Cognitive and Emotional Theory of Mind in Eating Disorders: The Mediating Role of Alexithymia

A number of studies have documented deficits in theory of mind (ToM), or the ability to infer the mental states of others, among individuals with eating disorders (EDs). Much of this research has focused on emotional ToM, as opposed to cognitive ToM, where mental inferences do not contain affective content. Alexithymia, a difficulty in the ability to correctly identify and describe one’s emotions, has also been reported among individuals with EDs. Alexithymia was hypothesized to mediate the relationship between ED symptoms and emotional ToM, as it has been shown in past research to significantly mediate emotion processing deficits in those with EDs. This study utilized 225 female college students who completed measures of ED symptoms, alexithymia, and cognitive and emotional ToM. There was not a significant relationship between ED symptoms and ToM as was hypothesized. However, ED symptoms as well as impairments in ToM were both associated with greater alexithymia. Participants who endorsed receiving a formal diagnosis for an ED performed significantly better on verbally mediated cognitive and emotional ToM tasks compared to those who had not. Interestingly, over half of the participants who had a diagnosis were receiving psychotherapy, which may have accounted for the findings. Moreover, participants who were receiving treatment for an ED displayed better ToM performance as well as reduced alexithymia compared to those who were not. Results from this study are not consistent with literature reporting impaired ToM among individuals with EDs. However, results do suggest that individuals with EDs may be able to improve their ToM ability and levels of alexithymia through psychotherapy.