{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:22:12Z","timestamp":1791890532487,"version":"4.3.4"},"reference-count":62,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Metacognition is a crucial aspect of understanding and attributing mental states, playing a key role in the psychopathology of eating disorders (EDs). This study aims to explore the diverse clinical profiles of metacognition among patients with EDs using latent profile analysis (LPA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A total of 395 patients with a DSM-5 diagnosis of ED (116 AN-R, 30 AN\/BP, 100 BN, 149 BED) participated in this study. They completed self-report measures assessing metacognition, eating psychopathology, depression, emotional dysregulation, personality traits, and childhood adversities. LPA and Welch ANOVAs were conducted to identify profiles based on metacognition scores and examine psychological differences between them. Logistic regression models were employed to explore associations between personal characteristics and different profiles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A 3-class solution had a good fit to the data, revealing profiles of high functioning (HF), intermediate functioning (IF), and low functioning (LF) based on levels of metacognitive impairments. Participants in the IF group were older and had a higher BMI than those in the HF and LF groups. Individuals with BN were largely categorized into HF and LF profiles, whereas participants with BED were mainly included in the IF profile. Participants in the LF group reported an impaired psychological profile, with high levels of depression, emotional dysregulation, childhood adversity, and personality dysfunction. Multinomial logistic regression analyses showed significant associations between metacognitive profiles and emotional and neglect abuse, emotion dysregulation, and detachment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This exploratory study unveils distinct metacognitive profiles in EDs, providing a foundation for future research and targeted interventions. In this light, metacognitive interpersonal therapy could be a valid and effective treatment for EDs, as suggested by the initial promising results for these patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2024.1391715","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T11:45:07Z","timestamp":1719229507000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Metacognition as a transdiagnostic factor across eating disorders: a latent profile analysis study"],"prefix":"10.3389","volume":"15","author":[{"given":"Matteo","family":"Aloi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Carcione","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Lo Coco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Rania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira Anna","family":"Carbone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"de Filippis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Segura-Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Tullio","family":"Liuzza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1002\/eat.22783","article-title":"Child maltreatment and eating disorders among men and women in adulthood: results from a nationally representative United States sample","volume":"50","author":"Afifi","year":"2017","journal-title":"Int. J. Eat. Disord."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1002\/erv.2742","article-title":"The role of self-monitoring metacognition sub-function and negative urgency related to binge severity","volume":"28","author":"Aloi","year":"2020","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s40337-021-00376-x","article-title":"Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study","volume":"9","author":"Aloi","year":"2021","journal-title":"J. Eat. Disord."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10899-021-10099-y","article-title":"Impaired metacognitive differentiation, high difficulty in controlling impulses and non-acceptance of emotions are associated with the severity of gambling disorder","volume":"39","author":"Aloi","year":"2023","journal-title":"J. Gambl. Stud."},{"key":"ref5","volume-title":"Diagnostic and statistical manual of mental disorders (DSM-5\u00ae)","year":"2013"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.psychres.2018.08.089","article-title":"Childhood emotional abuse and neglect in obese patients with and without binge eating disorder: personality and psychopathology correlates in adulthood","volume":"269","author":"Amianto","year":"2018","journal-title":"Psychiatry Res."},{"key":"ref7","doi-asserted-by":"crossref","DOI":"10.1093\/med:psych\/9780198527664.001.0001","volume-title":"Psychotherapy for borderline personality disorder","author":"Bateman","year":"2004"},{"key":"ref8","doi-asserted-by":"crossref","DOI":"10.1093\/med:psych\/9780199680375.001.0001","volume-title":"Mentalization-based treatment for personality disorders","author":"Bateman","year":"2016"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e113","DOI":"10.1007\/BF03325316","article-title":"Childhood maltreatment in women with binge-eating disorder: associations with psychiatric comorbidity, psychological functioning, and eating pathology","volume":"16","author":"Becker","year":"2011","journal-title":"Eat. Weight Disord."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.comppsych.2018.06.008","article-title":"Patients with binge eating disorder and obesity have qualitatively different interpersonal characteristics: results from an interpersonal Circumplex study","volume":"85","author":"Brugnera","year":"2018","journal-title":"Compr. Psychiatry"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s40519-015-0191-2","article-title":"The eating disorder examination: reliability and validity of the Italian version","volume":"20","author":"Calugi","year":"2015","journal-title":"Eat. Weight Disord."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.psychres.2010.12.032","article-title":"Metacognitive mastery dysfunctions in personality disorder psychotherapy","volume":"190","author":"Carcione","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref13","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-70455-1","volume-title":"Complex cases of personality disorders. Metacognitive interpersonal therapy","author":"Carcione","year":"2021"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"170","DOI":"10.3389\/fpsyg.2019.00170","article-title":"Metacognition as a predictor of improvements in personality disorders","volume":"10","author":"Carcione","year":"2019","journal-title":"Front. Psychol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.jsxm.2021.12.001","article-title":"Avoidant attachment style moderates the recovery of healthy sexuality in women with anorexia nervosa treated with enhanced cognitive behavior therapy (CBT-E): a 2-year follow-up study","volume":"19","author":"Cassioli","year":"2022","journal-title":"J. Sex. Med."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1007\/s40519-021-01107-6","article-title":"Exploring associations between personality trait facets and emotional, psychological and social well-being in eating disorder patients","volume":"27","author":"de Vos","year":"2022","journal-title":"Eat. Weight Disord."},{"key":"ref17","doi-asserted-by":"crossref","DOI":"10.4324\/9780203939536","volume-title":"Psychotherapy of personality disorders: Metacognition, states of mind, and interpersonal cycles","author":"Dimaggio","year":"2007"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1002\/eat.24067","article-title":"Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years","volume":"57","author":"Eielsen","year":"2024","journal-title":"Int. J. Eat. Disord."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1521\/pedi_2019_33_427","article-title":"Interpersonal problems in borderline personality disorder: associations with Mentalizing, emotion regulation, and impulsiveness","volume":"35","author":"Euler","year":"2021","journal-title":"J. Personal. Disord."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"690","DOI":"10.4081\/ripppo.2023.690","article-title":"Metacognitive interpersonal therapy-eating disorders versus cognitive behavioral therapy for eating disorders for non-underweight adults with eating disorders: study protocol for a pilot pre-registered randomized controlled trial","volume":"26","author":"Fioravanti","year":"2023","journal-title":"Res. Psychother."},{"key":"ref21","volume-title":"SCID-5-CV: Structured clinical interview for DSM-5 disorders, clinician version.","author":"First","year":"2016"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1177\/1073191113504984","article-title":"Reliability and validity of the personality inventory for DSM-5 (PID-5)","volume":"20","author":"Fossati","year":"2013","journal-title":"Assessment"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"339","DOI":"10.4081\/ripppo.2018.339","article-title":"Assessing mentalization in psychotherapy: first validation of the Mentalization imbalances scale","volume":"21","author":"Gagliardini","year":"2018","journal-title":"Res. Psychother."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"564291","DOI":"10.3389\/fpsyg.2020.564291","article-title":"Mentalizing subtypes in eating disorders: a latent profile analysis","volume":"11","author":"Gagliardini","year":"2020","journal-title":"Front. Psychol."},{"key":"ref25","volume-title":"Beck depression inventory-II. Manuale italiano","author":"Ghisi","year":"2006"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/BF02289845","article-title":"Three multivariate models: factor analysis, latent structure analysis, and latent profile analysis","volume":"24","author":"Gibson","year":"1959","journal-title":"Psychometrika"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1002\/jclp.21876","article-title":"Cultural adaptation of the difficulties in emotion regulation scale: reliability and validity of an Italian version","volume":"68","author":"Giromini","year":"2012","journal-title":"J. Clin. Psychol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1002\/cpp.2795","article-title":"Trajectories of interpersonal problems in residential eating disorder treatment: exploring the influence of primary diagnosis","volume":"30","author":"Harris","year":"2023","journal-title":"Clin. Psychol. Psychother."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.psychres.2016.08.044","article-title":"Factorial validity of the childhood trauma questionnaire in Italian psychiatric patients","volume":"245","author":"Innamorati","year":"2016","journal-title":"Psychiatry Res."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/08039488.2023.2291177","article-title":"A multifaceted approach to assessment of mentalization: the mentalization profile in patients with eating disorders","volume":"78","author":"Kjaersdam Tell\u00e9us","year":"2023","journal-title":"Nord. J. Psychiatry"},{"key":"ref31","volume-title":"Latent structure analysis","author":"Lazarsfeld","year":"1968"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"793094","DOI":"10.3389\/fpsyt.2022.793094","article-title":"The role of emotion regulation in eating disorders: a network meta-analysis approach","volume":"13","author":"Leppanen","year":"2022","journal-title":"Front. Psych."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1002\/cpp.753","article-title":"Obesity and interpersonal problems: an analysis with the interpersonal Circumplex","volume":"19","author":"Lo Coco","year":"2012","journal-title":"Clin. Psychol. Psychother."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1207\/s15327906mbr4104_4","article-title":"Distinguishing between latent classes and continuous factors: resolution by maximum likelihood?","volume":"41","author":"Lubke","year":"2006","journal-title":"Multivariate Behav. Res"},{"key":"ref35","first-page":"43","article-title":"Assessment of mentalization","volume-title":"Handbook of Mentalizing in mental health practice","author":"Luyten","year":"2012"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1002\/cpp.1959","article-title":"Metacognition in First episode psychosis: item level analysis of associations with symptoms and engagement","volume":"23","author":"MacBeth","year":"2016","journal-title":"Clin. Psychol. Psychother."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"106975","DOI":"10.1016\/j.appet.2023.106975","article-title":"The relationship between childhood trauma, eating behaviours, and the mediating role of metacognitive beliefs","volume":"188","author":"Martin","year":"2023","journal-title":"Appetite"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.appet.2015.03.036","article-title":"The mediating role of emotion dysregulation and depression on the relationship between childhood trauma exposure and emotional eating","volume":"91","author":"Michopoulos","year":"2015","journal-title":"Appetite"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.chiabu.2014.07.003","article-title":"Childhood trauma and eating psychopathology: a mediating role for dissociation and emotion dysregulation?","volume":"39","author":"Moulton","year":"2015","journal-title":"Child Abuse Negl."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1037\/tps0000176","article-title":"Ten frequently asked questions about latent class analysis","volume":"4","author":"Nylund-Gibson","year":"2018","journal-title":"Transl. Issues Psychol. Sci."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.eatbeh.2014.10.019","article-title":"Metacognition in eating disorders: comparison of women with eating disorders, self-reported history of eating disorders or psychiatric problems, and healthy controls","volume":"16","author":"Olstad","year":"2015","journal-title":"Eat. Behav."},{"key":"ref42","first-page":"185","article-title":"Development of a self-report measure of metacognition: the metacognition self-assessment scale (MSAS). Instrument description and factor structure","volume":"14","author":"Pedone","year":"2017","journal-title":"Clin. Neuropsychiatry"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1287\/mksc.12.1.103","article-title":"An empirical pooling approach for estimating marketing mix elasticities with PIMS data","volume":"12","author":"Ramaswamy","year":"1993","journal-title":"Mark. Sci."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"46","DOI":"10.36148\/2284-0249-366","article-title":"Adverse experiences in childhood: association with metacognition, personality disorders and distress","volume":"26","author":"Riccardi","year":"2020","journal-title":"J. Psychopathol."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"978","DOI":"10.21105\/joss.00978","article-title":"tidyLPA: an R package to easily carry out latent profile analysis (LPA) using open-source or commercial software","volume":"3","author":"Rosenberg","year":"2018","journal-title":"J. Open Source Softw."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1037\/per0000621","article-title":"Metacognitive interpersonal therapy in borderline personality disorder: clinical and neuroimaging outcomes from the CLIMAMITHE study\u2014a randomized clinical trial","volume":"14","author":"Rossi","year":"2023","journal-title":"Personal. Disord. Theory Res. Treat."},{"key":"ref47","first-page":"35","article-title":"\u201cEating me up from inside\u201d: a pilot study of Mentalization of self and others and emotion regulation strategies among young women with eating disorders","volume":"55","author":"Rothschild-Yakar","year":"2018","journal-title":"Isr. J. Psychiatry"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"2223","DOI":"10.3389\/fpsyg.2019.02223","article-title":"Mentalizing self and other and affect regulation patterns in anorexia and depression","volume":"10","author":"Rothschild-Yakar","year":"2019","journal-title":"Front. Psychol."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s12888-019-2112-9","article-title":"Reduced mentalizing in patients with bulimia nervosa and features of borderline personality disorder: a case-control study","volume":"19","author":"Sacchetti","year":"2019","journal-title":"BMC Psychiatry"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1080\/0803706X.2021.1873418","article-title":"Mentalizing and emotion regulation: evidence from a nonclinical sample","volume":"30","author":"Schwarzer","year":"2021","journal-title":"Int. Forum Psychoanal."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1186\/1471-244X-13-288","article-title":"Temperamental factors predict long-term modifications of eating disorders after treatment","volume":"13","author":"Segura-Garc\u00eda","year":"2013","journal-title":"BMC Psychiatry"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1002\/cpp.362","article-title":"How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications","volume":"10","author":"Semerari","year":"2003","journal-title":"Clin. Psychol. Psychother."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1080\/10503300500536953","article-title":"Understanding minds: different functions and different disorders? The contribution of psychotherapy research","volume":"17","author":"Semerari","year":"2007","journal-title":"Psychother. Res."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1097\/NMD.0000000000000339","article-title":"Personality disorders and mindreading: specific impairments in patients with borderline personality disorder compared to other PDs","volume":"203","author":"Semerari","year":"2015","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1016\/j.psychres.2012.07.015","article-title":"The development of the metacognition assessment interview: instrument description, factor structure and reliability in a non-clinical sample","volume":"200","author":"Semerari","year":"2012","journal-title":"Psychiatry Res."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1080\/08039488.2019.1707869","article-title":"The mentalization profile in patients with eating disorders: a systematic review and meta-analysis","volume":"74","author":"Simonsen","year":"2020","journal-title":"Nord. J. Psychiatry"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1928","DOI":"10.1002\/eat.23390","article-title":"Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: a secondary analysis of a transdiagnostic randomized controlled trial","volume":"53","author":"Sivyer","year":"2020","journal-title":"Int. J. Eat. Disord."},{"key":"ref58","doi-asserted-by":"publisher","first-page":"103445","DOI":"10.1016\/j.jvb.2020.103445","article-title":"Latent profile analysis: a review and \u201chow to\u201d guide of its application within vocational behavior research","volume":"120","author":"Spurk","year":"2020","journal-title":"J. Vocat. Behav."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"104802","DOI":"10.1016\/j.appet.2020.104802","article-title":"Childhood trauma and disordered eating: exploring the role of alexithymia and beliefs about emotions","volume":"154","author":"Strodl","year":"2020","journal-title":"Appetite"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1080\/10640266.2014.890447","article-title":"The Transdiagnostic nature of metacognitions in women with eating disorders","volume":"22","author":"Vann","year":"2014","journal-title":"Eat. Disord."},{"key":"ref61","first-page":"143","article-title":"Latent class analysis and latent profile analysis","volume-title":"Handbook of methodological approaches to community-based research: Qualitative, quantitative, and mixed methods","author":"Williams","year":"2016"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"Declaration of Helsinki: ethical principles for medical research involving human subjects","volume":"310","year":"2013","journal-title":"JAMA"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2024.1391715\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T13:35:33Z","timestamp":1719408933000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2024.1391715\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,24]]},"references-count":62,"alternative-id":["10.3389\/fpsyg.2024.1391715"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2024.1391715","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,24]]},"article-number":"1391715"}}