Dissertation committee:
Φραγκίσκος Γονιδάκης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Χαράλαμπος Παπαγεωργίου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Δικαίος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Ζέρβας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αρτέμιος Πεχλιβανίδης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Μιχόπουλος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ρωσσέτος Γουρνέλλης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
The present study aimed to investigate the complex role of dysfunctional metacognitive beliefs, self-reflectivity, delusionality and clinical insight in Eating Disorders (ED), their inter-relationships and their possible association with both specific and comorbid symptoms. The Metacognitive Questionnaire - MCQ-30, the Self-Reflection and Insight Scale -SRIS, the Interview based Schedule for the Assessment of Insight in Eating Disorders - SAI-ED, the Brown Assessment of Beliefs Scale - BABS, the Eating Disorder Examination Questionnaire - EDE-Q, the Hospital and Anxiety and Depression Scale - HADS and the Maudsley Obsessive-Compulsive Inventory - MOCI were used to assess 44 female patients with Anorexia Nervosa (AN), 50 female patients with Bulimia Nervosa and 37 healthy female controls.
Patients with AN and BN featured higher scores of dysfunctional metacognitive beliefs, which were positively correlated with both specific symptoms of eating disorders and the comorbid symptoms of anxiety, depression, and obsessionnality. More specifically, both AN and BN patients featured higher scores than healthy controls on the overall MCQ-30 score, and on the subscales of positive beliefs about worry, negative beliefs about uncontrollability and danger, and need to control thoughts. Patients with AN also featured higher scores on the cognitive self-consciousness subscale. Negative beliefs about uncontrollability and danger and need to control thoughts featured the strongest positive correlations with ED and comorbid symptoms. In regression analyzes, dysfunctional metacognitive beliefs predicted 21%, 38%, 25%, and 28% of variance in the overall EDE-Q, HADS-Anxiety, HADS-Depression, and MOCI scores, respectively. Mediation analyses have shown that comorbid symptomatology does not mediate the relationship between dysfunctional metacognitive beliefs and specific symptoms of ED. Consequently, dysfunctions in metacognitive beliefs may reflect a common, trans-diagnostic pathway in EDs towards a wide range of symptoms.
Regarding the correlations between other metacognitive factors and clinical symptoms, insight was found to be statistically significantly positively correlated to food concern, overall EDE-Q score, and comorbid symptoms of anxiety, depression, and obsessionnality. Insight was found to be statistically significantly positively correlated with dysfunctional metacognitive beliefs such as negative beliefs about uncontrollability and danger, need to control thoughts, positive beliefs about worry and cognitive confidence. These results suggest that self-insight in patients with EDs probably reflects their tendency to overestimate their own rather intense and rigid monitoring of their internal condition. In contrast, there was a statistically significant negative correlation between self-reflection and dysfunctional cognitive beliefs, such as cognitive self-consciousness, negative beliefs about uncontrollability and danger and need to control thoughts, findings that imply that ED patients are capable of engaging in healthy self-reflection processes.
Only some of AN patients and none of BN patients were categorized as having delusional beliefs. In particular, the group of restrictive-type AN showed higher frequency of delusional beliefs (33.33%) than patients with binge-purging, type of AN (13.04%). In all subgroups of patients there were patients who were categorized as having poor insight.
In AN patients, delusionality was found to be statistically significantly positively correlated with food restriction, while in patients with BN it was found to be statistically significantly positively correlated with concern about body shape, concern about body weight, and overall EDE-Q score, as well as with comorbid symptomatology, i.e. anxiety, depression and obsessionnality. On the contrary, clinical insight was found to be statistically significantly negatively correlated with food restriction in patients with AN, while in patients with BN it was found to be statistically significantly negatively correlated with body shape concern, body weight concern, overall EDE-Q score, and obsessionnality. A statistically significant negative correlation was observed between delusionality and clinical insight in ED patients. The above findings confirm the importance of regular evaluation of these parameters in clinical practice. Therefore, the therapists’ attitude, the therapeutic relationship and the treatment itself should approach potential insight deficits for a suitable therapeutic alliance to be gradually built.
In the BN sample, delusionality was also found to be statistically significantly positively correlated with dysfunctional metacognitive beliefs and in particular negative beliefs about uncontrollability and danger, need to control thoughts and cognitive confidence (lack of). On the contrary, dysfunctional metacognitive beliefs about negative beliefs about uncontrollability and danger and need to control thoughts were statistically significantly negatively associated with clinical insight subscales, namely disorder awareness, symptoms awareness, and treatment compliance.
