Altered medial frontal feedback learning signals in anorexia nervosa

Background

In their relentless pursuit of thinness, individuals with anorexia nervosa (AN) engage in maladaptive behaviors (restrictive food choices, over-exercising) which may originate in altered decision-making and learning.

Methods

In this fMRI study we employed computational modelling to elucidate the neural correlates of feedback learning and value-based decision making in 36 female AN patients and 36 age-matched healthy volunteers (12-24 years). Participants performed a decision task which required adaptation to changing reward contingencies. Data were analyzed within a hierarchical Gaussian filter model, which captures inter-individual variability in learning under uncertainty.

Results

Behaviorally, patients displayed an increased learning rate specifically after punishments. At the neural level, hemodynamic correlates for learning rate, expected value and prediction error did not differ between the groups. However, activity in the posterior medial frontal cortex was elevated in AN following punishment.

Conclusion

Our findings suggest that the neural underpinning of feedback learning is selectively altered for punishment in AN.