Relationship between neuropsychology, clinical traits, psychopathology and attitudes towards change in eating disorders

Abstract

Background: Research on the neuropsychological characteristics of eating disorders (EDs) has primarily focused on inhibitory control, set-shifting and central coherence, as well as attention bias and decision making. These neuropsychological aspects may be related to a more severe clinical status and also influence attitudes towards therapeutic change. The objective of this research was to analyse the relationship of psychopathological and clinical variables with neuropsychological characteristics of patients with EDs and to see the possible influence of these variables on patients’ attitude towards change. Methods: An observational analytical cross-sectional study was performed. The participants were 74 consecutive outpatients who received treatment at an ED unit. They were assessed during a 6-month period, using clinical (Psychiatric Status Rating Scale, modified) and neuropsychological tests (Letter Number Sequencing test; Stroop test; Symbol Digit Modalities Test; Rey-Osterrieth Complex Figure Test). They were asked to complete several self-report psychopathological questionnaires: Body Shape Questionnaire; Eating Disorders Inventory; Beck Depression Inventory; State-Trait Anxiety Inventory; Dissociative Experiences Scale; Attitudes Towards Change in Eating Disorders Scale (ACTA), but 23 participants (31.08%) did not return them. Descriptive statistics and multivariate analysis were performed to study the relationships between clinical and psychopathological neuropsychological variables.Results: Nineteen patients (25.68%) were diagnosed with restricting anorexia nervosa (AN), 19 (25.68%) with purging AN, 14 with bulimia nervosa (18.92%), 9 with binge eating disorder (12.16%) and 13 with ED not otherwise specified (17.57%). There were no significant differences among the groups regarding the scores on neuropsychological tests. Body max index (BMI) was related to the majority of the neuropsychological scores. Depression (BDI), severity of the illness status and BMI, were predictors of deficits in working memory (F=3.46; p <0.01, 33% of the variance). On the other hand, higher score on time of the copy [B=3.56; 95% CI (0.82-6.29), p<0.01] and lower score on memory time [B=-2.31; 95% CI [-4.58-(-0.05)]; p<0.05] predicted the score on the “Precontemplation” subscale of the ACTA (F=2.59; p<0.05; 16% of the variance). Higher score on the copy time [B=1.43; 95% CI (0.42-2.45); p<0.01] and lower score on the style index [B= -14.01; 95% CI (-24.98-(-3.04)); p<0.01] predicted the score on the “Contemplation” subscale of the ACTA (F=3.40; p<0.05; 22% of the variance). Conclusions: The main results suggest that neuropsychological dysfunctions in EDs are transdiagnostic dimensions and that BMI, the severity of the illness and depression predict some of these disturbances. Besides, they influence the attitudes towards change. The findings highlight the need of setting up a broad framework to increase the acknowledgment of the problem. This approach could enhance conventional therapy, providing additional cognitive remediation therapy to motivational interview aimed to improve the decisional balance. At present, there are no definitive conclusions about whether neuropsychological disturbances are underlying traits or consequences of the illness, thus comprehensive longitudinal studies are needed.