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

封面

如何引用文章

全文:

详细

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.

作者简介

Nikita Chernov

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

编辑信件的主要联系方式.
Email: n.chernov.psy@bk.ru
ORCID iD: 0000-0001-5347-0231
SPIN 代码: 9649-8443

Head of the Department of Psychotherapeutic Care and Social Rehabilitation

俄罗斯联邦, Moscow

Andrey Kibitov

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

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

Junior Researcher, Scientific and Clinical Center for Neuropsychiatry

俄罗斯联邦, Moscow

Maya 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 代码: 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

俄罗斯联邦, Moscow; Moscow

Tatiana Moiseeva

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

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

Cand. Sci (Psychology), Medical psychologist

俄罗斯联邦, Moscow

Alexandra 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

俄罗斯联邦, Moscow

Ekaterina Fedorova

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

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

Medical psychologist

俄罗斯联邦, Moscow

Elizaveta 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

俄罗斯联邦, Moscow

Olga Karpenko

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

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

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

俄罗斯联邦, Moscow

参考

  1. B80 Anorexia Nervosa [Internet]. In: ICD-11 for Mortality and Morbidity Statistics. Geneva: World Health Organization; с2025 [cited 2025 September 28]. Available from: https://icd.who.int/browse/2025-01/mms/en#263852475
  2. Cornelissen PL, Tovée MJ. Targeting body image in eating disorders. Curr Opin Psychol. 2021;41:71–77. doi: 10.1016/j.copsyc.2021.03.013
  3. Zanella E, Lee E. Integrative review on psychological and social risk and prevention factors of eating disorders including anorexia nervosa and bulimia nervosa: seven major theories. Heliyon. 2022;8(11):e11422. doi: 10.1016/j.heliyon.2022.e11422
  4. Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther. 2003;41(5):509–528. doi: 10.1016/s0005-7967(02)00088-8
  5. Vervaet M, Puttevils L, Hoekstra RHA, et al. Transdiagnostic vulnerability factors in eating disorders: A network analysis. Eur Eat Disord Rev. 2021;29(1):86–100. doi: 10.1002/erv.2805
  6. Delaquis CP, Godart N, Barry C, et al. Perfectionism, self-esteem, and affective symptoms in anorexia nervosa subtypes: A network analysis of French inpatients. J Clin Psychol. 2024;80(8):1852–1875. doi: 10.1002/jclp.23698
  7. Dahlenburg SC, Gleaves DH, Hutchinson AD. Anorexia nervosa and perfectionism: A meta-analysis. Int J Eat Disord. 2019;52(3):219–229. doi: 10.1002/eat.23009
  8. Welch E, Miller JL, Ghaderi A, Vaillancourt T. Does perfectionism mediate or moderate the relation between body dissatisfaction and disordered eating attitudes and behaviors? Eat Behav. 2009;10(3):168–175. doi: 10.1016/j.eatbeh.2009.05.002
  9. Hicks RE, Kenny B, Stevenson S, Vanstone DM. Risk factors in body image dissatisfaction: gender, maladaptive perfectionism, and psychological wellbeing. Heliyon. 2022;8(6):e09745. doi: 10.1016/j.heliyon.2022.e09745
  10. Wade TD, Tiggemann M. The role of perfectionism in body dissatisfaction. J Eat Disord. 2013;1:2. doi: 10.1186/2050-2974-1-2
  11. Ekici EM, Yildrim Z, Erdem S. Understanding the role of perfectionism in adult expectations of dietary restriction and thinness. Gulhane Med J. 2024;66(4):203–210. doi: 10.4274/gulhane.galenos.2024.16046
  12. Bernabéu-Brotóns E, Marchena-Giráldez C. Emotional Eating and Perfectionism as Predictors of Symptoms of Binge Eating Disorder: The Role of Perfectionism as a Mediator between Emotional Eating and Body Mass Index. Nutrients. 2022;14(16):3361. doi: 10.3390/nu14163361
  13. Halmi KA, Sunday SR, Strober M, et al. Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. Am J Psychiatry. 2000;157(11):1799–1805. doi: 10.1176/appi.ajp.157.11.1799
  14. Morgan-Lowes KL, Clarke PJF, Hoiles KJ, et al. The relationships between perfectionism, anxiety and depression across time in paediatric eating disorders. Eat Behav. 2019;34:101305. doi: 10.1016/j.eatbeh.2019.101305
  15. Zhang B, Cai T. Moderating effects of self-efficacy in the relations of perfectionism and depression. Studia Psychologica. 2012;54(1):15–21.
  16. Zhang J, Liu L, Wang W. The Moderating Role of Grit in the Relationship Between Perfectionism and Depression Among Chinese College Students. Front Psychol. 2021;12:729089. doi: 10.3389/fpsyg.2021.729089
  17. Chaaya R, Hallit R, Malaeb D, et al. Moderating effect of self-esteem between perfectionism and avoidant restrictive food intake disorder among Lebanese adults. BMC Psychiatry. 2024;24(1):325. doi: 10.1186/s12888-024-05762-8
  18. Abdollahi A, Gardanova ZR, Ramaiah P, et al. Moderating Role of Self-Compassion in the Relationships Between the Three Forms of Perfectionism with Anger, Aggression, and Hostility. Psychol Rep. 2023;126(5):2383–2402. doi: 10.1177/00332941221087911
  19. Kleka P, Brycz H, Zięba M, Fanslau A. Longitudinal study of metacognition’s role in self-efficacy and hope development. Sci Rep. 2024;14(1):29379. doi: 10.1038/s41598-024-80180-0
  20. Sun PP, Wang C, Teng LS. The Role of Well-Being and Grit in Metacognitive Self-Regulation Among Language Teachers: Partial Least Squares Structural Equation Modeling. Int J Appl Linguist. 2025;35(4):1883–1896. doi: 10.1111/ijal.12711
  21. Rader L, Forster SD, Gauggel S, et al. Take a step back to see your own value: on the role of metacognition in self-esteem regulation. Front Psychol. 2025;16:1530008. doi: 10.3389/fpsyg.2025.1530008
  22. Hochheiser J, Lundin NB, Lysaker PH. The Independent Relationships of Metacognition, Mindfulness, and Cognitive Insight to Self-Compassion in Schizophrenia. J Nerv Ment Dis. 2020;208(1):1–6. doi: 10.1097/NMD.0000000000001065
  23. Moritz S, Lysaker PH. Metacognition — What did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions. Schizophr Res. 2018;201:20–26. doi: 10.1016/j.schres.2018.06.001
  24. Palmieri S, Mansueto G, Ruggiero GM, et al. Metacognitive beliefs across eating disorders and eating behaviours: A systematic review. Clin Psychol Psychother. 2021;28(5):1254–1265. doi: 10.1002/cpp.2573
  25. Springfield CR, Bonfils KA, Chernov NV, et al. The paradoxical moderating effects of metacognition in the relationships between self-esteem, depressive symptoms, and quality of life in anorexia and bulimia. Consort Psychiatr. 2023;4(2):6–20. doi: 10.17816/CP6139
  26. Palmieri S, Sassaroli S, Ruggiero GM, et al. Perfectionism in patients with eating disorders: The role of metacognitive beliefs and repetitive negative thinking. Clinical Psychology & Psychotherapy. 2024;31(1):e2954. doi: 10.1002/cpp.2954
  27. Skugarevskii OA, Sivukha SV. [Body image: developing an assessment tool]. Psikhologicheskii zhurnal. 2006;(2):40–48. Belarus.
  28. Hewitt PL, Flett GL. Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. J Pers Soc Psychol. 1991;60(3):456–470. doi: 10.1037//0022-3514.60.3.456
  29. Gracheva II. [Adaptation of “multidimensional perfectionism scale” technique by P. Hewitt and G. Flett]. Psikhologicheskii zhurnal. 2006;27(6):73–81. Russian.
  30. Lysaker PH, Chernov N, Moiseeva T, et al. Metacognition Assessment Scale--Abbreviated; Russian Version (MAS-A) [Database record] [Internet]. APA PsycTests. c2020 [cited 2025 November 12]. doi: 10.1037/t79885-000. Available from: https://psycnet.apa.org/doiLanding?doi=10.1037%2Ft79885-000
  31. Lysaker PH, Clements CA, Plascak-Hallberg CD, et al. Indiana Psychiatric Illness Interview (IPII) [Database record]. APA PsycTests. c2002 [cited 2025 November 12]. doi: 10.1037/t79888-000. Available from: https://psycnet.apa.org/doiLanding?doi=10.1037%2Ft79888-000
  32. Hayes, A. F., & Rockwood, N. J. (2017). Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behaviour research and therapy, 98, 39–57. doi: 10.1016/j.brat.2016.11.001
  33. Rothschild-Yakar L, Stein D, Goshen D, et al. Mentalizing Self and Other and Affect Regulation Patterns in Anorexia and Depression. Front Psychol. 2019;10:2223. doi: 10.3389/fpsyg.2019.02223
  34. Esben S, Sorensen P. The role of metacognitive beliefs versus meta-emotion beliefs in disordered eating. Australian Psychologist. 2023;58(24):1–11. doi: 10.1080/00050067.2023.2181685
  35. Quattropani MC, Lenzo V, Faraone C, et al. The role of Metacognition in eating behavior: an exploratory study. Mediterranean Journal of Clinical Psychology. 2016;4(3). doi: 10.6092/2282-1619/2016.4.1213
  36. Smith KE, Mason TB, Lavender JM. Rumination and eating disorder psychopathology: A meta-analysis. Clin Psychol Rev. 2018;61:9–23. doi: 10.1016/j.cpr.2018.03.004
  37. Stackpole R, Greene D, Bills E, Egan SJ. The association between eating disorders and perfectionism in adults: A systematic review and meta-analysis. Eat Behav. 2023;50:101769. doi: 10.1016/j.eatbeh.2023.101769
  38. Howard LM, Olson AK, Pitz BN, Heron KE. The Role of Denial in Eating Disorder Development, Assessment, and Treatment. In: Patel VB, Preedy VR, editors. Eating Disorders. Cham: Springer; 2023. p. 367–383.
  39. Davenport E, Rushford N, Soon S, McDermott C. Dysfunctional metacognition and drive for thinness in typical and atypical anorexia nervosa. J Eat Disord. 2015;3:24. doi: 10.1186/s40337-015-0060-4

补充文件

附件文件
动作
1. JATS XML
下载

版权所有 © Chernov N.V., Kibitov A.A., Kulygina M.A., Moiseeva T.V., Grishanina A.M., Fedorova E.V., Ryauzova E.S., Karpenko O.A., 2025

Creative Commons License
此作品已接受知识共享署名-非商业性使用-禁止演绎 4.0国际许可协议的许可。

Согласие на обработку персональных данных с помощью сервиса «Яндекс.Метрика»

1. Я (далее – «Пользователь» или «Субъект персональных данных»), осуществляя использование сайта https://journals.rcsi.science/ (далее – «Сайт»), подтверждая свою полную дееспособность даю согласие на обработку персональных данных с использованием средств автоматизации Оператору - федеральному государственному бюджетному учреждению «Российский центр научной информации» (РЦНИ), далее – «Оператор», расположенному по адресу: 119991, г. Москва, Ленинский просп., д.32А, со следующими условиями.

2. Категории обрабатываемых данных: файлы «cookies» (куки-файлы). Файлы «cookie» – это небольшой текстовый файл, который веб-сервер может хранить в браузере Пользователя. Данные файлы веб-сервер загружает на устройство Пользователя при посещении им Сайта. При каждом следующем посещении Пользователем Сайта «cookie» файлы отправляются на Сайт Оператора. Данные файлы позволяют Сайту распознавать устройство Пользователя. Содержимое такого файла может как относиться, так и не относиться к персональным данным, в зависимости от того, содержит ли такой файл персональные данные или содержит обезличенные технические данные.

3. Цель обработки персональных данных: анализ пользовательской активности с помощью сервиса «Яндекс.Метрика».

4. Категории субъектов персональных данных: все Пользователи Сайта, которые дали согласие на обработку файлов «cookie».

5. Способы обработки: сбор, запись, систематизация, накопление, хранение, уточнение (обновление, изменение), извлечение, использование, передача (доступ, предоставление), блокирование, удаление, уничтожение персональных данных.

6. Срок обработки и хранения: до получения от Субъекта персональных данных требования о прекращении обработки/отзыва согласия.

7. Способ отзыва: заявление об отзыве в письменном виде путём его направления на адрес электронной почты Оператора: info@rcsi.science или путем письменного обращения по юридическому адресу: 119991, г. Москва, Ленинский просп., д.32А

8. Субъект персональных данных вправе запретить своему оборудованию прием этих данных или ограничить прием этих данных. При отказе от получения таких данных или при ограничении приема данных некоторые функции Сайта могут работать некорректно. Субъект персональных данных обязуется сам настроить свое оборудование таким способом, чтобы оно обеспечивало адекватный его желаниям режим работы и уровень защиты данных файлов «cookie», Оператор не предоставляет технологических и правовых консультаций на темы подобного характера.

9. Порядок уничтожения персональных данных при достижении цели их обработки или при наступлении иных законных оснований определяется Оператором в соответствии с законодательством Российской Федерации.

10. Я согласен/согласна квалифицировать в качестве своей простой электронной подписи под настоящим Согласием и под Политикой обработки персональных данных выполнение мною следующего действия на сайте: https://journals.rcsi.science/ нажатие мною на интерфейсе с текстом: «Сайт использует сервис «Яндекс.Метрика» (который использует файлы «cookie») на элемент с текстом «Принять и продолжить».