Neuropsychological investigation of decision-making in
anorexia nervosa
Paolo Cavedini
*
, Tommaso Bassi, Alessandro Ubbiali, Alessia Casolari,
Silvia Giordani, Claudia Zorzi, Laura Bellodi
Department of Neuropsychiatric Sciences, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20,
Via Stamira d’Ancona, 20127 Milan, Italy
Received 6 May 2003; received in revised form 23 January 2004; accepted 3 November 2004
Abstract
Anorexia nervosa (AN) could be considered a form of obsessive –compulsive disorder in which an impairment of the
cognitive domain related to decision-making was found. We explored this function in AN patients, as well as possible
differences between restricting type and binge/purge type, with the aim of examining the hypothesis that AN is part of the
obsessive–compulsive spectrum. Decision-making was assessed in 59 inpatients with AN and 82 control subjects using the
Gambling task, which simulates real-life decision-making by assessing the ability to balance immediate rewards against long-
term negative consequences. We confirmed the supposed deficit of decision-making in AN. However, restricting and binge
eating/purge subtypes showed different patterns of decision-making impairment. Poor performance on the Gambling task is
not a mere consequence of starvation and does not appear to be related to illness severity. The decision-making deficiency
that some AN patients show is linked to those individual features that contribute to the phenomenological expression of the
disorder.
D 2004 Elsevier Ireland Ltd. All rights reserved.
Keywords: Eating disorders; Obsessive – compulsive disorder; Executive functions; Gambling task
1. Introduction
Several authors have suggested that anorexia
nervosa (AN) could be considered a form of obses-
sive– compulsive disorder (OCD) (Halmietal.,
2003). At present, there is evidence from familial
and genetic studies that eating disorders (ED) should
be considered as one of the obsessive –compulsive
spectrum disorders (Matsunaga et al., 1999). In fact,
in families of patients with AN and bulimia nervosa,
there is a significantly increased familial risk for
OCD and chronic tics, without any relationship with
the OCD/tic co-diagnosis in the proband (Bellodi et
al., 2001). Furthermore, a segregation study on
Italian ED families showed that ED and OCD are
transmitted in ED families following an additive
Mendelian model of transmission (Cavallini et al.,
2000).
Neuropsychological studies, often associated in
patients affected by ED have revealed an impair-
ment in several cognitive domains (Fassino et al.,
0165-1781/$ - see front matter D 2004 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.psychres.2004.03.012
* Corresponding author. Tel.: +39-02-2643-3376; fax: +39-02-
2643-3265.
E-mail address: cavedini.paolo@hsr.it (P. Cavedini).
www.elsevier.com/locate/psychres
Psychiatry Research 127 (2004) 259 –266