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

## TL;DR

The study identifies three distinct executive functioning profiles in individuals with anorexia nervosa and healthy controls, suggesting that executive dysfunction may not be a universal trait and could inform personalized treatment strategies.

## Contribution

The study introduces a novel approach to identifying subtypes of executive functioning in anorexia nervosa, revealing that only a subset of patients exhibit specific EF deficits.

## Key findings

- Three distinct EF profiles were identified: 'high verbal', 'average', and 'low flexibility and inhibition'.
- The 'low flexibility and inhibition' profile was associated with greater illness severity and duration, primarily in adults with anorexia nervosa.
- This profile challenges the assumption that executive functioning inefficiencies are a universal feature of anorexia nervosa.

## Abstract

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.

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.

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.

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.

We identified three distinct executive functioning profiles among adolescents and adults with anorexia nervosa (AN) and adolescent healthy controls: Profile 1 (‘high verbal’), Profile 2 (‘average’), and Profile 3 (‘low flexibility and inhibition’).The low flexibility and inhibition profile, comprising only 12% of the AN sample and containing the highest proportion of adults across profiles, was associated with greater illness severity and duration, challenging the idea that executive functioning inefficiencies are a universal endophenotype of the disorder.These results represent a first step towards developing tailored treatment strategies based on executive functioning profiles.

We identified three distinct executive functioning profiles among adolescents and adults with anorexia nervosa (AN) and adolescent healthy controls: Profile 1 (‘high verbal’), Profile 2 (‘average’), and Profile 3 (‘low flexibility and inhibition’).

The low flexibility and inhibition profile, comprising only 12% of the AN sample and containing the highest proportion of adults across profiles, was associated with greater illness severity and duration, challenging the idea that executive functioning inefficiencies are a universal endophenotype of the disorder.

These results represent a first step towards developing tailored treatment strategies based on executive functioning profiles.