The mentalization profile in patients with eating disorders: a systematic review and meta-analysis

Simonsen, Caroline Bach; Jakobsen, Anne Gade; Grøntved, Simon; Telléus, Gry Kjærsdam

doi:10.1080/08039488.2019.1707869

Cited by 36 publications

(30 citation statements)

References 56 publications

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“…A recent review and meta-analysis has suggested that patients with ED may show specific problematics in different dimensions of mentalization, with more severe difficulties on the self dimension of mentalization (Simonsen et al, 2020). The results of this analysis are consistent with the study of Adenzato et al (2012), who found that patients with AN scored significantly lower on mentalization ability about themselves than healthy controls but exhibited a mentalization ability about others comparable with the healthy subjects.…”

Section: Introductionsupporting

confidence: 83%

“…The literature on EDs and mentalization has theoretically suggested the presence of specific failures of mentalization in these patients (Skårderud, 2007). From an empirical standpoint, different authors have enlightened the presence of mentalizing problems in patients with ED (see, e.g., Aloi et al, 2017;Maxwell et al, 2017;Simonsen et al, 2020). A previous study on 25 patients with EDs (n = 13 with anorexia-restricting type, n = 7 with anorexia binge/purge type, and n = 5 with bulimia nervosa) has suggested how these patients are characterized by lower levels of mentalization regarding the self and higher levels of alexithymia, using more emotional suppression and less cognitive reappraisal than controls (Rothschild-Yakar et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…This is an exploratory study which aimed at filling the literature gap on the presence of specific mentalizing profiles in ED patients. Given the exploratory nature of this study and since the available literature on the topic does not allow for specific conclusions and points out the necessity to have further studies before being able to identify specific mentalizing problematics in ED patients (Simonsen et al, 2020), no specific hypotheses on the profiles were made.…”

Section: Introductionmentioning

confidence: 99%

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Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis

et al. 2020

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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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Section: Introductionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis

et al. 2020

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“…Notwithstanding the influence of these factors, a significant body of research supports viewing AN as a disorder that includes core emotion dysregulation problems. Several systematic reviews found evidence of impaired recognition of, and response to, social-affective stimuli (Caglar-Nazali et al, 2014;Oldershaw et al, 2011), lower mentalization ability about oneself (Simonsen et al, 2020), emotion regulation (ER) difficulties (Aldao et al, 2010;Hatch et al, 2010;Oldershaw et al, 2015), and increased levels of alexithymia (Caglar-Nazali et al, 2014;Nowakowski et al, 2013;Oldershaw et al, 2015;Westwood et al, 2017) in individuals with AN. In fact, a multitude of methods have been used to assess disturbances along the temporal continuum of emotional processing in AN (e.g., selfreport measures, cognitive tasks, event-related potentials).…”

Section: Introductionmentioning

confidence: 99%

Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study

Castro

Miller

Araújo

et al. 2021

Euro Eating Disorders Rev

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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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“…Importantly in the context of this thesis, meta-regression analyses reported that longer duration of illness, but not age, were associated with more severe deficits in theory of mind. Simonsen et al (2020) also recently completed a systematic review and meta-analysis of mentalizing profile in individuals with eating disorders. They adopted a broad definition of mentalizing, including alexithymia, theory of mind, reflective function and mind-mindedness.…”

Section: Studies Of Mentalization and Eating Pathologymentioning

confidence: 99%

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa (Thesis)

Jewell¹

2021

Preprint

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Family therapy for adolescent anorexia nervosa (FT-AN) is the first line treatment for the disorder, but little is known about who the treatment works for, or how it works. This thesis investigates the potential value of the constructs of attachment and mentalization as predictors of outcome in family therapy for adolescent AN. The thesis presents a systematic review of attachment and mentalization and their association with child and adolescent eating pathology in which 22 relevant studies were found. In keeping with the evidence base for adults with eating disorders, both attachment and mentalization were found to be correlates of eating pathology in childhood and adolescence. However, evidence for these constructs in the process of treatment in child and adolescent eating disorders is scarce. In a second systematic review, the psychometric properties of attachment measures in middle childhood and adolescence were investigated across 53 studies. The overall conclusion of the study is that there is a lack of evidence of adequate psychometric properties for attachment measures in this age group.In the main study, attachment and mentalization were investigated as predictors of outcome in a sample of adolescents and their parents (n = 192) receiving FT-AN across three specialist outpatient eating disorder services. Mentalization, but not attachment, was found to predict poor clinical outcome at nine months after starting of treatment, with the strongest predictive effect being excessive certainty about mental states as assessed in parents. Therapeutic alliance scores at one month were predictive of outcome but did not play a mediating role in relation to baseline attachment or mentalization. In a further empirical study, definitions of eating disorder recovery were investigated through a qualitative analysis of comments on recovery-focused social media forums. Two super-ordinate themes emerged: firstly, recovery was defined as encompassing broad psychosocial domains of wellbeing; secondly, recovery was understood to be an ongoing process. Social connectedness to others was regarded as important both to the process and definition of eating disorder recovery. The final chapter of the thesis integrates findings from across the studies with emerging theoretical developments in the fields of attachment and mentalization. It is argued that attachment and mentalization represent worthwhile constructs for further FT-AN research, with a particular emphasis on the need to better understand the mechanisms by which excessive mental state certainty might lead to poor clinical outcomes.

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The mentalization profile in patients with eating disorders: a systematic review and meta-analysis

Cited by 36 publications

References 56 publications

Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis

Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis

Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa (Thesis)

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