Neurocognitive Profile of Avoidant/Restrictive Food Intake Disorder: Cognitive Flexibility, Delay Discounting, and...

Neurocognitive deficits are well-documented across psychiatric disorders and may indicate novel treatment targets. However, empirical data on the neurocognitive profile of avoidant/restrictive food intake disorder (ARFID) are lacking. To address this gap, this study examined three core neurocognitive domains altered in other eating disorders-cognitive flexibility, delay discounting, and detail orientation-in adults with ARFID and healthy controls (HCs).

Adults (18-45 years) with ARFID (n = 49) and HCs (n = 21) completed computerized tasks assessing cognitive flexibility (Category Switch Task), delay discounting (Delay Discounting Task), and detail orientation (Navon Task). We hypothesized that, relative to HCs, adults with ARFID would show poorer cognitive flexibility, steeper delay discounting, and greater detail orientation.

Compared to HCs, adults with ARFID showed larger response-time switch costs (U = 9456, p = 0.023) but smaller error-rate switch costs (U = 6832, p = 0.044). Consequently, set-shifting efficiency did not differ between groups (inverse efficiency score switch costs: U = 537, p = 0.672), indicating an accuracy-over-speed strategy supporting cognitive flexibility in ARFID. No group differences emerged in delay discounting (U = 618, p = 0.091) or detail orientation (U = 8016, p = 0.938). Regression analyses indicated that ARFID phenotype severity explained variance in task performance: greater fear of aversive consequences was associated with better set-shifting (p = 0.005), and greater lack of interest with reduced delay discounting (p = 0.004).

Contrary to expectations, adults with ARFID matched HCs in overall cognitive flexibility efficiency by strategically slowing responses, challenging assumptions of innate cognitive rigidity. Future research should test whether interventions that increase processing speed while preserving accuracy could improve everyday adaptability and eating behaviors in ARFID.