First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece.
Department of Clinical, Education and Health Psychology, University College London, UK.
Psychiatriki. 2020 Jul-Sep;31(3):225-235. doi: 10.22365/jpsych.2020.313.225.
The present study aimed to explore the role of dysfunctional metacognitive beliefs in Eating Disorders (EDs) and their potential associations with core and comorbid symptoms. The Metacognition Questionnaire-30 (MCQ-30), the Eating Disorder Examination Questionnaire 6.0 (EDE-Q), the Hospital Anxiety and Depression Scale (HADS) and the Maudsley Obsessive- Compulsive Inventory (MOCI) were used to evaluate 44 Anorexia Nervosa (AN), 50 Bulimia Nervosa (BN) patients and 37 controls. Patients featured more dysfunctional metacognitive beliefs which positively correlated with ED and comorbid symptoms. Both AN and BN patients had higher scores than healthy controls on MCQ-30 total score, Positive Beliefs about Worry, Negative Beliefs about Thoughts Uncontrollability and Danger and Need to Control Thoughts. AN patients also featured higher scores than healthy controls on Cognitive Self-Consciousness. No statistically significant difference was found between the two clinical groups in MCQ-30 total and subscale scores. Among metacognitive beliefs, Negative Beliefs about thoughts Uncontrollability and Danger showed the stronger correlations with core EDs symptoms, (coefficients ranging from 0.24 to 0.40), followed by Need to Control Thoughts (coefficients ranging from 0.22 to 0.38). Dysfunctional metacognitive beliefs were also significantly positively correlated with HADS-Anxiety, HADS-Depression and MOCI Total, in a similar manner. Dysfunctional metacognitive beliefs also predicted 19%, 35%, 20%, and 21% of the variance in Global EDE-Q, HADS-Anxiety, HADS-Depression and MOCI Total scores respectively, in regression analyses. Nevertheless, mediation analysis indicated that the relationship between Negative Beliefs about thoughts Uncontrollability and Danger and core EDs symptomatology as measured by EDE-Q, was not mediated by comorbid anxiety, depression and obsessionality. As a result, dysfunctions in metacognitive beliefs may reflect a common, trans-diagnostic path in AN and BN patients, towards a wide range of symptoms, both core and comorbid.
本研究旨在探讨功能失调的元认知信念在饮食失调（ED）中的作用及其与核心症状和共病症状的潜在关联。采用元认知问卷-30 项（MCQ-30）、饮食失调检查问卷 6.0 版（EDE-Q）、医院焦虑抑郁量表（HADS）和莫德斯利强迫症量表（MOCI）评估 44 例神经性厌食症（AN）、50 例贪食症（BN）患者和 37 名对照者。患者表现出更多的功能失调的元认知信念，这些信念与 ED 和共病症状呈正相关。AN 和 BN 患者在 MCQ-30 总分、对担忧的积极信念、对思维不可控性和危险的消极信念以及控制思维的需要方面的得分均高于健康对照组。AN 患者在认知自我意识方面的得分也高于健康对照组。在 MCQ-30 总分和分量表得分方面，两组患者之间无统计学差异。在元认知信念中，对思维不可控性和危险的消极信念与核心 ED 症状的相关性最强（系数范围为 0.24 至 0.40），其次是控制思维的需要（系数范围为 0.22 至 0.38）。功能失调的元认知信念也与 HADS 焦虑、HADS 抑郁和 MOCI 总分呈显著正相关，方式类似。在回归分析中，功能失调的元认知信念还分别预测了全球 EDE-Q、HADS 焦虑、HADS 抑郁和 MOCI 总分的 19%、35%、20%和 21%的变异。然而，中介分析表明，EDE-Q 测量的思维不可控性和危险的消极信念与核心 ED 症状之间的关系不受共病焦虑、抑郁和强迫性的中介。因此，元认知信念的功能障碍可能反映了 AN 和 BN 患者广泛的核心和共病症状的一种共同的、跨诊断的途径。
