Not Just a Choice, and Not Just a Habit: A Neural and Psychological Investigation of Maladaptive Food Avoidance in Anorexia Nervosa

Abstract

Anorexia Nervosa (AN) is characterized by severe and persistent dietary restriction that persists even when individuals consciously seek to change, suggesting that food avoidance in this population cannot be fully explained by either habit-based or goal-directed decision-making frameworks alone. The present study investigated the neural and behavioral mechanisms underlying maladaptive food-related decision making in AN, with a focus on task-dependent functional connectivity between the dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) during food choice. Using secondary fMRI data from Foerde et al. (2015), behavioral and neural responses during a food choice task were examined in individuals with AN and healthy controls. Behaviorally, AN rated foods less favorably, chose food at lower rates across all categories, and resisted liked-unhealthy foods significantly more than HC, reflecting both altered food perception and excessive dietary control. At the neural level, HC showed significantly stronger dlPFC-vmPFC connectivity than AN during high-fat food trials specifically, and significant group differences manifested during self-control failure rather than success trials. Taken together, these findings suggest that the prefrontal valuation circuit supporting flexible dietary self-control in healthy individuals is not the mechanism driving food restriction in AN. Instead, food avoidance in this population appears to reflect a more rigid, reorganized decision-making system operating through altered control and valuation pathways. Beyond this implication, these results suggest that interventions aimed at restoring flexible, context dependent communication between prefrontal control and valuation regions may be more effective than approaches that inadvertently reinforce rigid neural patterns already driving restriction in AN.