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Affect, reward, and punishment in anorexia nervosa: a narrative overview

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Abstract

Introduction

Anorexia nervosa (AN) is a serious psychiatric disorder that is difficult to treat and often follows a protracted course. A number of theoretical models have been proposed for the etiology and maintenance of AN. Two domains that have received substantial attention in the literature on AN are affect and reward/punishment processes. However, despite an overlap in the nature and implications of these processes, studies of AN addressing these constructs have typically investigated them independently.

Purpose

The purpose of this narrative review is to integrate the literature on the role of affect, reward, and punishment in AN.

Method

We provide a focused narrative overview of the literature relating to the affect, reward, and punishment in AN via a synthesis of recent reviews and meta-analyses.

Results

We first describe several prominent affect and reward/punishment-based conceptualizations of AN, followed by a brief overview of the existing empirical literature in these domains.

Conclusion

We provide a critical discussion of the disparate nature of these literatures in AN, including associated limitations. We then conclude with an extensive discussion of directions for future research that integrate the study of affect and reward/punishment processes in AN.

Level of evidence

Level V, narrative review.

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Acknowledgements

Margarita Sala is supported by the National Science Foundation (NSF) Graduate Research Fellowship under Grant No. DGE-1645420. Amy H. Egbert is supported by the National Science Foundation (NSF) Graduate Research Fellowship. Jason Lavender is supported by National Institute of Health (NIH) grant K23MH101342. Andrea Goldschmidt is supported by NIH grant K23DK105234. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the NSF or NIH.

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Authors and Affiliations

  1. Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, 75206, USA

    Margarita Sala

  2. Department of Psychology, Loyola University Chicago, Chicago, IL, USA

    Amy H. Egbert

  3. Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA

    Jason M. Lavender

  4. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center/The Miriam Hospital, Providence, RI, USA

    Andrea B. Goldschmidt

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  1. Margarita Sala
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Correspondence to Margarita Sala.

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Sala, M., Egbert, A.H., Lavender, J.M. et al. Affect, reward, and punishment in anorexia nervosa: a narrative overview. Eat Weight Disord 23, 731–737 (2018). https://doi.org/10.1007/s40519-018-0588-9

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