Shared Versus Unique Features of Neural Activation During Cognitive Flexibility Across Restrictive Eating Disorder Presentations.

OBJECTIVE

Restrictive eating disorders (EDs), including anorexia nervosa (AN) and atypical AN (Atyp-AN), are often associated with cognitive rigidity that can impede treatment. The dorsolateral prefrontal cortex (dlPFC) plays a central role in cognitive control, but it remains unclear whether its activation during cognitive flexibility will differ across restrictive ED presentations.

METHOD: Eighty-seven females with restrictive EDs (aged 14-35) (AN: n = 31; atyp-AN with history of AN [hx-AN]: n = 33; atyp-AN without history of AN [Atyp-AN]: n = 23) completed a task-switching paradigm during functional magnetic resonance imaging. We examined dlPFC activation during sustained (task-switching vs. completing a single task) and transient control (switching between task rules vs. repeating the same rule), testing for group differences and symptom associations.

RESULTS

The AN group showed a greater difference in left dlPFC activation during task switching vs. the single task compared to the hx-AN and Atyp-AN groups, driven by reduced activation during the single task condition. All groups showed similar increases in dlPFC activation during task switching and no differences in task performance. Across all participants, higher dlPFC activation during task switching vs. single task was associated with greater restraint symptoms.

DISCUSSION: These novel findings identified shared versus unique neural features of sustained and transient control across restrictive ED groups. Heightened dlPFC activation during transient control associated with restraint may represent a transdiagnostic feature shared across restrictive EDs. Alternatively, reduced dlPFC activation during the low-demand, single-task condition in those with typical, but not atypical AN, may reflect a difference in sustained control, with implications for tailoring interventions to distinct restrictive ED presentations.