3 - (SYM 124) an Examination of Self-report and Neuropsychological Assessments of Cognitive and Behavioral Inflexibility: The EDFLIX Accounts for the Greatest Variation in Disordered Eating Symptoms

Background: Cognitive and behavioral inflexibility are shared maintaining mechanisms across varied psychopathologies, including eating disorders (ED). Existing measures of flexibility, including self-report and objective measures, do not correlate with and may capture distinct facets of flexibility. We used a series of linear regression analyses to examine which measures of flexibility best account for ED symptoms and severity.

Method: 578 undergraduate students (57.8% female; 50.2% White) completed the Eating Disorder Examination Questionnaire (EDE-Q), along with the Eating Disorder Flexibility Index (EDFLIX), and two performance based assessments of flexibility: the Wisconsin Card Sorting Task (WCST) and Go-No-Go.

Results: Mean EDE-Q global score was 2.78 (SD = 1.44). Bivariate correlations indicated significant associations between the STROOP and Go-No-Go (r(515) = -.23, p < .001), STROOP and WCST (r(515) = .19, p < .001), and Go-No-Go and WCST (r(514) = -.10, p = .02). EDFLIX total score was associated with the WCST (r(515) = -.14, p = .001). EDFLIX “Food & Exercise” subscale was associated with the STROOP (r(516) = -.12, p = .01) and WCST (r(515) = -.18, p < .001), and “Weight & Shape” subscale was associated with the Go-No-Go (r(516) = .10, p = .03) and WCST (r(515) = -.11, p = .02). Linear regression models revealed that WCST and Go-No-Go perseveration errors and STROOP scores did not account for a significant amount of the variance in EDE-Q Global scores, nor any EDE-Q subscale scores (all p >.05). EDFLIX Total scores accounted for significant variance in EDE-Q Global scores [F (1,577) = 52.17, p < .001, R² = .08]. Post-hoc analyses revealed that the “General” [p < .05, b = -.01] and “Weight & Shape” [p < .001, b = -.07] subscales, but not EDFLIX “Food & Exercise” (p >.05) subscale, were significantly associated with EDE-Q Global scores.

Conclusions: Self-reported flexibility better accounts for disordered eating than neuropsychological assessments. Results suggest that utilization of ED specific flexibility assessments is critical for patients with EDs. Future research should continue to evaluate the psychometric properties of the EDFLIX across groups, evaluate objective measures of flexibility in clinical samples, as objective measures may capture cognitive deficits more readily in those with malnourished brains, and examine additional self-report measures of flexibility to evaluate whether self-report measures in general, or specifically measures assessing ED-specific flexibility, are most strongly associated with ED symptoms.