Examining Behavioral Markers of Reward Processing Dysfunction in Individuals With Anorexia Nervosa and Suicidal Thoughts and Behaviors

OBJECTIVE: Suicidal thoughts and behaviors (STBs) are common in individuals with anorexia nervosa (AN), including those who are weight-restored. Dysfunction in reward processing has been proposed as a mechanism linking AN to STBs; however, little research has interrogated putative reward links between these phenomena. The present study examined behavioral markers associated with STBs in weight-restored AN using two reward-related decision-making tasks. METHOD: Participants included individuals with weight-restored AN (n = 33) with STBs (AN+STB, n = 19) or without STBs (AN-only; n = 14) and healthy controls (HCs; n = 28). Using two behavioral tasks (Food Choice and Web-Surf Tasks), we examined group differences in anticipatory and consummatory reward processing across general and disorder-specific cues, as well as the discrepancy between anticipatory and consummatory responses. RESULTS: No group differences were observed in average responsivity to either general rewards (pleasant videos) or disorder-specific rewards (low-calorie food cues; ps > 0.05). However, the AN+STB group made fewer high-calorie food choices (lower anticipatory reward; p = 0.030), despite comparable tastiness ratings across groups (similar consummatory reward; p = 0.331), resulting in a greater discrepancy between high-calorie food taste ratings and choice (p = 0.035). Across the full sample, fewer high-calorie food choices and larger taste-choice discrepancies were associated with greater self-reported reward/compulsivity for self-starvation (ps < 0.01). DISCUSSION: Reward processing associated with STBs in weight-restored AN may be characterized by diminished anticipatory responses but preserved consummatory responses to disorder-relevant hedonic stimuli, particularly high-calorie foods. Future work clarifying the mechanisms underlying this discrepancy may improve our understanding of, and ability to target, a transdiagnostic dysfunction underlying both eating disorders and co-occurring suicidality.