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Increased Capacity to Delay Reward in Anorexia Nervosa

Published online by Cambridge University Press:  16 May 2012

Joanna E. Steinglass*
Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, New York
Bernd Figner
Center for Decision Sciences, Columbia University, New York, New York Department of Psychology, University of Amsterdam, The Netherlands
Staci Berkowitz
Department of Psychology, Drexel University, Philadelphia, Pennsylvania
H. Blair Simpson
Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, New York
Elke U. Weber
Center for Decision Sciences, Columbia University, New York, New York Graduate School of Business, Columbia University, New York, New York
B. Timothy Walsh
Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, New York
Correspondence and reprint requests to: Joanna Steinglass,1051 Riverside Drive, Unit 98, New York, NY 10032. E-mail:


Individuals with anorexia nervosa (AN) are often characterized as possessing excessive self-control and are unusual in their ability to reduce or avoid the consumption of palatable foods. This behavior promotes potentially life-threatening weight loss and suggests disturbances in reward processing. We studied whether individuals with AN showed evidence of increased self-control by examining the tendency to delay receipt of a monetary, non-food related, reward. Underweight AN (n = 36) and healthy controls (HC, n = 28) completed a monetary intertemporal choice task measuring delay discounting factor. Individuals with AN reduced the value of a monetary reward over time significantly less than HC (F[1,61] = 5.03; p = 0.029). Secondary analyses indicated that the restricting subtype of AN, in particular, showed significantly less discounting than HC (F[1,46] = 8.3; p = 0.006). These findings indicate that some individuals with AN show less temporal discounting than HC, suggestive of enhanced self-control that is not limited to food consumption. This is in contrast to other psychiatric disorders, for example, substance abuse, which are characterized by greater discounting. Though preliminary, these findings suggest that excessive self-control may contribute to pathological processes and individuals with AN may have neuropsychological characteristics that enhance their ability to delay reward and thereby may help to maintain persistent food restriction. (JINS, 2012, 18, 1–8)

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Copyright © The International Neuropsychological Society 2012

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