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Metacognition in eating disorders: Comparison of women with eating disorders, self-reported history of eating disorders or psychiatric problems, and healthy controls

Objective: The aim of the study was to compare a clinical sample with eating disorders to different control samples on self-report measures of metacognition and eating disorder symptoms, in order to investigate the role of metacognition in eating disorders.

Method: The clinical group consisted of 53 female patients with eating disorders who completed the Metacognitions Questionnaire-30 and the Eating Disorder Examination Questionnaire 6.0. One-hundred and fifty women who served as a control group completed the questionnaires as an Internet survey. This control group was divided into three groups based on self-reported history of eating and psychiatric problems (N = 47), other psychiatric problems (N = 37), or no such problems (healthy controls: N = 66).

Results: The clinical group scored significantly higher on dysfunctional metacognition than healthy controls, especially on “negative beliefs about uncontrollability and danger”, “need to control thoughts”, and total MCQ-30 score. Eating disorder symptomatology was positively correlated with metacognition. Metacognition explained 51% of the variance in eating disorder symptoms after controlling for age and BMI, with “need to control thoughts” as the most important factor.

Conclusion: Metacognitive beliefs may be central in understanding eating disorders, and metacognitive treatment strategies could be a promising approach in developing new psychological treatments for eating disorders.


Alex’s Notes: Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Eating Disorder Not Otherwise Specified (EDNOS) all share an intense fear of weight gain and body dysmorphia. These are indeed mental health disorders with devastating consequences. Psychology spans many areas of thought, one of which is metacognition. According to the researchers, metacognitions are beliefs that control, monitor, and appraise thinking. Another way to look at it is to consider foods you believe to be good or bad for your health. That good/bad belief about the food is the metacognition that affects how you perceive the food and your choices surrounding it.

The study consisted of 53 clinically diagnosed eating disorder patients, 47 women with self-reported history of eating problems, 37 women with self-reported history of other psychiatric problems, and 66 women who reported no history of psychiatric- or eating disorder problems (healthy controls). They ranged in age from 17-51 years with an average of 28.4 years, and the eating disorder patients had their disorder for an average of 12 years (ranging 1-35 years). Five of the EDNOS patients were overweight and thus put into their own category.

Several questionnaires were provided in person to the patients or over the internet to the other women.The Metacognitions Questionnaire-30 (MCQ-30) measures five factors of metacognition: positive beliefs (e.g.: “Worrying helps me to avoid problems in the future”), negative beliefs about uncontrollability and danger (e.g.: “My worrying is dangerous for me”), cognitive confidence (e.g.: “I have little confidence in my memory for words and names”), need for control thoughts (e.g.: “If I did not control a worrying thought, and then it happened, it would be my fault”), and cognitive self-consciousness (e.g.: “I think a lot about my thoughts”).The Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) has 28 items, and measures severity on of eating disorders symptomatology.

The clinical group and the group with a history of self-reported eating problems scored significantly higher on the EDE-Q than the other groups, as would be expected. For metacognition, the clinical group had significantly higher scores on the MCQ-30 than any of the other groups.The global EDE-Q score correlated especially high with the total MCQ-30 score (r = .67) and the MCQ-30 subscale “need to control thoughts” (r = .71), while the EDE-Q subscale “restraint” had the weakest correlations with the MCQ-30. In fact, MCQ-30 explained 50.8% of the variance in the total EDE-Q with age and BMI being controlled for.

What does it all mean?

In a nutshell, it means that metacognition predicts about 50% of the variance in eating disorder symptoms independent of age or BMI. Apart from that, it’s hard to shift through the implications without a background in psychology. Nonetheless, it seems prudent to further explore metacognition not just in clinical populations, but in everyone who has strong beliefs.


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