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Comment & Response
December 18, 2019

The Elusive Nature of Delay Discounting as a Transdiagnostic Process in Psychiatric Disorders—The Devil Is in the Detail—Reply

Author Affiliations
  • 1Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
  • 2Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
JAMA Psychiatry. 2020;77(3):325-326. doi:10.1001/jamapsychiatry.2019.4124

In Reply We thank King and Ehrlich for their thoughtful Letter critiquing our meta-analysis1 that examined delay discounting as a transdiagnostic process in psychiatric disorders. In our article, we proposed that delay discounting, an index of impulsive decision-making, falls on a continuum. At the aggregate level, most disorders examined (eg, major depressive disorder, bipolar disorder, schizophrenia, borderline personality disorder, binge-eating disorder, and bulimia nervosa) exhibited steeper, more impulsive, delay discounting compared with controls, whereas people with anorexia nervosa exhibited shallower, less impulsive, discounting compared with controls. We discussed that excessively shallow discounting in anorexia nervosa is consistent with clinical symptoms of the disorder, including excessive control over food intake. King and Ehrlich raised an important concern about analyzing anorexia nervosa as a unitary disorder instead of examining 2 potentially important factors: (1) clinical subtype (eg, restricting vs binge eating/purging) and (2) association of current weight status (eg, acute underweight vs weight restored) with outcomes. King and Ehrlich suggested that a more specific analysis would reveal that shallow discounting is limited to patients with restricting subtype who have acute underweight.

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