Neural Correlates of Reward and Symptom Expression in Anorexia Nervosa

Aim 1: To compare patterns of brain activity in reward circuits to typically rewarding cues and disorder-specific cues between weight-restored individuals with anorexia nervosa and non-eating disorder controls

Hypothesis 1a: Activity in reward circuitry will be elevated in response to typically rewarding cues in the non-eating disorder control group versus weight-restored anorexia nervosa group.

Hypothesis 1b: Activity in reward circuitry will be elevated in response to disorder-specific in the weight-restored anorexia nervosa group versus the non-eating disorder control group.

Aim 2: To specify the relationship between brain patterns related to reward and restrictive eating among weight-restored individuals with anorexia nervosa

Hypothesis 2a: Lower reward circuit activity in response to typically rewarding cues will predict lower test meal intake for weight-restored anorexia nervosa group versus the non-eating disorder control group.

Hypothesis 2b: Higher reward circuit activity in response to disorder-specific cues will predict lower test meal intake for the weight-restored anorexia nervosa group versus the non-eating disorder control group.

Aim 3: To identify the brain patterns in reward circuitry associated with the risk of relapse among weight-restored individuals with anorexia nervosa in the year following weight-restoration.

Hypothesis 3a: Lower reward circuit activity in response to typically rewarding cues will predict relapse in the weight-restored anorexia nervosa group.

Hypothesis 3b: Higher reward circuit activity in response to disorder-specific cues will predict relapse in the weight-restored anorexia nervosa group.

Inclusion criteria

• Age > 18 years old
• Current BMI > 18.5 kg/m2
• Ability to read and speak in English
• Right-handed
• Weight restored Anorexia Nervosa group: 1) DSM-5 diagnosis of AN in the past 6 months, with the exception of body image disturbance and intense fear of weight gain criteria; 2) BMI < 18.5 kg/m2 within past 6 months

Exclusion criteria

• Medical instability or current pregnancy
• Current substance use disorder, psychosis, or bipolar-I disorder
• Contraindication for fMRI
• History of neurological disorder/injury (e.g., stroke; head injury with > 10 minutes loss of consciousness)
• Food allergy that cannot be accommodated through substitutions to the laboratory test meal
• Lacking capacity to consent
• Non-eating disorder Control group: Current DSM-5 Axis-I diagnosis or current or past eating disorder diagnosis