Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: A systematic review and meta-analysis

TY - JOUR

T1 - Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa

T2 - A systematic review and meta-analysis

AU - Keegan, Ella

AU - Tchanturia, Kate

AU - Wade, Tracey D

N1 - © 2020 Wiley Periodicals LLC.

PY - 2020/12/11

Y1 - 2020/12/11

N2 - Objective: This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. Method: We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. Results: People with anorexia nervosa (Hedge's g = −0.53, 95% CIs: −0.80, −0.27, p <.001) and bulimia nervosa (Hedge's g = −0.70, 95% CIs: −1.14, −0.25, p =.002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = −0.38, 95% CIs: −0.50, −0.26, p <.001) and bulimia nervosa (Hedge's g = −0.55, 95% CIs: −0.81, −0.29, p <.001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. Discussion: Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.

AB - Objective: This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. Method: We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. Results: People with anorexia nervosa (Hedge's g = −0.53, 95% CIs: −0.80, −0.27, p <.001) and bulimia nervosa (Hedge's g = −0.70, 95% CIs: −1.14, −0.25, p =.002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = −0.38, 95% CIs: −0.50, −0.26, p <.001) and bulimia nervosa (Hedge's g = −0.55, 95% CIs: −0.81, −0.29, p <.001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. Discussion: Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.

KW - Central coherence

KW - set-shifting

KW - eating disorders

KW - Meta-analysis

UR - http://www.scopus.com/inward/record.url?scp=85097370205&partnerID=8YFLogxK

U2 - 10.1002/eat.23430

DO - 10.1002/eat.23430

M3 - Review article

C2 - 33305366

SN - 1098-108X

JO - The International journal of eating disorders

JF - The International journal of eating disorders

ER -