BACKGROUND In their relentless pursuit of thinness, individuals with anorexia nervosa (AN) engage in maladaptive behaviors (restrictive food choices and overexercising) that may originate in altered decision making and learning. METHODS In this functional magnetic resonance imaging study, we employed computational modeling to elucidate the neural correlates of feedback learning and value-based decision making in 36 female patients with AN and 36 age-matched healthy volunteers (12-24 years). Participants performed a decision task that required adaptation to changing reward contingencies. Data were analyzed within a hierarchical Gaussian filter model that captures interindividual variability in learning under uncertainty. RESULTS Behaviorally, patients displayed an increased learning rate specifically after punishments. At the neural level, hemodynamic correlates for the learning rate, expected value, and prediction error did not differ between the groups. However, activity in the posterior medial frontal cortex was elevated in AN following punishment. CONCLUSIONS Our findings suggest that the neural underpinning of feedback learning is selectively altered for punishment in AN.

中文翻译：

---

神经性厌食症患者内侧额叶反馈学习信号的改变

背景 在他们对瘦身的不懈追求中，患有神经性厌食症 (AN) 的个体会出现适应不良行为（限制性食物选择和过度运动），这些行为可能源于决策和学习的改变。方法 在这项功能性磁共振成像研究中，我们采用计算模型来阐明 36 名患有 AN 的女性患者和 36 名年龄匹配的健康志愿者（12-24 岁）的反馈学习和基于价值的决策的神经相关性。参与者执行了一项决策任务，需要适应不断变化的奖励突发事件。在分层高斯滤波器模型中分析数据，该模型捕捉不确定性下学习的个体差异。结果 在行为上，患者特别是在受到惩罚后表现出学习率的提高。在神经层面，各组之间的学习率、预期值和预测误差的血流动力学相关性没有差异。然而，AN 中后内侧额叶皮层的活动在惩罚后升高。结论我们的研究结果表明，反馈学习的神经基础被选择性地改变以应对 AN 中的惩罚。