Social emotional functioning and cognitive styles in eating disorders

Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, London, UK.
British Journal of Clinical Psychology (Impact Factor: 2.28). 09/2012; 51(3):261-79. DOI: 10.1111/j.2044-8260.2011.02026.x
Source: PubMed


Contemporary models of eating disorders (EDs) argue that both cognitive style (weak coherence and poor set shifting) and social emotional difficulties are involved in the maintenance of EDs. This study aimed to explore the factor structure of cognitive and social emotional functioning and to investigate whether a particular cognitive or social emotional profile was associated with a more severe and chronic form of illness.
A cross-sectional design was used to investigate cognitive and social emotional functioning in people with EDs compared to healthy controls (HCs) and those recovered from an ED.
Two hundred twenty-five participants were assessed (100 with an ED, 35 recovered from an ED, and 90 HCs) using a battery of set shifting, coherence, and social emotional measures.
There were no significant correlations between the cognitive or social emotional variables. A principal components analysis (PCA) identified three components: a fragmented perseverative cognitive style, for which the ED group scored highly, a global flexible cognitive style, for which HCs scored highly, and a social emotional difficulties profile, for which those with EDs scored highly. Individuals in recovery from an ED did not differ from the acute group, suggesting this cognitive and social emotional profile may be a trait associated with EDs. ED participants scoring highest for the fragmented perseverative cognitive style and social emotional difficulties had a more severe and chronic form of illness.
The findings provide empirical support for Schmidt and Treasure's (2006) maintenance model of EDs and suggest both cognition and emotional functioning should be considered in treatment.

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    • "In the adult literature, the presence of difficulties in these three domains in the AN population has received empirical and experimental support. For example, problems with abstract thinking are reported in a systematic review conducted by Lopez et al. [36] and have been shown to be experienced by AN patients in experimental studies [38,39]. In addition, problems with flexibility of thinking are reported in the systematic review [33] and large data-based studies of Tchanturia et al. [31,32]. "
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    ABSTRACT: The objectives of this study were to explore associations between autistic traits and self-reported clinical symptoms in a population with anorexia nervosa (AN). Experimental and self-report evidence reveals similarities between AN and autism spectrum condition (ASC) populations in socio-emotional and cognitive domains; this includes difficulties with empathy, set-shifting and global processing. Focusing on these similarities may lead to better tailored interventions for both conditions. A cross-sectional independent-groups design was employed. Participants with AN (n = 66) and typical controls (n = 66) completed self-report questionnaires including the Short (10-Item) Version Autism Spectrum Quotient (AQ-10) questionnaire (the first time this has been implemented in this population), the Eating Disorder Examination Questionnaire, the Hospital Anxiety and Depression Scale and the Work and Social Adjustment Scale. Group differences and the relationship between autistic traits and other questionnaire measures were investigated. The AN group had a significantly higher AQ-10 total score and a greater proportion scored above the clinical cut-off than the control group. Seven out of ten AQ-10 items significantly discriminated between groups. In the AN group, levels of autistic traits correlated with a greater self-reported anxiety and depression and a lower ability to maintain close relationships; however, eating disorder symptoms were not associated with autistic traits. Women with anorexia possess a greater number of autistic traits than typical women. AQ-10 items that discriminated between groups related to 'bigger picture' (global) thinking, inflexibility of thinking and problems with social interactions, suggesting that autistic traits may exacerbate factors that maintain the eating disorder rather than cause the eating disorder directly. Using screening instruments may improve understanding of patients' problems, leading to better tailoring of intervention. We conclude that further investigation of autistic traits in AN could inform new intervention approaches based on joint working between ASC and eating disorder services.
    Full-text · Article · Nov 2013 · Molecular Autism
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    • "Weak central coherence (an inability to see the forest for the trees) is thought to arise from an imbalance between global and detail processing and is common in people with EDs. People with EDs have a moderate to large superiority in detail processing tasks in the acute state [15,28] and after recovery [11,15,29,30]. Superior detail processing is also found to a degree in first degree relatives (sisters) [11,15,31]. "
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    ABSTRACT: To describe the evidence base relating to the Cognitive-Interpersonal Maintenance Model for anorexia nervosa (AN). A Cognitive-Interpersonal Maintenance Model maintenance model for anorexia nervosa was described in 2006. This model proposed that cognitive, socio-emotional and interpersonal elements acted together to both cause and maintain eating disorders. A review of the empirical literature relating to the key constructs of the model (cognitive, socio-emotional, interpersonal) risk and maintaining factors for anorexia nervosa was conducted. Set shifting and weak central coherence (associated with obsessive compulsive traits) have been widely studied. There is some evidence to suggest that a strong eye for detail and weak set shifting are inherited vulnerabilities to AN. Set shifting and global integration are impaired in the ill state and contribute to weak central coherence. In addition, there are wide-ranging impairments in socio-emotional processing including: an automatic bias in attention towards critical and domineering faces and away from compassionate faces; impaired signalling of, interpretation and regulation of emotions. Difficulties in social cognition may in part be a consequence of starvation but inherited vulnerabilities may also contribute to these traits. The shared familial traits may accentuate family members’ tendency to react to the frustrating and frightening symptoms of AN with high expressed emotion (criticism, hostility, overprotection), and inadvertently perpetuate the problem. The cognitive interpersonal model is supported by accumulating evidence. The model is complex in that cognitive and socio-emotional factors both predispose to the illness and are exaggerated in the ill state. Furthermore, some of the traits are inherited vulnerabilities and are present in family members. The clinical formulations from the model are described as are new possibilities for targeted treatment.
    Full-text · Article · Apr 2013 · Journal of Eating Disorders
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    • "anxiety are inconclusive (Bramon-Bosch et al. 2000; Woodside et al. 2004; Strober et al. 2006). The fi ndings from the present study are consistent with a fractionable model of non-social cognitive and social emotional risk to EDs (Steinglass et al. 2011; Harrison et al. 2012). It can be hypothesised that males and females with EDs share non-social cognitive risk factors (e.g., cognitive infl exibility and weak central coherence) but women have greater social emotional risk (specifi cally increased sensitivity to social threat). "
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    ABSTRACT: Objectives. Females are more likely to develop an eating disorder (ED) than males. Studies of affected men may therefore inform models of risk and resilience to EDs. The aim of this study was to examine putative neurocognitive intermediate phenotypes of EDs in affected males. Methods. Cognitive flexibility, central coherence (global/detail processing), complex emotion recognition and social-threat sensitivity were investigated in men with EDs and healthy men. Measures of distress, perfectionism, and obsessive compulsivity were collected. Results. Men with EDs were more cognitively inflexible across tasks and had more difficulty integrating global information than healthy men. Unexpectedly, there were no group differences on a visuospatial task of detail processing or on social-emotional processing tasks. Men with EDs had higher scores on measures of distress, perfectionism and obsessive compulsivity than healthy men. Conclusions. Men with EDs share some of the intermediate cognitive phenotype present in women with EDs. Like their female counterparts, males with EDs show an inflexible, fragmented cognitive style. However, relative to healthy men, men with EDs do not have superior detail processing abilities, poor emotion recognition or increased sensitivity to social-threat. It is possible that gender differences in social-threat processing contribute to the female preponderance of EDs.
    Full-text · Article · Jan 2013 · The World Journal of Biological Psychiatry
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