Willing to wait: Anorexia nervosa symptomatology is associated with higher future orientation and reduced intertemporal discounting

Abstract

Anorexia nervosa is a severe eating disorder characterized by food restriction in service of a future goal: thinness and weight loss. Prior work suggests altered intertemporal decision-making in this disorder, with more farsighted decisions-i.e. reduced delay discounting-in patients with acute anorexia nervosa. Future-oriented cognition, such as frequent prospective future thinking in daily life, promotes farsighted decision making. However, whether temporal orientation is altered in anorexia nervosa, potentially contributing to reduced delay discounting in this population, remains unclear. We measured delay discounting behavior, anorexia nervosa symptomatology, and temporal orientation in a large sample of never-diagnosed individuals. We found that higher anorexia nervosa symptomatology was associated with reduced delay discounting. Anorexia nervosa symptoms were also correlated with increased future-oriented cognition. Moreover, future-oriented cognition mediated the difference in delay-discounting behavior between high and low anorexia nervosa symptom groups. These results were unrelated to subjective time perception and independent of mood and anxiety symptomatology. Collectively, these findings suggest that future-oriented cognition may be a cognitive mechanism underlying altered intertemporal decision making in anorexia nervosa.

Fig. 1

Overview of experimental procedures. The Eating Attitudes Test (EAT-26) questionnaire was used as a metric of participants’ anorexia nervosa symptomatology. To index intertemporal behavioral choices, participants completed a delay discounting task. Future-oriented cognition was measured using a latent factor derived from the data of 2 questionnaires (ZTPI & CFC) and one task (PFE). Pre-registered exploratory and control analyses included subjective time measures (the Volle and Zauberman tasks) as well as dispositional negativity, a factor score derived from mood and anxiety questionnaires (BDI, ATQ, and STAI-T).

Fig. 2

Intertemporal decision making (A) and temporal orientation (B) as a function of anorexia nervosa symptoms. (A) Individuals with higher anorexia nervosa symptoms show reduced delay discounting compared to a low-symptom group. (B) Anorexia nervosa symptomatology is associated with a future-oriented cognitive style. *p < 0.05, ***p < 0.005.

Fig. 3

Future-oriented cognition significantly mediated the association between anorexia nervosa symptomatology and intertemporal discounting. Mediation paths with standardized regression coefficients are shown. The total effect relating anorexia nervosa symptom group and intertemporal discounting rate is shown in parenthesis. * p < 0.05.