Punishment sensitivity and the persistence of anorexia nervosa: High punishment sensitivity is related to a less favorable course of anorexia nervosa

Delving into the role of reward and punishment sensitivity in anorexia nervosa: Punishment responsivity as the only predictor of eating disorder symptom persistence in adolescents

OBJECTIVE

This study differentiated between self-reported punishment responsivity (PR) and motivation to avoid punishment (MP) and examined their relationship with anorexia nervosa (AN) and its course in a combined cross-sectional and longitudinal approach. We explored whether inconsistent findings regarding reward sensitivity may be explained by previous research not differentiating between reward responsivity (RR) and motivation to approach reward (MR).

METHOD

Participants were 69 adolescents with AN and 69 adolescents without AN matched on age, sex and educational level. Eating disorder (ED) symptom severity, PR, MP, RR, and MR were assessed at the start of treatment and 1 year later.

RESULTS

Only PR was higher in patients with AN than in the comparison group. Both PR and MP decreased over the course of 1 year, however, only the reduction in PR was related to the reduction in ED symptoms. Lastly, only higher baseline PR was independently related to less improvement in ED symptoms over the course of 1 year.

CONCLUSION

There was no support for the involvement of RS or its specific dimensions in AN. Most critical, the findings suggest that specifically the PR dimension of punishment sensitivity is related to the persistence of AN and could be an important target for treatment.

Change in motivational bias during treatment predicts outcome in anorexia nervosa

OBJECTIVE

Reward and punishment sensitivity are known to be altered in anorexia nervosa (AN). Most research has examined these constructs separately although motivated behavior is influenced by considering both the potential for reward and risk of punishment. The present study sought to compare the relative balance of reward and punishment sensitivity in AN versus healthy controls (HCs) and examine whether motivational bias is associated with AN symptoms and treatment outcomes.

METHODS

Adolescents and adults with AN (n = 262) in a partial hospitalization program completed the Eating Disorders Examination Questionnaire (EDE-Q), Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ) at admission and discharge. HCs (HC; n = 90) completed the BIS/BAS and SPSRQ. Motivational Bias Scores were calculated to reflect the dominance of reward versus punishment sensitivity.

RESULTS

Individuals with AN demonstrated significantly greater bias toward punishment sensitivity than HC. In AN, a bias toward punishment was associated with higher EDE-Q Global score at admission. Change in motivational bias during treatment predicted EDE-Q Global scores, but not BMI, at discharge, with greater increases in reward sensitivity or greater decreases in punishment sensitivity during treatment predicting lower eating pathology. Similar findings were observed using the BIS/BAS and SPSRQ.

DISCUSSION

Change in motivational bias during treatment is associated with improved outcomes in AN. However, it appears that much of the change in motivational bias can be attributed to changes in punishment sensitivity, rather than reward sensitivity. Future research should examine the mechanisms underlying punishment sensitivity decreases during treatment.

PUBLIC SIGNIFICANCE

Sensitivity to reward and punishment may be important treatment targets for individuals with anorexia nervosa (AN). To date, most research has considered reward and punishment sensitivity separately, rather than examining their relationship to each other. We found that the balance of reward and punishment sensitivity (i.e., motivational bias) differs between healthy controls and those with AN and that this bias is associated with eating disorder symptoms and treatment outcome.