Identifying Distinct Latent Profiles of Executive Functioning Among Adolescents and Adults With Anorexia Nervosa and Adolescent Healthy Controls.

OBJECTIVE

Research suggests executive functioning (EF) inefficiencies contribute to anorexia nervosa (AN) onset and maintenance. Identifying EF subtypes in adolescents and adults with AN compared to healthy controls (HC) may provide insights into differences in illness severity, risk for prolonged illness, and highlight who could respond best to different treatments.

METHOD: We conducted secondary analysis of 751 participants: adolescents (n = 559) and adults with AN (n = 74), and adolescent HC (n = 118). Latent profiles of six Delis Kaplan Executive Function System scores measuring EF constructs implicated in AN were derived. Differences across profiles on demographics, eating disorder cognitions (EDE/EDE-Q score), BMI/BMI z-score, length of illness, weight suppression, and full-scale IQ were examined.

RESULTS

A three-profile solution best fit the data: Profile 1 (n = 324)-'high verbal', Profile 2 (n = 349)-'average', and Profile 3 (n = 78)-'low flexibility and inhibition'. The low flexibility and inhibition profile comprised 10.6% of adolescents with AN, 30.0% of adults with AN, and 1.7% of adolescent HCs. Compared to other profiles, this profile was older, had a longer illness duration, higher EDE global scores, lower BMI z-scores, and lower full-scale IQ scores. No profile differences emerged in BMI or EDE-Q global scores.

DISCUSSION: Only a small subset of our sample showed marked difficulties in flexibility and inhibition, challenging the notion that EF difficulties are a core feature of AN. Adolescents with AN in this profile showed greater illness severity, suggesting vulnerability to a more prolonged course of illness. These findings are a first step towards developing tailored treatment strategies based on EF profiles.