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.

费力的任务通常被认为代价高昂，但工作的价值因个人和人群而异。虽然大多数心理健康状况的特点是缺乏动力和逃避努力，但神经性厌食症 （AN） 患者会持续从事大多数人认为没有回报的努力行为（食物限制、过度运动）。当前的 AN 模型差异性地将这种极端的体重控制行为归因于奖励反应的改变和夸大的认知控制。在对这些理论解释的新测试中，我们采用了一种既定的认知努力折扣范式与 fMRI 相结合，用于患有 AN （n = 48） 的年轻急性体重不足女性患者 （n = 48） 和年龄匹配的健康对照 （HC;n = 48）。与 AN 患者会体验到认知努力（作为 N-back 任务表现）的成本低于 HC 参与者的假设相反，各组在折扣奖励的主观价值 （SV） 或参与奖励评估的大脑区域的 SV 相关激活方面没有差异。相反，行为 （AN 中卓越的 N-back 性能和相关的努力评级） 和 fMRI 激活 （在 AN 决策过程中 SV 相关的额顶叶激活增加，即使更容易选择） 的所有组差异更表明控制增加。这些发现表明，虽然努力折扣在 AN 中可能相对完整，但在执行要求苛刻的任务和基于努力的决策期间，努力投资都很高;强调认知过度控制是一个重要的治疗目标。 未来的研究应确定体重恢复后基于努力的决策过程中的过度控制是否持续存在，并探索了解涉及疾病相关努力需求和奖励的任务在 AN 中的努力价值。