{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:48:49Z","timestamp":1793040529346,"version":"4.5.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T00:00:00Z","timestamp":1652054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) share a neuropsychological profile characterized by cognitive inflexibility as evident in set-shifting problems, and by strong detail focus. Clinically, both patient groups display a strong rigidity which may be explained by these neurocognitive difficulties. Cognitive inflexibility may hinder treatment uptake and help explain suboptimal treatment outcomes in both AN and OCD. This is the first study to compare clinical AN and OCD groups andto examine similarities and differences in cognitive flexibility. Specifically, this study aims to investigate neuropsychological outcomes and self-reported difficulties in both clinical groups and a control group, and explore associations between the different flexibility outcomes and illness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Two hundred participants (61 AN, 72 OCD and 67 HC) performed neuropsychological tasks on set-shifting abilities (Trail Making Task, Stroop color-word interference, Intradimensional-Extradimensional shift task), detail focus (Group Embedded Figures Test) and self-reported set-shifting abilities and attention to detail (DFlex).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Similarities between patient groups were found in terms of reduced set-shifting ability on the Trail Making Task and detail focus. Moreover, both patient groups self-reported more set-shifting problems but a less strong detail focus than HC, which in turn were not related to neuropsychological task outcomes in either of the groups. In both patient groups longer illness duration was associated to longer reaction times in the switching tasks and for both groups symptom severity was associated to higher experienced inflexibility and attention to detail.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cognitive inflexibility processes are largely similar in patients with AN and OCD. Both patient groups report inflexibility, yet this is unrelated to neuropsychological outcomes. Illness duration seems to contribute to poorer set-shifting and higher illness severity is linked to more experienced inflexibility. Findings highlight the need for entangling different domains of cognitive flexibility and detail focus and examining self-report measures for a cohesive understanding of clinically relevant flexibility weaknesses in AN and OCD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2022.868921","type":"journal-article","created":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T06:01:22Z","timestamp":1652076082000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":24,"title":["Cognitive and Experienced Flexibility in Patients With Anorexia Nervosa and Obsessive Compulsive Disorder"],"prefix":"10.3389","volume":"13","author":[{"given":"Lot Catharina","family":"Sternheim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"van Passel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Dingemans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Cath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Unna Nora","family":"Danner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1002\/wps.20251","article-title":"Etiological overlap between obsessive-compulsive disorder and anorexia nervosa: a longitudinal cohort, multigenerational family and twin study","volume":"14","author":"Cederl\u00f6f","year":"2015","journal-title":"World Psychiatry."},{"key":"B2","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1177\/0004867411432071","article-title":"The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample","volume":"46","author":"Swinbourne","year":"2012","journal-title":"Aust N Z J Psychiatry."},{"key":"B3","doi-asserted-by":"publisher","first-page":"703","DOI":"10.4088\/JCP.v67n0503","article-title":"The brown longitudinal obsessive compulsive study: clinical features and symptoms of the sample at intake","volume":"67","author":"Pinto","year":"2006","journal-title":"J Clin Psychiatry."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2036","DOI":"10.1038\/s41380-018-0115-4","article-title":"Examination of the shared genetic basis of anorexia nervosa and obsessive-compulsive disorder","volume":"25","author":"Yilmaz","year":"2020","journal-title":"Mol Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/j.cpr.2009.08.001","article-title":"What is the association between obsessive-compulsive disorder and eating disorders?","volume":"29","author":"Altman","year":"2009","journal-title":"Clin Psychol Rev."},{"key":"B6","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3389\/fpsyg.2014.00778","article-title":"Compulsivity in anorexia nervosa: a transdiagnostic concept","volume":"5","author":"Godier","year":"2014","journal-title":"Front Psychol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1002\/da.22586","article-title":"Temporal discounting across three psychiatric disorders: Anorexia nervosa, obsessive compulsive disorder, and social anxiety disorder","volume":"34","author":"Steinglass","year":"2017","journal-title":"Depress Anxiety."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1176\/appi.ajp.163.7.1282","article-title":"Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania","volume":"163","author":"Chamberlain","year":"2006","journal-title":"Am J Psychiatry."},{"key":"B9","doi-asserted-by":"publisher","first-page":"101905","DOI":"10.1016\/j.cpr.2020.101905","article-title":"Cognitive flexibility in acute anorexia nervosa and after recovery: a systematic review","volume":"81","author":"Miles","year":"2020","journal-title":"Clin Psychol Rev."},{"key":"B10","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.neuroscience.2016.07.030","article-title":"Cognitive inflexibility in obsessive-compulsive disorder","volume":"345","author":"Gruner","year":"2017","journal-title":"Neuroscience."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1017\/S0033291716000581","article-title":"The set-shifting profiles of anorexia nervosa and autism spectrum disorder using the wisconsin card sorting test: a systematic review and meta-analysis","volume":"46","author":"Westwood","year":"2016","journal-title":"Psychol Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"3365","DOI":"10.1017\/S0033291714000294","article-title":"Set-shifting ability across the spectrum of eating disorders and in overweight and obesity: A systematic review and meta-analysis","volume":"44","author":"Wu","year":"2014","journal-title":"Psychol Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1002\/eat.23430","article-title":"Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: a systematic review and meta-analysis","volume":"54","author":"Keegan","year":"2021","journal-title":"Int J Eat Disord."},{"key":"B14","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1002\/eat.22929","article-title":"A systematic review of reviews of neurocognitive functioning in eating disorders: the state-of-the-literature and future directions","volume":"51","author":"Smith","year":"2018","journal-title":"Int J Eat Disord."},{"key":"B15","doi-asserted-by":"publisher","first-page":"586","DOI":"10.3109\/15622975.2014.909606","article-title":"Central coherence in eating disorders: an updated systematic review and meta-analysis","volume":"15","author":"Lang","year":"2014","journal-title":"World J Biol Psychiatry."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1016\/j.cpr.2013.09.004","article-title":"The neuropsychology of adult obsessive-compulsive disorder: a meta-analysis","volume":"33","author":"Abramovitch","year":"2013","journal-title":"Clin Psychol Rev."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1017\/S0033291713001803","article-title":"Cognitive functioning in obsessive-compulsive disorder: A meta-analysis","volume":"44","author":"Shin","year":"2014","journal-title":"Psychol Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1177\/2167702614534210","article-title":"Obsessive-compulsive disorder is associated with broad impairments in executive function: a meta-analysis","volume":"3","author":"Snyder","year":"2015","journal-title":"Clin Psychol Sci."},{"key":"B19","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s11920-018-0928-5","article-title":"The role of habits in anorexia nervosa: where we are and where to go from here?","volume":"20","author":"Uniacke","year":"2018","journal-title":"Curr Psychiatry Rep."},{"key":"B20","doi-asserted-by":"publisher","first-page":"464","DOI":"10.3109\/15622975.2012.665478","article-title":"Set shifting and central coherence as neurocognitive endophenotypes in eating disorders: a preliminary investigation in twins","volume":"14","author":"Kanakam","year":"2013","journal-title":"World J Biol Psychiatry."},{"key":"B21","doi-asserted-by":"publisher","first-page":"452","DOI":"10.3109\/15622975.2011.639804","article-title":"Is attention to detail a similarly strong candidate endophenotype for anorexia nervosa and bulimia nervosa?","volume":"14","author":"Roberts","year":"2013","journal-title":"World J Biol Psychiatry."},{"key":"B22","doi-asserted-by":"publisher","first-page":"101298","DOI":"10.1016\/j.eatbeh.2019.05.001","article-title":"Obsessions are strongly related to eating disorder symptoms in anorexia nervosa and atypical anorexia nervosa","volume":"34","author":"Levinson","year":"2019","journal-title":"Eat Behav."},{"key":"B23","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1002\/erv.2635","article-title":"Associations between dimensions of anorexia nervosa and obsessive-compulsive disorder: an examination of personality and psychological factors in patients with anorexia nervosa","volume":"27","author":"Levinson","year":"2019","journal-title":"Eur Eat Disord Rev."},{"key":"B24","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000111555","article-title":"Symptom overlap between autism spectrum disorder, generalized social anxiety disorder and obsessive-compulsive disorder in adults: a preliminary case-controlled study","volume":"41","author":"Cath","year":"2008","journal-title":"Psychopathology."},{"key":"B25","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1111\/sjop.12163","article-title":"Poor cognitive flexibility, and the experience thereof, in a subclinical sample of female students with obsessive-compulsive symptoms","volume":"55","author":"Sternheim","year":"2014","journal-title":"Scand J Psychol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1159\/000505733","article-title":"Cognitive remediation therapy does not enhance treatment effect in obsessive-compulsive disorder and anorexia nervosa: a randomized controlled trial","volume":"89","author":"van Passel","year":"2020","journal-title":"Psychother Psychosom."},{"key":"B27","volume-title":"Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV).","author":"First","year":"1996"},{"key":"B28","first-page":"22","article-title":"The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry."},{"key":"B29","volume-title":"De nederlandse leestest voor volwassenen","author":"Schmand","year":"1992"},{"key":"B30","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#","article-title":"Assessment of eating disorders: interview or self-report questionnaire?","volume":"16","author":"Fairburn","year":"1994","journal-title":"Int J Eat Disord."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1001\/archpsyc.1989.01810110048007","article-title":"The Yale-Brown Obsessive Compulsive Scale. I development, use, and reliability","volume":"46","author":"Goodman","year":"1989","journal-title":"Arch Gen Psychiatry."},{"key":"B32","unstructured":"2006"},{"key":"B33","volume-title":"Trail Making Test: Manual for Administration","author":"Reitan","year":"1956"},{"key":"B34","first-page":"399","article-title":"Computerized assessment in neuropsychiatry using CANTAB: discussion paper","volume":"85","author":"Sahakian","year":"1992","journal-title":"J R Soc Med."},{"key":"B35","volume-title":"Executive Function System (D-KEFS)","author":"Delis","year":"2001"},{"key":"B36","volume-title":"A Manual for the Embedded Figure Test","author":"Witkin","year":"1971"},{"key":"B37","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.eatbeh.2011.04.001","article-title":"Development and validation of the Detail and Flexibility Questionnaire (DFlex) in eating disorders","volume":"12","author":"Roberts","year":"2011","journal-title":"Eat Behav."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1080\/13803395.2020.1842333","article-title":"Subjective cognitive rigidity and attention to detail: a cross-cultural validation of the detail and flexibility questionnaire (DFlex) in a French clinical sample","volume":"42","author":"Maria","year":"2020","journal-title":"J Clin Exp Neuropsychol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1186\/s12888-016-1109-x","article-title":"Cognitive remediation therapy (CRT) as a treatment enhancer of eating disorders and obsessive compulsive disorders: study protocol for a randomized controlled trial","volume":"16","author":"van Passel","year":"2016","journal-title":"BMC Psychiatry."},{"key":"B40","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1002\/eat.22243","article-title":"Advancing research on cognitive flexibility in eating disorders: the importance of distinguishing attentional set-shifting and reversal learning","volume":"47","author":"Wildes","year":"2014","journal-title":"Int J Eat Disord."},{"key":"B41","doi-asserted-by":"publisher","first-page":"e63964","DOI":"10.1371\/journal.pone.0063964","article-title":"Evaluation of enhanced attention to local detail in anorexia nervosa using the embedded figures test: An FMRI study","volume":"8","author":"Fonville","year":"2013","journal-title":"PLoS ONE"},{"key":"B42","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1002\/erv.2852","article-title":"The neural correlates of a central coherence task in young women with anorexia nervosa","volume":"29","author":"Leslie","year":"2021","journal-title":"Eur Eat Disord Rev."},{"key":"B43","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1017\/S0048577201393198","article-title":"Emotion regulation: affective, cognitive, and social consequences","volume":"39","year":"2002","journal-title":"Psychophysiology"},{"key":"B44","doi-asserted-by":"publisher","first-page":"152262","DOI":"10.1016\/j.comppsych.2021.152262","article-title":"Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: a systematic review and meta-analysis","volume":"109","author":"Puttevils","year":"2021","journal-title":"Compr Psychiatry."},{"key":"B45","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-24612-3_919","article-title":"Obsessive compulsive disorder","volume-title":"Encyclopedia of Personality and Individual Differences","author":"Abramowitz","year":"2020"},{"key":"B46","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1002\/jclp.22553","article-title":"Emotion regulation difficulties in obsessive-compulsive disorder","volume":"74","author":"Yap","year":"2018","journal-title":"J Clin Psychol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1017\/S1355617711000671","article-title":"Assessment of cognitive flexibility in anorexia nervosa-self-report or experimental measure? A brief report","volume":"17","author":"Lounes","year":"2011","journal-title":"J Int Neuropsychol Soc."},{"key":"B48","doi-asserted-by":"publisher","first-page":"e01588","DOI":"10.1002\/brb3.1588","article-title":"Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa?","volume":"10","author":"Sternheim","year":"2020","journal-title":"Brain Behav."},{"key":"B49","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.cpr.2018.09.003","article-title":"The impact of symptom severity on cognitive function in obsessive-compulsive disorder: a meta-analysis","volume":"67","author":"Abramovitch","year":"2019","journal-title":"Clin Psychol Rev."},{"key":"B50","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.psychres.2017.10.029","article-title":"An ecological approach to the behavioral assessment of executive functions in anorexia nervosa","volume":"259","author":"Spitoni","year":"2018","journal-title":"Psychiatry Res."},{"key":"B51","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12888-021-03120-6","article-title":"Is set-shifting and central coherence in anorexia nervosa influenced by body mass index, anxiety or depression?","volume":"21","author":"Fuglset","year":"2021","journal-title":"A systematic review. BMC psychiatry."},{"key":"B52","doi-asserted-by":"publisher","first-page":"e59600","DOI":"10.1371\/journal.pone.0059600","article-title":"Cognitive inflexibility in obsessive-compulsive disorder and major depression is associated with distinct neural correlates","volume":"8","author":"Remijnse","year":"2013","journal-title":"PLoS ONE"},{"key":"B53","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1002\/da.20484","article-title":"Duration effect of obsessive-compulsive disorder on cognitive function: a functional MRI study","volume":"26","author":"Nakao","year":"2009","journal-title":"Depress Anxiety."},{"key":"B54","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/2050-2974-1-13","article-title":"The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors","volume":"1","author":"Treasure","year":"2013","journal-title":"J, Eat Disord."},{"key":"B55","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1097\/YCO.0000000000000192","article-title":"Cognitive remediation therapy for eating disorders","volume":"28","author":"Danner","year":"2015","journal-title":"Curr Opin Psychiatry."},{"key":"B56","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12888-015-0434-9","article-title":"Cognitive remediation and emotion skills training (CREST) for anorexia nervosa in individual format: self-reported outcomes","volume":"15","author":"Tchanturia","year":"2015","journal-title":"BMC Psychiatry."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2022.868921\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T06:01:30Z","timestamp":1652076090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2022.868921\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,9]]},"references-count":56,"alternative-id":["10.3389\/fpsyt.2022.868921"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2022.868921","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,9]]},"article-number":"868921"}}