Mentalizing Deficits in Anorexia Nervosa: A Pilot Cross-Sectional Study

Abstract

Background and Aim: Anorexia nervosa (AN) is a severe mental health disorder characterized by the restriction of food intake and an intense fear of gaining weight. Individuals with AN often exhibit impaired mentalizing, which refers to the ability to understand oneself and others. This study aims to investigate whether body mass index (BMI) can predict low mentalizing in patients with AN and to compare mentalizing abilities between healthy controls and adults with anorexia. Methods: A total of 50 participants were included in the study, comprising 25 patients with anorexia nervosa (AN) and 25 healthy controls. To control potential confounding factors, participants were screened for comorbid conditions commonly associated with impaired mentalizing. Participants completed a self-report questionnaire online to assess mentalizing abilities, measured using the Reflective Functioning Questionnaire (certainty and uncertainty scales) and the Reading the Mind in the Eyes Test. Data analysis involved t-tests and MannWhitney tests to compare groups and Spearman's correlation to examine the relationship between mentalizing deficits, eating disorders, and BMI. Multiple regression and ANCOVA analyses were performed to explore predictors of mentalizing scores and account for covariates like age. Results: The ANCOVA analysis showed a significant difference in RMET scores between the groups (F = 5.04, p<.029), indicating impaired mentalizing in the AN group. Spearman's correlation showed a significant negative relationship between BMI and RFQ certainty (r = - .563, p = .04). RMET scores were positively correlated with BMI (r = .78, p < .001). Regression analysis indicated that BMI was a significant positive predictor of RFQ certainty (B = .378, p< .006). Conclusion: The study demonstrates that lower BMI is associated with impaired mentalizing abilities in individuals with anorexia nervosa, with BMI serving as a significant predictor of reflective functioning certainty. These findings emphasize the complex relationship between body weight and mentalizing in this population.