Academic journal article Journal of Eating Disorders

Comparison in Decision-Making between Bulimia Nervosa, Anorexia Nervosa, and Healthy Women: Influence of Mood Status and Pathological Eating Concerns

Academic journal article Journal of Eating Disorders

Comparison in Decision-Making between Bulimia Nervosa, Anorexia Nervosa, and Healthy Women: Influence of Mood Status and Pathological Eating Concerns

Article excerpt

Authors: Junko Matsumoto [1,2,3,4]; Yoshiyuki Hirano [1,2]; Noriko Numata [2,6]; Daisuke Matzuzawa [1,6]; Shunichi Murano [4]; Koutaro Yokote [7]; Masaomi Iyo [5,8,9]; Eiji Shimizu [1,2,6]; Michiko Nakazato (corresponding author) [1,2,5]


Eating disorders (EDs) are severe and enduring psychiatric disorders of eating behavior, including extreme, unhealthy decreases in food intake as well as severe overeating, accompanied by feelings of distress or excessive concern about body shape or weight [1]. Three types of eating disorders are recognized by the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) [2]: anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).

Decision-making is affected by the combination of emotional representations, sensitivity to immediate reward and long-term outcome according to the somatic marker hypothesis (SMH) [3]-[5]. Multiple cognitive functions such as attention, memory, learning [6],[7], risk-taking, and obsessive-compulsive traits [8] have been suggested as being involved in performances in decision-making [9],[10]. A previous study by Tchanturia et al. found impairment of emotional signal by skin conductance (SCR), showing the lowest emotional signal by demonstrating a lack of ability to be aware of emotional signal during decision-making task [11]. In BN, a previous study showed no significant correlation between SCR and performance in decision-making [12]. For this reason, it is unclear whether the AN and BN groups have different deficits in emotional skills during decision-making.

The role of emotion, specifically anxiety or worry, may influence the decision-making process [13]. High levels of worry may have expected consequences of future events that influence the performances of decision-making [14]. The majority of people with EDs have high levels of anxiety [15], worry, a defining cognitive feature, and a maintenance factor of anticipatory anxiety [16]. Heightened anxiety levels may affect the process of decision-making in AN or BN patients. However, few studies have focused on the effect of mood status on a prospect during the decision-making process in AN compared with BN. Two studies showed that decision-making in patients with AN may be related to anxiety [17],[18], whereas other studies showed that they were unrelated [7],[19]. Some studies suggested significant associations between measures of depressive disorder and decision-making [20],[21], but a number of other studies have indicated that depressive symptoms did not significantly influence decision-making ability in patients with EDs [7],[12],[22]-[24].

Alexithymia is commonly described as consisting of four features: (1) difficulty identifying and describing subjective feelings; (2) difficulty distinguishing between feelings and the bodily sensations of emotional arousal; (3) lack of fantasy; and (4) an externally orientated cognitive style [25]. Previous studies demonstrated that patients with EDs use maladaptive eating behaviors (e.g., binging, purging, or dietary restriction) as a way to avoid or cope with their emotions [26],[27], with many clinical studies suggesting that eating disorder symptoms are associated with emotional dysfunction [28],[29], with clear functional links expressed between emotional states and both bulimic and restrictive pathology. It has been suggested that patients with EDs tend to show alexithymia, but only one study has examined the relation in EDs in comparison with healthy controls (HC), showing that alexithymia was unrelated to decision-making in AN [30].

The Iowa Gambling Task (IGT) is a neuropsychological task that tests the decision-making ability to sacrifice immediate rewards in order to achieve long-term gain [3]. IGT assesses set-shifting ability, reaction to reward and punishment, and learning ability to decide advantageous over disadvantageous choice under uncertainty [31]. …

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