2026 ECNP Congress

PS01-1073

Avoidant/restrictive food intake disorder symptom profiles and association with cognitive flexibility in children and adolescents with obsessive-compulsive disorder

Meryem Kaşak — Ş. Bilgen Ulgar, H. Günal Okumuş, M. Esen Öksüzoğlu, G. Solgun, Y.S. Çelik, F.Z. Kırşan · Ankara Etlik City Hospital, Child and Adolescent Psychiatry, Ankara, Türkiye

2026 ECNP Congress

Introduction

Obsessive-Compulsive Disorder (OCD) and certain eating disorders have been well documented to share overlapping psychopathological features, and exploring these shared traits may reveal mechanisms that cut across diagnostic boundaries [1]. Specifically, OCD is clinically characterized by rigid thought patterns and ritualized compulsive behaviors [2], whereas Avoidant/Restrictive Food Intake Disorder (ARFID), a DSM-5 feeding and eating disorder, presents with food selectivity, sensory sensitivities, and inflexible eating behaviors [3]. However, unlike well-studied eating disorders such as anorexia nervosa, evidence on the comorbidity and psychopathological convergence between OCD and ARFID remains limited, particularly among children and adolescents. Cognitive rigidity has been increasingly recognized as a transdiagnostic risk factor that both predisposes to and maintains psychopathology across OCD and ARFID [4,5]; this construct may represent a core mechanism underlying the overlap between these disorders.

Aims

This study aimed to compare ARFID symptom profiles between children and adolescents with OCD and healthy controls, and, within the OCD group, to examine the association between cognitive rigidity and ARFID symptoms.

Methods

In this cross-sectional comparative study, 133 participants aged 10–18 years (71 treatment-naïve patients diagnosed with OCD via structured clinical interview according to DSM-5 criteria at their initial clinical presentation; 62 age-, sex-, and BMI-matched healthy controls) were assessed using validated self-report measures, including the Maudsley Obsessive-Compulsive Inventory (MOCI), the Nine-Item ARFID Screen (NIAS), the Cognitive Flexibility Inventory (CFI), and the Revised Child Anxiety and Depression Scale (RCADS).

Results

Regarding ARFID symptomatology, the OCD group reported significantly higher NIAS Picky Eating scores (Z = −4.59, p < .001, r = .40) and NIAS total severity (Z = −2.515, p = .012, r = .22), whereas NIAS Appetite and Fear subscale scores did not differ significantly between groups (both p > .05). Partial correlation analysis, controlling for age, sex, and BMI, revealed that NIAS Picky Eating scores were significantly associated with RCADS total anxiety-depression scores (r = .249, p = .011), OCD symptom severity (r = .330, p = .004), and were negatively associated with CFI Alternatives (r = −.190, p = .029) and CFI Control (r = −.227, p = .009) in the OCD group, indicating that lower cognitive flexibility was linked to greater picky eating severity.

Conclusions

These findings suggest that children and adolescents with OCD exhibit elevated ARFID symptoms — particularly picky eating — compared to healthy controls, and that cognitive rigidity may contribute to this clinical overlap. The significant negative association between cognitive flexibility and picky eating severity within the OCD group supports the notion that cognitive rigidity serves as a shared transdiagnostic mechanism linking OCD and ARFID symptomatology. However, these results should be interpreted cautiously given the cross-sectional design and relatively small sample size. Further longitudinal and mechanistic studies are warranted to clarify the directionality of these associations and to explore whether interventions targeting cognitive flexibility may address both OCD and ARFID-related eating difficulties in youth.

References

  1. Di Luzio, M., et al., 2026. Understanding the Relationship Between Avoidant/Restrictive Food Intake Disorder and Obsessive–Compulsive Symptoms: A Systematic Review. Nutrients 18(5), 874.
  2. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders (DSM-5): American Psychiatric Pub.
  3. Thomas, J.J., et al., 2017. Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Curr Psychiatry Rep 19,1–9.
  4. Chamberlain, S.R., et al., 2006. Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. American Journal of Psychiatry 163(7), 1282–1284.
  5. Mahr, F., et al., 2023. Neuropsychological Profiles and Clinical Correlates of Youths With Avoidant/Restrictive Food Intake Disorder and Anorexia Nervosa: An Exploratory Charter Investigation. Journal of Pediatric Neuropsychology 9(4), 200–213.