Prefrontal and ventral striatal neural correlates of reversal learning in anorexia nervosa and bulimia nervosa

Difficulty with reversal learning (RL)—appropriately shifting behavior following outcome contingency changes—may represent a shared or distinct mechanism across eating disorder (ED) diagnoses. We tested whether RL-related neural correlates differ among adults without and with EDs (anorexia nervosa, restricting subtype [AN-R], AN binge-eating/purging subtype [AN-BP], and bulimia nervosa [BN]) and whether these correlates correspond to ED-symptom severity and frequency. We hypothesized that individuals with EDs would demonstrate differential neural activation during RL relative to individuals without, that activation would differentiate AN-BP and BN versus AN-R, and that activation would predict ED-severity metrics. Medically stable participants with AN-R ( n = 22), AN-BP ( n = 20), and BN ( n = 29) comprised the ED group ( N = 71), contrasted with non-ED controls ( N = 27). Participants (91% female; M age = 25.9; 80% white, 14.5% Asian) completed clinical interviews and, in a separate session, a probabilistic RL task during functional magnetic resonance imaging. We examined differences in neural activation during RL in the ventral striatum and ventrolateral prefrontal cortex (vlPFC) between the ED and non-ED groups and between diagnostic groups, and conducted exploratory whole-brain analyses. Relations between neural activation and ED symptoms were examined. Lower right vlPFC and ventral striatum activation during RL characterized EDs. No between-ED diagnosis differences emerged. Lower right vlPFC activation predicted more frequent binge eating and purging but not global ED psychopathology. Individuals with EDs may experience difficulty recruiting certain RL-related brain regions, which may relate to difficulty changing ED behaviors. Future directions include investigation of how RL-associated neural networks maintain ED symptoms and influence treatment outcomes.