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Beyond Description and Deficits: How Computational Psychiatry Can Enhance an Understanding of Decision-Making in Anorexia Nervosa

  • EATING DISORDERS (J STEINGLASS, SECTION EDITOR)
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Abstract

Purpose of Review

Despite decades of research, knowledge of the mechanisms maintaining anorexia nervosa (AN) remains incomplete and clearly effective treatments elusive. Novel theoretical frameworks are needed to advance mechanistic and treatment research for this disorder. Here, we argue the utility of engaging a novel lens that differs from existing perspectives in psychiatry. Specifically, we argue the necessity of expanding beyond two historically common perspectives: (1) the descriptive perspective: the tendency to define mechanisms on the basis of surface characteristics and (2) the deficit perspective: the tendency to search for mechanisms associated with under-functioning of decision-making abilities and related circuity, rather than problems of over-functioning, in psychiatric disorders.

Recent Findings

Computational psychiatry can provide a novel framework for understanding AN because this approach emphasizes the role of computational misalignments (rather than absolute deficits or excesses) between decision-making strategies and environmental demands as the key factors promoting psychiatric illnesses. Informed by this approach, we argue that AN can be understood as a disorder of excess goal pursuit, maintained by over-engagement, rather than disengagement, of executive functioning strategies and circuits. Emerging evidence suggests that this same computational imbalance may constitute an under-investigated phenotype presenting transdiagnostically across psychiatric disorders.

Summary

A variety of computational models can be used to further elucidate excess goal pursuit in AN. Most traditional psychiatric treatments do not target excess goal pursuit or associated neurocognitive mechanisms. Thus, targeting at the level of computational dysfunction may provide a new avenue for enhancing treatment for AN and related disorders.

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Acknowledgements

Authors would like to acknowledge the Neuroplasticity in Support of Mental Health (NeuroPRSMH) interdisciplinary workgroup who provided feedback on and refinement of the theoretical areas outlined in this manuscript and Jesse W. Dzmobak who assisted with our figure.

Funding

This work was supported in part by the National Institutes of Health (K23MH112867, K23MH123910; T32MH096679; P50MH119569; UH3NS100548, R01MH119384, R21MH120785), the Hilda and Preston Davis Foundation, the MnDRIVE Brain Conditions Initiative, and the Medical Discovery Team—Addictions at the University of Minnesota.

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  1. Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN, F 253, USA

    Ann F. Haynos, Alik S. Widge & Lisa M. Anderson

  2. Department of Neuroscience, University of Minnesota, 6-145 Jackson Hall 321 Church St. SE, Minneapolis, MN, 55455, USA

    A. David Redish

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  1. Ann F. Haynos
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All authors contributed to the manuscript conception and design. The first draft of the manuscript was written by A. F. Haynos, and all authors provided feedback on subsequent versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ann F. Haynos.

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A.S. Widge reports consulting income from Circuit Therapeutics and Dandelion Science and multiple unlicensed patents in the area of neurostimulation. Other authors have no relevant financial or non-financial interests to disclose.

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Haynos, A.F., Widge, A.S., Anderson, L.M. et al. Beyond Description and Deficits: How Computational Psychiatry Can Enhance an Understanding of Decision-Making in Anorexia Nervosa. Curr Psychiatry Rep 24, 77–87 (2022). https://doi.org/10.1007/s11920-022-01320-9

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