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Open Access Highly Accessed Research article

Cognitive flexibility in verbal and nonverbal domains and decision making in anorexia nervosa patients: a pilot study

Giovanni Abbate-Daga1*, Sara Buzzichelli1, Federico Amianto1, Giuseppe Rocca1, Enrica Marzola1, Shawn M McClintock23 and Secondo Fassino1

Author Affiliations

1 Eating Disorders Center, Department of Neuroscience, University of Turin, Italy

2 University of Texas Southwestern Medical Center at Dallas, Psychiatry Dallas, Texas, USA

3 New York State Psychiatric Institute/Columbia University, Psychiatry New York, New York, USA

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BMC Psychiatry 2011, 11:162  doi:10.1186/1471-244X-11-162

Published: 7 October 2011



This paper aimed to investigate cognitive rigidity and decision making impairments in patients diagnosed with Anorexia Nervosa Restrictive type (AN-R), assessing also verbal components.


Thirty patients with AN-R were compared with thirty age-matched healthy controls (HC). All participants completed a comprehensive neuropsychological battery comprised of the Trail Making Test, Wisconsin Card Sorting Test, Hayling Sentence Completion Task, and the Iowa Gambling Task. The Beck Depression Inventory was administered to evaluate depressive symptomatology. The influence of both illness duration and neuropsychological variables was considered. Body Mass Index (BMI), years of education, and depression severity were considered as covariates in statistical analyses.


The AN-R group showed poorer performance on all neuropsychological tests. There was a positive correlation between illness duration and the Hayling Sentence Completion Task Net score, and number of completion answers in part B. There was a partial effect of years of education and BMI on neuropsychological test performance. Response inhibition processes and verbal fluency impairment were not associated with BMI and years of education, but were associated with depression severity.


These data provide evidence that patients with AN-R have cognitive rigidity in both verbal and non-verbal domains. The role of the impairment on verbal domains should be considered in treatment. Further research is warranted to better understand the relationship between illness state and cognitive rigidity and impaired decision-making.