Obsessive-compulsive symptoms in young women affected with anorexia nervosa and their relationship with personality, psychopathology and attachment style

Abstract Purpose Obsessive-compulsive symptoms (OC) are associated with greater morbidity and worse prognosis in anorexia nervosa (AN). We assessed the presence of non-eating OC in participants with AN and related them with their psychopathology, personality, and attachment style features. Methods Young women with AN (N = 41, 30 restricter and 11 binge-purging type) were assessed on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Participants with AN and 82 healthy controls (HC) completed the Temperament and Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), Symptom Checklist-90 (SCL- 90), Toronto Alexithymia Scale (TAS-20), and Attachment Style Questionnaire (ASQ), and were compared to underscore the AN features. Y-BOCS scores were correlated to psychopathology, personality, and attachment features in AN participants. Results AN had significantly higher scores than HC on EDI-2, SCL-90, TAS-20, ASQ-Need for Approval, and TCI-Harm Avoidance and Self-directedness. The Y-BOCS scores were significantly correlated with ASQ-Need for Approval, TAS-20-Difficulty in Describing Feelings, SCL-90-Phobic Anxiety, and Anxiety, EDI-2-Drive to Thinness and Asceticism. Need for Approval displayed the strongest and broadest correlation pattern with OC symptoms. Difficulty in describing feelings displayed the strongest correlation with compulsive OC symptoms. Conclusions OC traits in participants with AN are primarily associated with measures of insecure attachment rather than to their eating and general psychopathology. Therapeutic approaches to correcting insecure attachment may be considered a possible choice to treat OC symptoms in AN. The study suggests a new psychopathological perspective to understand the meaning of obsessive-compulsive symptoms in AN.