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Med."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0033291726105674_sec1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reinforcement motivation, particularly heightened punishment sensitivity and its imbalance relative to reward sensitivity (\u201cmotivational bias\u201d), can predict outcomes in anorexia nervosa (AN). However, previous studies did not account for affective symptoms, which are intertwined with reinforcement processes and illness trajectory. This study examined whether affective symptoms explain outcomes beyond reinforcement motivation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291726105674_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Adolescent girls and young women with AN (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0192; M\n                      <jats:sub>age<\/jats:sub>\n                      \u00a0=\u00a016.33\u00a0years, SD\u00a0=\u00a02.61) completed self-report measures of punishment\/reward sensitivity, depressive symptoms, and trait anxiety at treatment admission and at 1-year follow-up. Outcomes included ED symptoms, body mass index, and multidimensional recovery (Morgan\u2013Russell outcome assessment schedule). Cross-sectional comparisons included long-term recovered individuals (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0154) and healthy controls (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0440); longitudinal associations were tested using nested linear regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291726105674_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with AN and recovered individuals showed elevated punishment sensitivity (\u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u209a\u00a0=\u00a00.19) and stronger motivational bias (punishment&gt;reward; \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u209a\u00a0=\u00a00.17). At baseline, reinforcement motivation and affective symptoms showed limited predictive utility. Longitudinally, shifts in motivational bias were associated with ED symptoms and multidimensional outcomes (|\n                      <jats:italic>\u03b2|<\/jats:italic>\n                      \u00a0&gt;\u00a00.248,\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>FDR<\/jats:sub>\n                      \u00a0&lt;\u00a0.002), whereas changes in affective symptoms were the most robust and consistently associated predictors (|\n                      <jats:italic>\u03b2|<\/jats:italic>\n                      \u00a0&gt;\u00a00.173,\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>FDR<\/jats:sub>\n                      \u00a0&lt;\u00a0.017).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291726105674_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Depressive symptom improvement emerged as the key predictor of outcome, showing stronger associations with follow-up ED symptoms and psychosocial functioning than reinforcement motivation. While changes in reinforcement motivation accompanied ED outcomes, affective symptom change was more predictive across outcomes. These findings emphasize the importance of prioritizing affective processes within developmentally tailored AN treatment frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s0033291726105674","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:05:21Z","timestamp":1789625121000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Re-evaluating the predictive value of reinforcement motivation on outcome in anorexia nervosa: The role of affective symptoms"],"prefix":"10.1017","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2864-5578","authenticated-orcid":false,"given":"Joseph A.","family":"King","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9054-3592","authenticated-orcid":false,"given":"Clara M.","family":"Breier","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4222-9035","authenticated-orcid":false,"given":"Suse","family":"Siegmund","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1005-0090","authenticated-orcid":false,"given":"Franziska M.","family":"Korb","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"G\u00f6bel","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2735-0141","authenticated-orcid":false,"given":"Svea","family":"K\u00f6nigsmann","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3662-3601","authenticated-orcid":false,"given":"Claudia","family":"F\u00f6rster Ribet","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5112-405X","authenticated-orcid":false,"given":"Fabio","family":"Bernardoni","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1873-7081","authenticated-orcid":false,"given":"Veit","family":"Roessner","sequence":"additional","affiliation":[{"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2132-4445","authenticated-orcid":false,"given":"Stefan","family":"Ehrlich","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042aqky30","id-type":"ROR","asserted-by":"publisher"}],"name":"TU Dresden Faculty of Medicine Carl Gustav Carus: Technische Universitat Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"S0033291726105674_r12","doi-asserted-by":"publisher","DOI":"10.1002\/eat.24519"},{"key":"S0033291726105674_r91","volume-title":"IBM SPSS statistics for windows (Version 30). 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