Profiling Decision-Making Mechanisms in Binge Eating Disorder

Objective Binge eating disorder (BED) is a highly prevalent mental disorder associated with metabolic complications, reduced functioning, and poor quality of life, resulting in significant disease burden. Disordered decision-making is thought to drive behaviour in BED, but the specific mechanisms underlying this dysfunction remain unclear. Methods This study compared multiple aspects of decision-making between people with BED and higher weight (BED, n = 57), a control group matched by body mass index (BMI) without binge eating (HWC, n = 54), and lower weight controls (LWC, n = 54). We applied profile analyses to cognitive measures capturing three stages of decision-making: preference formation, choice implementation, and feedback processing. Additionally, we examined domains of psychological functioning shown to interact with cognitive mechanisms during decision-making – negative emotionality, maladaptive eating-related tendencies, and impulsive traits. Results We found generalised decision-making dysfunction in individuals with BED compared to the LWC but not the HWC group. However, BMI did not explain these differences. Poor overall psychological functioning clearly distinguished BED from both control groups, with elevated depressive symptoms and lack of perseverance emerging as key psychological characteristics. Discussion By mapping BED profiles across multiple components of decision-making, our findings indicate that domain-general cognitive dysfunction is an important mechanism in BED, alongside more well-recognised psychological features. These findings may further efforts to refine aetiological models of binge eating, providing more holistic and explanatory theories. They may also form a foundation for novel interventions and personalised approaches to treatment.