Temptation and restraint. The role of reward and punishment sensitivity in anorexia nervosa, obesity, and unsuccessful dieting

Currently about 50% of the Dutch population is overweight or obese. This means that half of the population is at increased risk for chronic diseases and psychological problems. How is it that so many people have difficulty restricting their food intake? And how can this be reconciled with the other end of the spectrum were patients with anorexia nervosa are so proficient in restricting their food intake that it becomes a threat to their health?In this dissertation it was studied whether individual differences in sensitivity to reward and punishment may play a role in this. We examined whether youngsters with obesity are particularly sensitive to reward (e.g., the rewarding value of food), and youngsters with anorexia nervosa particularly sensitive to punishment (e.g., becoming fat). We did not find a clear role for reward and punishment sensitivity in obesity. However, youngsters with anorexia nervosa were indeed more sensitive to punishment than youngsters without an eating disorder, which may help them to persist in their extreme food restriction. Further, we examined whether youngster with anorexia nervosa might be able to resist the temptation of food because food does not automatically attract their attention. This was indeed the case. Whereas the attention of youngsters without an eating disorder was automatically drawn towards food cues, youngsters with anorexia nervosa who were just starting treatment did not show such a bias in attention. During the follow-up assessment one year later their attention was still not automatically drawn to food even though their eating disorder symptoms had reduced substantially. An important next step is to examine whether the lack of automatic attention for food sets these individuals at risk for relapse, and thereby contributes to the chronic nature of anorexia nervosa.

PhD ceremony 12 September 2019