Neural correlates of impaired decision-making in Anorexia Nervosa.

Abstract

Individuals suffering from Anorexia Nervosa (AN) are characterized primarily by an extreme fear of gaining weight and getting fat. They exhibit a disturbed eating pattern, whereby they resist food (or purge after a binge) to immediately relieve the anxious feelings of possible weight-gain, at the expense of long-term physical and mental health, Therefore, it has been implicated that individuals with AN do not seem to guide their decision-making by future consequences, but rather base their decision-making on serving some immediate goal. It has been shown that individuals with AN also tend to choose immediate gain at the expense of long-term gain in the economic decision-making task known as the Iowa Gambling Task (IGT). This might suggest a behavioural tendency towards short-term goals at the expense of long-term goals that results in impaired decision-making in addition to disturbed eating behaviour. The IGT distinguishes itself from other decison-making tasks in that it is based on a theory that holds that adequate emotional processing is necessary in the cognitive process of decision-making. Specifically, it proposes that an individual generates bodily responses to reward and punishment, and that the individual needs to ‘learn’ from this bodily feedback which choices are advantageous. Since the neurobiological structures underlying this type of decision-making overlap with the neurobiological correlates of eating behaviour, reward and cognitive control, it is interesting to investigate neurobiological alterations in these structures that might contribute to disturbed eating patterns and impaired decision-making. In the current review neurobiological alterations will be discussed regarding reward processing, sensitivity to punishment and cognitive control that might underlie disturbed eating patterns as well as impaired decision-making in AN.