Delving into the role of reward and punishment sensitivity in anorexia nervosa: Punishment responsivity as the only predictor of eating disorder symptom persistence in adolescents.

Objective: This study differentiated between self-reported punishment responsivity (PR) and motivation to avoid punishment (MP) and examined their relationship with anorexia nervosa (AN) and its course in a combined cross-sectional and longitudinal approach. We explored whether inconsistent findings regarding reward sensitivity may be explained by previous research not differentiating between reward responsivity (RR) and motivation to approach reward (MR).

Method: Participants were 69 adolescents with AN and 69 adolescents without AN matched on age, sex and educational level. Eating disorder (ED) symptom severity, PR, MP, RR, and MR were assessed at the start of treatment and 1 year later.

Results: Only PR was higher in patients with AN than in the comparison group. Both PR and MP decreased over the course of 1 year, however, only the reduction in PR was related to the reduction in ED symptoms. Lastly, only higher baseline PR was independently related to less improvement in ED symptoms over the course of 1 year.

Conclusion: There was no support for the involvement of RS or its specific dimensions in AN. Most critical, the findings suggest that specifically the PR dimension of punishment sensitivity is related to the persistence of AN and could be an important target for treatment.