Cognitive flexibility, central coherence, and quality of life in anorexia nervosa

Cognitive flexibility is a mental function that refers to the ability to switch flexibly between different rules, tasks, and actions. Central coherence is another mental function that is often considered as 'bigger picture' thinking or the ability to see 'the forest for the trees', whereas weak central coherence is mirrored by an excessive focus on detail. Previous research has shown that anorexia nervosa (AN) is associated with both weak cognitive flexibility and weak central coherence. These two factors have been incorporated in theoretical models of the development and maintenance of AN and are targeted in specific treatments for AN. It is known that these two factors are associated with poor quality of life (QoL) in other mental disorders such as schizophrenia. However, only little attention has been paid to the question whether they are also associated with QoL in AN. In the present study, neuropsychological (performance based) and self-report measures were used to assess cognitive flexibility and central coherence alongside QoL in 138 adult patients with AN. We found that only low self-reported levels of cognitive flexibility and central coherence were associated with poor QoL. The association between central coherence and QoL was particularly strong in those patients who had the restricting subtype of AN.