Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: A specific impairment of cognitive perspective taking in anorexia nervosa?

Bora, E., & Köse, S. (2016).

International Journal of Eating Disorders, 49(8), 739-740.


Deficits in theory of mind (ToM), ability to infer mental states of others, can play a significant role in interpersonal difficulties and/or unawareness of illness observed in AN and other eating disorders including bulimia Nervosa (BN). 

Current meta‐analysis aimed to summarize available evidence for deficits in ToM in AN and BN and examine the effects of number of study‐level variables on observed findings. In this meta‐analysis, 15 studies (22 samples with eating disorders) investigating ToM performances of 677 individuals with AN or BN and 514 healthy controls were included. 

AN was associated with significant deficits in ToM (d = 0.59) which were more pronounced in the acute patients (d = 0.67). Small sized deficits in ToM were observed in BN (d = 0.34) and recovered AN (d = 0.35). Both cognitive perspective‐taking (ToM‐PT) (d = 0.99) and decoding mental states (ToM‐decoding) (d = 0.61) aspects of ToM were impaired in acute AN. ToM‐decoding impairment in BN was modest. There was no evidence for significant ToM‐PT deficit in BN. Several study‐level variables including longer duration of illness, lower BMI, and depressive symptoms were associated with more severe deficits in ToM in AN. 

ToM deficits, particularly in ToM‐PT, can be a specific feature of AN but not BN. ToM impairment can contribute to poor insight, treatment resistance, and social impairment in AN.

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