Insensitivity to Losses: A Core Feature in Patients With Anorexia Nervosa?

Biol Psychiatry Cogn Neurosci Neuroimaging. 2019 Nov;4(11):995-1003. doi: 10.1016/j.bpsc.2019.05.001. Epub 2019 May 13.


Background: Patients with anorexia nervosa (AN) demonstrate aberrations in choice behavior, including impairments in laboratory measures of decision making. Although a wealth of studies suggest that these aberrations arise from alterations in value processing, it remains unclear by which core component of value processing this is mediated.

Methods: We fit trial-by-trial data of patients with AN (n = 60 first cohort, n = 216 second cohort) and healthy control participants (n = 55) performing the Iowa Gambling Task to a computational model based on prospect utility theory. We determined, per participant, the best-fit model parameters and compared these between the groups.

Results: Analyses revealed a decreased estimate of model parameter λ in patients with AN, indicative of an attenuation of loss-aversive behavior in the Iowa Gambling Task. In comparison, measures of reward sensitivity, value-based learning, and exploration versus exploitation were unaltered in patients with AN. A measurement in a second independent cohort replicated the finding that loss aversion, typically observed in healthy individuals, is reduced in patients with AN.

Conclusions: We show that patients with AN, in contrast to healthy control participants, demonstrate reduced loss-aversive behavior. This finding provides important fundamental insights into the decision-making capacity of patients with AN, suggesting alterations in the mechanisms involved in value processing related to negative feedback.

Keywords: Anorexia nervosa; Computational modeling; Decision making; Eating disorders; Iowa Gambling Task; Value.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa / physiopathology*
  • Decision Making / physiology*
  • Female
  • Humans
  • Male
  • Models, Theoretical
  • Reward*
  • Young Adult