Impaired decision-making in symptomatic anorexia and bulimia nervosa patients: a meta-analysis.
BACKGROUND
Impaired decision-making is a potential neurocognitive phenotype of eating disorders. It is therefore important to disentangle the decision-making deficits associated with the eating disorder subtypes and determine whether this putative impairment is a state or trait marker of the disease or more related to starvation. We systematically reviewed the literature on decision-making in eating disorders and conducted a meta-analysis to explore its role in anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED).


METHODS
A search of the Medline and EMBASE databases and article references was performed. A total of 23 studies (2044 participants) met the selection criteria. When the Iowa gambling task (IGT) was used in at least three of the studies, a meta-analysis was run.


RESULTS
IGT performance was significantly worse in patients with an eating disorder diagnosis (AN, BN or BED) compared with healthy controls, indicating that eating disorders have a negative effect on decision-making. Hedges' g effect sizes were moderate to large (-0.72 in AN, -0.62 in BN, and -1.26 in BED). Recovered AN patients had IGT scores similar to those of healthy controls. Restrictive AN patients had significantly lower IGT net scores than purging AN patients, and both AN subtypes had worse performances than healthy controls. Age and body mass index did not explain results.


CONCLUSIONS
Decision-making was significantly altered in patients with eating disorders. Poor decision-making was more pronounced during the acute phase than in the recovered state of AN. Nutritional status during the acute phase of the disease did not seem to influence decision-making skills.
Université Montpellier I & CHU Montpellier & Inserm,U1061,Montpellier,France.
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Guillaume
CMME (Groupe Hospitalier Sainte-Anne),Université Paris Descartes,Paris,France.
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Gorwood
Department of Psychiatry & Douglas Mental Health University Institute,McGill Group for Suicide Studies,McGill University,Montréal (Québec),Canada.
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Jollant
Department of Psychiatry & Douglas Mental Health University Institute,McGill University,Montréal (Québec),Canada.
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Van den Eynde
Université Montpellier I & CHU Montpellier & Inserm,U1061,Montpellier,France.
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Courtet
Department of Psychiatry & Douglas Mental Health University Institute,McGill Group for Suicide Studies,McGill University,Montréal (Québec),Canada.
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Richard-Devantoy
D000856:Anorexia Nervosa / Q000523:psychology*; D056912:Binge-Eating Disorder / Q000523:psychology*; D015992:Body Mass Index; D052018:Bulimia Nervosa / Q000523:psychology*; D003657:Decision Making; D006801:Humans; D009483:Neuropsychological Tests; D013647:Task Performance and Analysis
Decision-making; Iowa gambling task; eating disorders