A systematic review on executive functions in female adolescents with eating disorders: Implications on daily life and relevance to rehabilitation

Background: Eating Disorders (ED) are prevalent in female adolescents and have far-reaching effects on daily participation and quality of life (QoL). Daily participation highly depends on Executive Functions (EF). Existing knowledge about EF in ED, as expressed in real life, is not fully documented or clear. Aim: We aimed to (i) characterise literature on EF deficits in ED among female adolescents; (ii) examine common methodologies of evaluating EED difficulties; (iii) identify literature gaps regarding EF implications on daily participation and QoL; and (iv) clarify concepts pertaining EF’s role in ED to optimise rehabilitation. Methods: A systematic review was conducted using thematic synthesis to analyse relevant studies from four databases, covering the period between January 2000 and December 2023. The quality of the studies was assessed using the Critical Appraisal Skills Program Qualitative Research Checklist tool. We followed the guidelines of the PRISMA statement. Results: Forty-four articles met the inclusion criteria, 79.5% showed significant evidence of EF deficits in female adolescents with ED. Up to 19% of adolescents with ED showed EF deficits that explained ED symptomatology, reduced daily participation, and deteriorated QoL. Most studies used neuropsychological tools to measure EF. Ecological measurements that reflect EF implications on daily life were rarely used. Conclusion: ED rehabilitation should integrate ecological measures to evaluate EF implications on daily life. This approach is specifically relevant during adolescence to optimise development, daily participation, and QoL.