For those with anorexia nervosa, it is (1) not a “natural” or dominant brain response to eating like those without AN. (2)It is difficult to trust what and when to eat. (3) It is not typical to experience pleasure in eating a variety of foods. (4) Eating is anxiety provoking. Not eating appears to reduce anxiety. Individuals with AN tend to experience reduced sensitivity to reward and increased sensitivity to punishment. Altered sensitivity to reward and punishment is observed in those with AN, for both food and general rewards/losses and thus suggests a broader deficit in reward processing. Hunger does not increase reward sensitivity in AN, suggesting a deficit in translating physiological signals to motivated behavior, and explaining why individuals with AN can restrict food despite starvation. Altered reward processing may be why we see low motivation for recovery and anhedonia. Decreased brain response to reward in the cognitive circuitry in AN is associated with elevated anxiety, suggesting a brain basis for coding food as risky.