Avoidance habit learning after recovery from anorexia nervosa: An <scp>fMRI</scp> study

BACKGROUND: Anorexia Nervosa (AN) has been linked to altered self-regulatory control processes and maladaptive habitual avoidance behavior. Both goal-directed and habit systems may be relevant to AN, in which restrictive eating behavior can appear highly deliberate and increasingly automatic over time. A previous fMRI study identified behavioral and neural markers hinting at heightened self-regulatory control ('overcontrol') during an avoidance habit task in acutely underweight adolescents and young women with AN. Extending this research to recovered individuals with a history of AN (recAN), we aimed to clarify whether these findings persist and can be seen as trait vulnerabilities. METHODS: A sample of 40 recAN and 40 pairwise age-matched healthy control (HC) participants carried out a three-phase experimental paradigm including (1) training of goal-directed response-outcome behavior, (2) training of avoidance stimulus-response pairings, and (3) a test of habitual response interference. Our fMRI analysis strategy focused on capturing training-related changes in neural activity related to reinforcement learning processes. RESULTS: Analyses of main effects of task confirmed expected behavioral and fMRI results. However, unlike previous findings of greater activation in frontoparietal control regions in young acutely underweight patients with AN during the establishment of avoidance behavior and of higher task performance, all behavioral task measures, region-of-interest fMRI, and follow-up whole-brain analyses yielded no group differences between recAN and HC. CONCLUSIONS: Our findings of intact avoidance habit learning after recovery from AN suggest that correlates of overcontrol previously observed in acutely underweight individuals with AN may reflect state-dependent rather than persistent trait markers of the disorder.