The impact of punishment on cognitive control in a clinical population characterized by heightened punishment sensitivity.

Abstract

Punishments can help inform us to make adaptive changes in behavior. However, previous research suggested that only low punishment-sensitive individuals "learn" from punishment, whereas high punishment-sensitive individuals do not. Here we used a flanker interference task with performance-contingent punishment signals to test the hypothesis that a clinical group characterized by heightened punishment sensitivity (i.e., patients with anorexia nervosa [AN]) would fail to adapt to conflict following punishment. To distinguish between state and trait factors, we tested for between-group differences in separate cohorts of acutely underweight patients (acAN; n = 40) and weight-recovered former patients (recAN; n = 25) relative to age-matched healthy controls (n = 48). The acAN patients showed an abnormally reversed congruency-sequence effect in error rates following punishment, despite generally superior accuracy, suggesting that punishment distracted acAN patients and interfered with interference control. The influence of punishment was more subtle in recAN and did not reach statistical significance, but both reaction time and error rate data hinted that elevated sensitivity to punishment negatively affects cognitive control even after long-term weight normalization. Together, these findings emphasize that punishment sensitivity may be a clinically relevant trait marker in AN and provide novel experimental evidence that punishment may have a detrimental impact on adaptive behavior in the disorder. General Scientific Summary The effect of punishment on cognitive control has been shown to be dependent on individual differences in trait punishment sensitivity in healthy individuals. In a between-groups design, this study finds that whereas punishments during performance of a flanker interference task promote adaptive behavior in healthy control participants characterized by low punishment sensitivity, they have a detrimental impact in individuals with anorexia nervosa, a clinical group characterized by high punishment sensitivity.