Investigation of the relationship of cognitive flexibility and central coherence with emotion regulation skills in anorexia nervosa and bulimia nervosa

Objectives: Cognitive flexibility; it is evaluated as the ability to adapt to certain situations, switch from one thought to another, or look at different problems with multifaceted strategies. It has been suggested that poor cognitive flexibility in anorexia nervosa is an endophenotype for the disease and that it is associated with rigid-compulsive behaviors in the disease. Although there are more contradictory results in bulimia nervosa, there are studies indicating that cognitive flexibility is impaired. Central coherence reflects the degree to which an individual focuses on general structure compared to details in information processing. There are studies that found a decrease in central coherence in both eating disorders. It has been observed that individuals with eating disorders have difficulty coping with negative emotions. It has been stated that the neurocognitive structure of the individual is effective in the development of emotion regulation skills. The aim of this study is to compare the cognitive flexibility, central coherence and emotion regulation skills of eating disorders patients and healthy controls, and analyze the relationship of the cognitive flexibility and central coherence with emotion regulation skills in eating disorders patients. We also examine the relationship of cognitive flexibility, central coherence and emotion regulation skills with other clinical features in eating disorders patients. Methods: The study's sample group consists of 14 AN and 16 BN patients and 15 healthy controls selected considering the age, gender and education year of the patients. All participants are evaluated using MINI 5.0.0 Plus, Benton Visual Memory Test, Wisconsin Card Sorting Test, Rey-Osterrieth Complex Figure Test, Alexander/ Cattell intelligence test, Eating Disorders Examination Questionnaire, Difficulties in Emotion Regulation Scale, Hospital Anxiety - Depression Scale and Maudsley Obsessive Compulsive Inventory. Results: In our study, no difference was found between groups for WCST scores reflecting cognitive flexibility and central coherence index and subindex scores. DERS total scores of the clinical group were higher than the healthy controls, but there was no difference between the AN and BN groups. In the AN group, DERS non acceptance subscale scores correlated 4 positively with the total number of WCST errors and negatively with WCST percent conceptual level response and the number of completed categories. In the BN group, DERS impulse and goals subscales scores correlated negatively with the total number of WCST errors and positively with WCST percent conceptual level response In addition, the number of WCST perseverative errors correlate negatively with DERS total and clarity subscale scores in BN patients. Considered cognitives domains had no relationship with the severity of eating disorder symptoms in the BN group. In the AN group, we found a positive correlation between the EDEQ restraint subscale scores and the number of completed categories on WCST. When emotional regulation difficulties and eating disorder symptom severity were analyzed, a positive correlation was found between AN group's DERS total scores and EDE-Q total scores. On the other hand, in the BN group, we found a negative correlation between the EDE-Q restraint subscale scores and DERS goals subscale scores, and a positive correlation between EDE-Q weight concerns and DERS strategies subscales scores. Conclusion: Anorexia and bulimia nervosa patients have no difference in cognitive flexibility and central coherence compared to healthy controls. We show that the clinical group has more difficulties in emotion regulation than the healthy controls. In accordance with our hypothesis, we found a positive relationship between poor cognitive flexibility and difficulty in accepting emotional reactions in AN patients, and a negative relationship between poor cognitive flexibility and difficulty in emotion regulation in BN patients, contrary to what we expected.