REVIEW An Examination of the Ravello Profile — A Neuropsychological Test Battery for Anorexia Nervosa Kristin Stedal 1 * , Ian Frampton 1,2 , Nils Inge Landrø 3 & Bryan Lask 1,2,4,5 1 Regional Eating Disorders Service, Oslo University Hospital Ullevål, Norway 2 Gt. Ormond St. Hospital for Children NHS Trust, London, UK 3 Center for the Study of Human Cognition, Department of Psychology, University of Oslo, Norway 4 Huntercombe Hospital Group, UK 5 Ellern Mede Centre for Eating Disorders, London, UK Abstract The Ravello Profile test battery was developed to ensure a consistent methodology when researching neuropsychological functioning in anorexia nervosa (AN). To date, 157 patients with AN have been assessed with the full Ravello Profile. The present review is the first study to systematically investigate the tests included in the battery. Fifteen experimental studies, comparing AN patients with healthy control participants on at least one of the Ravello Profile tests, were identified, and effect sizes were calculated. Three of the tests, Verbal Fluency Test (VFT), Rey Complex Figure Test (RCFT) and Trail Making Test (TMT), were meta-analysed, and the pooled standardized effect size was significant for all three tests (0.25, À0.68 and 0.49, respectively). Patients with AN performed significantly better than healthy control participants on assessment of verbal fluency (VFT) and worse on tests of visual memory (RCFT) and set-shifting (TMT). The Ravello Profile test battery appears to consist of tests that are appropriate for assessing characteristic neuropsychological profiles specific in AN. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords anorexia nervosa; neuropsychology; assessment *Correspondence to: Kristin Stedal, Regional Eating Disorders Service, Oslo University Hospital Ullevål, PO Box 4956 Nydalen, Oslo, Norway. Tel: +47 23016215; Fax: +47 23016231. Email: kristin.stedal@ulleval.no Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.1160 Introduction Anorexia nervosa (AN) is a disorder characterized by the determined pursuit of thinness and accompanying severe weight loss together with disturbed body image and intense anxiety about eating. Patients with AN often have a highly distorted perception of how they look and continue to feel the need to lose weight even when they are so thin that their health is seriously at risk (Fairburn, Shafran, & Cooper, 1999). They have an intense fear of gaining weight and feel that their value as a person is directly affected by their body size. In addition, they have a high need for control and perfectionist tenden- cies (Woodside, 1995) and cognitive and behavioural inflexibility (Tchanturia et al., 2004a). Clinical neuropsychology is concerned with the relationship be- tween behavioural expression and brain dysfunction, assessed by means of psychometric tests or qualitative assessments. Neuropsycho- logical testing is increasingly being used for examining psychiatric populations to inform diagnosis and to aid treatment planning. It has been argued that the cognitions and behaviours seen in AN can be conceptualized in terms of neuropsychological impairments (Frampton & Hutchinson, 2007). For example, executive functioning deficits, such as poor problem solving ability, may lead to difficulties with handling novel situations (Shallice, 1982). Thus, the need for control seen in many of the patients with AN could be the result of a desire to minimize the exposure to unfamiliar situations. Set-shifting impairments could cause cognitive and behavioural inflexibility. Weak central coherence (the inability to achieve a balance between global and detailed focused attention) has been implicated in body size esti- mation errors (Frei, 2009). What evidence is there that patients with AN do indeed exhibit these kinds of deficits? Neuropsychological studies have investigated different areas of functioning. Some consistent findings have been identified in set shifting (Roberts, Tchanturia, Stahl, Southgate, & Treasure, 2007), central coherence (Lopez et al., 2008), visual mem- ory and visuospatial skills (Lopez et al., 2008; Lopez, Tchanturia, Stahl, & Treasure, 2009), whereas other areas remain unclear. Stud- ies investigating set shifting in patients with AN, their healthy sisters and a healthy control group have suggested that impaired set shift- ing (Holliday, Tchanturia, Landau, Collier, & Treasure, 2005) and central coherence (Tenconi et al., 2010) could be endophenotypes of AN. This suggests that neuropsychological impairment may both pre-exist and maintain AN development, rather than simply being a consequence of the illness itself. The Ravello Profile Literature reviews of these individual studies (Lena, Fiocco, & Leyenaar, 2004; Lopez et al., 2008; Roberts et al., 2007; Zakzanis, Campbell, & Polsinelli, 2010) have produced inconsistent results Eur. Eat. Disorders Rev. (2011) © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.