Objective: Building on recent models of anorexia nervosa (AN) that emphasize the importance of impaired social cognition in the development and maintenance of the disorder, the present study aimed at examining whether women with AN have more difficulties with inferring other people's emotional and non-emotional mental states than healthy women. Results: Women with AN showed poorer emotional mental state inference, whereas non-emotional mental state inference was largely intact. Groups did not differ in undermentalizing (overly simplistic theory of mind) and overmentalizing (overly complex or over-interpretative mental state reasoning).Performance in the MASC was independent of levels of eating disorder psychopathology and symptoms of depression and anxiety. Discussion:The findings suggest that AN is associated with specific difficulties in emotional mental state inference despite largely intact non-emotional mental state inference. Upon replication in larger samples, these findings advocate a stronger emphasis on socio-emotional processing in AN treatment.

Objective Patients with anorexia nervosa (AN) often show difficulties in the perception, expression, and regulation of emotions and a strong avoidance of aversive feelings. According to psychobiological models, dietary restraint and accompanying weight loss may serve as a maladaptive mechanism of emotion regulation by attenuating aversive emotional states in AN, thereby contributing to the maintenance of the disorder. Method Twenty‐seven women with AN and 26 age‐matched healthy women were shown short film‐clips to elicit fear, sadness, amusement, and neutral emotional states. Eyeblink startle response was measured by electromyography in reaction to startle‐eliciting acoustic stimuli presented 12 times binaurally during each film‐clip. Results As compared to healthy controls, patients with AN showed a blunted startle response to the fear‐ but not to the sadness‐eliciting stimulus. Discussion The findings support the assumption that underweight is associated with attenuated emotional reactivity to fear‐eliciting material in AN. This is in line with the hypothesis that starvation and low body weight constitute a maladaptive mechanism of emotion regulation in AN, contributing to the maintenance of the disorder.