Anorexia nervosa (AN) is an eating disorder associated with intense fear of weight gain, food
refusal, and severe weight loss. AN has the highest mortality rate among the psychiatric
disorders; however, little is known about biomarkers, and no medication has been approved for
AN. Many individuals only partially recover, and treatment options, especially for the
psychological components of the illness, are not very effective, highlighting the need for
more effective treatments.
Brain reward pathways have a direct impact on the drive to eat, and a variety of neuroimaging
studies have suggested altered reward processing in AN. The neurotransmitter dopamine has a
central role in the reward circuitry to drive food approach, and the dynamic interplay
between dopamine receptor response and food restriction could have implications for the
pathophysiology of AN. Dopamine-related brain function has been studied indirectly using
functional magnetic resonance brain imaging (fMRI) and tasks that deliver reward stimuli
unexpectedly, that elicit the so-called prediction error (PE) response.
Research in AN showed repeatedly altered PE processing suggesting altered dopamine circuit
function in the disorder.
Dopamine and PE response have also been associated with altered reversal learning, which has
important treatment implication for AN as reversal learning is impaired in the disorder and
modulation of the dopamine system could improve treatment.
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