Reduced mentalizing in patients with bulimia nervosa and features of borderline personality disorder: A case-control study

Sofia Sacchetti,Peter Fonagy,Paul Robinson,Catherine Ouellet-Courtois,Ajay Clare,Anthony Bateman,Alexandra Bogaardt,Patrick Luyten

doi:10.1186/s12888-019-2112-9

Sofia Sacchetti, Peter Fonagy + Show 6 more

Open Access

https://doi.org/10.1186/s12888-019-2112-9

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Abstract

BackgroundMentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in some mental disorders such as Borderline Personality Disorder (BPD). Some studies have suggested that Eating Disorders (EDs) may also be associated with impairments in mentalizing, but studies have not always yielded consistent results. This is the first study to systematically investigate mentalizing impairments in patients with Bulimia Nervosa (BN) compared with controls. In addition, we investigated whether impairments in mentalizing were related to BPD features, rather than BN per se, given the high comorbidity between BPD and BN.MethodsPatients with BN (n = 53) and healthy controls (HCs; n = 87) completed a battery of measures assessing mentalizing including the Reflective Function Questionnaires (RFQ), the Object Relations Inventory (ORI; Differentiation-Relatedness Scales) and the Reading The Mind in The Eyes Test (RMET).ResultsPatients with BN scored significantly lower than HCs on all tests of mentalizing, with moderate to large between-group effect sizes. These differences were partially accounted for by BPD features as assessed with the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and partially by bulimic symptoms measured with the Eating Disorder Examination Questionnaire (EDE-Q).ConclusionsPatients with BN have significantly lower levels of mentalizing as assessed with a broad range of tests compared to HCs. These differences were related to both bulimic symptoms and BPD features. Although further research in larger samples is needed, if replicated, these findings suggest that poor mentalizing may be a significant factor in BN patients and should be addressed in treatment, regardless of the presence of BPD features.

Highlights

Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in some mental disorders such as Borderline Personality Disorder (BPD)
We focused on several dimensions of mentalizing: uncertainty and certainty in interpreting mental states (Reflective Function Questionnaire); externally-based mentalizing such as others’ emotion recognition (Reading the Mind in the Eyes Test); and the level of differentiation and relatedness in descriptions of self and others (Differentiation-Relatedness Scale)
Bulimia Nervosa (BN) patients and healthy controls (HCs) did not significantly differ in their age distribution and there was no statistical difference in Body Mass Index (BMI) between both samples

Summary

Introduction

Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in some mental disorders such as Borderline Personality Disorder (BPD). Some studies have suggested that Eating Disorders (EDs) may be associated with impairments in mentalizing, but studies have not always yielded consistent results. This is the first study to systematically investigate mentalizing impairments in patients with Bulimia Nervosa (BN) compared with controls. EDs are a family of psychopathologies often resistant to treatment with high relapse rates [28, 37]. The vast majority of relapses occur in the first months after treatment completion [49]. In light of this data, it is important to clarify the core psychological mechanisms

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