Cognitive Flexibility and Everyday Function in Anorexia Nervosa

Abstract

Background: Individuals with anorexia nervosa (AN) tend to perform more poorly on cognitive flexibility tasks, and cognitive rigidity may be a risk factor associated with the development and maintenance of the disorder. Individuals with AN also experience difficulties in their everyday function. This thesis synthesizes and reconsiders the evidence related to cognitive flexibility and everyday function in AN by comparing the most common measures used to newer measures, and asking – Are there other reasons that participants with AN may perform more poorly on these tests?

Method: 135 adults with a lifetime diagnosis of AN and 156 adult control participants participated in the studies. Studies directly compared common and alternative measures of cognitive flexibility and everyday function, explored everyday strengths and goals of individuals currently in treatment for AN, and provided further evaluation of a measure of everyday flexibility.

Results: Comparison of the Work and Social Adjustment Scale to functional milestones demonstrated subjective and objective function measures are not consistent. Comparison of the Wisconsin Card Sorting Test to the Cued Task Switching Paradigm found no evidence that scores from the two tests were associated, that working memory span moderated scores, and that neither test predicted eating disorder symptoms when accounting for mood. The Eating Disorder Flexibility Index (EDFLIX), was a strong predictor of eating disorder symptoms beyond emotion regulation (DERS and ERQ), and mood (DASS-21). The Client Assessment of Strengths, Interests and Goals provided data to support the further use of strength-based approaches to recovery.

Conclusion: The general conclusion of this body of research is that there are alternative interpretations for scores on the current measures, and that our understanding of cognitive flexibility and everyday function in AN has been shaped, and limited, by how they are measured.