C3

Anorexia nervosa as a model for increased volitional control: intrinsic value of effort, behavioral automaticity and real life implications

Project Aims

A major goal of the CRC-940 is to elucidate the neural mechanisms underlying dysfunctional volitional control as expressed in mental and neurodegenerative disorders. Suggesting that Anorexia nervosa (AN) might serve as a model disorder for „too much control“, patients typically  have a heightened ability to resist temptations and forgo immediate or risky rewards in the pursuit of long-term goals and increased willingness to engage in difficult tasks. A related hypothesis is that elevated volitional control in AN may be facilitated by increased reliance on automatic behaviors and habits. We have yet to develop a fundamental understanding of the specific mechanisms that may underlie increased cognitive control AN and why some sub-processes seem to be more affected than others. To gain new insight, our aim is to address these questions via different approaches.

We will investigate decision making with high ecological validity by implementing a smartphone-based approach. Additionally we study typical patterns of resting state functional connectivity.  A further objective is to test an alternative explanation for the excessive cognitive control in AN – that AN is characterized by habits and automaticity. Finally, we address potential costs of increased cognitive control in everyday-life as well as by assessing clinical outcome. All assessments in AN patients are followed-up after treatment and compared to recovered patients (recAN) and healthy control subjects (HC) to dissociate state from trait factors.

Recent Findings

Results from recent experiments largely support the hypotheses described above. Using fMRI we found tonically-elevated activation of a region of dorsolateral prefrontal cortex associated with cognitive control in a sample of recAN participants during reward-related processing (Ehrlich et al., 2015). Indicative of increased neural efficiency, fMRI data obtained during an intertemporal choice paradigm showed decreased response in the frontoparietal control network (FPN; and notably ACC) for difficult decisions in acutely ill AN participants relative to HC (King et al., 2016), despite generally normal (but faster) reward-based decision making (Ritschel et al., 2015). This propensity to forgo immediate rewards in the pursuit of ling-term goals may be uniqueliy magnified in AN, as AN patients (but not HC) who have higher plasma levels of the appetite-stimulating hormone ghrelin preferably choose delayed rewards (Bernadoni et al., in revision). Results of our ecological momentary assessment (EMA) study illustrate the everyday “costs” of increased cognitive control: AN patients invest three times as much time as HC ruminating (Seidel et al., 2016), which was correlated with decreased striatal responses following volitional emotion regulation (Seidel et al., 2017).

Project Members

Principal Investigator

Prof. Dr. med. Stefan Ehrlich
Professor (W3) and Attending Physician
Phone: +49 (0)351 458-5214
E-Mail:

Dr. Ilka Böhm
Phone: +49 (0)351 458-4284
E-Mail: 

Staff

Dr. Fabio Bernardoni
Phone: +49 (0)351 458-5245
E-Mail:

Dr. rer. nat. Joseph King
Postdoctoral Researcher
Phone: +49 (0)351 458-7155
E-Mail:

Maria Seidel 
Postdoctoral researcher
Phone: +49 (0)351 458-2671
E-Mail:

Publications

  • Ehrlich, S. (2021) Anorexia nervosa im Kindes- und Jugendalter. Monatsschrift Kinderheilkunde; 3:1-10. doi: 10.1007/s00112-021-01144-6. 
  • Steinhäuser, JL., King, JA., Tam, FI., Seidel, M., Biemann, R., Wronski, M-L., Geisler, D., Roessner, V., Ehrlich, S. (2021) Is Serum BDNF Altered in Acute, Short- and Long-Term Recovered Restrictive Type Anorexia Nervosa? Nutrients; 13(2):432. doi: https://doi.org/10.3390/nu13020432.
  • Tam, F., Gerl, MJ., Klose, C., Surma, MA., King, J., Seidel, M., Weidner, K., Roessner, V., Simons, K., Ehrlich, S. (2021) Adverse Effects of Refeeding on the Plasma Lipidome in Young Individuals With Anorexia Nervosa? Journal of the American Academy of Child and Adolescent Psychiatry; S0890-8567(21)00137-4. Epub ahead of print. doi: 10.1016/j.jaac.2021.02.014. 
  • Tam, F., Steding, J., Steinhäuser, JL., Ritschel, F., Gao, W., Weidner, K., Roessner, V., Kirschbaum, C., Ehrlich, S. (2021) Hair endocannabinoid concentrations in individuals with acute and weight-recovered anorexia nervosa. Progress in Neuro-Psychopharmacology and Biological Psychiatry; 107:110243. doi: 10.1016/j.pnpbp.2021.110243. 
  • Batury, VL., Walton, E., Tam, F., Wronski, ML., Buchholz, V., Frieling, H., Ehrlich, S. (2020) DNA methylation of ghrelin and leptin receptors in underweight and recovered patients with anorexia nervosa. J Psychiatric Res; 131:271-278. doi: 10.1016/j.jpsychires.2020.08.026. 
  • Bernardoni, F., Bernhardt, N., Pooseh, S., King, J.A., Geisler, D., Ritschel, F., Boehm, I., Seidel, M., Roessner, V., Smolka, M.N., Ehrlich, S. (2020) Metabolic state and value-based decision-making in acute and recovered female patients with anorexia nervosa. J Psychiatry Neurosci.; 45(4):253-261. doi: 10.1503/jpn.190031. 
  • Boehm, I., Walton, E., Alexander, N., Batury, V.L., Seidel, M., Geisler, D., King, J.A., Weidner, K., Roessner, V., Ehrlich, S. (2020) Peripheral serotonin transporter DNA methylation is linked to increased salience network connectivity in females with anorexia nervosa. J Psychiatry Neurosci.; 45(3):206-213.  doi: 10.1503/jpn.190016. 
  • Doose, A., King, J.A., Bernardoni, F., Geisler, D., Hellerhoff, I., Weinert, T., Roessner, V., Smolka, M.N., Ehrlich, S. (2020) Strengthened Default Mode Network Activation During Delay Discounting in Adolescents with Anorexia Nervosa After Partial Weight Restoration: A Longitudinal fMRI Study. J Clin Med.; 9(4):900. doi: 10.3390/jcm9040900.
  • Fürtjes, S., Seidel, M., King, J.A., Boehm, I., Jaite, C., Roessner, V., Ehrlich, S. (2020) A Naturalistic Investigation of Cognitive-Affective Dysfunction in Anorexia Nervosa: The Role of Inefficiency. International Journal of Eating Disorders; 53(2):239-247. doi: 10.1002/eat.23189
  • Geisler, D., Borchardt, V., Boehm, I., King, J. A., Tam, F. I., Marxen, M., Biemann, R., Roessner, V., Walter, M., & Ehrlich, S. (2020). Altered global brain network topology as trait marker in patients with anorexia nervosa. Psychological Medicine. doi:10.1017/S0033291718004002  
  • King, J.A., Bernardoni, F., Geisler, D., Ritschel, F., Doose, A., Pauligk, S., Pásztor, K., Weidner, K., Roessner, V., Smolka, M.N., Ehrlich, S. (2020) Intact value-based decision-making during intertemporal choice in women with remitted anorexia nervosa? An fMRI study. Journal of Psychiatry and Neuroscience; 45(2):108-116. doi: 10.1503/jpn.180252.
  • Mattheus, H.K., Wagner, C., Becker, K., Bühren, K., Correll, C.U., Egberts, K.M., Ehrlich, S.,  Fleischhaker, C., Föcker, M., Hahn, F., Hebebrand, J., Herpertz‐Dahlmann, B., Jaite, C.,  Jenetzky, E., Kaess, M., Renner, T.J., Roessner, V., Schulze, U., Sinzig, J., Wessing, I., von Gontard, A. (2020) Incontinence and constipation in adolescent patients with anorexia nervosa – Results of a multi-center study from a German web-based registry for children and adolescents with anorexia nervosa. .; Int J Eat Disord.; 53(2):219-228doi: 10.1002/eat.23182.  
  • Schmalbach, I., Herhaus, B., Pässler, S., Runst, S., Berth, H., Wolff-Stephan, S. & Petrowski, K. (2020). Cortisol Reactivity in Patients with Anorexia Nervosa after Stress Induction. Translational Psychiatry, 10(1):275. doi: 10.1038/s41398-020-00955-7.
  • Tam, F., Seidel, M., Böhm, I., Ritschel, F., Bahnsen, K., Weidner, K., Roessner, V., Ehrlich S. (2020) Peptide YY3-36 concentration in acute and long-term recovered anorexia nervosa. European Journal of Nutrition. doi: 10.1007/s00394-020-02210-7. Epub ahead of print.
  • Ehrlich, S., King, J.A., Boehm, I. (2019) Connecting the Nodes of Altered Brain Network Organization in Eating Disorders. Journal of the American Academy of Child and Adolescent Psychiatry; 58(2):156-158. doi: 10.1016/j.jaac.2018.11.005. 
  • Ehrlich, S., King, J.A., Boehm, I. (2019) To Eat or Not to Eat: Advancing the Neuroscience of Hedonic Versus Controlled Eating Across Weight and Eating Disorders. Journal of the American Academy of Child and Adolescent Psychiatry; 58(2):151-153. doi: 10.1016/j.jaac.2018.07.902. 
  • Jaite, C., Bühren, K., Dahmen, B., [... ] Ehrlich, S. [...], Hebebrand, J., Föcker, M., Herpertz-Dahlmann, B. (2019) Clinical characteristics of inpatients with childhood vs. adolescent Anorexia nervosa. Nutrients; 11:2593. doi:10.3390/nu11112593 
  • King, J.A., Korb, F.M., Vettermann, R., Ritschel, F., Egner, T., Ehrlich, S. (2019) Cognitive overcontrol as a trait marker in anorexia nervosa? Aberrant task- and response-set switching in remitted patients. Journal of Abnormal Psychology; 128(8):806-812. doi: 10.1037/abn0000476.
  • Seidel, M., Borchardt, V., Geisler, D., King, J.A., Boehm, I., Pauligk, S. (2019) Abnormal Spontaneous Regional Brain Activity in Young Patients With Anorexia Nervosa. Journal of the American Academy of Child & Adolescent Psychiatry; 58(11):1104-1114.  doi: 10.1016/j.jaac.2019.01.011.
  • Steding, J., Boehm, I., King, J.A., Geisler, D., Ritschel, F., Seidel, M., Doose, A., Jaite, C., Roessner, V., Smolka, M.N., Ehrlich, S. (2019). Goal-directed vs. habitual instrumental behavior during reward processing in anorexia nervosa: an fMRI study. Scientific Reports; 9(1):13529. doi: 10.1038/s41598-019-49884-6
  • Von Schwanenflug, N., Müller, DK., King, J.A., Ritschel, F., Bernardoni, F., Mohammadi, S., Geisler, D., Roessner, V., Biemann, R., Marxen, M., Ehrlich, S. (2019). Dynamic changes in white matter microstructure in anorexia nervosa: findings from a longitudinal study. Psychological medicine; 49(9):1555-1564. doi: 10.1017/S003329171800212X.
  • Walton, E., Hibar, D., Yilmaz, Z., Jahanshad, N., Cheung, J., Batury, VL., Seitz, J., Bulik, CM.; PGC-ED; ENIGMA Genetics Working Group, Thompson, PM., Ehrlich, S. (2019). Exploration of Shared Genetic Architecture Between Subcortical Brain Volumes and Anorexia Nervosa. Molecular Neurobiology ; 56(7):5146-5156. doi: 10.1007/s12035-018-1439-4. 
  • Seidel, M., Bochardt, V., Geisler, D., King, J. A., Boehm, I., Pauligk, S., Bernadoni, F., Biemann, R., Roessner, V., Walter, M., & Ehrlich, S. (2018). Abnormal Spontaneous Regional Brain Activity in Young Patients With Anorexia Nervosa. Journal of the American Academy of Child and Adolescent Psychiatry. doi:10.1017/S0033291718004002
  • Fürtjes, S., Seidel, M., King, J. A., Boehm, I., Biemann, R., Roessner, V., & Ehrlich, S. (2018). Rumination in Anorexia Nervosa: Cognitive-Affective and Neuroendocrinological Aspects. Behaviour Research and Therapy, 111, 92-98. doi:10.1016/j.brat.2018.10.001
  • King, J.A., Frank, G.K.W., Thompson, P.M., & Ehrlich S. (2018). Structural Neuroimaging of Anorexia Nervosa: Future Directions in the Quest for Mechanisms Underlying Dynamic Alterations. Biological Psychiatry, 83(3), 224-234. doi:10.1016/j.biopsych.2017.08.011
  • von Schwanenflug, N., Müller, D. K., King, J. A., Ritschel, F., bernadoni, F., Mahammadi, S., Geisler, D., Roessner, V., Biemann, R., Marxen, M., & Ehrlich, S. (2018) Dynamic changes in white matter micorstructure in anorexia nervosa: findings from a longitudinal study. Psychological Medicine. doi:org/10.1017/S003329171800212X
  • Frank, G.K.W., Favaro, A., Marsh, R., Ehrlich, S., & Lawson, E.A. (2018). Toward valid and reliable brain imaging results in eating disorders. International Journal of Eating Disorders, doi:10.1002/eat.22829
  • Seidel, M., King, J.A., Ritschel, F., Boehm, I., Geisler, D., Bernardoni, F., Holzapfel, L., Diestel, S., Diers, K., Strobel, A., Goschke, T., Walter, H., Roessner, V., & Ehrlich, S. (2018). The real-life costs of emotion regulation in anorexia nervosa: a combined ecological momentary assessment and fMRI study. Translational Psychiatry, 8(1), 28.  doi:10.1038/s41398-017-0004-7
  • Boehm, I., Flohr, L., Steding, J., Holzapfel, L., Seitz, J., Roessner, V., & Ehrlich, S. (2018). The Trajectory of Anhedonic and Depressive Symptoms in Anorexia Nervosa: A Longitutional and Cross-Sectional Approach. European Eating Disorders Review, 26(1), 69-74. doi:10.1002/erv.2565
  • Ritschel, F., Clas, S., Geisler, D., Haas, V., Seide, M., Steding, J., Roessner, V., Kirschbaum, C., & Ehrlich, S. (2018). Is hypercortisolism in anorexia nervosa detectable using hair samples? Journal of psychiatric research, 98, 87 -94. doi:10.1016/j.jpsychires.2017.11.010
  • Bernardoni, F., King, J.A., Geisler, D., Birkenstock, J., Tam, F.I., Weidner, K., Roessner, V., White, T., & Ehrlich, S. (2018). Nutritional Status Affects Cortical Folding: Lessons Learned From Anorexia Nervosa. Biological Psychiatry, 84(9), 692-701. doi:doi:10.1016/j.biopsych.2018.05.008
  • Seidel, M., King, J.A., Ritschel, F., Boehm, I., Geisler, D., Bernardoni, F., Beck, M., Pauligk, S., Biemann, R., Strobel, A., Goschke, T., Walter, H., Roessner, V., & Ehrlich, S. (2017). Processing and regulation of negative emotions in anorexia nervosa: an fMRI study. NeuroImage. Clinical, 18, 1-8. doi:10.1016/j.nicl.2017.12.035
  • Bernardoni, F., Geisler, D., King, J.A., Javadi, A.H., Ritschel, F., Murr, J., Reiter, A.M.F., Rössner, V., Smolka, M.N., Kiebel, S., & Ehrlich S. (2018). Altered Medial Frontal Feedback Learning Signals in Anorexia Nervosa. Biological Psychiatry, 83(3), 235-243.  doi:10.1016/j.biopsych.2017.07.024
  • Boehm, I., King, J. A., Bernadoni, F., Geisler, D., Seidel, M., Ritschel, F., Goschke, T., Haynes, J. D., Roessner, V., & Ehrlich, S. (2017). Subliminal and supraliminal processing of reward-related stimuli in anorexia nervosa. Psychological Medicine, 48(5), 790-800. doi:10.1017/S0033291717002161
  • Geisler, D., Ritschel, F., King, J.A., Bernardoni, F., Seidel, M., Boehm, I., Runge, F., Goschke, T., Roessner, V., Smolka, M.N., & Ehrlich, S. (2017). Increased anterior cingulate cortex response precedes behavioural adaptation in anorexia nervosa. Scientific Reports, 13(7), 42066. doi:10.1038/srep42066
  • King, J.A., Geisler, D., Bernardoni, F., Ritschel, F., Boehm, I., Seidel, M., Mennigen, E., Ripke, S., Smolka, M.N., Roessner. V., & Ehrlich, S. (2016). Altered Neural Efficiency of Decision Making During Temporal Reward Discounting in Anorexia Nervosa. J Am Acad Child Adolesc Psychiatry. 55(11), 972-979.                     doi:10.1016/j.jaac.2016.08.005
  • Pfuhl, G., King, J.A., Geisler, D., Roschinski, B., Ritschel, F., Seidel, M., Bernardoni, F., Müller, D.K., White, T., Roessner, V., & Ehrlich, S. (2016). Preserved white matter microstructure in young patients with anorexia nervosa? Human Brain Mapping, 37(11), 4069-4083. doi:10.1002/hbm.23296

  • Boehm, I., Geisler, D., Tam, F., King, J.A., Ritschel, F., Seidel, M., Bernardoni, F., Murr, J., Goschke, T., Calhoun, V.D., Roessner, V., & Ehrlich, S. (2016). Partially restored resting-state functional connectivity in women recovered from anorexia nervosa.        Journal of Psychiatry & Neuroscience,  41(6), 377-385. doi: 10.1503/jpn.150259

  • Seidel, M., Petermann, J., Diestel, S., Ritschel, F., Boehm, I., King, J.A., Geisler, D., Bernardoni, F., Roessner, V., Goschke, T., & Ehrlich S. (2016). A Naturalistic Examination of Negative Affect and Disease-related Rumination in Anorexia Nervosa. European child & adolescent Psychiatry, 25(11), 1207-1216.              doi:10.1007/s00787-016-0844-3

  • Bernardoni, F., King, J.A., Geisler, D., Stein, E., Jaite, C., Naetsch, D., Tam, F.I., Boehm, I., Seidel, M., Roessner, V., & Ehrlich, S. (2016). Weight restoration therapy rapidly reverses cortical thinning in anorexia nervosa: A longitudinal study. Neuroimage, 130, 214-22. doi:10.1016/j.neuroimage.2016.02.003

  • Geisler, D., Borchardt, V., Lord, A., Boehm, I., Ritschel, F., Zwipp, J., Clas, S., King, J.A., Wolff-Stephan, S., Roessner, V., Walter, M., & Ehrlich, S. (2016). Abnormal functional global and local brain connectivity in female patients with anorexia nervosa. Journal of Psychiatry & Neuroscience, 41(1),6-15. doi:10.1503/jpn.140310

  • Boehm, I., Finke, B., Tam, F.I., Fittig, E., Scholz, M., Gantchev, K., Roessner, V., & Ehrlich, S. (2016). Effects of perceptual body image distortion and early weight gain on long-term outcome of adolescent anorexia nervosa. European child & adolescent Psychiatry, 25(12), 1319-1326. doi:10.1007/s00787-016-0854-1

  • Ehrlich, S., Geisler, D., Ritschel, F., King, J.A., Seidel, M., Boehm, I., Breier, M., Clas, S., Weiss, J., Marxen, M., Smolka, M.N., Roessner, V., & Kroemer, N.B. (2015). Elevated cognitive control over reward processing in recovered female patients with anorexia nervosa. Journal of Psychiatry & Neuroscience, 40(5), 307-15. doi:10.1503/jpn.140249

  • King, J., Geisler, D., Ritschel, F., Schober, I., Seidel, M., Roschinski, B., Soltwedel, L., Zwipp, J., Pfuhl, G., Marxen, M., Roessner, V., & Ehrlich, S. (2015). Global cortical thinning in acute anorexia nervosa normalizes following long-term weight restoration. Biological Psychiatry, 77(7), 624-32. doi:10.1016/j.biopsych.2014.09.005

  • Ritschel, F., King, J. A., Geisler, D., Flohr, L., Neidel, F., Schober, I., Seidel, M., Zwipp, J., Ripke, S., Smolka, M. N., Roessner, V., & Ehrlich, S. (2015). Temporal delay discounting in acutely ill and weight-recovered patients with anorexia nervosa. Psychological Medicine, 45(6), 1229-1239. doi:10.1017/S0033291714002311
  • Ehrlich, S., Lord, A.R., Geisler, D., Borchardt, V., Böhm, I., Seidel, M., Ritschel, F., Schulze, A., King, J.A., Weidner. K., Roessner, V., & Walter, M. (2015). Reduced functional connectivity in the thalamo-insular subnetwork in patients with acute anorexia nervosa. Human Brain Mapping, 36(5), 1772–1781.   doi:10.1002/hbm.22736
  • Seidel, M., King, A.K., Ritschel, F., Döpmann, J., Bühren, K., Seitz, J., Roessner, V., Westphal, S., Egberts, K., Burghardt, R., Wewetzer, C., Fleischhaker, V., Hebebrand, J., Herpertz-Dahlmann, B., & Ehrlich, S. (2015). Serum visfatin concentration in acutely ill and weight-recovered patients with anorexia nervosa. Psychoneuroendocrinology, 53, 127-35. doi:10.1016/j.psyneuen.2014.12.010
  • Boehm, I., Geisler, D., King, J., Ritschel, F., Seidel, M., Deza Araujo, Y., Petermann, J., Lohmeier, H., Weiss, J., Walter, M., Roessner, V., & Ehrlich, S. (2014). Increased resting state functional connectivity in the fronto-parietal and default mode network in anorexia nervosa. Frontiers in Behavioral Neuroscience, 8, 346. doi:10.3389/fnbeh.2014.00346
  • Boraska, V., Franklin, C.S., […] Ehrlich, S. et al .(2014). A genome-wide association study of anorexia nervosa. Molecular Psychiatry, 19(10), 1085-94.    doi10.1038/mp.2013.187
  • Huckins, L.M., Boraska, V., […] Ehrlich, S., et al. (2014). Using ancestry-informative markers to identify fine structure across 15 populations of European origin. European Journal of Human Genetics, 22(10),1190-200. doi:10.1038/ejhg.2014.1
  • Kappel, V., Ehrlich, S., & van Noort, B. (2014). Anorexia nervosa aus neurowissenschaftlicher Sicht. Fachzeitschrift Psychotherapie im Dialog, 4, 2-6. doi:10.1055/s-0033-1363022
  • Kappel, V., van Noort, B., Ritschel, F., Seidel, M., & Ehrlich S. (2014). Anorexia nervosa: Aktuelle neurowissenschaftliche Befunde. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 42(1), 39-50. doi:10.1024/1422-4917/a000268
  • Zwipp, J., Hass, J., Schober, I., Geisler, D., Ritschel, F., Seidel, M., Weiss, J., Roessner, V., Hellweg, R., Ehrlich, S. (2014). Serum brain-derived neurotrophic factor and cognitive functioning in underweight, weight-recovered and partially weight-recovered females with anorexia nervosa. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 54,163-169. doi:10.1016/j.pnpbp.2014.05.006

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Tobias Riemschüssel
Last modified: May 07, 2021