Mental Capacity, Decision-Making and Emotion Dysregulation in Severe Enduring Anorexia Nervosa
Open accessAbstract
Severe and Enduring Anorexia Nervosa (SE-AN) is a chronic eating disorder characterized by long-term starvation and its physical and psychological sequelae, and severe loss of quality of life. Interactions between neurobiological changes caused by starvation, vulnerability (personality) traits, and eating behaviors play a role. Several other factors, such as increased fear and decreased social cognition, have also been found in relation to SE-AN. With this in mind, we aim to add to the understanding of SE-AN by introducing the concept of mental capacity (MC), which refers to the ability to understand and process information—both on a cognitive and an emotional level—and then make a well-informed choice. MC may be an important construct within the context of SE-AN. Furthermore, we will argue how impaired decision-making processes may underlie, fuel, or contribute to limited MC in SE-AN. We will speculate on the importance of dysfunctional emotion processing and anxiety-related processes (e.g., a high intolerance of uncertainty) and their potential interaction with decision-making. Lastly, we will propose how these aspects, which to our knowledge have previously received little attention, may advise research and treatment or help in dealing with the “want but cannot” situation of life-threatening AN.
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Research has documented extensive cognitive impairments associated with malnutrition in anorexia nervosa, including brain atrophy, cognitive distortions, reduced executive functioning, and emotional processing issues.
“This raises profound concerns, given that research has documented extensive cognitive impairments associated with malnutrition in anorexia nervosa, including brain atrophy, cognitive distortions, reduced executive functioning, and emotional processing issues (151–155).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [155]
The Emotional Processing and Decision-Making sections describe emotional-processing problems and disturbed decision-making in anorexia nervosa; the Mental Capacity section also describes distorted appreciation. The paper mentions neurobiological changes caused by starvation, but the passages do not document brain atrophy or reduced executive functioning, or attribute the full list of impairments to malnutrition. Page numbers were not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMalnutrition exacerbates depressive and obsessional symptoms, promotes eating disordered cognitions, and impairs decision making.
“malnutrition exacerbates depressive and obsessional symptoms, promotes eating disordered cognitions and impairs decision making [10, 11].”
From Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined (2022) · cites this paper as [10]
Compulsory treatment is not the solution for all patients with diminished mental capacity who refuse treatment; in some situations, it may do more harm than good.
“Van Elburg et al. [20] state,”CT [compulsory treatment] is not the solution for all patients with diminished MC [mental capacity] who refuse treatment. In some situations, it may do more harm than good.””
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“This raises profound concerns, given that research has documented extensive cognitive impairments associated with malnutrition in anorexia nervosa, including brain atrophy, cognitive distortions, reduced executive functioning, and emotional processing issues (151 – 155).”
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- Authors
- van Elburg, A., Danner, U. N., Sternheim, L. C., Lammers, M., & Elzakkers, I.
- Affiliations
- Utrecht University (NL)
- GGNet (NL)
- Altrecht GGZ (NL)
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2021-03-11
- Volume
- 12
- Pages
- 545317-545317
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7991306
- OpenAlex
- W3137665104
- Cited by
- 55
- References
- 75
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 11 · 2023: 10 · 2022: 13 · 2021: 6
- FWCI
- 6.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- severe and enduring anorexia nervosa, decision-making capacity, decision-making, emotional dysregulation, starvation, intolerance of uncertainty, anxiety, social cognition, personality traits
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