Cognitive flexibility subtypes and anorexia nervosa symptom severity: Evaluating the contribution of perfectionism

Impaired cognitive flexibility (CF) and elevated perfectionism are well-documented in anorexia nervosa (AN), yet their contribution to symptom severity remains unclear. The current study aimed to examine whether CF predicts symptom severity and whether perfectionism contributes to these associations, by applying a model-based approach distinguishing three CF subtypes. Thirty-one women with AN completed three CF tasks, as well as the Eating Disorders Examination-Questionnaire, the Multidimensional Perfectionism Scale, and the Depression Anxiety Stress Scale, assessing symptom severity, perfectionism, and emotional distress, respectively. Hierarchical regression analyses indicated that the final model including CF variables was not significant, as none of the CF subtypes predicted symptom severity, and the addition of perfectionism did not alter this pattern. However, perfectionism showed an independent association with AN symptom severity when examined without CF subtypes. These findings suggest that CF may be less central to AN severity than previously proposed, and challenge models positioning CF as a key predictor of AN severity, whereas perfectionism appears to play a more direct role.