Academic journal article Journal of Eating Disorders

Neurocognitive Functions and Social Functioning in Young Females with Recent-Onset Anorexia Nervosa and Recovered Individuals

Academic journal article Journal of Eating Disorders

Neurocognitive Functions and Social Functioning in Young Females with Recent-Onset Anorexia Nervosa and Recovered Individuals

Article excerpt

Author(s): Mette Bentz[sup.1,2], Jens Richardt Moellegaard Jepsen[sup.1,3], Gry Kjaersdam Tellnus[sup.4,5], Ulla Moslet[sup.1], Tine Pedersen[sup.1,6], Cynthia M. Bulik[sup.7,8,9] and Kerstin Jessica Plessen[sup.1,2]

Plain English Summary

Difficulties in interacting with others are more common among young persons with anorexia nervosa than among their peers, and the same holds for youth who have recovered from anorexia nervosa. We thus investigated whether young individuals with anorexia nervosa and those recovered from anorexia nervosa showed difficulties in specific areas of mental abilities: the ability to switch between tasks and strategies, the tendency to focus overly on details, speed of problem solving, the ability to keep information in mind when needed, memory for spoken information, the ability to stay attentive, and finally the ability to interpret sayings in a non-literal fashion. We further investigated whether performance in these domains was associated with the capacity for social interaction in these groups. We found a normal level of functioning in all mental tasks. Moreover, participants with less accurate memory for spoken information were more likely to show difficulties in social interaction. This information might be useful in planning treatments that are helpful for the individual patient in the future.

Background

Anorexia nervosa (AN) is a life-threatening psychiatric disorder characterized by distorted body image and a persistent restriction of food intake leading to low body weight, often by applying inflexible rules and rigid behaviors around eating [1, 2]. Despite a growing body of research, the etiology of AN is not mapped out clearly, and success rates of available treatments are modest. A contemporary model of AN, the social-emotional maintenance model, [3, 4] proposes that an interaction between intrapersonal and interpersonal factors, reinforced by the effects of starvation, maintains the disorder. Moreover, this model highlights the importance of neurocognitive deficits, especially inflexibility and exaggerated attention to detail, and deficits in social cognition, for the emergence and the maintenance of anorectic symptoms [4].

We have previously observed impaired social functioning in young females with first-episode AN without autism spectrum disorder (ASD), [5] when assessing social functioning with a semi-structured, standardized assessment of social interaction, which emphasizes communication and socio-emotional reciprocity [6]. Moreover, young females fully recovered from childhood or adolescent-onset AN [5] displayed a similar degree of impairment in social function suggesting that these inefficiencies do not improve with recovery. To date, it is not clear, however, which factors determine the presence and the degree of difficulties of social function in young individuals with AN.

Evidence from other disorders suggests that specific neurocognitive functions play a role in the capacity of social function. For instance, a broad range of neurocognitive functions predicts approximately a quarter of the variance in social functioning among individuals with schizophrenia [7]. Further, impairments of social and executive functions co-occur and interact in individuals with ASD [8, 9]. Finally, a prospective study of adolescents with AN reported that individuals with co-existing neurocognitive deficits and ASD-traits had a lower rate of recovery from AN [10-12].

Adults with AN display impairments of social functioning (e.g. as defined by the RDoC [13] domain "Systems for Social Processes") [14, 15]. Moreover, cognitive inflexibility and a cognitive style of superior local processing in the context of weak central coherence have consistently been reported in adults with AN [16, 17]. These findings inspired the hypothesis that cognitive inflexibility and weak central coherence may represent possible endophenotypes of AN [18-21]. The fact, however, that adolescents with AN display normal levels of flexibility, as well as central coherence [22, 23] calls for further inquiring the trait-like nature and the continuity of these findings. …

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