Reduced contextual influence on decision conflict during delay discounting persists after weight-restoration in anorexia nervosa

Prior research has investigated whether the capacity of individuals with anorexia nervosa (AN) to forgo food rewards in their pursuit of thinness may manifest as more delayed gratification in delay discounting tasks, but results have been mixed. In a previous study examining mouse-cursor movement trajectories during a delay discounting task, underweight patients with AN made similar decisions relative to healthy controls, but displayed more stable levels of decision-making conflict. Here, we employed the exact same methods to test whether these changes persist after long-term weight restoration. We recorded mouse-cursor trajectories during a delay discounting task in 45 female adolescents and young women weight-restored from AN (wrAN) and 90 female healthy controls (HC). We examined group differences in deviations from a direct choice path as a measure of decision-making conflict strength and moderation effects of associated predictors (e.g., choice difficulty). No group differences were detected in either delay discounting parameters or mouse cursor trajectories, and the effect of the aforementioned predictors on deviations was reduced in wrAN relative to HC. Persisting reduced variability of conflict strength across decisions might reflect a cognitive-behavioral trait marker of AN. This may enable individuals with AN to pursue long-term (body-weight) goals, because particularly conflicting choices may not be experienced as such.