Cognitive inflexibility as transdiagnostic risk factor in psychopathological disorders

Cognitive inflexibility (CI), an inability to adapt to environmental changes, is posited as a transdiagnostic factor maintaining symptoms in multiple psychopathologies. Prior focus on merely symptom-based classifications may inhibit the comprehension and treatment of mental disorders, potentially missing their underlying causes. The Research Domain Criteria (RDoC) offers a holistic approach, emphasizing transdiagnostic factors and integrating insights from various disciplines. CI, aligning with the Cognitive Control construct in the RDoC, has been associated with Eating Disorders, especially Restrictive-type Anorexia Nervosa (AN-R), though with inconclusive evidence. Traditional diagnostic methods for eating disorders face challenges, highlighting the need for a transdiagnostic perspective. The current research aimed to explore this direction by elucidating the role of CI in AN-R and, to a lesser extent, in Bulimia Nervosa (BN). Addressing critical gaps is essential to achieve this objective, particularly: The nature of CI - whether the deficit is domain-general or domain-specific (Study 1), the impact on cognitive processes due to variations in symptom intensity among AN-R patients, as well as the potential deficit of cognitive flexibility in BN (Study 2), and CI multifaceted characterization - specifically, whether the compromised ability is reversal learning, set/task-switching, or both (Study 3). Findings from the current study, using the Probabilistic Reversal Learning task, revealed a cognitive flexibility deficit in AN-R and BN compared with controls. This deficit was domain-specific for patients with low to medium symptom intensity and domain-general for those with high intensity. Reversal learning, compared to set/task switching (measured using the Task Switching and Wisconsin Card Sorting Test), was identified as the impaired ability. Data were analyzed using Computational Modeling, offering robust techniques. These findings suggest integrating cognitive flexibility interventions with standard therapies like Cognitive-Behavioral Therapy for AN-R and BN. In conclusion, CI emerges as a potential consistent maintaining factor in AN-R, and potentially in BN. The results obtained pave the way for future investigations into other disorders where the role of CI is still debated.