Reduced mentalizing in patients with bulimia nervosa and features of borderline personality disorder: A case-control study.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968559 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-244X (Electronic) Linking ISSN: 1471244X NLM ISO Abbreviation: BMC Psychiatry Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Borderline Personality Disorder/*complications ; Borderline Personality Disorder/*psychology ; Bulimia Nervosa/*complications ; Bulimia Nervosa/*psychology ; Mentalization/*physiology; Adolescent ; Adult ; Borderline Personality Disorder/physiopathology ; Bulimia Nervosa/physiopathology ; Case-Control Studies ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Surveys and Questionnaires ; Young Adult

Background: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in some mental disorders such as Borderline Personality Disorder (BPD). Some studies have suggested that Eating Disorders (EDs) may also be associated with impairments in mentalizing, but studies have not always yielded consistent results. This is the first study to systematically investigate mentalizing impairments in patients with Bulimia Nervosa (BN) compared with controls. In addition, we investigated whether impairments in mentalizing were related to BPD features, rather than BN per se, given the high comorbidity between BPD and BN.
Methods: Patients with BN (n = 53) and healthy controls (HCs; n = 87) completed a battery of measures assessing mentalizing including the Reflective Function Questionnaires (RFQ), the Object Relations Inventory (ORI; Differentiation-Relatedness Scales) and the Reading The Mind in The Eyes Test (RMET).
Results: Patients with BN scored significantly lower than HCs on all tests of mentalizing, with moderate to large between-group effect sizes. These differences were partially accounted for by BPD features as assessed with the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and partially by bulimic symptoms measured with the Eating Disorder Examination Questionnaire (EDE-Q).
Conclusions: Patients with BN have significantly lower levels of mentalizing as assessed with a broad range of tests compared to HCs. These differences were related to both bulimic symptoms and BPD features. Although further research in larger samples is needed, if replicated, these findings suggest that poor mentalizing may be a significant factor in BN patients and should be addressed in treatment, regardless of the presence of BPD features.

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PB-PG-0408-15183 United Kingdom DH_ Department of Health

Keywords: Borderline personality disorder; Bulimia nervosa; Differentiation-relatedness; Eating disorder; Mentalizing; Reading the mind in the eyes; Reflective function; Theory of mind

Date Created: 20190508 Date Completed: 20200127 Latest Revision: 20231011

20231011

PMC6501333

10.1186/s12888-019-2112-9

31060534