Analysis Paralysis

As I have promised, I'm going to do a few posts on some of the things I learned while at the AED conference last weekend.

The best session I went to was called "Who's Who in the Brain?" and it looked at what neural systems malfunction in anorexia.  To try and summarize the talk would be ludicrous, especially since the best part was interactive.  Basically, session leaders Bryan Lask and Ken Nunn had us get into groups of 8 (since most of the participants were MDs or PhDs, there was a little bit of eye rolling at this suggestion) and we each took on a role of one of the neural systems profiled, from the nucleus accumbens (the pleasure center) to the prefrontal cortex (PFC, the "executive" or decision-making part of the brain).

We were given the task of trying to decide where to meet for dinner.  We each had to play the part of the brain part we were assigned (I was the basal ganglia, which is involved in movement/exercise, precision, and also malfunctions during OCD. I'm pretty tight with my basal ganglia...) in deciding where to meet for dinner.  As the basal ganglia, I needed to know exactly where and when to meet, like give me some GPS coordinates, people, and exactly how much money did we have to spend?  So perhaps a little neurotic, but I was bound and determined to get us there on time.

The other five group members also provided their feedback, and the insula carried all of our messages to the prefrontal cortex, who made the final decision.  We were going to meet at the hip Asian joint down the street at 6:45 pm for drinks and sushi. Ta-da! Decision made.

Then, we had to make the same decision in a malfunctioning anorexic brain.  As the basal ganglia, I couldn't find the "perfect" restaurant or the "perfect" entree or be sure that everyone else in the group would agree.  The prefontal cortex was also malfunctioning, and pretty much left the five brain parts to rule in anarchy.  The insula was simply missing in action and none of the brain parts could talk to anyone else.

Our decision?

Skip dinner.  All around the room, the groups returned with the same verdict: no dinner.  With a malfunctioning brain, the decision was just too complicated, and so the "brains" defaulted on not eating.

Our group decided we'd get tattoos instead (there was some sort of inside joke there--it was tremendously funny at the time, but I can't exactly remember why). Another group went to the gym.  Mostly, people retreated to their rooms and spent a socially isolated evening on their own.

Sound familiar?

Lask and Nunn referred to this conundrum--an endless shouting by the various parts of the brain while the prefrontal cortex merely shrugged its shoulders and the insula had long since left the building--as analysis paralysis.  Wikipedia defines it as:

Figuring out where to go for dinner seems like a pretty simple decision.  It's not like figuring out where to move or whether to take that job or how much to invest in your 401(k).  It's just dinner.  Yet the decision making process, though it can happen lightning fast, is also very complicated.  If the brain can't share and process information--if the insula isn't working properly--the brain gets stuck on the simplest of decisions, like a scratched record or CD.

The insula is known to malfunction in anorexia.  Starvation reduces blood flow to the brain, which makes other areas of the brain malfunction as well.  Soon, the simplest questions cause paralysis and the brain defaults to a simple answer: no.  I already ate. I'm not hungry. I'm busy. No thanks. I'd rather not. No. No. No.

It's our way of avoiding analysis paralysis.  Our brains, Nunn said, are rather like Congress.  Lots of bickering, lots of going back and forth, and without strong leadership, nothing gets done. Actually, even with strong leadership, things don't always get done in Congress, but I digress.  Even if the insula alone isn't working properly, the entire brain is affected, and it gets stuck in analysis paralysis.

The solution is for other people to step in and act as the insula and prefrontal cortex of the person suffering from anorexia, whether it's parents, caregivers, friends, or therapists.  It's often too complicated to decide what to eat, and so it helps for someone else to do a bit of the decision making, sometimes in the form of making all food choices, or giving guidelines in others.  Eventually, the brain regains enough function to begin to take over those decisions, and being able to easily make decisions is a sign of recovery.


Kendra (voice in recovery) said...

Squeeeeel!!!! Now you are speaking my language!!!! My neuropsychiatry class was my favorite because it opened my eyes in many ways to what I had struggled with and what others currently struggle with. It also helps me to talk through panic attacks because I KNOW what is going on. The science calms me. Such important info and why I love love neuro science :) Thanks for sharing

hm said...


This is my life story right now. Every decision presented to me makes me freeze and become incapable. So I avoid and avoid and avoid, people, outings, adventures, food, everything. Because it's just all to damn much.

I feel like a kid in a Charlie Brown episode and the whole world sounds like the adults sound on that show- everything anyone says to me sounds like, "Mwah wah wah, wah wah- Wah wah wah" and I can't make sense out of any of it.

You are saying this is a sign of starvation. I thought it was just a sign of the stress I am under. Now I am thinking I might actually be causing it.

Sitting in shock.

Cathy (UK) said...

I'd have loved to have attended this talk :) I'm looking forward to the new book of Lask et al. too.

Carrie, did Lask and Nunn mention to what extent these neurological quirks are likely attributable to starvation alone, and whether or not they may pre-date the onset of AN and even be involved in the aetiology of AN?

PJ said...

Okay, this is a brilliant post! And it must have been a brilliant session!! What an amazingly astute way to illustrate the problems facing the brain of someone with anorexia.
And it now makes perfect sense that even when I really want to eat, it still takes me two hours to just resort to a bowl of cereal :)
(It also makes perfect sense that without the strong leadership of the prefrontal cortex it's no wonder the ED gets to take control so easily)

Sarah at Journeying With Him said...

Oh my goodness. I wish I could have been there to participate in that lecture! I dream of teaching college classes someday as an adjunct professor, and I would love to teach other people in such an interactive way that they really get someone else's situation like participants in that session must have. I imagine they went from eye-rolling to actually really empathizing with their clients in a new way. That's amazing! And I love the metaphor about Congress--snarky and illuminating at the same time. Thank you so much for recapping this session in such a detailed, well-written way! Looking forward to more recaps.

Heather said...

This is a great post, as the others before have stated.
Analysis paralysis seems to pervade most decision making aspects of my life, from the nominal to the life altering. It is amazing to have science behind it.
I must say though that over the years, in order to function, my eating disorder has become more and more insidious.
The option of “skipping dinner” rarely presents itself, however, I may continue to engage in restrictive consumption. The idea that I’m not all out “forgoing eating” is in and of itself extremely damaging, yet because it is not stark starvation, I don’t harangue myself in the same way I would if I was opting not to eat at all.
I have often been known to revert to that default of safe behaviors, once the decision making process becomes too overwhelming. This being said, just because I’m not completely skipping a meal doesn’t mean I’m not letting the eating disorder. For me, this post helped me to see how I can convince myself I am “okay” when really, I am in fact reacting in the same way.

HikerRD said...

Fascinating post, Carrie. So now we have a good, neuro scientific understanding of why we agonize about such decisions. The solution, though is less complicated. Allow others to assist in the process, as you suggest. Or preplan meals, so that you are not struggling with the decision making and the difficulty of eating at the very same time.
Looking forward to hearing more from the conference.

Abby said...


This hits home. I find I struggle with this a lot even in recovery. If things aren't perfect I tend to get paralyzed.

Charlotte UK said...

An amazing post and I am in awe of how you are able to write so clearly and coherently and explain a complex presentation so brilliantly. Thank you.

Fiona Marcella said...

as Charlotte has said, a brilliantly explained post about what sounds to have been a great session.

anne said...


First, I'm thrilled you got to meet Ken Nunn. He was wonderful to me long ago and helped me with treatment questions I had about my daughter. I've never forgotten that.


Carrie, I'm interested in links between executive functioning (or dysfunctioning) and the development of eating disorders. Have any studies been done linking the two?
My daughter has a 'comorbid' diagnosis of executive function difficulties. Did this come up as a risk factor?

The_Timekeeper said...

What leaves me scratching my head is that my experience of "analysis paralysis" is only true for eating disorder related decisions, thoughts, function/dysfunction, etc. I don't generally find decisions in any other area of my life difficult and, really, make them fairly easily, quickly and confidently. How can the same neurology misfire for this specific ED problem but otherwise maintain relatively normal (or better) function?

Cathy (UK) said...


There are a number of recent studies examining aspects of executive (dys)function in AN, often alongside autistic traits. I am interested to know whether, in all cases, this 'analysis paralysis' pre-dated the onset of AN, or is a symptom of AN. I would guess that it varies from person-to-person.

@ The_Timekeeper

Interesting that you say that this decision making only influences the area of your life relating to eating... I know I have always had difficulties with this area (and have tended to do the same things over and over again..) in ALL aspects of my life. Thus, when I developed AN it was not really surprising...

Anonymous said...

I think you just described the inner workings of my current brain.

I am not really able to make any decisions well right now and you explained the science behind why this is most likely happening to me as I'm suffering from an ED.

Decisions don't seem to be clear in my brain - I recently had signed up for a course and then withdrew. It was a course that I wanted to do and there were pro's and con's to taking it. It felt like my brain was split in half - one part of it looking at the pro's of the course, the other half looking at the cons. It left me feeling like I was in between the two sides of my brain and didn't know how to make a decision.

I've been noticing this a lot with myself - the fact that I can't make decisions very easily and that my brain gets very confused. It gets frustrating because I wish that I could just make a decision and not be in that place in between where I get so confused and anxious.

Cammy said...

Very interesting role-playing exercise! I definitely identify with that. There have been times (fortunately almost entirely in the past now) when I would end up sitting on the kitchen floor crying because I was famished and knew I needed to eat, even wanted to, but was completely incapable of picking out the "right" thing. I'd spend close to an hour trying to decide sometimes. Damn whacked out insula!!! I definitely noticed, once I got past a certain weight threshold, that I was calmer and able to make decisions much better, I'd be interested in seeing some data on whereabouts on the BMI range that is supposedly thought to take place?

Anonymous said...

This is fascinating. Carrie, thank you so much for sharing. I love your blog. It is so informative. I would love to learn more about the biology of ED's. I definitely struggle with the decision-making process; and it does spill into other areas of my life. I have high levels of OCD and find it hard to 'relax' if my surroundings aren't clean/ordered.

Going out with friends to eat is nerve-wracking for me and I err on the side of 'safe' foods- not necessarily low-calorie foods, but foods I'm used to that don't stress me out. I find it difficult to concentrate on what people are saying at the same time. I eat too slowly because while I'm talking, I'm caught up in the hyper-analysis of 'when is it okay to take a bite without looking gluttonous or awkward?', and worrying about what people think of me in general.

Being offered food spontaneously sends my anxiety skyrocketing just by virtue of the fact that it's unexpected, and the aforementioned self-consciousness I feel eating in the presence of others. I seem to have lost touch with my former ability to make spontaneous decisions. I get flustered. If I order badly, because I'm put on the spot, I will agonise over it all night and it will interfere with my concentration.

I think what I can take away from this post (as will many others) is reassurance and the understanding will help me not beat myself up over it and see the bigger picture. I am not 'crazy'. I have a mental illness that effects my brain chemistry and behaviour. I think we can be SO hard on ourselves when we struggle with social eating. It's a very lonely, alienating experience without support.

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