Reflective functioning in anorexia nervosa: does it differ from healthy controls and what is its relation to psychopathology?

BACKGROUND: Previous studies found an impairment in the capacity to mentalize (operationalized as "reflective functioning", RF) in patients with anorexia nervosa (AN), but only few studies used a validated interview procedure. The aim of this study was an assessment of RF in patients with anorexia nervosa in comparison to healthy controls (HCs), using both an expert-rated measure as well as a self-report measure. Further, the study aimed to explore the relationship between RF and various aspects of psychopathology. METHODS: 30 female patients with AN (mean age: 26.2 ± 10.1 years) and 30 matched HCs (mean age: 27.4 ± 9.9 years) were assessed and compared regarding their level of RF using the Brief Reflective Functioning Interview (BRFI) and the Mentalization Questionnaire (MZQ). The interrelations between RF values and eating disorder psychopathology (BMI, EDI, EDE-Q), body experience (DKB-35), general psychopathology (PHQ-9, PHQ-15, GAD-7) and impairment in personality functioning (OPD-SQS) were explored using correlation coefficients. RESULTS: On the RF-Scale (RF-BRFI), RF was M = 3.63 (SD = 0.67) in the AN group and M = 4.13 (SD = 0.94) in the HC group. It was significantly lower for patients with AN than for HCs (t(52.5) = 2.38; p = 0.011). Mentalizing in the AN group as assessed with the MZQ was M = 3.24 (SD = 0.71), demonstrating significantly worse self-reported mentalizing capacities compared to HCs (M = 1.73; SD = 0.45; p < 0.0001). RF as measured with the BRFI was only correlated to the EDI-subscale "weight concern", while RF values of the MZQ were correlated with various aspects of psychopathology except depressive symptoms and BMI. CONCLUSION: The study confirmed the finding that patients with AN show impaired mentalizing. Strengthening the ability to mentalize might therefore be a relevant focus in treatment. However, associations of RF with psychopathology depend on the RF-measure used. Therefore, a better understanding of which aspects of mentalizing are captured by the RF-measures available would be an important basis for further research. Trial registration DRKS00031108.