DAVIS, CAROLINE, ROBERT D. LEVITAN, PIERANDREA MUGLIA, CARMEN BEWELL, AND JAMES L. KENNEDY. Decision-making deficits and overeating: a risk model for obesity. Obes Res. 2004;12: 929 -935. Objective: To demonstrate that human overeating is not just a passive response to salient environmental triggers and powerful physiological drives; it is also about making choices. The ventromedial prefrontal cortex has been strongly implicated in the neural circuitry necessary for making advantageous decisions when various options for action are available. Decision-making deficits have been found in patients with ventromedial prefrontal cortex lesions and in those with substance dependence-impairments that reflect an inability to advantageously assess future consequences. That is, they choose immediate rewards in the face of future long-term negative consequences. Research Methods and Procedures:We extended this research to the study of overeating and overweight, testing a regression model that predicted that poor decision making (as assessed by a validated computerized gambling task) and a tendency to overeat under stress would correlate with higher BMI in a group of healthy adult women (N ϭ 41) representing a broad range of body weights. Results: We found statistically significant main effects for both independent variables in the predicted direction (p Ͻ 0.05; R 2 ϭ 0.35). Indeed, the decision-making impairments across the 100 trials of the computer task were greater in those with high BMI than in previous studies with drug addicts.Discussion: Findings suggested that cortical and subcortical processes, which regulate one's ability to inhibit short-term rewards when the long-term consequences are deleterious, may also influence eating behaviors in a culture dominated by so many, and such varied, sources of palatable and calorically dense sources of energy.

Objective: The aim of this study was to examine the impact of childhood sexual abuse (CSA) on clinical characteristics and premature termination of treatment in anorexia nervosa (AN). Method: The participants were 77 consecutive patients with AN admitted to an inpatient eating disorders unit. The patients were assessed in terms of eating disorder symptoms, general psychopathology, and CSA history at admission to hospital. Results: Thirty-seven patients (48%) reported a history of CSA before the onset of the eating disorder. Individuals with a history of CSA reported significantly greater psychiatric comorbidity, including higher levels of depression and anxiety, lower self-esteem, more interpersonal problems, and more severe obsessive-compulsive symptoms. Patients with the binge-purge subtype of AN (AN-BP) were significantly more likely to report a history of CSA prior to the onset of the eating disorder as compared with patients with the restricting subtype (AN-R) of the illness (65% of the AN-BP patients vs. 37% of the AN-R patients; p < .02). Contrary to our predictions, abused patients were not significantly more likely to dropout of treatment overall. However, patients of the binge-purge subtype (AN-BP) with a history of CSA were significantly more likely to terminate treatment prematurely as compared with the other patients. Carter et al. / Child Abuse & Neglect 30 (2006) [257][258][259][260][261][262][263][264][265][266][267][268][269] Conclusions: Consistent with previous findings, the present results indicate that the prevalence of CSA is high among individuals seeking inpatient treatment for AN. A history of CSA was associated with greater psychiatric disturbance overall and a higher rate of dropout for patients of the binge-purge subtype.

These findings suggest not only that readiness to make changes is an important indicator of future inpatient treatment outcome, but that it is the mechanism by which eating disorder symptomatology predicts success in a treatment program.