Impaired theory of mind in unaffected first-degree relatives of patients with anorexia nervosa.

OBJECTIVE: Previous studies have shown theory of mind (ToM) is affected in patients with anorexia nervosa (AN). There has also been growing interest in the study of endophenotypes in psychiatric disorders, since they allow better understanding of genetic mechanisms underlying different conditions, making them potential targets for future treatment. The goal of this study was to investigate whether ToM inefficiencies observed in patients with AN, are shared by unaffected first-degree relatives. METHOD: Performance on two ToM tasks (Reading the Mind in the Eyes and Faux Pas Test) were compared in 17 unaffected first-degree relatives of AN patients and in 17 healthy individuals matched for age and level of education. Depression, anxiety, obsessive compulsive, and eating disorder symptoms were also assessed and correlated with ToM and clinical/demographic variables. RESULTS: Significant differences between groups were observed in all ToM tasks, with relatives of AN patients showing poorer performance. ToM assessment did not correlate with any clinical or demographic variable. CONCLUSIONS: The preliminary results of this study suggest unaffected first-degree relatives of AN patients display similar patterns of difficulty in ToM as reported previously for AN patients, supporting the hypothesis that ToM inefficiencies are a familial trait in this condition.

Emotional reactivity to social stimuli in patients with eating disorders.

Patients with eating disorders often display a wide range of difficulties in psychosocial functioning. Most of the studies on this subject have focused on theory of mind; however, little is known about the subjective emotional reactivity of patients to social situations. The aim of this study was to evaluate the patients' perceptions of their own emotions when viewing pictures with social content. Emotional reactivity was assessed in 85 women (29 with anorexia nervosa, 28 with bulimia nervosa, and 28 healthy controls) by using 30 images from the International Affective Picture System. Images were divided into categories based on its social content and its emotional valence. The emotional response was evaluated through the Self-Assessment Manikin. Patients with bulimia nervosa presented higher arousal and lower control when viewing images with social content of pleasant, unpleasant, and neutral valence. Patients with anorexia nervosa reported higher arousal and lower control only for social images with neutral valence. There were no differences between groups for the control images. The finding of specific differences in emotional reactivity to pictures with social content contributes to a more accurate understanding of the difficulties of patients in social situations.

Theory of mind and central coherence in eating disorders: two sides of the same coin?

The aim of this study was to evaluate central coherence and theory of mind (ToM) and explore the relationships between these domains in patients with eating disorders (ED). ToM and central coherence were assessed in 72 women [24 with anorexia nervosa (AN), 24 with bulimia nervosa (BN) and 24 healthy controls (HC)]. The Reading the Mind in the Eyes (RME) and the Faux Pas Test (FPT) to measure ToM, and the copy strategy of the Rey-Osterrieth Complex Figure Test to assess central coherence were used. It was observed that patients with ED had a decrease in central coherence skills compared with the control group; that patients with anorexia had a poor performance on RME ToM task compared with BN patients and HCs, and also that these measures were related in both clinical groups. The statistically significant correlation between them suggests that the central coherence and ToM measures might involve common cognitive processes. These results provide a better understanding of the nature of the socio-cognitive deficits observed in patients with eating disorders.

Theory of mind in eating disorders and their relationship to clinical profile.

OBJECTIVE: This study aimed to assess cognitive and affective theory of mind (ToM) in patients with eating disorders and to explore its relationship with the clinical and psychopathological profile. METHOD: Theory of mind was assessed in 65 women, consisting of 22 with anorexia nervosa (AN), 19 with bulimia nervosa (BN), and 24 healthy controls (HC), using the Reading the Mind in the Eyes Test and the Faux Pas Test. These tasks evaluate affective and cognitive ToM, respectively. We also examined the correlations between performance on ToM tasks and the clinical psychopathological profile, which was extensively evaluated through self-report instruments and clinical interviews. RESULTS: Patients with AN had poorer performance than BN patients and HCs had in the affective ToM task, particularly in recognizing negative emotions and emotions in male eyes. Moreover, this deficit showed no correlation with the psychopathological profile. Performance in the BN group was equivalent to that of HCs in both tasks. CONCLUSIONS: In this study, patients with AN showed an impairment in affective ToM, independent of their clinical status. Consistent with other studies, our findings demonstrate a specific difficulty in social cognition in patients with AN. This may be a trait marker in this population and should be considered in treatment. Furthermore, patients with AN and BN have different difficulty profiles in this domain of social cognition.