The impact of theory of mind and neurocognition on delusionality in anorexia nervosa

ABSTRACT

The current study aimed to examine the impact of theory of mind (ToM) deficits on body image delusionality in anorexia nervosa (AN) while accounting for the effect of other cognitive functions. ToM and other cognitive functions were assessed in 46 patients with AN and 42 healthy controls. We used the Brown Assessment of Beliefs Scale to assess the degree of delusionality of body image beliefs in AN patients. Delusional body image beliefs were identified in 26.1% and overvalued ideas in 30.4% of the AN patients. Moderate but significant associations were found between impairments in ToM—overall capacity, cognitive and affective components—and body image delusionality. The effect of overall ToM performance on delusionality remained significant after controlling for other cognitive factors. General intelligence was also significantly associated with delusionality. Our findings support the notion that difficulties in taking the perspective of others contribute to insight impairment in AN. Further investigation is required to examine the effect of failures in social cognition and metacognition on insight in AN.

KEYWORDS:

• Anorexia nervosa
• body image
• delusionality
• insight
• theory of mind

Author contributions

G. Konstantakopoulos designed the study, wrote the protocol, collected the data, statistically analyzed the data, and wrote the first draft of the manuscript. F. Gonidakis was involved in writing the protocol and collecting the data. N. Ioannidi and P. Patrikelis carried out the neuropsychological assessments of the patients. All authors contributed to and have approved the final manuscript.

Acknowledgments

We thank the clinicians at the Eating Disorders Unit of Eginition Hospital for their assistance with participant recruitment, as well as the participants themselves.

Disclosure statement

All the authors declare that they have no conflict of interest with respect to this study or its publication.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.