Decision making trouble : the case of eating disorders

Decision making trouble : the case of eating disorders

Case study outline

I. Description and why it is problematic

II. Definitions and pattern: are eating disorders impulsivity disorders ?

1) Eating disorders : from anorexia to bulimia nervosa... 2) ...the bulimia crisis : a methodological approach...

3) ... eating disorders, a subtype of impulsivity disorder ?

III. Experiences and research relevant to eating disorders

1) The UPPS scale and how it applies to eating disorders

2) The Minesotta experiment and what it reveals about eating disorders

3) How such studies may be useful in helping eating disorder patients to regain control over their decision making

Conclusion Bibliography

I. Description and why it is problematic

The dinner was lovely, her friends had just left. She was well sated, and about to clean up everything. But what about all those leftovers ? Reasoning rationally in such a situation would require her to tidy everything away in tupper ware boxes, and store them in the fridge, for her next meal. However, an uncontrollable pulse pushes her to ingest everything left, from the cold pizza to the chocolate cake. Her stomache aches awfully, a voice inside her head begs her to stop, but her body does not obey... Her hands are now reaching the cupboard, where cereals, bread and jam are luring her...

Bulimia nervosa is a typical example of an impulsivity disorder, among many others.

When a person faces two or more choices, this person is in a situation of decision making. While the Ancients broadly considered that « man is a rational animal » (Aristotle), it is however clear that emotions do influence our decision making, sometimes to an extent of making us consider irrational options over more balanced preferences. Impulsivity may be defined as acting or speaking using emotions rather than reason. The impulsive individual may not be able to resist or delay a temptation, despite knowing it is not objectively in his interest. According to Kahneman’s theory, the decision making would thus be based on system 1 solely, as an impulsive action requires little mental effort and is often guided by subconcious mechanisms. Eventhough not all impulsivity acts are wrong – indeed some may underline a survival strategy – such behaviors often lead to negative or even dangerous outcomes, for the person itself and its surroundings.

So how to put an end to such behaviors, or at least restrain their occurrence ? How to guide an individual into making safer and wiser decisions, and to involve more the « system 2 » - which Kahneman refers to as the logical reasoning - in the decision making process ?

Impulsive behaviors cover a wide range of disorders, from substance abuse to pyromania or trichotillomania (the impulsive pulling out of one’s hair). In this case study, I will focus on eating disorders as decision biases based on excessive impulsiveness. Eventhough a wide range of eating disorders may be indentified such as EDNOS (Eating Disorder Not Otherwise Specified), binge eating or orthorexia (the obsession over healthy eating), the two most studied eating disorders are probably bulimia and anorexia nervosa.

II. Definitions and pattern: are eating disorders impulsivity disorders ?

1) Eatingdisorders:fromanorexiatobulimianervosa...

Bulimia may be defined as the inability to resist urges to ingest vast amounts of foods, usually at an inappropriately fast pace, and without any prior reflexion. On the other hand anorexia is a trouble in which the sufferer engages in restrictive eating behavior, sometimes to the point of starvation. While the anorexic is

usually very picky about the food allowed, which is classified into « safe » and « unsafe » categories based on calories, fat and sugar content, the bulimic may indulge in just anything during a « binge crisis », from dry flour to raw butter. Eventhough bulimia and anorexia may seem like completely divergent disorders, as they literally involve opposite behaviors, they are actually more linked than one may think. Indeed, it is not uncommon for individuals to get through both disorders, either subsequently or alternatively. Such an interchangability may seem paradoxical: in one case the individual restricts and thus exercises a strong self control but in the other case the individual succumbs to over self indulgement. So how can a same individual engage in such opposite behaviors? Understanding the motives of the matter requires to understand its process and origins.

2) ...thebulimiacrisis:amethodologicalapproach...

A bulimia crisis, being by definition impulsive, does not follow a preconceived pathway. However, a typical process is to be noticed in the way an individual carries out a binge episode. Indeed, a bulimia crisis is to be distinguished from simple « cruches » that anyone experiences every now an then.

First, the rise of an urge creates a desire to act in a way that is objectively against one’s own interests – in the case of bulimia, the act of eating to the point of making oneself sick. The urge creates a sense of arousal, a need for action, which leads to succombing into temptation, and eat without any discernement. While doing so, the individual may not even be really conscious of his acts, but rather feel like he is acting mechanically, his actions being controlled by something external to his mind. After the urge has been satisfied, the individual then « comes back to real life », caught by a deep feeling of remorse. The bingeing can then be divided in a three steps action : the « pre-crisis » rise in tension, the bingeing and the aftermath, tinged with culpability.

3) ...eatingdisorders,asubtypeofimpulsivitydisorders?

Elster’s idea of impulsivity is not consistent with eating disorders. Indeed, Elster would have qualified the acts lying behind such disorders as irrational. According to Elster’s theory, they are three main motives lying behind irrationality: the lack of willingness, emotion biases and urgency. However, such a theory was developed according to people with « standard norms of rationality », who experience occasional decision biases. It is thus questionable whether his theory applies to impulsivity disorders, in

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