Insight and depressive symptoms in eating disorders: the mediating role of disorder-specific psychopathology

To study whether the insight described in psychosis also occurs in eating disorders (EDs), whether it differs between anorexia nervosa (AN) and bulimia nervosa (BN), and whether diagnosis-specific ED psychopathology mediates this relationship.

Cross-sectional baseline data from a prospective cohort of 103 day-hospital patients with AN or BN were analyzed. Standardized measures of insight, depressive symptoms, and ED psychopathology were administered. Exploratory factor analysis was conducted on depressive symptoms, followed by diagnosis-stratified correlation analyses between insight dimensions and depressive symptom factors. Mediation models were then applied to examine whether diagnosis-specific ED psychopathology accounted for significant associations.

Three depressive dimensions were identified: emotional, apathetic, and self-critical, explaining 56.26% of the variance. In AN, affective distress was associated with poorer insight into hypothetical contradiction and treatment engagement, whereas negative self-cognitions where associated with better recognition and relabeling of ED pathology. In BN, depressive symptoms were associated with reduced insight into body weight concerns and treatment engagement. ED-specific psychopathology significantly mediated the relationship between depressive symptoms and insight in both AN and BN.

These findings reveal that depressive symptoms and insight are associated in distinct patterns in anorexia and bulimia, and appear to be linked through different ED-specific psychopathological pathways. Highlighting these diagnosis-specific associations contributes to a more nuanced understanding of insight in EDs and underscores the need for tailored clinical approaches.