Food-specific decision-making in anorexia nervosa: a comparative study of clinical, at-risk, and healthy control groups.

This study compared individuals with Restrictive Anorexia Nervosa (R-AN;  = 40), Healthy Controls (HCs;  = 45), and individuals at risk for eating disorders (RI;  = 38) using a Reinforcement Learning (RL) paradigm. Participants completed a Probabilistic Reversal Learning (PRL) task involving food-related and neutral contexts. The study examined whether RL impairments in R-AN are context-specific and whether they reflect maintaining factors or preclinical markers. R-AN participants showed reduced learning rates in food-related contexts compared to HC and RI but performed similarly in neutral contexts. Only R-AN individuals showed within-group differences between food and neutral tasks, indicating a disorder-specific impairment. The RI group performed comparably to HCs, suggesting that RL deficits are unlikely to be risk markers. These findings highlight the context-specificity of RL deficits in R-AN, which may act as maintaining factors and could be targeted to improve cognitive flexibility and food-related decision-making.