The Role of Habits in Anorexia Nervosa: Where We Are and Where to Go From Here?
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Purpose of Review
The persistent maladaptive eating behavior characteristic of anorexia nervosa (AN) can be understood as a learned habit. This review describes the cognitive neuroscience background and the existing data from research in AN.
Behavior is habitual after it is frequently repeated and becomes nearly automatic, relatively insensitive to outcome, and mediated by dorsal frontostriatal neural systems. There is evidence for such behavior in AN, in which restrictive intake has been related to dorsal frontostriatal systems. Other neural and neurocognitive data provide mixed findings, some of which suggest disturbances in habit systems in AN.
There are compelling behavioral and neural data to suggest that habit systems may underlie the persistence of AN. The habit model needs further research, via more direct behavioral hypothesis testing and probes of the development of habitual behavior. Investigation of the habit-centered model of AN may open avenues for the development of novel treatments.
KeywordsAnorexia nervosa Habit Reward Cognitive neuroscience Eating disorders Frontostriatal
Compliance with Ethical Standards
Conflict of Interest
Blair Uniacke, B. Timothy Walsh, Karin Foerde, and Joanna Steinglass declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 2.American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association; 2013.Google Scholar
- 4.Gard MCE, Freeman CP. The dismantling of a myth: a review of eating disorders and socioeconomic status. Int J Eat Disord. 1996:1–12.Google Scholar
- 5.Balleine BW, O’Doherty JP. Human and rodent homologies in action control: corticostriatal determinants of goal-directed and habitual action. Neuropsychopharmacology. 2010:48–69.Google Scholar
- 8.Balleine BW, Dickinson A. Goal-directed instrumental action: contingency and incentive learning and their cortical substrates. Neuropharmacology. 1998:407–19.Google Scholar
- 10.White NM, McDonald RJ. Multiple parallel memory systems in the brain of the rat. Neurobiol Learn Mem. 2002:125–84.Google Scholar
- 19.Holl AK, Wilkinson L, Tabrizi SJ, Painold A, Jahanshahi M. Probabilistic classification learning with corrective feedback is selectively impaired in early Huntington’s disease-evidence for the role of the striatum in learning with feedback. Neuropsychologia. 2012;50:2176–86.CrossRefPubMedGoogle Scholar
- 42.••Foerde K, Steinglass JE, Shohamy D, Walsh BT. Neural mechanisms supporting maladaptive food choices in anorexia nervosa. Nat Neurosci. 2015;18:1571–3. This study is the first test of the habit-centered hypothesis, demonstrating that among individuals with AN, but not healthy controls, neural activity in the dorsal striatum is associated with making choices about what to eat. CrossRefPubMedPubMedCentralGoogle Scholar
- 44.•Steinglass JE, Glasofer DR, Walsh E, Guzman G, Peterson CB, Walsh BT, Attia EWS. Targeting habits in anorexia nervosa: a proof-of-concept randomized trial. Psychol Med. 2018; (online Feb 19). This study showed that a behavioral intervention-targeting habits was associated with decreased eating disorder pathology and habit strength, as compared with standard supportive psychotherapy in AN. Google Scholar
- 53.Gillan CM, Kosinski M, Whelan R, Phelps EA, Daw ND. Characterizing a psychiatric symptom dimension related to deficits in goal-directed control. elife. 2016;5Google Scholar
- 56.Behavioral Assessment Methods for RDoC Constructs. Natl Inst Ment Health 2016. Available from: https://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/behavioral-assessment-methods-for-rdoc-constructs.shtml
- 60.• Gillan CM, Otto AR, Phelps EA, Daw ND. Model-based learning protects against forming habits. Cogn Affect Behav Neurosci. 2015;15:523–36. This study found that individual differences in model-based (goal-directed) learning predicted the formation of habits. CrossRefPubMedPubMedCentralGoogle Scholar
- 62.Friedel E, Koch SP, Wendt J, Heinz A, Deserno L, Schlagenhauf F. Devaluation and sequential decisions: linking goal-directed and model-based behavior. Front Hum Neurosci. 2014;8Google Scholar
- 74.Berlim MT, van den Eynde F, Tovar-Perdomo S, Daskalakis ZJ. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Psychol Med. 2014;44:225–39.CrossRefPubMedGoogle Scholar