Distinct delay discounting patterns in anorexia nervosa: Comparing monetary and exercise rewards across clinical subgroups

Aims: People with anorexia nervosa (AN) often engage in compulsive exercise to control weight and manage emotions, altering the reward associated with physical activity. Delay-discounting evaluates preference for immediate over delayed rewards, potentially indicating struggles with prioritizing long-term gains. However, the impact of AN on these factors remains unexplored. This study aims to assess the attitudes of individuals with AN using a modified exercise delay discount task, comparing them with the general population. Methods: A sample of 76 individuals (70 women, 92.1%) with a diagnosis of AN was compared with a sample of 124 people (115 women, 92.7%) without a lifetime diagnosis of any eating disorder. Two different delay discount tasks were used to evaluate different constructs: a standardized monetary delay discount task and a modified version focused on physical activity. Results: The standardized monetary delay discount task confirmed the existence of varied monetary rewards in different subtypes of AN. The exercise-related task demonstrated a specific emphasis on exercise within AN, showing a tendency to delay physical activity by looking for a greater amount of exercise. On the contrary, the general population opted for immediate exercise proposals. Conclusions: Our findings suggest that the tendency to delay physical activity could be related to the compulsive nature of exercise in patients with AN, with a possible change in cognitive evaluation based on the magnitude of exercise. Finally, in addition to psychological problems related to eating disorders, additional cognitive factors likely contribute to exercise compulsiveness, necessitating further research exploration.