Prospective associations between cognitive flexibility and eating disorder symptoms in anorexia nervosa and bulimia nervosa

• Published in: Psychiatry research Vol. 332; p. 115717
• Main Authors: Dougherty, Elizabeth N., Bottera, Angeline R., Forester, Glen, Schaefer, Lauren M., Forbes, Erika E., Wildes, Jennifer E.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2024
• Subjects: Anorexia Nervosa - psychology; Binge-Eating Disorder - psychology; Bulimia - psychology; Bulimia Nervosa - psychology; Cognition; Eating disorders; Feeding and Eating Disorders; Humans; Reversal learning; Set-shifting; Reversal learning; Set-shifting; Eating disorders
• ISSN: 0165-1781; 1872-7123; 1872-7123
• DOI: 10.1016/j.psychres.2024.115717

•Examined relations between cognitive flexibility and eating disorder symptoms.•Examined whether relations differed by eating disorder diagnosis.•Deficits in reversal learning predicted greater eating disorder severity in AN-BP.•Deficits in reversal learning predicted greater purging in AN-BP and BN.•Set-shifting differentially predicted loss of control eating in AN-BP and BN. This study investigated concurrent and prospective associations between measures of reversal learning and attentional set-shifting and eating disorder symptoms at baseline, 3 months, and 6 months among individuals with anorexia nervosa restricting subtype (AN-R, n = 26), AN binge eating/purging subtype (AN-BP, n = 22), bulimia nervosa (BN, n = 35), and healthy controls (n = 27), and explored whether these associations differed by diagnosis. At baseline, participants completed diagnostic interviews, height/weight measurements, and measures of set-shifting (the Intradimensional/Extradimensional shift task) and reversal learning (a probabilistic reversal learning task). At 3- and 6-month follow-up, participants with eating disorders completed assessments of weight and eating disorder symptoms. A one-way analysis of variance found no evidence that baseline reversal learning and attentional set-shifting differed across diagnostic groups. Multilevel modeling analyses indicated that perseverative errors (an index of reversal learning) predicted an increase in purging over time for individuals with AN-BP and BN. Set-shifting errors differentially predicted frequency of loss of control eating for individuals with AN-BP and BN; however, set-shifting was not related to loss of control eating when examined separately in AN-BP and BN. These findings suggest that disentangling facets of cognitive flexibility may help understand change in eating disorder symptoms.