Journal of Neural Transmission

, Volume 119, Issue 9, pp 1047–1057 | Cite as

Cognitive flexibility in juvenile anorexia nervosa patients before and after weight recovery

  • Katharina Bühren
  • Verena Mainz
  • Beate Herpertz-Dahlmann
  • Kerstin Schäfer
  • Berrak Kahraman-Lanzerath
  • Christina Lente
  • Kerstin Konrad
Biological Child and Adolescent Psychiatry - Original Article


Deficits in set-shifting abilities have been robustly described in adult patients with anorexia nervosa (AN). These deficits are associated with behavioral traits, such as rigidity and perfectionism, and are independent of starvation. However, little is known about neurocognitive deficits in juvenile patients with AN. The brain circuits that support set shifting are not fully mature in these patients. One possibility is that neuroendocrinological changes, such as elevated cortisol levels, contributing to alterations in cognitive performance in individuals with AN. Set-shifting abilities (Visual Set-Shifting Task), cortisol levels, self-reported perfectionism and obsessive personality traits were assessed in 28 female adolescent patients with AN before (T0) and after (T1) weight rehabilitation and compared with 27 age- and IQ-matched healthy controls (CG). Compared with the CG, AN patients showed increased reaction times (RT) in shift trials (p < 0.001) and reduced error rates in both shift and non-shift trials across time points (p < 0.05). Across all subjects, perfectionism was associated with increased RTs during shift trials at T1 (r = 0.35, p < 0.05). Subjects with lower cortisol levels showed increased RTs and more errors in non-shift trials (p < 0.05). In contrast to the findings in adult patients, adolescent patients with AN did not display a marked deficit in set-shifting abilities. Instead, they demonstrated a perfectionistic cognitive style that was characterized by increased RTs in shift trials but improved accuracy. One could speculate that the shorter duration of illness and the incomplete maturation of the prefrontal cortices contribute to these findings.


Anorexia nervosa Neuropsychology Adolescence Set-shifting Cortisol Trait 



This study was supported by the German Ministry for Research and Education (BMBF No. 01GV0602, ISRCTN67783402, DRKS00000101).


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Katharina Bühren
    • 1
  • Verena Mainz
    • 2
  • Beate Herpertz-Dahlmann
    • 1
    • 5
  • Kerstin Schäfer
    • 1
  • Berrak Kahraman-Lanzerath
    • 2
  • Christina Lente
    • 4
  • Kerstin Konrad
    • 2
    • 3
    • 5
  1. 1.Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity Hospital of the RWTH AachenAachenGermany
  2. 2.Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity Hospital of the RWTH AachenAachenGermany
  3. 3.Cognitive Development Group, Institute of Neuroscience and Medicine (INM 3), Research Center JülichJülichGermany
  4. 4.Department of Medical StatisticsUniversity of AachenAachenGermany
  5. 5.JARA-Brain Translational MedicineJülichGermany

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