The onset on anorexia nervosa is thought to be the result of a combination of predisposing factors and a triggering event or events that predate onset. Triggers often include teasing, bullying, or criticism, especially pertaining to food, weight, or body shape.

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Perfectionism or cognitive rigidity may serve as both a risk factor and a maintenance factor for anorexia nervosa. This includes obsessive-compulsive traits, all-or-nothing/black-or-white thinking, excessive attention to detail, and fear of making mistakes. In children, these traits lead individuals to be more influenced by societal rules and appearance norms, and thus more likely to develop obsessive-compulsive dieting behaviors once they have begun following a trigger event. Perfectionism and OCPD traits are associated with adverse outcomes for patients. Obsessive-compulsive spectrum disorders are present in 50% of ED patients, while other ED patients often have obsessive-compulsive or anxious traits. Obsessive thoughts and compulsive behaviors are often worsened as a result of starvation, leading to increasingly strict dieting rules.

Perfectionism/Cognitive Rigidity in Anorexia Nervosa

Treasure, J., & Schmidt, U. (2013). The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders, 1, 1-10. https://doi.org/10.1186/2050-2974-1-13

The Cognitive-Interpersonal Maintenance Model of Anorexia Nervosa Revisited: A Summary of the Evidence for Cognitive, Socio-Emotional and Interpersonal Predisposing and Perpetuating Factors

Triggers for Anorexia Nervosa

Set shifting, or cognitive flexibility from one mindset to another, is more difficult for people with eating disorders. This may be due to brain development-related genetic factors, as set shifting requires increased activation in the frontal and parietal regions but decreased activation in the striatal regions. Weak set shifting is an inherited vulnerability to anorexia nervosa that is also demonstrated in first-degree relatives, however it is worsened by starvation. Patients with less set shifting impairment are more likely to recover, and set shifting skills improve following recovery.

Set Shifting in Anorexia Nervosa

Central coherence, or the ability to see the bigger picture, is weakened in eating disorder patients due to an imbalance between global and detail processing. Strong focus on details is an inherited vulnerability to anorexia nervosa that is also demonstrated in first-degree relatives. Impaired set shifting contributes to weakened central coherence by making it difficult to alternate between global and detail processing. Although impaired central coherence is a result of food restriction in anorexia nervosa, it also serves to perpetuate the disorder by impeding environmental adaptation. 

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