At times, we may all get stuck in our ways or run up against our own rigid minds. However, when rigidity starts to impact all aspects of life – when a person becomes overly perfectionistic, has difficulty giving up control, or is mentally consumed with how things should be to the point where they struggle to live a healthy life – they may be exhibiting symptoms of obsessive-compulsive personality disorder.
Key features of obsessive-compulsive personality disorder are unhealthy perfectionism, needing things to be very orderly, and trying to overcontrol situations and relationships. These are traits we sometimes see in individuals experiencing eating disorders, particularly anorexia nervosa. As a result, our team was interested in investigating the role these traits may play in symptoms of anorexia nervosa among patients treated at the Columbia Center for Eating Disorders.
When people come join us in our scientific mission here, filling out questionnaires is usually part of the experience. Information provided about emotional and behavioral experiences just prior to receiving treatment (and sometimes again along the way) have helped us learn a lot over the years.
Evaluating Obsessive-Compulsive Personality Traits
Recently, we delved into information from a measure of obsessive-compulsive personality disorder, the Pathological Obsessive Compulsive Personality Scale (POPS).
The POPS looks at five aspects of obsessionality:
- Rigidity – the experience of getting stuck in one way of approaching life
- Emotional Overcontrol – difficulty experiencing emotional ups and downs and exerting extra effort to control one’s emotions
- Maladaptive Perfectionism – wanting everything to be “just right” at the expense of one’s healthy functioning
- Reluctance to Delegate – difficulty letting others help
- Difficulty with Change – experiencing life changes as much more challenging than would be expected
Study Purpose
We examined if and how obsessive-compulsive personality traits measured by the POPS before and after treatment showed up in patients with anorexia nervosa. Like many of our other studies, we asked people without a history of an eating disorder (i.e., healthy controls) the same questions to compare and contrast between groups.
We hypothesized that patients would experience more symptoms measured by the POPS than healthy controls. We were also curious how obsessive-compulsive personality traits related to the presentation and severity of anorexia nervosa.
Study Methods
In this study, 208 female adults and adolescents with anorexia nervosa who received treatment in our inpatient program between 2012 and 2022 were compared with 124 healthy females. Those in the control group were at a healthy weight and did not have a history of psychiatric illness or serious illness, or take any psychiatric medications.
Everyone completed the POPS, and assessments of eating disorder symptoms, eating-related intrusive thoughts (i.e., obsessions) and rituals, and other psychiatric conditions. Participants also provided height and weight, used to calculate body mass index.
Results
Results from this study confirmed our hypothesis.
The patient group experienced more obsessive-compulsive personality traits across all POPS domains compared with healthy volunteers. Among patients, those with more obsessive-compulsive personality traits also experienced more severe eating disorder symptoms and eating-related preoccupations and rituals at the time of hospital admission.
We looked at other factors commonly associated with eating disorder severity such as
- how long patients had been ill,
- at what age the eating disorder started, and
- weight history.
Surprisingly, patients with greater obsessive-compulsive personality traits were not necessarily struggling with anorexia nervosa for longer. Nor were they more likely to have developed their eating disorder earlier or been at a lower body mass index at admission or discharge.
Despite a reduction in eating disorder symptoms among patients from admission to discharge, obsessive-compulsive personality traits did not seem to lessen over the course of inpatient eating disorder treatment.
In our sample, a small number of patients had diagnoses of anorexia nervosa and obsessive-compulsive disorder. Obsessive-compulsive disorder is known to frequently co-occur with obsessive-compulsive personality disorder. When these two illnesses present together, patients tend to have more severe symptoms.
When we examined this subgroup of participants, we found that they had even greater levels of total obsessive-compulsive personality traits compared with those with anorexia nervosa who did not have comorbid obsessive-compulsive disorder. This difference was notable down to the domain level of two of the five features, wanting everything to be “just right” and experiencing life changes as much more challenging than would be expected.
What does this mean?
Summary
Obsessive-compulsive personality traits occur at more elevated levels among patients with anorexia nervosa than in the general population. This pattern is even more prominent among those with anorexia nervosa and obsessive-compulsive disorder.
Obsessive-compulsive personality traits are related to eating disorder symptom severity, such as greater restriction and more significant concerns with food, body shape, and weight.
Unfortunately, these obsessive-compulsive personality symptoms, on average, are not significantly improved with inpatient treatment aimed at addressing eating disorder symptoms.
Context and Implications
Personality traits can be resistant to change; the work often requires ongoing psychotherapy. So, this lack of change during inpatient treatment may make sense since this level of care is more time-limited than outpatient care. And, the focus of therapy in inpatient settings is primarily to support improvement in eating behavior and weight. However, the trend with obsessive-compulsive personality traits in our sample stands out from prior studies examining other psychological symptoms. For example, mood symptoms also assessed with questionnaire data from patients in our inpatient program resolved or improved significantly over the course of intensive eating disorders treatment.
Treatment programs may want to get creative in testing (and evaluating!) ways to target rigidity more broadly as people receive care for anorexia nervosa.
Cognitive-behavioral approaches, along with education about symptoms and assessment of the ways rigid thinking has impacted one’s life, are helpful in the treatment of obsessive-compulsive personality disorder. It’s reasonable to expect that this kind of work could continue into outpatient treatment.
To read more about the study described above, check out:
Touzeau, C. E., A. Allam, A. F. Muratore, E. Attia, and J. E. Steinglass. 2025. “ Rigid Minds: The Role of Obsessive-Compulsive Personality Traits in Anorexia Nervosa.” International Journal of Eating Disorders 1–7. https://doi.org/10.1002/eat.24532.
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