Anorexia nervosa is an eating disorder characterized by excessive weight loss, persistent interference with weight gain, and body image disturbance.  Anorexia can lead to severe medical complications, is difficult to treat, and a high percentage of patients eventually die by suicide (Selby, Bulik, et al., 2010). Although it is well established that many with anorexia experience body dissatisfaction and apprehension about weight gain, the rewarding aspects of weight loss may be particularly pronounced during the development of anorexia and have not been well studied (Walsh, 2013). Many anorexic patients believe their ability to lose weight makes them more attractive and builds self-control and confidence. Another source of positive reinforcement in anorexia may be through exposure to stimuli that promote extreme weight loss, such as content posted on “Pro-Ana” (Pro-Anorexia) websites, which feature images of thin/emaciated women and inspirational quotes for weight loss.

One particular factor we have examined is the role of low positive emotion differentiation (PED), or difficulty understanding and distinguishing between discrete positive emotions, may contribute to an enhanced reward response and elevated positive emotion. In a paper my lab recently published in the journal Clinical Psychological Science, 118 anorexic patients completed multiple daily emotional and behavioral assessments for two weeks. Using these data we were able to examine the role of low PED in promoting weight loss behaviors. Our findings indicated that those with anorexia who had low PED appeared to engage in more weight loss behaviors over the course of two weeks than those with high PED. Furthermore, we demonstrated that for those with low PED, more weight loss behaviors at one time resulted in increased subsequent levels of positive emotion. Similarly, higher levels of positive emotion at one signal predicted the report of more weight loss behaviors at the subsequent signal. These findings demonstrate that many with anorexia experienced positive emotion as a function of engaging in weight loss behaviors, and that such positive emotion may increase motivation for further weight loss behaviors. These psychological findings also dovetail with recent neuropsychological advances of elevated responding to rewards in anorexia, as indicated by greater ventral striatal activation in response to underweight images (Fladung et al., 2010).

There are important clinical implications for these findings. One way to enhance current treatments and weight restoration in anorexia may involve harnessing positive emotion from other areas of life. By channeling the motivations for weight loss activities into new activities that facilitate autonomy, competency, and relatedness, patients can start the formation of a new identity that’s not so focused on shape, weight, and nutritional control. Such activities may include reward-reinforcement oriented activities from various areas, including arts, humanities, and recreational activities, and these activities may also simultaneously improve ability to cope with negative emotion.

Additional details on the study can be found on:

The publication webiste for Clinical Psychological Science:

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