Everyday flexibility and functional milestones in anorexia nervosa: survey results from a mixed community sample

Abstract

Purpose This study examined the relationship between self-reported cognitive-behavioral flexibility scores on the Eating Disorder Flexibility Index (EDFLIX) and objective social and occupational functional milestones in participants with a lifetime diagnosis of anorexia nervosa (AN). The Work and Social Adjustment Scale (WSAS) was included to compare objective and subjective measures. Methods 114 female adult participants with a current (53.5%) or past (46.5%) full or partial AN syndrome diagnosis completed an online survey which included functional milestone questions, the EDFLIX, WSAS, EDE-Q, and DASS-21. Results Everyday flexibility scores were significantly associated with WSAS scores, but not functional milestones for the same domain. Lower flexibility was related to higher WSAS work impairment but was not associated with poor occupational outcomes. Lower flexibility was related to higher WSAS social impairment but was not associated with less frequent social contact with friends. Milestones across work, social and relationship areas were not significantly correlated, suggesting individuals have areas of strength and weakness across functional domains. In contrast, WSAS ratings indicated broad functional impairment. Conclusion Results from the milestones suggest self-reported cognitive-behavioral flexibility is not a strong determinant of everyday function. Results from the subjective WSAS function measure and the more objective functional milestones were not consistent. To obtain a more balanced assessment of everyday functioning in AN, both subjective and objective measures should be considered. Level of evidence Level III Case–control analytic study. Supplementary Information The online version contains supplementary material available at 10.1007/s40519-021-01300-7.

Measuring cognitive flexibility in anorexia nervosa: Wisconsin Card Sorting Test versus cued task-switching

“…The results of the exploratory analysis suggest more systematic investigation of the associations between stress, clinical symptoms, and flexibility in AN is warranted. Lower self-reported flexibility was strongly associated with higher EDE-Q scores, and moderately associated with stress, consistent with past research in AN [ 6 , 7 ]. Higher stress was also a significant independent predictor of higher EDE-Q scores.…”

Eating disorder psychopathology, psychiatric impairment, and symptom frequency of atypical anorexia nervosa versus anorexia nervosa: A systematic review and meta‐analysis

“…Similar to the studies that examined non‐ED specific impairment, Bohn et al (2008), which used the CIA, reported no significant differences between AN and atypAN. Dann et al (2022a, 2022b) also reported no significant differences as measured with the Work and Social Adjustment Scale (WSAS). In contrast, Birgegard et al (2012) and Pauls et al (2022) found higher levels of impairment in the AN group than in the atypAN group with the CIA and Eating Disorders Quality of Life Scale (EDQLS), respectively.…”

“…Nine (45%) studies examined the difference between AN and atypAN using the composite global score on the EDE or EDE‐Q. Five (56%) studies reported no significant differences between the two groups on global severity (Birgegard et al, 2012; Dann et al, 2022a, 2022b; Kim et al, 2023; Matthews et al, 2022; Rosello, Gledhill, Yi, Watkins, Harvey, Hosking, Viner et al, 2021; Rosello, Gledhill, Yi, Watkins, Harvey, Hosking, & Nicholls, 2021). Three (33%) studies reported the atypAN group had greater severity on the global composite score than the AN group (Garber et al, 2019; Jablonski et al, 2022; Sawyer et al, 2016), whereas one (11%) study reported the AN group had greater severity than the atypAN group (Wade & O'Shea, 2015).…”

What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure

“…Lastly, an additional axis devoted to functional outcomes is warranted. Improvements in everyday functioning are meaningful treatment outcomes for patients [ 72 ], and despite current illness, AN patients have enduring functional strengths which could be integrated into treatment [ 73 ]. What is so remarkable about AN is the oft-observed degree of resilience when it comes to academic achievement, or the ability to outperform others in a scholastic or work environment.…”