Everyday flexibility and functional milestones in anorexia nervosa: survey results from a mixed community sample

PURPOSE: This study examined the relationship between self-reported cognitive-behavioral flexibility scores on the Eating Disorder Flexibility Index (EDFLIX) and objective social and occupational functional milestones in participants with a lifetime diagnosis of anorexia nervosa (AN). The Work and Social Adjustment Scale (WSAS) was included to compare objective and subjective measures. METHODS: 114 female adult participants with a current (53.5%) or past (46.5%) full or partial AN syndrome diagnosis completed an online survey which included functional milestone questions, the EDFLIX, WSAS, EDE-Q, and DASS-21. RESULTS: Everyday flexibility scores were significantly associated with WSAS scores, but not functional milestones for the same domain. Lower flexibility was related to higher WSAS work impairment but was not associated with poor occupational outcomes. Lower flexibility was related to higher WSAS social impairment but was not associated with less frequent social contact with friends. Milestones across work, social and relationship areas were not significantly correlated, suggesting individuals have areas of strength and weakness across functional domains. In contrast, WSAS ratings indicated broad functional impairment. CONCLUSION: Results from the milestones suggest self-reported cognitive-behavioral flexibility is not a strong determinant of everyday function. Results from the subjective WSAS function measure and the more objective functional milestones were not consistent. To obtain a more balanced assessment of everyday functioning in AN, both subjective and objective measures should be considered. LEVEL OF EVIDENCE: Level III Case–control analytic study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40519-021-01300-7.