Neuropsychological and Cognitive Correlates of Recovery in Anorexia Nervosa

Abstract

Objective To identify clinical or cognitive measures either predictive of illness trajectory or altered with sustained weight-recovery in adult women with anorexia nervosa. Methods Participants were recruited from prior studies of women with anorexia nervosa (AN-C) and in weight-recovery following anorexia nervosa (AN-WR). Participants completed a neuropsychological battery at baseline and clinical assessments at both baseline and follow up. Groups based on clinical outcome (continued eating disorder, AN-CC; newly in recovery, AN-CR; sustained weight-recovery, AN-WR) were compared using one-way ANOVAs with Bonferroni-corrected post hoc comparisons. Results AN-CC had poorer neuropsychological function and self-competence at baseline than AN-CR. AN-CR showed changes in depression and externalizing bias, a measure of self-related attributions. AN-WR differed from both AN-CC and AN-CR at baseline in externalizing bias, but only from AN-CC at outcome. Discussion Neuropsychological function when recently ill may be a prognostic factor, while externalizing bias may provide a clinical target for recovery.

Residual eating disorder symptoms and clinical features in remitted and recovered eating disorder patients: A systematic review with meta‐analysis

“…Recovered AN patients do not significantly differ from controls in important elements of social functioning, in terms of empathy, emotional recognition, or social conformity according to one study (Morris et al, 2013). Self-liking was found to not significantly differ between sustained weight-restored AN and acutely ill AN (Harper et al, 2017), whereas self-esteem was lower than healthy controls in both recovered AN (Brockmeyer et al, 2013) and BN patients (Daley et al, 2008).…”

“…Alexithymia was found to be greater in recovered AN compared to controls in one study and not differ significantly between sustained weight-restored AN and acutely ill AN patients in another (Harper et al, 2017). Schizotypal features such as suspiciousness, intimacy and identity issues, interpersonal inhibition, and social avoidance (Holliday, Uher, Landau, Collier, & Treasure, 2006;McAdams & Krawczyk, 2011) were found to improve in AN but were elevated compared to controls and not differ significantly from acutely ill patients.…”

“…In AN, weight-restored or recovered AN patients showed higher depression, anxiety, body image anxiety, and obsessive-compulsive symptomatology compared to healthy controls or were found to not differ significantly from acutely ill AN patients is numerous studies (Bamford et al, 2014;Bang et al, 2016;Brockmeyer et al, 2012;Buehren et al, 2011;Danner et al, 2012;Frank et al, 2013;Friederich et al, 2012;Harper et al, 2017;Harrison, Tchanturia, & Treasure, 2011;Haynos et al, 2014;Holtkamp, Müller Remitted AN patients compared to healthy controls exhibited dysfunctional personality traits such as greater perfectionism, compulsivity, a tendency toward inhibition (restricted expression and intimacy problems), trait anxiousness, and affective liability, punishment sensitivity, and harm avoidance (Danner et al, 2012;Friederich et al, 2012;Lindner et al, 2014;Shott et al, 2016;Yau et al, 2013). However, in one study, obsessive-compulsive traits and impulsiveness in fully recovered AN did not differ significantly from healthy controls (Lindner et al, 2014).…”

“…Compared to acutely ill patients, several improvements have been documented: weight-restored AN patients improved in slight starvation-induced memory deficits (Buehren et al, 2011). Sustained weight-restored AN exhibited greater externalizing bias, differing significantly from both acute AN and newly weight-restored AN (Harper et al, 2017). Sustained weight-restored AN exhibited greater externalizing bias, differing significantly from both acute AN and newly weight-restored AN (Harper et al, 2017).…”

Are socio‐emotional and neurocognitive functioning predictors of therapeutic outcomes for adults with anorexia nervosa?

“…Similarly, there are significant differences observed between people currently ill with AN and those recently recovered from AN on measures of cognitive flexibility, such as set-shifting tasks (Harper, Brodrick, Van Enkevort, & McAdams, 2017). Poor cognitive flexibility has been shown to relate to longer and more severe AN symptomatology (Westwood, Eisler, et al, 2016;Westwood, Stahl, et al, 2016), and 10 years after recovery from AN, healthy set-shifting is observed (Gillberg, Råstam, Wentz, & Gillberg, 2007).…”