Skip to main content Accessibility help

An investigation of decision making in anorexia nervosa using the Iowa Gambling Task and skin conductance measurements



The objective of this study is to determine (a) if decision making ability is impaired in patients with anorexia nervosa (AN) and in people with good recovery from AN and (b) whether any impairment in decision making is associated with alterations in skin conductance responses (SCR). Patients with AN (n = 29), healthy controls comparable in age and IQ (HC, n = 29), and women long term recovered from AN (n = 14), completed the Iowa Gambling Task (IGT) while their SCR were measured. AN patients performed poorly in the IGT compared to the HC and to the recovered AN participants. AN patients had decreased anticipatory SCR prior to choosing cards and reduced SCR after losses compared to HC. IGT performance and the SCR of recovered AN participants did not differ from the HC. Decision making ability is impaired in AN. It is associated with a significantly attenuated SCR. Neither of these features are found in recovered AN. The association between impaired decision making ability and a decreased autonomic response is consistent with the predictions of the Somatic Marker Hypothesis. (JINS, 2007, 13, 635–641.)


Corresponding author

Correspondence and reprint requests to: Dr. Kate Tchanturia, PO59 Eating Disorders, Institute of Psychiatry, Kings College, London SE5 8AF, UK. E-mail:


Hide All


Bechara, A., Damasio, H., Damasio, A.R., & Lee, G.P. (1999). Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making. The Journal of Neuroscience, 19, 54735481.
Bechara, A., Damasio, H., Tranel, D., & Damasio, A.R. (1997). Deciding advantageously before knowing the advantageous strategy. Science, 275, 12931295.
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 53, 561571.
Bergen, A.W., Yeager, M., Welch, R.A., Haque, K., Ganjei, J.K., van den Bree, M.B., Mazzanti, C., Nardi, I., Fichter, M., Halmi, K., Kaplan, A., Strober, M., Treasure, J., Woodside, B., Bulik, C., Bacanu, S., Devlin, B., Berrettini, W., Goldman, D., & Kaye, W. (2005). Association of Multiple DRD2 Polymorphisms with anorexia nervosa. Neuropsychopharmacology, 30, 17031710.
Blinder, B., Cumella, E.J., & Sanathara, V.A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosoatic Medicine, 68, 454462.
Cavedini, P., Bassi, T., Ubbiali, A., Casolari, A., Giordani, S., Zorzi, C., & Bellodi, L. (2004). Neuropsychological investigation of decision-making in anorexia nervosa. Psychiatry Research, 127, 259266.
Cavedini, P., Riboldi, G., D'Annucci, A., Belotti, P., Cisima, M., & Bellodi, L. (2002). Decision-making heterogeneity in obsessive-compulsive disorder: Ventromedial prefrontal cortex function predicts different treatment outcomes. Neuropsychologia, 40, 205211.
Dalgleish, T., Yiend, J., Bramham, J., Teasdale, J.D., Ogilvie, A.D., Malhi, G., & Howard, R. (2004). Neuropsychological processing associated with recovery from depression after stereotactic subcaudate tractotomy. American Journal of Psychiatry, 161, 19131916.
Damasio, A. (2004). Looking for Spinoza. London: Vintage.
Davidson, R.J., Pizzagali, D., Nitschke, J.B., & Putnam, K. (2002). Depression: Perspectives from affective neuroscience. Annual Review of Psychology, 53, 545574
Fairburn, C.G. & Beglin, S.J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363370.
Fein, G., Klein, L., & Finn, P. (2004). Impairment on a simulated gambling task in long-term abstinent alcoholics. Alcoholism Clinical and Experimental Research, 28, 14871491.
Garon, N., Moore, C., & Waschbusch, D.A. (2006). Decision making in children with ADHD only, ADHD-anxious/depressed, and control children using a child version of the Iowa Gambling Task. Journal of Attention Disorders, 9, 607619.
Green, M.W., Elliman, N.A., Wakeling, A., & Rogers, P.J. (1996). Cognitive functioning, weight change and therapy in anorexia nervosa. Journal of Psychiatric Research, 30, 401410.
Halmi, K.A. & Sunday, S.R. (1991). Temporal patterns of hunger and fullness ratings and related cognitions in anorexia and bulimia. Appetite, 16, 219237.
Hornak, J., O'Doherty, J., Bramham, J., Rolls, E.T., Morris, R.G., Bullock, P.R., & Polkey, C. (2004). Reward-related reversal learning after surgical excisions in orbito-frontal or dorsolateral prefrontal cortex in humans. Journal of Cognitive Neuroscience, 16, 463478.
Jollant, F., Bellivier, F., Leboyer, M., Astruc, B., Torres, S., Verdier, R., Castelnau, D., Malafosse, A., & Courtet, P. (2005). Impaired decision making in suicide attempters. American Journal of Psychiatry, 162, 304310.
Kaye, W.H., Ebert, M.H., Raleigh, M., & Lake, R. (1984). Abnormalities in CNS monoamine metabolism in anorexia nervosa. Archives of General Psychiatry, 41, 350355.
Kaye, W.H., Klump, K.L., Frank, G.K., & Strober, M. (2000). Anorexia and bulimia nervosa. Annual Review of Medicine, 51, 299313.
Lattimore, P., Gowers, S., & Wagner, H. (2000). Autonomic arousal and conflict avoidance in anorexia nervosa: A pilot study. European Eating Disorders Review, 8, 3139.
Lawrence, N., Wooderson, S., Mataix-Cols, D., David, R., Speckens, A., & Phillips, M. (2006). Decision-making and set-shifting impairments are associated with distinct symptom dimensions in OCD. Neuropsychology, 20, 409419.
Maia, T.V. & McClelland, J.L. (2004). A reexamination of the evidence for the somatic marker hypothesis: What participants really know in the Iowa Gambling Task. Proceedings of the National Academy of Sciences of the United States of America PNAS, 101, 1607516080.
Nelson, H.E. & Willison, J.W. (1992). National Adult Reading Test (NART). (2nd ed.) Windsor.
Papezova, H., Yamamotova, A., & Uher, R. (2005). Elevated pain threshold in eating disorders: Physiological and psychological factors. Journal of Psychiatric Research, 39, 431438.
Roberts, M., Tchanturia, K., Stahl, D., Southgate, L., & Treasure J. (2007). A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychological Medicine (in press, online).
Rolls, E.T. (1996). The orbitofrontal cortex. Philosophical Transactions of the Royal Society: Biological Sciences, 351, 14331443.
Rottenberg, J., Gross, J.J., & Gotlib, I.H. (2005). Emotion context insensitivity in major depressive disorder. Journal of Abnormal Psychology, 114, 627639.
Scarna, A., McTavish, S.F., Cowen, P.J., Goodwin, G.M., & Rogers, R.D. (2005). The effects of a branched chain amino acid mixture supplemented with tryptophan on biochemical indices of neurotransmitter function and decision-making. Psychopharmacology, 179, 761768.
Southgate, L., Tchanturia, K., & Treasure, J. (2005). Neuropsychological performance in Anorexia Nervosa: A systematic review of Frontal Lobe functions. In P.I. Swain (Ed.), Eating Disorders: New Research. New York: Nova Science Publishers.
Tchanturia, K., Brecelj Anderluh, M., Morris, R., Rabe-Hesketh, S., Collier, D., Sanchez, P., & Treasure, J. (2004). Cognitive Flexibility in anorexia nervosa and bulimia nervosa. Journal of International Neuropsychological Society, 10, 513520.
Tchanturia, K., Campbell, I.C., Morris, R., & Treasure, J. (2005). Neuropsychological studies in anorexia nervosa. International Journal of Eating Disorders, 37, 572576.
Tomb, I., Hauser, M., Deldin, P., & Caramazza, A. (2002). Do somatic markers mediate decisions on the gambling task? Nature Neuroscience, 5, 11031104.
Uher, R., Brammer, M.J., Murphy, T., Campbell, I.C., Ng, V.W., Williams, S.C., & Treasure, J. (2003). Recovery and chronicity in anorexia nervosa: Brain activity associated with differential outcomes. Biological Psychiatry, 54, 934942.
Uher, R., Murphy, T., Brammer, M.J., Dalgleish, T., Phillips, M.L., Ng, V.W., Andrew, C., Williams, S., Campbell, I., & Treasure, J. (2004). Medial prefrontal cortex activity associated with symptom provocation in eating disorders. American Journal of Psychiatry, 161, 12381246.
Uher, R. & Treasure, J. (2005). Brain lesions and eating disorders. Journal of Neurology Neurosurgery and Psychiatry, 76, 852857.


Related content

Powered by UNSILO

An investigation of decision making in anorexia nervosa using the Iowa Gambling Task and skin conductance measurements



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.