Socio-cognitive processing in people with eating disorders: Computerized tests of mentalizing, empathy and imitation skills.

Alessio Maria Monteleone,Janet Treasure,Elisa Corsi,Michel‐Pierre Coll,Valdo Ricca,Valentina Cardi,Giammarco Cascino,Sophie Sowden,Geoffrey Bird

doi:10.1002/eat.23556

Abstract

ObjectiveEating disorders are psychiatric illnesses characterized by extreme eating behaviors, such as sustained food restriction or loss of control over eating. Symptoms are thought to be maintained by a variety of mechanisms, one of which may be the socio‐cognitive impairments associated with eating disorders. While some previous work has addressed socio‐cognitive impairments in eating disorders, this work has relied mostly on self‐report data.MethodHere we employed computerized tests of (a) mentalizing (ability to infer the mental states of others); (b) empathy (the degree to which the emotional states of others can be identified and the degree to which the states of others impact one's own emotional state); and (c) imitation (the degree to which observation of another's actions prompts the performance of those actions); in a group of 78 women with an eating disorder and a matched control group of 66 healthy women.ResultsPeople with eating disorders showed both hyper‐ and hypo‐mentalizing and reduced accuracy of emotional and cognitive mental state inference. They displayed less imitation of observed actions, but no differences in empathy compared to healthy controls. Although anxiety and depressive symptoms had significant effects on mentalizing, most of the observed inter‐group differences persisted.DiscussionWomen with eating disorders have difficulties mentalizing and imitating observed actions despite intact non‐social automatic imitation, compared to healthy controls. These findings provide an indication that intervention modules to strengthen specific areas of social cognition might be helpful to improve patients' social skills.

Highlights

Eating disorders are psychiatric illnesses characterized by the use of extreme eating behaviors, such as sustained food restriction or loss of control over eating
We investigated mentalizing, empathy and imitation—three distinct socio-cognitive processes in which the state of another can influence the state of the self (Happé, Cook, & Bird, 2017), in individuals with eating disorders
When depression was included as covariate, the analysis of covariance (ANCOVA) showed that the effect of the group persisted on all the Movie for the Assessment of Social Cognition (MASC) scores except that on Hypomentalization (F1,141 = .79, p = .4), with a significant effect of depression on the MASC Total score (F1,141 = 4.98, p = .027), Accuracy of cognitive mental states (F1,141 = 5.5, p = .02) and Hypomentalization (F1,141 = 5.7, p = .018)

Summary

Introduction

Eating disorders are psychiatric illnesses characterized by the use of extreme eating behaviors, such as sustained food restriction or loss of control over eating. Socio-cognitive impairment in eating disorders have been the subject of recent systematic reviews and meta-analyses (Monteleone, Treasure, Kan, & Cardi, 2018; Oldershaw et al, 2011) which have detailed difficulties in emotion perception and processing, a tendency to misunderstand and misinterpret signals from others, and an overestimation of the likelihood of social rejection This area of investigation has been limited by an overreliance on selfreport data (Caglar-Nazali et al, 2014), the lack of consensus with respect to a taxonomy of socio-cognitive processes which may be impacted by psychopathology (Happé & Frith, 2014; Seyfarth & Cheney, 2015), and the paucity of research on the consequences of poor socio-cognitive ability such as loneliness and isolation This area of investigation has been limited by an overreliance on selfreport data (Caglar-Nazali et al, 2014), the lack of consensus with respect to a taxonomy of socio-cognitive processes which may be impacted by psychopathology (Happé & Frith, 2014; Seyfarth & Cheney, 2015), and the paucity of research on the consequences of poor socio-cognitive ability such as loneliness and isolation (c.f. Cardi, Tchanturia, & Treasure, 2018; Monteleone et al, 2019)

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