilfe des Ravello Profils kann die Rolle kognitiver Funktionen bei der Entstehung einer AN über eine umfassende Altersspanne systematisch untersucht werden.

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Perception of Autonomy and Connectedness Prior to the Onset of Anorexia Nervosa and Bulimia Nervosa

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000150 ◽

2012 ◽

Vol 40 (1) ◽

pp. 61-68 ◽

Cited By ~ 8

Author(s):

Julia Huemer ◽

Maria Haidvogl ◽

Fritz Mattejat ◽

Gudrun Wagner ◽

Gerald Nobis ◽

...

Keyword(s):

Anorexia Nervosa ◽

Risk Factor ◽

Bulimia Nervosa ◽

Family Environment ◽

Significant Influence ◽

Diagnostic Interview ◽

Individual Autonomy ◽

Mothers And Fathers ◽

Image Test ◽

Restrictive Type

Objective: This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients. Methods: A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA). Results: Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum – sister pairs sum comparison – of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor. Conclusions: Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.

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