Moderating effect of metacognition on the relationship between perfectionism, body image disturbance, and body mass index in anorexia nervosa: a cross-sectional study

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Abstract

BACKGROUND: Despite theoretical concepts about the key role of perfectionism in the formation of the symptoms of anorexia nervosa (AN), the aspects of the mutual influence between body mass index (BMI), perfectionism, and body image in patients with AN remain insufficiently studied or contradictory. Studying integrative cognitive processes, such as metacognition, may reveal new mechanisms of perfectionism’s influence on the clinical manifestations of AN.

AIM: The assessment of the moderating effect of metacognition on perfectionism associated with BMI and body image in patients with AN.

METHODS: A cross-sectional study was conducted involving patients with AN who were undergoing inpatient treatment. Perception of one’s own body was assessed using the Body Image Questionnaire. Perfectionism was assessed using the Multidimensional Perfectionism Scale. The level of metacognition of patients was assessed using the Metacognition Assessment Scale-Abbreviated, which evaluates Self-reflectivity, Understanding the other’s mind, Decentration, and Mastery (the ability to develop adaptive strategies for coping and behaviour regulation). BMI was also recorded.

RESULTS: A total of 130 patients were examined. At a Mastery score of ≥4 higher perfectionism scores were associated with an increase in BMI, and at a Mastery level of ≤1 a higher level of perfectionism was associated with decreasing of BMI. Even with minimal Self-reflectivity scores (≥2), the negative effect of perfectionism on body image was evident. Body image disturbance was positively correlated with perfectionism. No correlations were found between BMI and perfectionism and between BMI and body image disturbance.

CONCLUSION: The effect of perfectionism on body image disturbance and BMI in patients with AN depends on the magnitude of Self-reflectivity and Mastery. The obtained data indicate the necessity of incorporating psychotherapy aimed at the development of metacognition in patients with AN.

About the authors

Nikita V. Chernov

Mental-health clinic No. 1 named after N.A. Alexeev

Author for correspondence.
Email: n.chernov.psy@bk.ru
ORCID iD: 0000-0001-5347-0231
SPIN-code: 9649-8443

Head of the Department of Psychotherapeutic Care and Social Rehabilitation

Russian Federation, Moscow

Andrey A. Kibitov

Mental-health clinic No. 1 named after N.A. Alexeev

Email: n.chernov.psy@bk.ru
ORCID iD: 0000-0001-7766-9675
SPIN-code: 5502-2307
ResearcherId: ACG-0527-2022

Junior Researcher, Scientific and Clinical Center for Neuropsychiatry

Russian Federation, Moscow

Maya A. Kulygina

Mental-health clinic No. 1 named after N.A. Alexeev; Lomonosov Moscow State University

Email: n.chernov.psy@bk.ru
ORCID iD: 0000-0003-4255-8240
SPIN-code: 9513-0968

Cand. Sci (Psychology), Leading Research, Scientific and Clinical Center for Neuropsychiatry, Associate professor, Department of Mental Health and Clinical Psychiatry, Faculty of Psychology

Russian Federation, Moscow; Moscow

Tatiana V. Moiseeva

Mental-health clinic No. 1 named after N.A. Alexeev

Email: n.chernov.psy@bk.ru
ORCID iD: 0000-0002-0279-5180
SPIN-code: 2573-2755

Cand. Sci (Psychology), Medical psychologist

Russian Federation, Moscow

Alexandra M. Grishanina

Mental-health clinic No. 1 named after N.A. Alexeev

Email: n.chernov.psy@bk.ru
ORCID iD: 0000-0003-0867-9364

Medical psychologist

Russian Federation, Moscow

Ekaterina V. Fedorova

Mental-health clinic No. 1 named after N.A. Alexeev

Email: n.chernov.psy@bk.ru
ORCID iD: 0000-0003-3994-3148
Scopus Author ID: 59013159400

Medical psychologist

Russian Federation, Moscow

Elizaveta S. Ryauzova

Mental-health clinic No. 1 named after N.A. Alexeev

Email: n.chernov.psy@bk.ru
ORCID iD: 0009-0003-6448-1501

Medical psychologist

Russian Federation, Moscow

Olga A. Karpenko

Mental-health clinic No. 1 named after N.A. Alexeev

Email: n.chernov.psy@bk.ru
ORCID iD: 0000-0002-0958-0596
SPIN-code: 9600-0688

MD, Cand. Sci (Med.), Principal Researcher, Scientific and Clinical Center for Neuropsychiatry

Russian Federation, Moscow

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Copyright (c) 2025 Chernov N.V., Kibitov A.A., Kulygina M.A., Moiseeva T.V., Grishanina A.M., Fedorova E.V., Ryauzova E.S., Karpenko O.A.

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