Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task.

Kate Tchanturia,Robin Morris,Amy Harrison,Helen Davies,Michiko Nakazato,Marion Roberts,Ulrike Schmidt,Janet Treasure,Antonio Verdejo García

doi:10.1371/journal.pone.0028331

Abstract

BackgroundPeople with eating disorders (ED) frequently present with inflexible behaviours, including eating related issues which contribute to the maintenance of the illness. Small scale studies point to difficulties with cognitive set-shifting as a basis. Using larger scale studies will lend robustness to these data.Methodology/Principal Findings542 participants were included in the dataset as follows: Anorexia Nervosa (AN) n = 171; Bulimia Nervosa (BN) n = 82; Recovered AN n = 90; Healthy controls (HC): n = 199. All completed the Wisconsin Card Sorting Task (WCST), an assessment that integrates multiple measurement of several executive processes concerned with problem solving and cognitive flexibility. The AN and BN groups performed poorly in most domains of the WCST. Recovered AN participants showed a better performance than currently ill participants; however, the number of preservative errors was higher than for HC participants.Conclusions/SignificanceThere is a growing interest in the diagnostic and treatment implications of cognitive flexibility in eating disorders. This large dataset supports previous smaller scale studies and a systematic review which indicate poor cognitive flexibility in people with ED.

Highlights

There is a growing literature in the neurobiological underpinnings of the psychopathology of eating disorders (ED) [1]
All groups were well matched for age; the recAN group was significantly older than the other groups
This study explored Wisconsin Card Sorting Task (WCST) performance as a measure of cognitive flexibility, reporting various outcomes in a large dataset of actively ill, recovered and healthy controls collated from several studies conducted within our department

Summary

Introduction

There is a growing literature in the neurobiological underpinnings of the psychopathology of eating disorders (ED) [1]. The neurobiological basis for this impairment is not established, but some evidence from studies assessing firstdegree relatives suggests that it could be a candidate endophenotype [3,4,5] This trait has been found in adolescent cases of people with AN [6] and in small-scale studies with people who have recovered from AN [5,7]. In this context, the assessment of cognitive flexibility using standardised tests to measure set-shifting and problem solving is relevant to clinical practice. Using larger scale studies will lend robustness to these data

Methods

Results

Conclusion