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Insensitivity to Losses: A Core Feature in Patients With Anorexia Nervosa?

Journal article
Authors J. P. H. Verharen
U. N. Danner
S. Schröder
E. Aarts
A. A. van Elburg
Roger A. H. Adan
Published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
ISSN 2451-9022
Publication year 2019
Published at Institute of Neuroscience and Physiology
Language en
Keywords Anorexia nervosa, Computational modeling, Decision making, Eating disorders, Iowa Gambling Task, Value
Subject categories Neurosciences


Background: Patients with anorexia nervosa (AN) demonstrate aberrations in choice behavior, including impairments in laboratory measures of decision making. Although a wealth of studies suggest that these aberrations arise from alterations in value processing, it remains unclear by which core component of value processing this is mediated. Methods: We fit trial-by-trial data of patients with AN (n = 60 first cohort, n = 216 second cohort) and healthy control participants (n = 55) performing the Iowa Gambling Task to a computational model based on prospect utility theory. We determined, per participant, the best-fit model parameters and compared these between the groups. Results: Analyses revealed a decreased estimate of model parameter λ in patients with AN, indicative of an attenuation of loss-aversive behavior in the Iowa Gambling Task. In comparison, measures of reward sensitivity, value-based learning, and exploration versus exploitation were unaltered in patients with AN. A measurement in a second independent cohort replicated the finding that loss aversion, typically observed in healthy individuals, is reduced in patients with AN. Conclusions: We show that patients with AN, in contrast to healthy control participants, demonstrate reduced loss-aversive behavior. This finding provides important fundamental insights into the decision-making capacity of patients with AN, suggesting alterations in the mechanisms involved in value processing related to negative feedback. © 2019

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