Restrictive Eating Through the Lens of Choice

Excessive food restriction is a central characteristic of anorexia nervosa and other eating disorders, yet the mechanisms underlying such eating behavior is not well understood. Viewing restrictive eating through the lens of choice and decision making has provided a way to examine the neural basis of a key behavioral disturbance in individuals with anorexia nervosa. Although complex eating behavior is reduced to a simple choice, behavior on experimental tasks with neuroimaging can be linked to real eating behavior, thereby providing a tighter link between brain activity and clinically relevant maladaptive eating. The basic neurocircuitry of decision making has been examined across humans and animals, providing well-described neural targets to examine for possible neuromodulatory interventions. In addition, the decision-making approach has elucidated how components of food valuation contribute to food choices. As bottom-up determinants of food valuation and motivation in eating disorders become better understood, these can be integrated within a decision-making framework to understand their contribution to food decisions, which must continuously be made and that are challenging for individuals with eating disorders.