A multi-modal assessment of fear conditioning in adolescent anorexia nervosa.

OBJECTIVE: Anorexia nervosa (AN) is a pernicious psychiatric disorder which is principally characterized by a fear of weight gain. Notwithstanding the centrality of fear in the psychopathology of AN, controlled assessments of negative valence systems are lacking. Herein we assess fear conditioning in adolescent females with AN. METHOD: Adolescent girls (Mage = 14.6 years, ±1.57) with DSM-5 diagnoses of AN (N = 25) and age-matched control girls (Mage = 14.8 years, ±1.46) with no DSM-5 diagnoses (N = 25) completed structured clinical interviews and participated in a classical three-phase Pavlovian fear conditioning paradigm. Participants with comorbid anxiety disorders were excluded. Skin conductance response (SCR) was measured, alongside self-reported fear, valence, and fear expectancy ratings. RESULTS: Both groups demonstrated significant differential acquisition across all four measures. Regarding group comparisons, no differences emerged for self-reported fear, valence, and fear expectancy ratings during acquisition, although for SCR, those with AN demonstrated reduced physiological arousal relative to controls. Both groups demonstrated significant differential extinction for unconditioned stimuli (US) expectancy, self-report fear, and self-report valence. No statistically significant group differences were evident during extinction to the conditioned stimuli (CS)+, on any outcome measure. However, controls reported more positive valence to the CS- than those with AN. CONCLUSIONS: Contrary to our hypotheses, our preliminary assessment did not find support for elevated fear responding among adolescent girls with AN with regards to fear acquisition or extinction. These data suggest that AN in adolescent girls may not be associated with a heightened propensity to acquire fear, but conversely, may suggest that exposure treatments for AN may be helpful, since extinction learning is intact in AN. PUBLIC SIGNIFICANCE: AN is characterized by fear-related symptoms, including food and weight-related fear, and behavioral avoidance, yet controlled studies assessing fear learning are limited. Our preliminary assessment of adolescent AN indicates no abnormalities in fear learning among adolescents with AN. These findings may inform existing mechanistic models of AN psychopathology, and the development of exposure-based treatments for AN.

Economic Decisions with Ambiguous Outcome Magnitudes Vary with Low and High Stakes but Not Trait Anxiety or Depression.

Most of life's decisions involve risk and uncertainty regarding whether reward or loss will follow. Decision makers often face uncertainty not only about the likelihood of outcomes (what are the chances that I will get a raise if I ask my supervisor? What are the chances that my supervisor will be upset with me for asking?) but also the magnitude of outcomes (if I do get a raise, how large will it be? If my supervisor gets upset, how bad will the consequences be for me?). Only a few studies have investigated economic decision making with ambiguous likelihoods, and even fewer have investigated ambiguous outcome magnitudes. In the present report, we investigated the effects of ambiguous outcome magnitude, risk, and gains/losses in an economic decision-making task with low stakes (Study 1; $3.60-$5.70; N = 367) and high stakes (Study 2; $6-$48; N = 210) using a within-subjects design. We conducted computational modeling to determine individuals' preferences/aversions for ambiguous outcome magnitudes, risk, and gains/losses. We additionally investigated the association between trait anxiety and trait depression and decision-making parameters. Our results show that increasing stakes increased ambiguous gain aversion and unambiguous risk aversion but increased ambiguous sure loss preference; participants also became more averse to ambiguous sure gains relative to unambiguous risky gains. There were no significant effects of trait anxiety or trait depression on economic decision making. Our results suggest that as stakes increase, people tend to avoid uncertainty in the gain domain (especially ambiguous gains) but prefer ambiguous vs unambiguous sure losses.