On weight and waiting: delay discounting in anorexia nervosa pretreatment and posttreatment
Open accessAbstract
Background Individuals with anorexia nervosa (AN) override the drive to eat, forgoing immediate rewards in favor of longer-term goals. We examined delay discounting and its neural correlates in AN before and after treatment to test a potential mechanism of illness persistence.Methods Inpatients with AN (n = 59) and healthy control subjects (HC, n = 39) performed a delay discounting task at two time points. A subset (n = 30 AN, n = 22 HC) participated in functional magnetic resonance imaging scanning during the task. The task consisted of a range of monetary choices with variable delay times, yielding individual discount rates-the rate by which money loses value over time.Results Before treatment, the AN group showed a preference for delayed over earlier rewards (i.e., less steep discount rates) compared with HC; after weight restoration, AN did not differ from HC. Underweight AN showed slower response times for earlier versus delayed choices; this reversed with treatment. Underweight AN showed abnormal neural activity in striatum and dorsal anterior cingulate; normalization of behavior was associated with increased activation in reward regions (striatum and dorsal anterior cingulate) and decision-making regions (dorsolateral prefrontal cortex and parietal cortex).Conclusions The undernourished state of AN may amplify the tendency to forgo immediate rewards in favor of longer-term goals. The results suggest that behavior that looks phenotypically like excessive self-control does not correspond with enhanced prefrontal recruitment. Rather, the results point to alterations in cingulostriatal circuitry that offer new insights on the potential role of abnormalities in decision-making neural systems in the perpetuation of AN.
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AN patients have altered frontostriatal activation on executive function tasks including the Wisconsin Card Sorting Task and delay discounting.
“Similarly, AN patients have also been shown to have altered frontostriatal activation on executive function tasks, including the Wisconsin Card Sorting Task (Lao-Kaim et al., 2015), and delay discounting (Wierenga et al., 2014; Decker et al., 2015).”
From Cortico-striatal-thalamic loop circuits of the salience network: A central pathway in psychiatric disease and treatment (2016) · cites this paper as Decker et al., 2015
Not only has heightened DD been correlated with health and disorder-related outcomes, but lower-than-average discount rates have also been associated with pathology (e.g., anorexia).
“not only has heightened DD been correlated with health and disorder-related outcomes, but lower-than-average discount rates have also been associated with pathology (e.g., anorexia; Decker, Figner, & Steinglass, 2015).”
From Behavioral trainings and manipulations to reduce delay discounting: A systematic review (2019) · cites this paper as Decker, Figner, & Steinglass, 2015
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“Similarly, AN patients have also been shown to have altered frontostriatal activation on executive function tasks, including the Wisconsin Card Sorting Task (LaoKaim et al., 2015), and delay discounting (Wierenga et al., 2014; Decker et al., 2015).”
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- Authors
- Decker, J. H., Figner, B., & Steinglass, J. E.
- Affiliations
- Weill Cornell Medicine (US)
- Radboud University Nijmegen (NL)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Decker, Johannes Hugo
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 78
- Issue
- 9
- Pages
- 606-614
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC4478277
- OpenAlex
- W2110534460
- Cited by
- 163
- References
- 51
- Citations by year
- 2026: 5 · 2025: 20 · 2024: 13 · 2023: 10 · 2022: 8 · 2021: 15 · 2020: 21 · 2019: 16 · 2018: 11 · 2017: 21 · 2016: 14 · 2015: 9
- FWCI
- 17.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Biological Psychiatry (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- National Institute of Mental Health (K23MH076195)
- National Science Foundation (NSF SES–0922743, PA001–115327)
- National Institutes of Health (T32GM007739)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- anorexia nervosa, delay discounting, impulsivity, weight restoration, striatum, dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, decision-making, treatment response
- MeSH terms
- Adult, Anorexia Nervosa, Body Weight, Brain, Brain Mapping, Female, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Neuropsychological Tests, Reward, Body Mass Index, Treatment Outcome, Young Adult, Delay Discounting
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