Investigating Associations between General and Disorder-Specific Reward and Suicidality in Anorexia Nervosa

Altered reward processing is proposed to be central to the pathology of anorexia nervosa (AN), but less is known about how aspects of reward dysfunction relate to suicidal thoughts and behaviors (STBs) in AN. We compared responses on self-report measures of general (i.e., anticipatory, consummatory, and social reward) and disorder-specific (i.e., self-starvation reward) reward between individuals with AN with (AN+STBs; n=28) or without (AN; n=31) a lifetime history of active STBs and healthy controls (HC; n=32). Further, we examined whether interactions between general and disorder-specific reward dysfunction were associated with a history of active STBs in AN. Compared to the AN and HC groups, the AN+STBs group reported lower anticipatory (p<.001) and social reward (p=.003), while both AN+STBs and AN groups reported higher self-starvation reward than HCs (p<.001). Consummatory reward did not differ by group (p=.553). The interaction between anticipatory and self-starvation reward was significantly associated with STB risk (p=.007): individuals with AN who reported high self-starvation reward were at elevated risk for STBs regardless of anticipatory reward levels, whereas those with low self-starvation reward showed increased STBs only when anticipatory reward was also low. All results remained robust after accounting for the effects of depression. Taken together, our results suggest that the combination of general and disorder-specific reward processes may shape distinct risk profiles for suicidality among individuals with AN.