How mental health alters decision making
The effects of mental health disorders can alter decision-making processes and compound the symptoms.
All of us are wired to seek rewards and avoid losses, and that remains true in people with mental health disorders. But in those people the nature of the risks and rewards and the way they activate the brain is skewed.
That altered decision-making creates challenges for people trying to make good decisions for their own health, whether it's overcoming depression, anxiety or eating disorders.
Young kids make decisions based on a set of rules they construct about the world around them – don't draw on the walls, don't spit your food, do eat your vegetables. As teenagers, we stop making decisions based on constructed rules and start independently weighing the risks and rewards of different options, but with a greatly reduced regard to risks.
Unlike their peers, people with anorexia never make the switch from following rules to flouting danger. If anything, their rules become more elaborate.
"Imagine if you had all of those rules and were really afraid of taking risks," says Kathleen Fitzpatrick, assistant professor of psychiatry and behavioral sciences. "They experience a lot of distress when they don't follow the rules." That's why people with anorexia continue to do well in school, sports and other areas, she says. That's what the rules dictate.
But their rules also dictate strict eating patterns – and breaking those rules is extremely distressing, even if those rules dictate unhealthy habits.
Those conditions add up to a decision-making pattern where following strict eating rules is rewarding and not following the rules is stressful. Weigh those and the brain chooses the questionable rewards of not eating.
Kids with depression are stuck in a similar predicament, with brain changes that prevent healthy decisions, says Manpreet Singh, assistant professor of psychiatry and behavioral sciences.
In kids with depression the brain activates in unusual ways in response to potential rewards or losses. "Even when a child is healthy but has a parent with a mental health disorder, their brain is already regarding rewards and losses differently," Singh says.
One difference is that their brains are predisposed to foresee more defeat and less reward than another child. That anticipation will spur decisions to avoid the very things that would allow them to feel better about themselves – do homework and succeed in school, for example.
"This has impact on kids who we see clinically who fail school because they don't have the motivation to do the work or even get out of bed," Singh says.
The pathways that anticipate bad outcomes are based on a brain chemical called dopamine. Singh is beginning work testing whether drugs that alter dopamine pathways could reset this predisposition to anticipate failure, and help kids make better decisions.