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How Eating Disorders Can Lead To Bad Decision Making

What classes do I sign up for? Which restaurant do I want to eat at? How much money is appropriate to spend on a birthday gift? Which is the best highway to take to get home? Whether we realize it or not, decision-making is an essential daily function. We rely on our decision-making abilities to guide us through our actions. But what affects these abilities? Data has shown that individuals with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) have long-term difficulty in decision-making. While serious eating disorders such as AN and BN can have short-term effects such as drastic weight loss and skewed self-image, it is also important to consider the long-term effects that these diseases may have. While some may think that rehabilitation of these diseases mainly involve the process of eating healthy and emotional and mental rehabilitation, rehabilitation, as this article proves, must reach far beyond for these individuals. Differences in decision-making are an important aspect to explore, as treatment in later stages of the disease should be adjusted to these findings. Chan et al.’s study demonstrated the effects of these diseases on what could be life-changing decisions.


Previous studies have already identified differences in decision-making between individuals with AN/BN and individuals without these disorders in tasks such as the Iowa Gambling Task (IGT). The IGT simulates real-life decision-making in which participants are given four decks of virtual cards. Drawing cards can either produce a win or loss of money, and the goal of the task is to win as much money as possible. The participants don’t know, however, that “loss” cards are distributed throughout some of the decks of cards, leading to “good decks” and “bad decks”. Usually, healthy participants are good are recognizing “good decks” and “bad decks” in about 50 selections, and could therefore succeed in the task. Those with eating disorders, however, demonstrated to be worse at the IGT than control participants. Individuals with AN and BN would overall base their decisions on the potential value of immediate losses/gains instead of the final outcome, and further, those with AN were even worse at the IGT than those with BN (Garrido and Subirá, 2013), and further,

Chan et al.’s study points out that there hadn’t been any research on the actual differences in the decision-making process between those with AN and those with BN. In order to determine these differences, the researchers used methodology termed cognitive modeling. Cognitive modeling breaks down the decision-making process into different conceptual levels of processing, and produces a good representation of the multi-step processing of decision-making (yay cognitive psychology!). The model that they used to analyze the IGT in this experiment was called Prospect Valence Learning model (PVL).

So, how does decision-making work? These researchers explained decision-making as a function of individual’s expectation of valence; in other words, individuals may associate positive feelings with one deck of cards and negative feelings with another deck based on whether they’ve won or lost. While the PVL model measures many different parameters, this study focused on learning/memory, feedback sensitivity, and loss aversion. Learning/memory is an important measure in determining whether individuals focus on the immediate or the long-term. Loss aversion is a measure that demonstrates whether people would rather avoid losses than gain something. Measuring feedback sensitivity demonstrates whether individuals were more sensitive to rewards or punishments.

The researchers hypothesized that individuals with AN would be highly sensitive to punishment and would demonstrate impaired learning/memory functions. This impaired memory would be seen almost like a retroactive interference; individuals with AN would base their decisions on the most recent outcome instead of their previous outcomes. The researchers hypothesized that individuals with BN, however, would show sensitivity to rewards/gains. In thinking about the characteristics of each disease, these predictions make sense; individuals with BN reward themselves with binge eating, whereas those with AN punish themselves by skipping meals. Moreover, the individuals don’t think about long-term consequences, and instead think about their immediate goals (like weight loss).

The researchers were partially correct in their hypothesis. Consistent with their predictions, those with AN demonstrated impaired learning/memory. However, they did not show any significant difference of loss aversion in comparison to the healthy control group. Therefore, it seems that individuals with AN are NOT more sensitive to punishment than any other person, although the researchers attributed this finding to the limitations in testing centers of the experiment. The researchers were also correct in their predictions that individuals with BN would be more sensitive to reward. Ultimately, this study demonstrated good groundwork for the underlying differences in decision-making between individuals with AN versus BN. While this experiment tested decision-making as a cognitive process, the results can push past these boundaries and can be useful in non-cognitive fields, like rehabilitation for individuals with eating disorders. In discovering this focused information, counselors can perhaps better focus their treatment to tackle these issues in decision-making.

The important take-home message here is how an unhealthy body image and lack of control over eating disorders affect decision-making in a bad way, as we see in this study. While those suffering eating disorders may think that recovery is much more related to the direct effects of the eating disorder (as this study proves the immediate is often more of a focus for them than the long-term), it becomes clear that the disorder has affected much more than that, reaching cognitive processes that we would seem to think are unrelated.


Interested in how other factors can influence your decision-making in a bad way? Read more about how staying healthy improves decision-making. This blog post is about individuals that depend on unhealthy substances, like cocaine and methamphetamine, make decisions in similar ways to how those with AN and BN make decisions.



Chan, T. W. S., Ahn, W., Bates, J., Busemeyer, J., Guillaume, S., Redgrave, G., Danner, U., Courtet, P. (2014). Differential impairments underlying decision making in anorexia nervosa and bulimia nervosa: A cognitive modeling analysis. International Journal of Eating Disorders47:2, 157-167.

Garrido, I., Subirá, S. (2013). Decision-making and impulsivity in eating disorder patients. Pyschiatry Research. 207:1-2, 107-112.

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  1. November 25th, 2014 at 14:09 | #1

    I really enjoyed reading this post because I’ve never really considered the effects AN and BN can have on cognition. I think it is interesting that individuals with AN showed impairments in learning and memory. However, that is a very large category, and I think future research should investigate exactly what processes in learning and memory are preserved and what processes are impaired. Could it be possible that these individuals show differences in pattern recognition? Maybe they have difficulty relating new information to old information? Are there only differences in LTM, or is STM impaired as well? The implications for this knowledge is exciting, too, especially when it comes to how individuals with AN may learn differently. If we are better able to understand learning in individuals with AN, we can specify interventions that are best appropriate for this type of learning. This article also raised a few questions for me about the causal relationship of AN/BN and learning and memory. Does AN/BN cause impairments (particularly through the modulation of biological factors – ie. not having enough energy to properly carry out cognitive processes) or are people with learning/memory impairments more vulnerable to developing AN/BN? Overall, I think this is a fantastic post that really spurred a lot of thought for me! Eating disorders are a prevalent issue in society today, and I think it’s important that we understand their effects of cognition. Great post, Anna!

  2. Sara Heilbronner
    December 3rd, 2014 at 08:47 | #2

    This is an eye-opening post, both for the answers it offers and questions it raises! Like Courtney, I was also intrigued by the notion that eating disorders can impact as seemingly distant and irrelevant a realm as cognition. It is most definitely an enlightening discovery—one with significant “real-world” benefits—that people with AN engage in decision-making processes that differ from those of BN sufferers: as both Anna and Courtney wrote, intervention tactics can now be more individually (and thus more effectively) tailored to the particular characteristics of these clearly distinct diseases.

    While the present research has undoubtedly revealed some valuable information about eating disorders and the ways in which methods of decision-making can be affected, I think that, in some ways, its value lies in the questions it has raised. First off, what is the key underlying basis for the initial or “original” formation of one’s decision-making processes? In other words, how is this process determined in the first place? Is each of us born with some genetically predetermined method of making choices? Does or can this cognitive method change as a function of task? As a function of time, personality, and life events? If so, why and how? And do all of these variables result in the same amount and type of shift in decision-making processes, or is the shift more susceptible to one variable’s impact than that of another?

    This post also got me to wondering: are decision-making processes considered to be a cognitively controllable or automatic? For instance, with regards to the present study, let’s say that individuals with AN and BN receive tools through counseling that help them to control or inhibit their “expectations of valence.” Would the ensuing decision-making processes be considered to be controlled (because individuals directly manipulated the initial step that ultimately sets the stage for the type of decision-making that will occur) or would they still be considered automatic (for the actual cognitive process at the very moment of making one’s decision wasn’t technically manipulated)? Perhaps this question leads to a more crucial one (imagine that!): exactly how long is the decision-making process, and is there a point or stage in the process that is most critical to determining the entire outcome of the process?

    Eating disorders, painfully pervasive in nature, hold a tight grip on the lives of those struggling through them. Now that we know more about the effect that these terrible diseases have not just on physical health and emotional well-being but also on psychological, cognitive-level processes, perhaps in society there will arise newfound levels of sympathy for and patience with AN and BN sufferers.

  3. December 10th, 2015 at 11:10 | #3

    This was an informative post that I thought worked really well for college aged readers. Eating disorders are prevalent today so it is good to know how and why they affect our mental cognition. I found the Iowa Gambling Task to be an interesting way to see how people associate their decision making as an effect of their disorder. I took Professor Sheet’s abnormal class and read a memoir about Portia de Rossi and her struggle with anorexia. I found the part about the immediate or long-term loss so interesting when comparing it to her struggle. The study that Anna mentions in her blog about the cards being associated with the value of either immediate loss/gain or long-term loss/gain correlated well with what I learned about Portia. She would only focus on immediate losses or gains which caused her to punish herself in many ways regarding her weight (i.e restricting food from herself or over-exercising). Her disorder also showed a higher order of cognitive processing. During the worse part of her disorder she had trouble remembering things, had no energy, was delusional and had a break down that put her in the hospital. Her cognitive processing and control had an impact on her short-term memory which is really scary to think about. Overall I thought this post was great because it went into depth about the cognitive part of the disorders!

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