Poor Cognitive Flexibility in Eating Disorders: Examining the Evidence using the Wisconsin Card Sorting Task

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.

Normative body dissatisfaction and eating psychopathology in teenage girls: the impact of inflexible eating rules

“…Further studies are needed to longitudinally explore the development of eating psychopathology, its risk factors, and inflexible adherence to eating rules. Given the large body of evidence derived from neuropsychological studies on inflexible thinking style in disordered eating patients [23,24,22], the findings from the current study should also be corroborated through experimental designs using neuropsychological tasks, which overcome the limitation of using selfreport measures. Besides, more work is needed to confirm this study's findings on patients with eating disorders.…”

“…This may occur when the individual blindly follows rigid eating rules, without meeting internal and external cues, and consequently engages in disordered eating behaviours with possible damaging consequences [11]. A large number of studies using neuropsychological tasks have been gathering support that eating disorders patients, especially with restrictive eating patterns, present an inflexible cognitive style [22][23][24]. This pattern of poor flexibility of thinking has been identified as a vulnerability trait, as being associated with the maintenance of the disorder, and with poorer treatment outcomes [25].…”

Taste sensitivity in anorexia nervosa: A systematic review

“…The findings of this study suggesting that there are in fact no differences in the perception of sweetness or fat intensity between people with AN and HC indicates that the documented aversion to this stimuli in individuals with AN reflects subjective perception, rather than objective taste alterations. Instead, sweetness and fat avoidance in AN may instead be driven by the cognitive resistance and inflexibility documented in this population (Lang, Stahl, Espie, Treasure, & Tchanturia, 2014; Tchanturia et al, 2012; Westwood, Stahl, Mandy, & Tchanturia, 2016). …”

Emotions mediate the relationship between autistic traits and disordered eating: A new autistic-emotional model for eating pathology

“…Current evidence points to a strong role for three particular deficits, impaired theory of mind (Caglar-Nazali et al, 2014;Davis et al, 2016 ), weak central coherence (Lang et al, 2014), and deficits in executive functions, including problems in set-shifting (Roberts et al, 2007;Tchanturia et al, 2012;Westwood et al, 2016). Social interaction impairments and reciprocal communication deficits, which are key symptoms of ASD, have also been reported in ED patients (Wentz et al, 2009;Zucker et al, 2007).…”