Bulimia nervosa and anorexia nervosa are two of the three most common eating disorders in the U.S. and throughout the world. Teenage girls and young women have the highest chances of developing these conditions. In a study published in April 2015 in the Journal of Eating Disorders, researchers from several Japanese institutions sought to determine if women with bulimia and women with anorexia undergo significant changes in their typical decision-making processes. These researchers also explored the connection between alterations in decision-making and the presence of mood-related problems such as depression, anxiety and alexithymia.

Bulimia and Anorexia

The American Psychiatric Association recognizes and officially defines several types of eating disorders, including bulimia nervosa, anorexia nervosa and a more common condition called binge-eating disorder. People with bulimia experience recurring episodes of food binging, during which they consume excessive amounts of calories in a short time; they also experience subsequent purging episodes designed to eliminate the consumed calories from their bodies. Physical problems associated with bulimia include vomiting-related tooth decay, potentially severe dehydration and a dehydration-related alteration of the body’s levels of critically important substances called electrolytes. Bulimia-related electrolyte imbalances can trigger possibly fatal changes in heart rate or heart function.

People with anorexia have an altered perception of their personal appearance that makes them feel overweight even though they have an actual body weight that’s at least 15 percent below the general medical standard for their age, gender and height. This altered perception leads to issues such as an extreme fear of gaining weight, a highly selective pattern of eating and a complete avoidance of eating when circumstances allow. Physical problems associated with anorexia include potentially fatal changes in heart function and a loss of normal menstruation in teenage girls and women. Some people with anorexia consistently restrict their calorie intake, while others go through episodes of the binging and purging classically found in cases of bulimia.


Decision-making belongs to a larger suite of abilities that psychologists and psychiatrists commonly refer to as executive function. Other closely related skills grouped under this heading include the ability to think logically and the ability to use past experiences as a guide for present and future action. Decision-making skills and all other executive function-related abilities develop gradually over the normal course of human growth and development. As a rule, they only reach their fully mature form in people age 25 and older.

Bulimia, Anorexia and Women’s Decision-Making

In the study published in the Journal of Eating Disorders, researchers from Japan’s Tochigi Medical Center, University of Fukui and several branches of Chiba University used a project involving 109 women between the ages of 18 and 38 to assess the impact that bulimia nervosa and anorexia nervosa have on women’s typical decision-making processes. Thirty-six of the study participants had diagnosed cases of bulimia, while 22 had diagnosed cases of anorexia. The remaining 51 participants constituted a comparison group of generally healthy women unaffected by bulimia or anorexia. The women in all three groups took a screening test, called the Iowa Gambling Task, designed to gauge the ability to make logical or rational decisions in changing circumstances. In addition, all of the women took mood-related screening tests that included the Hospital Anxiety and Depression Scale and the Toronto Alexithymia Scale. (Alexithymia is a mental state characterized by an inability to identify or distinguish among various emotions.)

The researchers concluded that women with bulimia and women with anorexia experience significant alterations in their decision-making processes. In women with bulimia, altered decision-making is associated with heightened concerns about weight gain. In women with anorexia, altered decision-making is associated with the presence of the binging and purging behaviors normally linked to bulimia. In both women with bulimia and women with anorexia, the researchers also linked changes in normal decision-making to the presence of significant indications of depression, as well as the presence of significant indications of anxiety.


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