Perfectionism, and divergent and flexible thinking in anorexia nervosa

Perfectionism and flexible thinking are frequently reported as impaired in anorexia nervosa (AN), however, the role of perfectionism and cognitive flexibility in eating disorder (ED) symptoms is unclear. Further, it is unclear how individuals with AN may differ in these domains compared to the general community with high or low ED symptoms. Sixty-seven individuals with lifetime AN, 112 community controls with high ED symptoms (high ED-CCs) and 111 community controls with low ED symptoms (low ED-CCs) completed an online survey examining perfectionism, cognitive flexibility, and divergent thinking. Participants with lifetime AN and high ED-CCs showed significantly elevated perfectionism compared to low ED-CCs. Participants with lifetime AN also reported significantly poorer cognitive flexibility. No group differences were found for divergent thinking. A mediation analysis across the entire sample revealed that perfectionism mediated the relationship between cognitive flexibility and ED symptoms, but did not remain significant when only the AN group was included in the model. This study provides a greater understanding of self-reported cognitive flexibility and perfectionism in AN which can be used to enhance treatments that focus on improving specific thinking skills. Further, it highlights different types of perfectionism and provides potential avenues for treatment personalisation.