Inflated responsibility and perfectionism in child and adolescent anorexia nervosa

Theory suggests that cognitive biases in obsessive compulsive disorder (OCD) may occur in individuals with anorexia nervosa (AN) and anorexia nervosa /eating disorder not otherwise specified (AN/EDNOS), which may partly explain the large co-morbidity between the two disorders. The aim of the current study was to investigate the cognitive biases of inflated responsibility (IR) and perfectionism in children and adolescents who had been diagnosed with AN and AN/EDNOS. An additional aim was to investigate the relationship between IR and perfectionism and to test an interaction effect on AN severity. The relationship between young people and their parents’ levels of inflated responsibility was also investigated.
A cross-sectional multi-site pilot study using standardised questionnaires was conducted. Full ethical approval was gained and 30 young people diagnosed with AN and AN/EDNOS and 32 of their parents participated. This included 22 matched pairs of children and parents.
Children and adolescents with AN and AN/EDNOS reported significantly higher levels of IR and perfectionism, compared to the published data for non-clinical norms. Self-orientated perfectionism was associated with frequency of IR thoughts. There was also a significant interaction effect: young people who had a higher frequency of IR thoughts and self-orientated perfectionism had lower BMIs. Parents reported higher levels of IR compared to the published non-clinical norms, but there was no relationship between child and parent IR.
Further independent replication of these results is needed. IR and perfectionism should be considered in the assessment and treatment of child and adolescent AN and AN/EDNOS, both in individual and systemic interventions. This research also adds to the growing body of literature examining cognitive biases of OCD in an AN population, which may offer some insight into the overlap between the two disorders.