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Decision Making in Eating Disorders

Decision Making in Psychology

In terms of psychology, decision-making is considered to be a cognitive process that involves choosing between two or more alternatives based on the beliefs and preferences of the decision maker. This process involves weighing out the costs and benefits of a situation followed by the choice of a course of action or preferred option. The main method to measure decision-making in psychological terms is the Iowa gambling task (IGT) which aims to simulate real life decision-making by using four decks of cards to choose from. Other methods include the Game of Dice Task (GDT) that also uses rules administering gains and losses for the decision maker.

Decision Making Deficits in Anorexia Nervosa

Anorexia Nervosa is characterised by the distorted image individuals have of their own bodies and the desire to deliberately lose weight[1]. Other behaviours include excessive exercise, vomiting, self-harming, and the use of an anorectic. However, these do not appear in all cases[2]. Research has found that individuals with this disorder have a deficit in decision-making[3]. The leading method to measure this deficit is the use of the Iowa gambling task (IGT) in which individuals are required to choose between different decks of cards[4]. It tests a persons ability to focus on long-term gains rather than the possible immediate effects[5]. Individuals without Anorexia Nervosa learn to avoid disadvantageous decks and improved their performance over time[6]. On the other hand, individuals with Anorexia Nervosa do not improve their performance over time[7] and show deficits in decision-making[8] They continue to ignore long-term consequences of their decisions and consistently score low on the task[9]. This is a behaviour exhibited in everyday life. An individual with Anorexia Nervosa may starve themselves for short-term gains but ignore the long-term costs of potential medical issues[10]

Another problematic behaviour that commonly arises with this illness is self-harm[11]. Patients with Anorexia Nervosa are more susceptible to exhibiting this behaviour than someone who does not suffer from the illness[12]. When looking at adolescents, the IGT shows that those who self-harm perform worse and therefore show more of a deficit in decision making than someone who does not self-harm[13]. In addition, someone who has self-harmed in the past but does not currently scores higher in the decision making task than those who self-harm in the present[14]. Although causation cannot be established, decision making skills improve when the behaviour of self-harming is discontinued[15].

Decision Making Deficits in Bulimia Nervosa

Bulimia Nervosa is characterised by episodes of overeating due to a loss of control followed by behaviours to counter act the excessive intake of food, such as purging or starvation[16]. In some cases, self-harming also presents itself as a secondary behaviour[17]. A commonly used method to test decision-making skills is the Iowa gambling task (IGT). Individuals without an eating disorder improve their performance by the end of the task and choose the more advantageous decks of cards[18] Individuals with Bulimia Nervosa do not improve and perform badly by continuing to choose the decks that give them the immediate reward without any long term gains[19]. This mirrors their everyday behaviour of purging that gives short-term gratification of food instead of considering the long-term consequences common in this disorder that arise afterwards such as guilt and shame[20].

Self-harming is a behaviour that presents itself in some cases of Bulimia Nervosa and is also related to deficits in decision making[21]. According to research, by improving decision making skills, self-harming incidents can be decreased as an individual appreciates the long term consequences of their decisions instead of the focusing on the short term gratification that they receive[22].

Decision Making Deficits in Binge Eating Disorder

Binge Eating Disorder is a mental disorder illness classified by episodes involving a large amount of food intake[23]. However, this is a separate illness from Bulimia Nervosa, as the individual does not partake in compensatory behaviours such as purging[24]. Little research has been conducted on decision making and binge eating disorder compared to Anorexia Nervosa and Bulimia Nervosa. However, it is still clear that this disorder exhibits more risky behaviours than someone without the disorder when partaking in the Game of Dice Task (GDT)[25]. Most individuals do not change their risky choices even after they have received negative feedback/consequences from various decision making tasks. Thus, people with binge eating disorder have impairment in processing feedback resulting in over eating without the decision to then partake in compensatory behaviours[26].

Temporal Discounting in Eating Disorders

Temporal discounting (also know as delayed discounting, time preference, time discounting) refers to the idea that we give rewards greater value when they move closer to us in time. On the contrary, rewards have less value when they are further away in time[27]. ). Individuals with binge eating disorder tend to exhibit higher levels of temporal discounting as they choose the immediate gratification of food and fail to delay their reward [28]. On the other hand, individuals with Anorexia Nervosa show lower levels of temporal discounting as sufferers have an increased ability to delay their reward that assists them in restricting their food intake[29]. Research into temporal discounting in Bulimia Nervosa has yet to be conducted.

Decision Making Impairments Linked to Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD) is characterised by the need to repeatedly check things or the repetition of certain thoughts or behaviours[30]. Similarities in phenotype between eating disorders and OCD suggests that the two groups share comparable traits[31]. Frequently checking weight and shape can be reflected in OCD by repeatedly checking windows and doors in order to feel in control[32]. Likewise, both disorders display similar performances on the Iowa gambling task (IGT)[33]. Whereas a person considered to be healthy would gradually shift their choices towards the advantageous decks, someone with OCD would continue to seek immediate gratification and choose from the disadvantageous decks of cards[34]. The same behaviour can be seen in Anorexia Nervosa and Bulimia Nervosa.

Decision Making Functioning Being Used as a Predictor of Treatment Outcome

Research into decision making in eating disorders can be applied to real world situations. For example, how someone scores on the Iowa gambling task can be used as a predictor of outcome after receiving treatment[35]. Those who score much lower on the task had an overall worse nutritional status later on than those who scored slightly higher[36]. Better decision making skills contribute to making better decisions where nutrition is concerned. However, performance on the IGT does not relate to the severity of the illness as research shows no correlation between decision making and body mass index (BMI) score[37]. Therefore decision making deficits, in general, are not directly caused by starvation and are instead a result of an individual’s phenotype[38].

Impulsivity and Decision Making in Eating Disorders Impulsivity is a behaviour affecting our decisions that does not include thought into the future or consequences that may arise due to making a decision there and then[39]. The action is often not appropriate to the situation and produces an undesirable outcome[40]. Impulsivity contributes to a variety of behaviours seen in eating disorders. Compared to Anorexia Nervosa, those suffering from Bulimia Nervosa exhibit high levels of impulsivity[41]. This is present during binging episodes when they do not consider the long term consequences they will face when the episode is over[42]. High impulsivity levels can also be found in those suffering with Binge Eating Disorder compared to those without the disorder[43].

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  38. ^ Cavedini, Paolo; Zorzi, Claudia; Bassi, Tommaso; Gorini, Alessandra; Baraldi, Clementina; Ubbiali, Alessandro; Bellodi, Laura (December 2006). "Decision-making functioning as a predictor of treatment outcome in anorexia nervosa". Psychiatry Research. 145 (2–3): 179–187. doi:10.1016/j.psychres.2004.12.014.
  39. ^ Zuckerman, M (1983). "Biological bases of sensation seeking, impulsivity, and anxiety". {{cite journal}}: Cite journal requires |journal= (help)
  40. ^ White, Jennifer L.; Moffitt, Terrie E.; Caspi, Avshalom; Bartusch, Dawn Jeglum; et al. (1994). "Measuring impulsivity and examining its relationship to delinquency". Journal of Abnormal Psychology. 103 (2): 192–205. doi:10.1037/0021-843X.103.2.192. {{cite journal}}: Explicit use of et al. in: |last5= (help)
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