A Systematic Review of Central Coherence in Young People with Anorexia Nervosa

Abstract

Objectives: It is hypothesised that Weak Central Coherence (superior attention to detail with poorer bigger picture thinking) is a possible endophenotype for Anorexia Nervosa (AN). Currently the neuropsychological profile of children and adolescents with AN in unclear. The present review aimed to summarise the available literature with regards to the central coherence abilities of children and adolescents with AN, and clarify their neuropsychological profile.Method: The search found seven eligible studies. Meta-analyses were not possible due the variation in tasks used.Results: Evidence of less efficient global processing in children with AN was observed in a number of studies. The strongest evidence was observed from studies using the Rey Osterrieth Complex Figures Test (ROCFT). A visual comparison of ROCFT from child and adult AN studies highlighted similarities in global processing profiles. Conclusions:Evidence of inefficient global processing was observed across a number of studies. However methodological flaws in the current literature were highlighted and made interpretation difficult. These are discussed and recommendations for future research are made.

Neuropsychological and Behavioural Short‐Term Effects of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study

“…This contradicts several findings of an improvement on central coherence aspects, more specifically SI, after adults with AN received CRT (Lock et al, ; Tchanturia, Lloyd, & Lang, ). However, cognitive weaknesses in central coherence appear to be less pronounced in adolescents compared to adults with AN (Lang & Tchanturia, ). Moreover, the CCI is a relatively new measure and validity and reliability have not been extensively evaluated.…”

“…Central coherence is the ability to process the overall context (global processing) and not to focus on isolated details (Booth, ; Frith & Happé, ). Neuropsychological findings in adolescent AN are less consistent and show either subtle weaknesses (Allen et al, ; Lang & Tchanturia, ; McAnarney et al, ) or no cognitive weaknesses in both domains (Andres‐Perpina et al, ; Fitzpatrick, Darcy, Colborn, Gudorf, & Lock, ; Lang, Stahl, Espie, Treasure, & Tchanturia, ). However, problems with cognitive flexibility might be very slight in children and adolescents with AN and a combination of continued underweight with a prolonged duration of illness, may lead to a manifestation of cognitive weaknesses in adulthood (Lang et al, ).…”

Is set-shifting and central coherence in anorexia nervosa influenced by body mass index, anxiety or depression? A systematic review

“…Individuals with weak central coherence have a preference for details over global processing. These findings are most commonly seen in adults, and findings from studies including adolescents are less consistent [ 7 , 8 ]. It is worth noting that adolescence is a time of considerable development of the brain and cognitive abilities, affecting the development of both executive functions and social cognition [ 9 ].…”

Cognitive remediation therapy for adolescent inpatients with severe and complex anorexia nervosa: A treatment trial

“…One brief treatment adjunct showing positive outcomes in adults needing inpatient care for severe and enduring AN is cognitive remediation therapy (CRT; Tchanturia, Giombini, Leppanen, & Kinnaird, ; Tchanturia, Lounes, & Holttum, ). CRT aims to target inefficiencies in central coherence and set‐shifting, known to be cognitive‐maintaining factors for AN (Harrison, Tchanturia, Naumann, & Treasure, ; Treasure & Schmidt, ) and observed in both adolescent and adult AN populations (Lang, Lopez et al, ; Lang, Stahl et al, ; Lang & Tchanturia, ; Lang et al, ; Westwood, Stahl, Mandy, & Tchanturia, ; Wu et al, ). Cognitive exercises are used to build and improve cognitive skills to facilitate thinking around emotions, beliefs, and behaviour change in relation to the illness itself if/when the patient is ready to access more intensive forms of psychotherapy (Tchanturia et al, ).…”