Mentalisation in Anorexia Nervosa and disordered eating

Abstract

Background It is posited that attachment difficulties in infancy may result in reduced mentalisation capacity (understanding self and others’ subjective thoughts/mental processes), leading to potentially deleterious psychopathological outcomes such as eating disorders. The exact nature of the relationship between mentalisation and eating disorders/disordered eating is unclear however. Objectives A systemic review examined whether those with Anorexia Nervosa (AN) experience mentalisation deficits compared to those without EDs. An empirical study, examining the link between mentalisation and disordered eating (DE) in an adolescent sample, was conducted to assess whether borderline trait features mediated the relationship between the two constructs. Method A systematic search of 6 databases was conducted, and articles were assessed against predetermined inclusion/exclusion criteria. Included articles were assessed against 14 quality criteria and study findings were reported. For the empirical study, 162 participants aged 12-18 completed a questionnaire pack including mentalisation, borderline traits, impulsivity, emotion dysregulation and depression scales, and sociodemographic questions. Results Results from 10 articles indicated those with AN may experience subtle mentalisation deficits, particularly in recognising negative emotions in others. Mentalisation ability may also vary according to interpersonal context. Mediation analyses found mentalisation ability exerted a significant effect on DE indirectly through borderline trait features, and partially through emotion dysregulation, but not impulsivity. Conclusion More robust empirical studies are required in order to assess the relationship between mentalisation and AN. Findings regarding the link between mentalisation, borderline traits and DE may further aid psychological assessment/treatment. Therapies where the main focus is improving mentalisation capacity may be useful.