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Research on decision-making from the perspectives of economics, game theory, and neuroscience has been expanding rapidly over the last three decades [Kable, J. W., & Glimcher, P. W. (2009). The neurobiology of decision: Consensus and Controversy. Neuron, 63, 733–745]. However, there is relatively little exploration of impairment of decision-making, as a symptom of psychic dysfunction, in clinical psychiatric or psychoanalytic literature. As a result there is a widening gap between the understanding of psychopathology among clinically oriented psychiatrists and psychoanalysts, and the evolving importance of decision-making as presented by the neuroscience research community. “Decision-making” as a psychic function is not currently considered an important criteria for defining, classifying, understanding or treating psychopathology. This paper is an attempt by a clinician to point to the significance of decision-making as a clinical phenomenon, and to explore the various components of decision-making that are relevant to clinicians and can serve as guideposts for further neurobiological research.