The Interaction Between Mentalizing, Empathy and Symptoms in People with Eating Disorders: A Network Analysis Integrating Experimentally Induced and Self-report Measures

Abstract

Background. The role of mentalizing and empathy in the socio-emotional processing deficits of Eating Disorder (ED) patients has been under investigated. We aimed to assess these psychological processes and their interplay with ED symptoms by means of the network analysis approach.Methods. Seventy-seven women with EDs completed self-report questionnaires assessing ED, anxious and depressive symptoms, and underwent two computerized tasks; the Movie for the Assessment of Social Cognition (MASC), assessing emotional and non-emotional mental state inferences, and the Empathic Accuracy Task-Revised (EAT-R), measuring accuracy in identifying others' emotions and the extent to which those emotions are shared. A partial correlation network and bridge function analyses were computed.Results. In the partial correlation network inference of cognitive mental states and shape concern were the nodes with the highest strength centrality. Inference of emotional mental states was the node with the highest bridge strength in the cluster of social cognition functions. Empathic and mentalizing abilities were directly connected with each other and with ED symptoms.Conclusions. This is the first network analysis study which integrates self-reported symptoms and objective socio-cognitive performance in people with EDs. Results highlight the importance of mentalizing abilities in that they contribute to maintenance of ED psychopathology and to empathic ability.

A systematic review of network analysis studies in eating disorders: Is time to broaden the core psychopathology to non specific symptoms

“…More studies are also needed to explore the connections between psychopathology and the external field through network analysis, an area of investigation that has been already emphasised in EDs (Levinson et al., 2018; Smith et al., 2018). The findings of our review demonstrate that, so far, this area of investigation includes only two studies (Monteleone et al., 2019, 2020b) assessing the connection of ED psychopathology with childhood traumatic experiences or socio‐cognitive deficits and few studies investigating in terms of centrality the connection with personality dimensions (Solmi et al., 2018; Vervaet et al., 2020) and identity (Cascino et al., 2019).…”

“…In accordance with this study, early maladaptive schema (over‐vigilance and inhibition of emotions and impaired autonomy and performance) were external field nodes resulting highly central in samples with mixed EDs (Vervaet et al., 2020), although their possible bridge role was not assessed. Another study (Monteleone, Corsi, et al., 2020) explored the connections of ED‐specific and affective symptoms with mentalizing and empathy, assessed through experimental tasks, and displayed emotional mental state inference and restraint as the bridge nodes between psychopathology and socio‐cognitive processes. This was the only study including data from multiple levels of assessment in an ED network.…”

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

“…Thus, imitation should be considered a distinct process from mentalizing and empathy, although they likely interact in determining everyday social competence (Bird & Viding, 2014;Happé & Frith, 2014). Support for the interaction between socio-cognitive processes and psychopathology has been provided by a previous network analysis exploring the associations between mentalizing, empathy, affective symptoms and eating disorder psychopathology in the eating disorder sample described in the current study (Monteleone et al, 2020). Findings from that study indicated that mentalizing and empathic processes interact with each other and with eating disorder and affective symptoms, and that this interplay contributes to the maintenance of eating disorder psychopathology.…”

Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study

“…Development of the NA approach over the past decade has provided a theoretical framework that was adopted to identify the central symptoms of different psychiatric disorders, such as bipolar disorder [15], depression [16], obsessive compulsive disorder [17] and schizophrenia [18]. More recently, researchers in the field of eating disorders have applied NA to examine the symptoms of anorexia nervosa [19][20][21][22] and bulimia nervosa [23][24][25].…”