Abstract
Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.
| Original language | English (US) |
|---|---|
| Article number | 101872 |
| Journal | Clinical Psychology Review |
| Volume | 79 |
| DOIs | |
| State | Published - Jul 2020 |
Bibliographical note
Funding Information:This work was supported by the National Institute of Mental Health of the National Institutes of Health (award numbers T32MH082761 , K23MH112867 , and K23MH101342 ), Klarman Family Foundation , and Hilda and Preston Davis Foundation . This research did not receive funding from agencies in the public, commercial, or not-for-profit sectors. The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the National Institute of Health, Uniformed Services University, or the Department of Defense. We thank Dr. Stephen Wonderlich and Dr. Kelly Berg for their contributions to informing the concept of this manuscript.
Funding Information:
Ann F. Haynos, Ph.D. is an Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Minnesota. Dr. Haynos received her Ph.D. in clinical psychology from the University of Nevada, Reno and completed a predoctoral internship at Duke University Medical Center and a postdoctoral fellowship at the University of Minnesota through the NIMH-funded T32 Midwest Regional Postdoctoral Training Grant in Eating Disorders Research. Dr. Haynos' research focuses on unifying psychology and neuroscience to elucidate and intervene upon the precise decision-making mechanisms that promote the development and maintenance of eating disorders, especially anorexia nervosa. She is also interested in using novel computational methods and analytical tools to enhance research on eating disorders.
Funding Information:
Jason M. Lavender, Ph.D. is the Deputy Director of Research for the Military Cardiovascular Outcomes Research Program (MiCOR) at the Uniformed Services University of the Health Sciences. He received his Ph.D. in clinical psychology from the University at Albany, State University of New York and completed a postdoctoral research fellowship at the Neuropsychiatric Research Institute through the NIMH-funded T32 Midwest Regional Postdoctoral Training Grant in Eating Disorders Research. Dr. Lavender's research focuses on dispositional and momentary factors contributing to the onset and maintenance of dysregulated eating among individuals across the weight spectrum. His interests also include multi-method study designs, with an emphasis on linking laboratory-based methods and real-world, real-time data collection.
Funding Information:
This work was supported by the National Institute of Mental Health of the National Institutes of Health (award numbers T32MH082761 , K23MH112867 , and K23MH101342 ), Klarman Family Foundation , and Hilda and Preston Davis Foundation . The National Institutes of Health, Klarman Family Foundation, and Hilda and Preston Davis Foundation had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Funding Information:
This work was supported by the National Institute of Mental Health of the National Institutes of Health (award numbers T32MH082761, K23MH112867, and K23MH101342), Klarman Family Foundation, and Hilda and Preston Davis Foundation. This research did not receive funding from agencies in the public, commercial, or not-for-profit sectors. The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the National Institute of Health, Uniformed Services University, or the Department of Defense. We thank Dr. Stephen Wonderlich and Dr. Kelly Berg for their contributions to informing the concept of this manuscript.This work was supported by the National Institute of Mental Health of the National Institutes of Health (award numbers T32MH082761, K23MH112867, and K23MH101342), Klarman Family Foundation, and Hilda and Preston Davis Foundation. The National Institutes of Health, Klarman Family Foundation, and Hilda and Preston Davis Foundation had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Publisher Copyright:
© 2020 Elsevier Ltd
Keywords
- Anorexia nervosa
- Appetitive
- Aversive
- Eating disorders
- Punishment
- Reward
