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

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 could influence attitudes towards therapeutic change.The objective of this research was to analyse the relationships of psychopathological and clinical variables with neuropsychological characteristics of patients with EDs and to explore 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, psychopathological and 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 scores on the neuropsychological tests. Body max index (BMI) was related to the majority of the neuropsychological scores. Depression (BDI), trait anxiety, severity of the illness and BMI were predictors (F=3.46; p<0.01, 28.5% of the variance) of working memory scores. On the other hand, higher scores on copy time [B=3.56; 95% CI (0.82-6.29); p<0.01, 10.2% of the variance] and lower scores on memory time [B=-2.31; 95% CI [-4.58-(-0.05)]; p<0.05, 7.4% of the variance] predicted scores on the Precontemplation subscale of the ACTA (F=2.59; p<0.05; 17.6% of the variance). Higher scores on copy time [B=1.43; 95% CI (0.42-2.45); p<0.01] and lower scores on the style index [B=-14.01; 95% CI (-24.98-(-3.04); p<0.01] predicted scores 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 the presence of depression predict some of these disturbances. Moreover, they influence attitudes towards change. The findings highlight the need to set up a broad framework to increase acknowledgement of the problem. This approach could enhance conventional therapy by providing additional cognitive remediation therapy to motivational interviewing with the goal of improving 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.