Decision making, central coherence and set-shifting: a comparison between Binge Eating Disorder, Anorexia Nervosa and Healthy Controls

Abstract

BackgroundSeveral studies have investigated the cognitive profile in patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN); on the contrary few studies have evaluated it in patients with Binge Eating Disorder (BED). The purpose of this study was to compare decision making, central coherence and set-shifting between BED and AN patients.MethodsA battery of neuropsychological tests including the Iowa Gambling Task (IGT), the Rey-Osterrieth Complex Figure Test (RCFT), the Wisconsin Card Sorting Test (WCST), the Trial Making Task (TMT) and the Hayling Sentence Completion Task (HSCT) were administered in a sample of 135 women (45 AN, 45 BED, 45 Healthy Controls [HC]). Furthermore, Beck Depression Inventory (BDI) was administered to evaluate depressive symptoms. Years of education, age, Body Mass Index (BMI) and depression severity were considered as covariates in statistical analyses.ResultsBED and AN patients showed high rates of cognitive impairment compared to HC on the domains investigated; furthermore, the cognitive profile of BED patients was characterised by poorer decision making and cognitive flexibility compared to patients with AN. Cognitive performance was strongly associated with depressive symptoms.ConclusionsIn the present sample, two different neurocognitive profiles emerged: a strong cognitive rigidity and a central coherence based on the details was predominant in patients with AN, while a lack of attention and difficulty in adapting to changes in a new situation seemed to better describe patients with BED. The knowledge of the different cognitive profiles of EDs patients may be important for the planning their psychotherapeutic intervention.

Neurocognitive Treatments for Eating Disorders and Obesity

“…Typically, individuals with AN show impairment in the areas of cognitive flexibility and decision making (12). Individuals with AN exhibit imbalance in the ventral limbic and dorsal executive circuits which are implicated in inhibition, decision making and reward response (13).…”

Cognitive impairment and gene expression alterations in a rodent model of binge eating disorder

“…Behavioral disinhibition or loss of control over eating, is mainly regulated by prefrontal cortex, and post treatment relapses occur commonly in BED patients [21, 22], suggesting that some other facets of BED such as its cognitive implications need to be taken into consideration in developing effective treatment strategies. In one study, BED patients performed more poorly on a battery of neuropsychological tests for cognitive flexibility, attention, decision-making, as well as visuospatial recognition and recall memory when compared to patients with anorexia nervosa and healthy controls [23]. In another study of patients with known neurodegenerative diseases, those with co-morbid binge eating disorder had greater atrophy in right-sided orbitofrontal-insular-striatal circuit and were more likely to be diagnosed with frontotemporal dementia [24].…”

Processing of novel stimuli as cognitive remediation therapy in patients with eating disorder / Procesamiento de estímulos novedosos como terapia de remediación cognitiva en pacientes con trastorno alimentario

“…Este estudio incluyó a pacientes con BN y AN, y aunque la TCR se ha usado predominantemente en pacientes con AN (Tchanturia, Whitney y Treasure, 2006), otros estudios han explorado los efectos de este tipo de modalidad terapéutica en pacientes con BN, en quienes también se ha reportado que presentan alteraciones en el control cognitivo y el pensamiento flexible (Aloi et al, 2015). Futuros estudios deberán conducirse en muestras de mayor tamaño y con la inclusión de grupos control, para poder indagar en qué medida la intervención propuesta impacta diferencialmente de acuerdo al tipo de TCA, y con respecto a otras modalidades de intervención.…”

“…Estos estilos de pensamiento, que con frecuencia coinciden con rasgos de personalidad relacionados con el trastorno obsesivo-compulsivo , están presentes no sólo en fases agudas, sino aún después de haber mejorado sus condiciones clínicas (Abbate-Daga et al, 2011;Aloi et al, 2015;Darcy, Fitzpatrick y Lock, 2016;Roberts et al, 2010;Stedal, Frampton, Landro y Lask, 2012). llamada "Con la cabeza en las nubes" (CCN).…”