Mentalizing Oneself and Others in Anorexia Nervosa: From Subjective Evaluation to Performance

The present study examined impairment in two main dimensions of mentalizing (self-other and emotional-cognitive) in patients with anorexia nervosa (AN) by combining self-reported measures with performance-based tasks.

Forty-five patients with AN recruited from an eating disorder unit and 45 healthy controls (HCs) recruited from the general population completed the Mentalization Scale and the Movie for Assessment of Social Cognition.

The results revealed that in self-reported evaluations of their mentalization process, patients with AN hypo-mentalized about themselves and others' mental states. However, they used more hyper-mentalizing than HCs when mentalizing others' emotional and cognitive mental states in performance-based tasks. Finally, the severity of eating symptoms in patients with AN was associated with higher levels of perceived hypo-mentalizing about their own mental states and lower levels of perceived hypo-mentalizing of others' mental states. No associations were found between the severity of eating symptoms and mentalizing performance.

This study emphasizes the importance of mentalizing impairment in patients with AN, which should be considered via a multidimensional approach that considers both emotional and cognitive dimensions and the ability to assess patients' competences.