Effortful tasks are generally experienced as costly, but the value of work varies greatly across individuals and populations. While most mental health conditions are characterized by amotivation and effort avoidance, individuals with anorexia nervosa (AN) persistently engage in effortful behaviors that most people find unrewarding (food restriction, excessive exercise). Current models of AN differentially attribute such extreme weight-control behavior to altered reward responding and exaggerated cognitive control. In a novel test of these theoretical accounts, we employed an established cognitive effort discounting paradigm in combination with fMRI in young acutely underweight female patients with AN (n = 48) and age-matched healthy controls (HC; n = 48). Contrary to the hypothesis that individuals with AN would experience cognitive effort (operationalized as N-back task performance) as less costly than HC participants, groups did not differ in the subjective value (SV) of discounted rewards or in SV-related activation of brain regions involved in reward valuation. Rather, all group differences in both behavior (superior N-back performance in AN and associated effort ratings) and fMRI activation (increased SV-related frontoparietal activation during decision-making in AN even for easier choices) were more indicative of increased control. These findings suggest that while effort discounting may be relatively intact in AN, effort investment is high both when performing demanding tasks and during effort-based decision-making; highlighting cognitive overcontrol as an important therapeutic target. Future research should establish whether exaggerated control during effort-based decision-making persists after weight-recovery and explore learning the value of effort in AN with tasks involving disorder-relevant effort demands and rewards.

艰苦的任务通常被认为代价高昂，但工作的价值因个人和群体的不同而存在很大差异。虽然大多数心理健康状况的特点是缺乏积极性和逃避努力，但患有神经性厌食症 (AN) 的人却持续从事大多数人认为没有回报的努力行为（限制食物、过度运动）。目前的 AN 模型将这种极端的体重控制行为归因于奖励反应的改变和认知控制的夸大。在对这些理论解释的一项新颖测试中，我们在患有 AN 的年轻体重严重不足的女性患者 ( n = 48) 和年龄匹配的健康对照 (HC； n = 48) 中采用了既定的认知努力贴现范式与功能磁共振成像 (fMRI) 相结合。与 AN 个体相比 HC 参与者体验认知努力（可操作为 N-back 任务绩效）成本更低的假设相反，各组在折扣奖励的主观价值 (SV) 或 SV 相关的大脑激活方面没有差异涉及奖励评估的区域。相反，所有群体在行为（AN 中出色的 N-back 表现和相关的努力评级）和功能磁共振成像激活（AN 决策过程中 SV 相关额顶叶激活的增加，即使是为了更容易的选择）更能表明控制力的增强。这些发现表明，虽然在 AN 中，努力折扣可能相对完整，但在执行要求较高的任务和基于努力的决策过程中，努力投入都很高；强调认知过度控制是一个重要的治疗目标。 未来的研究应该确定体重恢复后基于努力的决策过程中是否存在过度控制，并探索在涉及与疾病相关的努力需求和奖励的任务中学习 AN 中努力的价值。