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Zeeck A, Lau I, Endorf K, Schaefer L, Euler S, Lahmann C, Hartmann A. Mentalizing in psychotherapeutic processes of patients with eating disorders. Front Psychiatry 2024; 15:1367863. [PMID: 38707623 PMCID: PMC11067051 DOI: 10.3389/fpsyt.2024.1367863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Background Improvement in the capacity to mentalize (i.e., reflective functioning/RF) is considered both, an outcome variable as well as a possible change mechanism in psychotherapy. We explored variables related to (in-session) RF in patients with an eating disorder (ED) treated in a pilot study on a Mentalization-Based Treatment (MBT) - oriented day hospital program. The research questions were secondary and focused on the psychotherapeutic process: What average RF does the group of patients show in sessions and does it change over the course of a single session? Are differences found between sections in which ED symptomatology is discussed and those in which it is not? Does RF increase after MBT-type interventions? Methods 1232 interaction segments from 77 therapy sessions of 19 patients with EDs were rated for RF by reliable raters using the In-Session RF Scale. Additionally, content (ED symptomatology yes/no) and certain MBT interventions were coded. Statistical analysis was performed by mixed models. Results Patients showed a rather low RF, which increased on average over the course of a session. If ED symptomatology was discussed, this was associated with significantly lower RF, while MBT-type interventions led to a significant increase in RF. Conclusions Results suggest that in-session mentalizing can be stimulated by MBT-typical interventions. RF seems to be more impaired when disorder-specific issues are addressed. Further studies have to show if improving a patient´s ability to mentalize their own symptoms is related to better outcomes.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Inga Lau
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Endorf
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Laura Schaefer
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Gagliardini G, Pandolfi G, Colli A. Attachment, Mentalization, Emotion Dysregulation, and Empathy in Eating Disorders: Comparing Anorexic and Bulimic Patients. J Nerv Ment Dis 2024:00005053-990000000-00167. [PMID: 38704653 DOI: 10.1097/nmd.0000000000001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
ABSTRACT Eating disorders (EDs) represent a wide range of clinical symptoms related to food intake, body image, and weight issues, and include anorexia nervosa-restricting type (AN-R), anorexia nervosa-binge-purge type (AN-BP), and bulimia nervosa (BN). The aim was to investigate the characteristics of attachment, mentalization, emotion dysregulation, and empathy in a sample of 102 patients with EDs. A sample of 102 patients and therapists completed a series of measures for the assessment of ED pathology, mentalization, empathy, and emotion dysregulation. Pearson correlations and analysis of variance were used to test the characteristics of the variables among the groups. In relation to attachment and emotion dysregulation, no significant differences were found. In relation to mentalization, significant difference in good mentalization was found in AN-R subtype compared with the BN subtype. In relation to empathy, results showed significantly lower scores in BN subtype on affective empathy compared with the AN-BP subtype, and in AN-R subtype on cognitive empathy. Finally, we used Z-scores for each item ranked by value (higher to lower) to develop different clinical prototypes for each group. Our results point toward the clinical need to address the assessed variables, specifically mentalization, emotion dysregulation, and empathy, in the diagnosis and treatment of EDs.
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Kjaersdam Telléus G, Simonsen CB, Jakobsen AG, Dalgaard MK, Rasmussen SM, Nilsson KK. A multifaceted approach to assessment of mentalization: the mentalization profile in patients with eating disorders. Nord J Psychiatry 2024; 78:146-152. [PMID: 38134216 DOI: 10.1080/08039488.2023.2291177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
Purpose: The existing literature, however sparse, suggests an association between eating disorders (ED) and mentalization ability. The aim of this study was to investigate the mentalization profile (MP) in patients with ED. It was hypothesized that patients with ED would have a lower degree of mentalization ability compared to healthy controls (HC).Materials and methods: The study is based on a cross-sectional survey on a sample of patients diagnosed with ED compared to a HC group.Results and conclusion: A total of 88 participants, distributed between patients with ED (N = 30) and HC (N = 58) were included.Results: The study results show statistically significant differences between patients with ED and HC. Thus, patients with an ED scored significantly higher on Reflective Functioning Questionnaire (uncertainty about mental states) (RFQ-U) (mean difference: 0.31, p = 0.048) and Toronto Alexithymia Scale (TAS-20) (mean difference: 0.44, p = 0.019) compared to the HC. Furthermore, the results indicated that patients with Bulimia Nervosa (BN) may have a lower ability to mentalize about oneself as well as a generally lower ability to mentalize across different dimensions of the mentalization profile as the BN group scored significantly higher on RFQ-U (mean difference: 0.71, p = 0.023) and TAS-20 (mean difference: 0.89, p = 0.006) compared to the Anorexia Nervosa (AN) group. Further research should be conducted to gain knowledge on the mentalization ability in patients with an ED.
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Affiliation(s)
- Gry Kjaersdam Telléus
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | - Caroline Bach Simonsen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | | | | | - Sofie Martine Rasmussen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristine Kahr Nilsson
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
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Chizhova OA, Iuzbashian PG. [Alexithymia and self-harm in people with borderline personality disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:102-108. [PMID: 38261291 DOI: 10.17116/jnevro2024124011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To estimate the prevalence of alexithymia and self-harm in patients with borderline personality disorder (BPD). To assess the role of alexithymia in the emergence of self-harm in patients with BPD. MATERIAL AND METHODS We studied 104 patients (85 women, 19 men aged 21 to 25 years (64.4%)), including 54 patients with and 50 patients without BPD. Most of them had incomplete higher education (55%). We used the Russian version of the 20-item Toronto Alexithymia Scale (TAS-20) to reveal alexithymia and SCID-II to diagnose BPD. The presence of self-harm behavior was confirmed by the subjects' anamnesis data. RESULTS The prevalence of alexithymia in patients with BPD was 83.3%, in the control group it was 52% (p=0.001). The prevalence of self-aggression was 70.3% (n=38) in patients with BPD, and 12% (n=6) in people without BPD. Self-harm among persons with alexithymia was noted in 62.5% (n=45). During the analysis, a connection between auto-aggression and alexithymia was found at the level of a statistical trend (p=0.051). CONCLUSION Alexithymia and self-harm are more common in patients with BPD than in healthy people. This type of emotional dysregulation mediates self-harm in patients with BPD.
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Affiliation(s)
- O A Chizhova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P G Iuzbashian
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Horváth Z, Paksi B, Eisinger A, Felvinczi K, Demetrovics O, Demetrovics Z. Longitudinal joint trajectories of gambling disorder and hypomentalization: A latent class growth analysis among young adults. Compr Psychiatry 2023; 126:152409. [PMID: 37566950 DOI: 10.1016/j.comppsych.2023.152409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/01/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Only a few studies have investigated the relationship between risk for gambling disorder (GD) and mentalization difficulties. However, these results on positive correlations were all from cross-sectional studies; therefore, it would be important to investigate the longitudinal relationship between the constructs. AIMS It was aimed to identify subgroups of gamblers with different joint growth trajectories of risk for GD and hypomentalization (i.e., uncertainty of understanding own and others' mental states) and to compare the identified latent classes along impulsivity, sensation seeking and depression. METHODS Data from waves 1-3 of the Budapest Longitudinal Study were used. The final sample included 219 young adult gamblers who completed the study questionnaire and reported past-year gambling in all three waves (Females: N = 93 [42.29%]; Mean age: 28.36 years [SD = 4.29]). Standardized questionnaires were administered to measure the main constructs. RESULTS A four-class model was retained based on latent class growth analysis. Class 1 had consistently moderately high risk for GD and hypomentalization, and Class 4 presented consistently low risk for GD and hypomentalization. Classes 2-3 were characterized by low risk for GD and increasing hypomentalization. Class 1 had significantly higher sensation seeking and depression compared with the other subgroups in multiple cases. Class 4 showed significantly lower impulsivity and sensation seeking than the other classes. CONCLUSIONS Elevated hypomentalization was presented among individuals with risk for GD. However, there is little empirical evidence to support that the two constructs have convergently changing trajectories. A cautious interpretation of the results is recommended due to low symptom presence.
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Affiliation(s)
- Zsolt Horváth
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar.
| | - Borbála Paksi
- Institute of Education, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Andrea Eisinger
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Katalin Felvinczi
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar
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Fithall K, Gray IE, Linardon J, Phillipou A, Donaldson PH, Albein-Urios N, Enticott PG, Fuller-Tyszkiewicz M, Kirkovski M. Exploring the role of autistic traits and eating disorder psychopathology on mentalising ability in the general population. BMC Psychol 2023; 11:269. [PMID: 37674242 PMCID: PMC10483798 DOI: 10.1186/s40359-023-01306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This study evaluated the role of overlapping traits and characteristics related to autism spectrum disorder (autism) and anorexia nervosa (AN) in the general population, and the impact of these traits on mentalising ability. METHODS A sample of young adults (N = 306), aged 18-25 years, was recruited to complete an online study that consisted of 4 measures: the Autism-Spectrum Quotient, Eating Disorder Examination Questionnaire, the Mentalization Scale, and the Reading the Mind in the Eyes task. RESULTS Higher levels of autistic traits, particularly difficulty with attention switching, were associated with increased eating disorder psychopathology. Overall, autistic traits and eating disorder psychopathology were related among females, but not males. Difficulty with attention switching, however, was related to eating disorder psychopathology among both females and males. Autistic traits also appear to have a greater role in mentalising ability than does eating disorder psychopathology. CONCLUSION The role of attention switching in overlapping traits of autism and eating disorder psychopathology needs to be more comprehensively evaluated by future research, as does the role of biological sex. Expanded knowledge in this field will help to better understand and evaluate symptoms at presentation, leading to clearer diagnoses and potentially better treatment outcomes.
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Affiliation(s)
- Kate Fithall
- School of Psychology, Deakin University, Geelong, Australia
| | - Indigo E Gray
- School of Psychology, Deakin University, Geelong, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Australia
| | - Andrea Phillipou
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Mental Health, Austin Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Melissa Kirkovski
- School of Psychology, Deakin University, Geelong, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
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Warne N, Heron J, Mars B, Solmi F, Biddle L, Gunnell D, Hammerton G, Moran P, Munafò M, Penton‐Voak I, Skinner A, Stewart A, Bould H. Emotional dysregulation in childhood and disordered eating and self-harm in adolescence: prospective associations and mediating pathways. J Child Psychol Psychiatry 2023; 64:797-806. [PMID: 36541428 PMCID: PMC10152493 DOI: 10.1111/jcpp.13738] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emotional dysregulation may be a risk factor for disordered eating and self-harm in young people, but few prospective studies have assessed these associations long-term, or considered potential mediators. We examined prospective relationships between childhood emotional dysregulation and disordered eating and self-harm in adolescence; and social cognition, emotional recognition, and being bullied as mediators. METHODS We analysed Avon Longitudinal Study of Parents and Children data on 3,453 males and 3,481 females. We examined associations between emotional dysregulation at 7 years and any disordered eating and any self-harm at 16 years with probit regression models. We also assessed whether social cognition (7 years), emotional recognition (8 years) and bullying victimisation (11 years) mediated these relationships. RESULTS Emotional dysregulation at age 7 years was associated with disordered eating [fully adjusted probit B (95% CI) = 0.082 (0.029, 0.134)] and self-harm [fully adjusted probit B (95% CI) = 0.093 (0.036, 0.150)] at age 16 years. There was no evidence of sex interactions or difference in effects between self-harm and disordered eating. Mediation models found social cognition was a key pathway to disordered eating (females 51.2%; males 27.0% of total effect) and self-harm (females 15.7%; males 10.8% of total effect). Bullying victimisation was an important pathway to disordered eating (females 17.1%; males 10.0% of total effect), but only to self-harm in females (15.7% of total effect). Indirect effects were stronger for disordered eating than self-harm. CONCLUSIONS In males and females, emotional dysregulation in early childhood is associated with disordered eating and self-harm in adolescence and may be a useful target for prevention and treatment. Mediating pathways appeared to differ by sex and outcome, but social cognition was a key mediating pathway for both disordered eating and self-harm.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | | | - Lucy Biddle
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | - Gemma Hammerton
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Marcus Munafò
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Ian Penton‐Voak
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Andy Skinner
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Integrative Cancer Epidemiology ProgrammeBristol Medical School, University of BristolBristolUK
| | - Anne Stewart
- Department of PsychiatryUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Gloucestershire Health and Care NHS Foundation TrustGloucesterUK
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Gori A, Topino E. Exploring and Deepening the Facets of Mentalizing: The Integration of Network and Factorial Analysis Approaches to Verify the Psychometric Properties of the Multidimensional Mentalizing Questionnaire (MMQ). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4744. [PMID: 36981653 PMCID: PMC10049311 DOI: 10.3390/ijerph20064744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Mentalization is a complex and multifaceted trans-theoretical and trans-diagnostic construct that has found increasing application in the clinical context. This research aimed at deepening the psychometric properties of the Multidimensional Mentalizing Questionnaire (MMQ), a 33-item theoretically based self-report questionnaire allowing for a comprehensive assessment of mentalizing, by integrating factor analysis and network analysis approaches. A sample of 1640 participants (Mage = 33 years; SD = 13.28) was involved in the research. The six-factor structure was confirmed for the MMQ, and both the total and the subdimensions demonstrated good reliability. The network analysis has further enriched these results, showing the central role of the items attributable to Emotional Dysregulation or Reflexivity in influencing the network as well as the contribution of aspects related to Relational Discomfort in managing the flow of communication flow. Such findings may have useful clinical implications and emphasize the usefulness of the MMQ in both research and clinical practice.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy
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Chevalier V, Simard V, Achim J. Meta-analyses of the associations of mentalization and proxy variables with anxiety and internalizing problems. J Anxiety Disord 2023; 95:102694. [PMID: 36905852 DOI: 10.1016/j.janxdis.2023.102694] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/13/2023]
Abstract
Mentalization, the high-order function of detecting and interpreting one's own and others' mental states, has gained interest in the fields of clinical and developmental psychopathology. However, little is known about mentalization's associations with anxiety and broader internalizing problems. Using the framework of the multidimensional model of mentalization, the aim of this meta-analysis was to quantify the strength of the association between mentalization and anxiety/internalizing problems and to identify potential moderators of this association. A systematic review of the literature led to the inclusion of 105 studies (N = 19,529) covering all age groups. The global effect analysis showed a small negative association between mentalization and the overall anxious and internalizing symptomatology (r = -0.095, p = .000). Various effect sizes were found for associations between mentalization and specific outcomes (unspecified anxiety, social anxiety, generalized anxiety, and internalizing problems). The methods of assessment of mentalization and anxiety moderated their association. Findings support the presence of modest impairments in the mentalizing capacities of anxious individuals, likely influenced by their vulnerability to stress and the context in which they mentalize. Further studies are needed to draw a clear profile of mentalizing capacities with regard to specific anxious and internalizing symptomatologies.
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Affiliation(s)
- Valérie Chevalier
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada
| | - Valérie Simard
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Charles-Le Moyne Research Center, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Research Center of the Sainte-Justine University Hospital, 3175 Côte-Sainte-Catherine Road, Montréal, QC H3T 1C5, Canada.
| | - Julie Achim
- Department of Psychology, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Charles-Le Moyne Research Center, 150 Place Charles-Le Moyne, Suite 200, Longueuil J4K 0A8, QC, Canada; Research Center of the Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal Sacré-Coeur Hospital, 5400, Gouin Blvd West, Montreal H4J 1C5, QC, Canada
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Stalujanis E, Zeeck A, Euler S. Mentalisieren und Mentalisierungsbasierte Therapie (MBT) bei Essstörungen. PDP - PSYCHODYNAMISCHE PSYCHOTHERAPIE 2023. [DOI: 10.21706/pdp-22-1-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Zeeck A. Psychodynamisch orientierte (teil-)stationäre Behandlung von Essstörungen. PDP - PSYCHODYNAMISCHE PSYCHOTHERAPIE 2023. [DOI: 10.21706/pdp-22-1-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Horváth Z, Demetrovics O, Paksi B, Unoka Z, Demetrovics Z. The Reflective Functioning Questionnaire-Revised- 7 (RFQ-R-7): A new measurement model assessing hypomentalization. PLoS One 2023; 18:e0282000. [PMID: 36827243 PMCID: PMC9956064 DOI: 10.1371/journal.pone.0282000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Although it is a widely used questionnaire, limitations regarding the scoring procedure and the structural validity of the eight-item Reflective Functioning Questionnaire (RFQ-8) were raised. The present study aimed to examine further the latent dimensionality of the RFQ-8 and to examine linear and non-linear associations between mentalization difficulties and maladaptive psychological characteristics. Data from two separate representative samples of young adults (N = 3890; females: 51.68%; mean age: 27.06 years [SD = 4.76]) and adults (N = 1385; females: 53.20%; mean age: 41.77 years [SD = 13.08]) were used. In addition to the RFQ-8, standardized questionnaires measured the levels of impulsivity, sensation seeking, rumination, worry and well-being. Confirmatory factor analysis (CFA) was used to test the model fit of competing measurement models. CFA revealed that a revised, seven-item version of the RFQ (RFQ-R-7) with a unidimensional structure showed the most optimal levels of model fit in both samples. Impulsivity, sensation seeking, rumination and worry consistently presented significant, positive, linear associations with general mentalization difficulties in both samples. Significant quadratic associations were also identified, but these relationships closely followed the linear associations between the variables and increased only marginally the explained variance. The supported unidimensional measurement model and the associations between the general mentalization difficulties factor and maladaptive psychological characteristics indicated that the RFQ-R-7 captures a dimension of hypomentalization ranging between low and high levels of uncertainty. Increasing levels of hypomentalization can indicate a risk for less adaptive psychological functioning. Further revisions of the RFQ-8 might be warranted in the future to ensure adequate measurement for hypermentalization.
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Affiliation(s)
- Zsolt Horváth
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- * E-mail:
| | | | - Borbála Paksi
- Institute of Education, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
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Bizzi F, Riva A, Charpentier Mora S, Tironi M, Sforza SE, Milani LM, Nacinovich R. Investigating Functioning Profile of Adolescents with Anorexia before and during the COVID-19 Pandemic: A Cross-Sectional Study on Mentalizing, Alexithymia, and Impulsiveness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3670. [PMID: 36834365 PMCID: PMC9959039 DOI: 10.3390/ijerph20043670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Anorexia nervosa (AN) usually emerges in adolescence when important changes occur in cognitive, emotional, and social processes. Mentalizing, alexithymia, and impulsiveness represent key dimensions for the understanding and interpretation of psychological difficulties in AN. The outbreak of the COVID-19 pandemic has impacted adolescents with AN, showing a worsening of the disease. The main aims of the present paper are (1) to compare adolescents with AN before and during the COVID-19 pandemic and (2) to explore the relationship between mentalizing, alexithymia, impulsiveness, and psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. One hundred and ninety-six AN female adolescents (N = 94 before COVID-19; N = 102 during COVID-19) participated in this study. The results show that adolescents with AN during the COVID-19 pandemic had a more impaired functioning profile than the before COVID-19 group. Mentalizing, alexithymia, and impulsiveness had a predictive role on psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. In conclusion, our data reveal that the COVID-19 pandemic has likely represented a stress condition that affects mental health; worsening the severity of adolescents with AN clinical condition. Lastly, predictive patterns suggest the existence of a link between difficulties in the ability to face the problems of the present time using effective strategies and the severity of psychological symptoms.
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Affiliation(s)
- Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Anna Riva
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Simone Charpentier Mora
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Marta Tironi
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Sofia Elena Sforza
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- School of Medicine and Surgery, University of Brescia, 25123 Brescia, Italy
| | - Lorenzo Maria Milani
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- NeuroMI—Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milan, Italy
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14
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Meier AF, Zeeck A, Taubner S, Gablonski T, Lau I, Preiter R, Gläser H, Zipfel S, Herzog W, Wild B, Friederich HC, Resmark G, Giel K, Teufel M, Burgmer M, Dinkel A, Herpertz S, Löwe B, Tagay S, von Wietersheim J, De Zwaan M, Hartmann A. Mentalization-enhancing therapeutic interventions in the psychotherapy of anorexia nervosa: An analysis of use and influence on patients’ mentalizing capacity. Psychother Res 2022; 33:595-607. [DOI: 10.1080/10503307.2022.2146542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alexander Ferdinand Meier
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Svenja Taubner
- Institute for Psychosocial Prevention, Center for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Thorsten Gablonski
- Department for Psychology, Psychotherapy and Psychoanalysis, Institute for Psychology, University of Klagenfurth, Klagenfurth, Austria
| | - Inga Lau
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Romi Preiter
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Hannes Gläser
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR Universityhospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL-Hospital Muenster and University Hospital Muenster, Muenster, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Bernd Löwe
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- TH Köln, University of Applied Sciences, Köln, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Martina De Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Armin Hartmann
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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15
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Saure E, Raevuori A, Laasonen M, Lepistö-Paisley T. Emotion recognition, alexithymia, empathy, and emotion regulation in women with anorexia nervosa. Eat Weight Disord 2022; 27:3587-3597. [PMID: 36258146 PMCID: PMC9803740 DOI: 10.1007/s40519-022-01496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Anorexia nervosa (AN) is associated with challenges in recognizing, understanding, and interpreting one's own and other's emotional states, feelings, and thoughts. It is unknown whether difficulties in emotion processing occur independently of common comorbid symptoms of AN and predict acute eating disorder characteristics. We aimed to examine emotion recognition, alexithymia, emotion regulation, and empathy in individuals with AN and to assess whether these predict eating disorder symptoms independently from comorbid symptoms. METHODS Participants included 42 women with AN and 40 healthy control (HC) women between 18-30 years. Basic and complex emotion recognition was assessed with face photos and video clips. Alexithymia, empathy, emotion regulation, and comorbid symptoms (anxiety, depressive, and obsessive-compulsive symptoms and ASD traits) were assessed with self-assessment questionnaires. RESULTS Participants with AN exhibited difficulties in basic and complex emotion recognition, as well as increased alexithymia, decreased empathy, and challenges in emotion regulation when compared to HCs. After controlling for comorbid symptoms, differences remained only in complex emotion recognition. Challenges in emotion recognition were associated with lower body mass index, and increased alexithymia was associated with increased eating disorder symptoms. Increased challenges in emotion regulation were associated with a shorter duration of illness, higher body mass index, and increased eating disorder symptoms. CONCLUSIONS Participants with AN displayed widespread deficit in emotion processing, but only challenges in complex emotion recognition occurred independently from comorbid symptoms. Deficits in emotion processing may contribute to the illness severity and thus could be an important treatment target. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland.
- BABA Center and Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Anu Raevuori
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Marja Laasonen
- School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Tuulia Lepistö-Paisley
- Department of Child Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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16
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Affective cognition in eating disorders: a systematic review and meta-analysis of the performance on the "Reading the Mind in the Eyes" Test. Eat Weight Disord 2022; 27:2291-2307. [PMID: 35384555 PMCID: PMC9556412 DOI: 10.1007/s40519-022-01393-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/13/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Reading the Mind in the Eyes Test (RMET) is listed in the National Institute of Mental Health's Research Domain Criteria as a tool apt to measure the understanding of others' mental states. People diagnosed with anorexia nervosa (AN) showed poorer performances on the RMET than healthy controls. Less data are available concerning other eating disorders. METHODS Systematic review of four major databases from inception to July 15, 2021 following the PRISMA guidelines. Meta-analysis of cross-sectional observational studies comparing the scores of the RMET between patients with eating disorders and age- and-gender matched control groups. RESULTS Out of 21 studies, we retrieved 29 independent samples of patients diagnosed with an eating disorder. Patients with active AN (n = 580) showed worse performances on the RMET than controls (n = 1019). Year of publication accounted for 61% of the (substantial: I2 = 81%) heterogeneity in the meta-analysis. Earlier studies were more likely to find worse performances on the RMET of patients with active AN than later studies. Patients with bulimia nervosa (n = 185) performed poorly as compared to controls (n = 249), but the results were not statistically significant on the random-effect model. Obese patients with binge-eating disorder (n = 54) did not differ on the RMET from obese controls (n = 52). Patients with eating disorder not otherwise specified (n = 57) showed minimal differences compared to controls (n = 96). Study quality was good in six studies only. CONCLUSIONS Patients with eating disorders do not suffer from an impaired understanding of others' mental states, except for a still-to-be-identified subgroup of patients with active AN. LEVEL OF EVIDENCE I, systematic review and meta-analysis.
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17
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Ruan VA, Hartz A, Hueck M, Dahmen B, von Polier G, Herpertz-Dahlmann B, Konrad K, Schulte-Rüther M, Seitz J. Neural mechanisms underlying social recognition and theory of mind in adolescent patients with bulimia nervosa and transdiagnostic comparison with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:486-500. [PMID: 35701077 DOI: 10.1002/erv.2911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Theory of mind (ToM) is important for social interactions and typical development and has been found to be impaired in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Hypoactivation in frontotemporal brain regions seems to be the underlying neural mechanism in AN while whole-brain analyses in BN are lacking. METHODS We used the well-validated social recognition task fMRI paradigm to assess ToM in a total of 72 female adolescents (16 BN, 18 AN and 38 matched healthy controls [HC]). RESULTS Compared to HCBN , patients with BN showed hyperactivity during ToM-activity in the right frontal pole, middle temporal gyrus and left temporal pole and differed fundamentally from hypoactivation in these regions observed in patients with AN before and after short-term weight rehabilitation. Interaction and overlap analyses confirmed that similar regions were affected in opposite directions in both diseases. Hyperactivations in BN in the right middle temporal gyrus and right frontal pole were associated with clinical BN-severity markers binging and purging frequency. DISCUSSION The hyperactivation in BN suggest different underlying neural mechanisms for ToM compared to AN. Hyperactivity might correspond to a different but also ineffective cognitive style in patients with BN when approaching social interactions. These important transdiagnostic differences are relevant for future brain-targeted therapeutic approaches.
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Affiliation(s)
- Vanessa Ande Ruan
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, Aachen, Germany
- Clinic for Obstetrics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Arne Hartz
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, Aachen, Germany
| | - Manuel Hueck
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, Aachen, Germany
| | - Brigitte Dahmen
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, Aachen, Germany
| | - Georg von Polier
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, Aachen, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Reseaerch Centre Jülich, Jülich, Germany
| | - Beate Herpertz-Dahlmann
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, Aachen, Germany
| | - Kerstin Konrad
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Child Neuropsychology Section, University Hospital Aachen, Aachen, Germany
- Institute of Neurosciences and Medicine Jüllich, Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jüllich, Jülich, Germany
| | - Martin Schulte-Rüther
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Child Neuropsychology Section, University Hospital Aachen, Aachen, Germany
- Institute of Neurosciences and Medicine Jüllich, Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jüllich, Jülich, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Seitz
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, Aachen, Germany
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18
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Quattropani MC, Geraci A, Lenzo V, Sardella A, Schimmenti A. Failures in Reflective Functioning, Dissociative Experiences, and Eating Disorder: a Study On a Sample of Italian Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:365-374. [PMID: 35600515 PMCID: PMC9120272 DOI: 10.1007/s40653-022-00450-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 05/27/2023]
Abstract
Although impairments in mentalizing and dissociation have been linked to the onset of eating disorders, there is still a paucity of studies investigating their relationships among adolescents. This study aimed at investigating the role of failures in reflective functioning and dissociation in predicting the risk of eating disorders during adolescence. The Eating Disorder Inventory-3 (EDI-3), the Reflective Functioning Questionnaire (RFQ), and the Adolescent Dissociative Experiences Scale (A-DES) were administered to a sample of 427 adolescents between 13 and 20 years old. Results of correlational analysis showed that the risk of eating disorders was positively correlated with uncertainty about mental states. Eating disorder risk was also inversely correlated with certainty about mental states. Dissociation scores and its domain scores were all positively related to the risk of eating disorders. Results of regression analysis displayed that uncertainty about mental states and dissociation were statistically significant predictors of an increased risk of eating disorders. Gender and BMI were also significant predictors in the final model, which explained 24% of the variance. Regarding the specific dissociative domains, findings indicate that the depersonalization/derealization factor was the only significant predictor for the risk of eating disorder. The present study points out that uncertainty about mental states and dissociation could play a relevant role in increasing the risk of eating disorders during adolescence.
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Affiliation(s)
| | - Alessandra Geraci
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, Reggio Calabria, Italy
| | - Alberto Sardella
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE – Kore University of Enna, Enna, Italy
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19
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Zeeck A, Taubner S, Gablonski TC, Lau I, Zipfel S, Herzog W, Wild B, Friederich HC, Resmark G, Giel K, Teufel M, Burgmer M, Dinkel A, Herpertz S, Löwe B, Tagay S, von Wietersheim J, De Zwaan M, Zettl M, Meier AF, Hartmann A. In-Session-Reflective-Functioning in Anorexia Nervosa: An Analysis of Psychotherapeutic Sessions of the ANTOP Study. Front Psychiatry 2022; 13:814441. [PMID: 35677868 PMCID: PMC9169151 DOI: 10.3389/fpsyt.2022.814441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/19/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Previous research suggests that patients with anorexia nervosa (AN) show an impaired capacity to mentalize (reflective functioning, RF). RF is discussed as a possible predictor of outcome in psychotherapeutic processes. The study aimed to explore RF in sessions of patients with AN and its association with outcome and type of treatment. METHODS A post-hoc data analysis of selected cases from a randomized trial on outpatient psychotherapy for AN was conducted. Transcripts from 84 sessions of 28 patients (early phase, middle phase, and end of treatment) were assessed using the In-Session-Reflective-Functioning-Scale [14 cognitive-behavior therapy, enhanced (CBT-E); 14 focal psychodynamic therapy (FPT); 16 with good, 12 with poor outcome after 1 year]. Relations between the level of RF, type of treatment, and outcome were investigated using mixed linear models. Additionally, associations with depressive symptoms, weight gain, and therapeutic alliance were explored. RESULTS Mean in-session RF was low. It was higher in FPT when compared to CBT-E treatments. The findings point to an association between RF increase and a positive outcome. An increase in BMI in the first half of treatment was associated with higher subsequent in-session RF. There was no association between RF and depressive symptoms or the therapeutic alliance. DISCUSSION Patients with AN show a low capacity to mentalize in sessions, which seems to be at least partly dependent on the degree of starvation. The results suggest a possible relationship between an increase in in-session RF and outcome, which has to be replicated by further studies.
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Affiliation(s)
- Almut Zeeck
- Center for Mental Health, Department of Psychosomatic Medicine und Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Svenja Taubner
- Center for Psychosocial Medicine, Institute for Psychosocial Prevention, University Hospital, Heidelberg, Germany
| | - Thorsten C Gablonski
- Department for Psychology, Psychotherapy and Psychoanalysis, Institute for Psychology, University of Klagenfurth, Klagenfurth, Austria
| | - Inga Lau
- Center for Mental Health, Department of Psychosomatic Medicine und Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Beate Wild
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital Muenster, Muenster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Bernd Löwe
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- TH Köln, University of Applied Sciences, Köln, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Martina De Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Max Zettl
- Center for Psychosocial Medicine, Institute for Psychosocial Prevention, University Hospital, Heidelberg, Germany
| | - Alexander F Meier
- Center for Mental Health, Department of Psychosomatic Medicine und Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Hartmann
- Center for Mental Health, Department of Psychosomatic Medicine und Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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20
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Raimondi G, Samela T, Lester D, Imperatori C, Carlucci L, Contardi A, Balsamo M, Innamorati M. Psychometric Properties of the Italian Mentalization Questionnaire: Assessing Structural Invariance and Construct Validity. J Pers Assess 2021; 104:628-636. [PMID: 34694942 DOI: 10.1080/00223891.2021.1991362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mentalization is an important interpersonal ability, necessary for adaptive interpersonal relationships and emotion regulation. Deficits in mentalization have been associated with poor psychological outcomes and have been observed in patients with Borderline Personality Disorder. The Mentalization Questionnaire (MZQ) has been developed as self-report measure of mentalization deficit. The aim of the study was to investigate the dimensionality of the MZQ in a nonclinical sample composed of Italian adults from the general population and to analyze its performance in categorizing individuals with higher risk of borderline symptoms. A non-clinical sample of 1,015 adults (709 women and 306 men) was administered the Italian versions of the MZQ, the Reflective Functioning Questionnaire (RFQ), and a measure of borderline psychopathology. A revised single-factor solution fitted the data well and demonstrated metric invariance across gender. The internal consistency (Ordinal α = 0.87) and stability (r = 0.84) were satisfactory. The MZQ was moderately associated with the RFQ dimensions. The ROC curve analysis showed that the MZQ was able to discriminate satisfactorily people with higher risk for borderline symptomatology from those with lower risk. The MZQ may, therefore, be considered a reliable and valid measure of mentalization for categorizing people at higher risk for borderline pathology.
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Affiliation(s)
- Giulia Raimondi
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Tonia Samela
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | | | - Leonardo Carlucci
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Anna Contardi
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Michela Balsamo
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
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21
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Castro TF, Miller K, Araújo MX, Brandão I, Torres S. Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study. EUROPEAN EATING DISORDERS REVIEW 2021; 29:955-968. [PMID: 34472158 DOI: 10.1002/erv.2858] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This 15 years longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term recovery from anorexia nervosa (AN), and its link to anxiety and depression. METHOD Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, emotion regulation difficulties (ER; only assessed in recovery phase), and completed an experimental task to analyse emotional experience. RESULTS In spite of significant improvement in alexithymia, anxiety, and depression with AN recovery, some emotion functioning difficulties did not normalize. The occurrence of comorbid anxiety and depression explained the reduced ability to identify, understand, and accept emotions in long-term recovery (relative to controls), but not the increased global difficulty in using ER strategies, which revealed a more stable nature of deficit. With recovery, negative emotions linked to situations addressing food and body weight are felt more intensely. CONCLUSIONS Managing emotions, especially the negative ones, remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behaviour can serve as an affect regulatory function, increasing the risk of relapse. Emotional education is an important avenue in protecting long-term AN relapse.
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Affiliation(s)
- Telma Fontão Castro
- Department of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Kylee Miller
- Department of Pediatrics, Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Maria Xavier Araújo
- Department of Psychology and Education, University Portucalense, Porto, Portugal.,Department of Psychology, Centro Hospitalar S. João, Porto, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar S. João, Porto, Portugal
| | - Sandra Torres
- Department of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto, Porto, Portugal
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22
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Zeeck A, Endorf K, Euler S, Schaefer L, Lau I, Flösser K, Geiger V, Meier AF, Walcher P, Lahmann C, Hartmann A. Implementation of mentalization-based treatment in a day hospital program for eating disorders-A pilot study. EUROPEAN EATING DISORDERS REVIEW 2021; 29:783-801. [PMID: 34272786 DOI: 10.1002/erv.2853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Aim of the pilot study was to evaluate the effectiveness of a day hospital program for eating disorders (EDs) after implementation of mentalization-based treatment (MBT), including a comparison to a historical matched control group. METHOD All consecutively admitted patients with an ED were included in a prospective, observational study over a period of 2 years. Main outcome criteria were eating and overall psychopathology. Furthermore, changes in the capacity to mentalize (reflective functioning [RF]), difficulties with affect regulation and interpersonal problems were assessed at admission, discharge and a three months follow-up. RESULTS Thirty-eight out of fourty patients could be included. The program led to significant reductions in eating and general pathology. There was significant improvement in RF, difficulties in emotion regulation and interpersonal functioning. However, there was no advantage in comparison to a matched control group (main outcomes). ED symptoms showed a slight renewed increase after discharge, while body mass index further increased. RF change was predictive of change in overall psychopathology, but not ED symptoms. Drop-out rate was 13.2%. CONCLUSION The program showed no advantage in comparison to a historical control group concerning a reduction in eating and overall psychopathology. However, it was associated with low drop-out rates, and changes which MBT targets: An increase in RF and a reduction of interpersonal problems as well as difficulties in emotion regulation.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Endorf
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland
| | - Laura Schaefer
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Inga Lau
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Valeria Geiger
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Alexander Ferdinand Meier
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter Walcher
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Cortés-García L, McLaren V, Vanwoerden S, Sharp C. Attachment, mentalizing, and eating disorder symptoms in adolescent psychiatric inpatients and healthy controls: a test of a mediational model. Eat Weight Disord 2021; 26:1159-1168. [PMID: 32989688 DOI: 10.1007/s40519-020-01017-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Research has supported a link between insecure attachment and eating disorders (EDs) in adolescents; however, mechanisms accounting for this association remain unclear. Growing evidence suggests impaired mentalizing as a potential mechanism. Yet, little is known about the relationship between mentalizing and ED symptoms or how it relates to the link between attachment and EDs in adolescents. This study examined mentalizing deficits in adolescents with ED symptoms relative to psychiatric and healthy controls and tested a mediational model, wherein mentalizing capacity mediates the relationship between attachment and ED symptoms. METHOD Inpatient adolescents with EDs and other pathology (n = 568) and healthy controls (n = 184) were administered the child attachment interview, the movie for the assessment of social cognition and the diagnostic interview schedule for children to assess attachment, mentalizing and ED symptoms, respectively. RESULTS Inpatients showed lower attachment security and more hypermentalizing than healthy adolescents. Hypermentalizing explained the association between insecure attachment and ED symptoms. CONCLUSIONS These findings suggest potential utility of targeting mentalizing in prevention and treatment of EDs in adolescents. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- L Cortés-García
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela. Campus Vida, Calle Xosé María Suárez Núñez, s/n, 15782, Santiago de Compostela, A Coruña, Spain.
| | - V McLaren
- Department of Psychology, University of Houston, Houston, TX, United States
| | - S Vanwoerden
- Department of Psychology, University of Houston, Houston, TX, United States
| | - C Sharp
- Department of Psychology, University of Houston, Houston, TX, United States
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Gagliardini G, Gullo S, Tinozzi V, Baiano M, Balestrieri M, Todisco P, Schirone T, Colli A. Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis. Front Psychol 2020; 11:564291. [PMID: 33329192 PMCID: PMC7734030 DOI: 10.3389/fpsyg.2020.564291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/28/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in several mental disorders. Some studies have suggested that eating disorders (EDs) may also be associated with impairments in mentalizing. The aim of this work is to investigate the possible presence of mentalizing subtypes in a sample of patients with EDs. Method: A sample of patients with eating disorders (N = 157) completed a battery of measures assessing mentalization and related variables, including the Reflective Functioning Questionnaire (RFQ), the Difficulties in Emotion Regulation Strategies (DERS), the Interpersonal Reactivity Index (IRI). Clinicians rated patients in relation to imbalances in different dimensions of mentalization to prementalizing modes and attachment style by using the Mentalization Imbalances Scale, the Modes of Mentalization Scale (MMS), and the Adult Attachment Questionnaire. A latent profile analysis was conducted to test the possible presence of different subgroups. MANOVA was used to test the possible differences between the four mentalizing profiles in relation to emotion dysregulation (DERS), empathy (IRI), and adequate and impairments in mentalizing (MMS and RFQ). Results: The latent profile analysis suggested the presence of four different profiles in relation to impairments in the dimensions of mentalization: (1) affective/self/automatic imbalances, (2) external imbalance, (3) cognitive/self/automatic imbalances, and (4) cognitive/other/automatic imbalances. Patients belonging to profile 1 are characterized by the prevalence of affective mentalization that overwhelms the capacity to reflect on mental states with an imbalance on the self-dimension; profile 2 patients are excessively focused on the external cues of mentalization; profile 3 patients are characterized by an over-involvement on the cognitive and self-facets of mentalization, with an impairment in adopting the other mind perspective; and profile 4 patients have similar impairments compared to profile 3 patients but with an excessive focus on others and deficits in self-reflection. These profiles were heterogeneous in terms of EDs represented in each group and presented significant differences on various variables such as attachment style, emotion dysregulation, empathy, interpersonal reactivity, and reflective function. This study represents, so far, the first work that confirms the presence of different mentalizing patterns in ED patients. Conclusions: ED patients can be classified in relation to impairments in different dimensions of mentalization above and beyond ED diagnosis.
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Affiliation(s)
- Giulia Gagliardini
- Department of Humanities, "Carlo Bo" University of Urbino, Urbino, Italy
| | - Salvatore Gullo
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Valeria Tinozzi
- Department of Humanities, "Carlo Bo" University of Urbino, Urbino, Italy
| | - Monica Baiano
- Centre for Eating Disorders, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Matteo Balestrieri
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | | | - Tiziana Schirone
- Department of Humanities, "Carlo Bo" University of Urbino, Urbino, Italy
| | - Antonello Colli
- Department of Humanities, "Carlo Bo" University of Urbino, Urbino, Italy
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