Failures in Reflective Functioning, Dissociative Experiences, and Eating Disorder: A Study on a Sample of Italian Adolescents
Open accessAbstract
Although impairments in mentalizing and dissociation have been linked to the onset of eating disorders, there is still a paucity of studies investigating their relationships among adolescents. This study aimed at investigating the role of failures in reflective functioning and dissociation in predicting the risk of eating disorders during adolescence. The Eating Disorder Inventory-3 (EDI-3), the Reflective Functioning Questionnaire (RFQ), and the Adolescent Dissociative Experiences Scale (A-DES) were administered to a sample of 427 adolescents between 13 and 20 years old. Results of correlational analysis showed that the risk of eating disorders was positively correlated with uncertainty about mental states. Eating disorder risk was also inversely correlated with certainty about mental states. Dissociation scores and its domain scores were all positively related to the risk of eating disorders. Results of regression analysis displayed that uncertainty about mental states and dissociation were statistically significant predictors of an increased risk of eating disorders. Gender and BMI were also significant predictors in the final model, which explained 24% of the variance. Regarding the specific dissociative domains, findings indicate that the depersonalization/derealization factor was the only significant predictor for the risk of eating disorder. The present study points out that uncertainty about mental states and dissociation could play a relevant role in increasing the risk of eating disorders during adolescence.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A growing number of studies have examined the role of mentalizing, operationalized as reflective functioning, in a wide array of mental disorders.
“Turning to the psychological factors underneath symptoms of psychopathology, a growing number of studies have examined the role of mentalizing, operationalized as reflective functioning, in a wide array of mental disorders [10,11].”
From Failures in Reflective Functioning and Reported Symptoms of Anxiety and Depression in Bereaved Individuals: A Study on a Sample of Family Caregivers of Palliative Care Patients (2022) · cites this paper as [11]
The Introduction (page unavailable) says an increased number of studies have investigated mentalizing, operationalized as reflective functioning, in eating disorders. The Discussion mentions findings in schizophrenia and after traumatic brain injury, but the paper does not establish the claimed growth of research across a wide array of mental disorders. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Statistical Power Analysis for the Behavioral Sciences (2nd ed.).
Lachenbruch, P. A., & Cohen, J. (1989) · Journal of the American Statistical Association · doi:10.2307/2290095 · Cited by 37,385 · see citing works
(1969) · Cited by 18,340 · see citing works
Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.05.017 · Cited by 6,278 · see citing works
The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.040 · Cited by 4,973 · see citing works
GPOWER: A general power analysis program
Erdfelder, E., Faul, F., & Buchner, A. (1996) · Behavior Research Methods, Instruments, & Computers · doi:10.3758/bf03203630 · Cited by 4,864 · see citing works
Affect Regulation, Mentalization, and the Development of the Self
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2018) · doi:10.4324/9780429471643 · Cited by 3,886 · see citing works
Handbook of attachment: theory, research, and clinical applications
(2009) · Choice Reviews Online · doi:10.5860/choice.46-4135 · Cited by 3,818 · see citing works
A Secure Base: Clinical Applications of Attachment Theory
Bowlby, J. (1998) · Medical Entomology and Zoology · Cited by 3,379 · see citing works
Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.22 · Cited by 1,611 · see citing works
The relation of attachment status, psychiatric classification, and response to psychotherapy.
Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, G., Target, M., & Gerber, A. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.64.1.22 · Cited by 1,124 · see citing works
The relation of attachment status, psychiatric classification, and response to psychotherapy.
Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, G., Target, M., & Gerber, A. J. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.64.1.22 · Cited by 1,083 · see citing works
Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.002 · Cited by 1,052 · see citing works
Stice, E., Marti, C. N., & Rohde, P. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0030679 · Cited by 822 · see citing works
Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y.-W., Warren, F., Howard, S., Ghinai, R., Fearon, P., & Lowyck, B. (2016) · PLOS ONE · doi:10.1371/journal.pone.0158678 · Cited by 754 · see citing works
Are there two qualitatively distinct forms of dissociation? A review and some clinical implications
Holmes, E. A., Brown, R. J., Mansell, W., Fearon, R. P., Hunter, E. C. M., Frasquilho, F., & Oakley, D. A. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.08.006 · Cited by 619 · see citing works
Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2017.17010025 · Cited by 541 · see citing works
Dissociation: Clinical and Theoretical Perspectives
Roth, N. (1995) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1995.49.4.599 · Cited by 402 · see citing works
ARMSTRONG, J. G., PUTNAM, F. W., Carlson, E. B., Libero, D. Z., & Smith, S. R. (1997) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199708000-00003 · Cited by 372 · see citing works
Dissociation of cognitive from affective components of theory of mind in schizophrenia
Shamay‐Tsoory, S., Shur, S., Barcai-Goodman, L., Medlovich, S., Harari, H., & Levkovitz, Y. (2006) · Psychiatry Research · doi:10.1016/j.psychres.2005.10.018 · Cited by 350 · see citing works
Handbook of mentalizing in mental health practice
BATEMAN, A. W. (2012) · Cited by 302 · see citing works
A systematic review and meta-analysis of ‘Systems for Social Processes' in eating disorders
Caglar-Nazali, H. P., Corfield, F., Cardi, V., Ambwani, S., Leppanen, J., Olabintan, O., Deriziotis, S., Hadjimichalis, A., Scognamiglio, P., Eshkevari, E., et al. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.12.002 · Cited by 294 · see citing works
Prevention of eating disorders: A systematic review and meta-analysis
Le, L. K., Barendregt, J. J., Hay, P., & Mihalopoulos, C. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.02.001 · Cited by 277 · see citing works
Attachment and eating disorders: A review of current research
Tasca, G. A., & Balfour, L. (2014) · International Journal of Eating Disorders · doi:10.1002/eat.22302 · Cited by 227 · see citing works
Schimmenti, A., & Caretti, V. (2014) · Psychoanalytic Psychology · doi:10.1037/a0038019 · Cited by 222 · see citing works
Different types of ‘dissociation’ have different psychological mechanisms
Brown, R. J. (2006) · Journal of Trauma & Dissociation · doi:10.1300/j229v07n04_02 · Cited by 217 · see citing works
Relation of clinical variables to dissociative phenomena in eating disorders
Demitrack, M. A., Putnam, F. W., Brewerton, T. D., Brandt, H., & Gold, P. W. (1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.9.1184 · Cited by 187 · see citing works
Dissociative experiences and trauma in eating disorders
Vanderlinden, J., Vandereycken, W., van Dyck, R., & Vertommen, H. (1993) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199303)13:2 · Cited by 181 · see citing works
Feelings of insecurity: Review of attachment and eating disorders
Zachrisson, H. D., & Skårderud, F. (2010) · European Eating Disorders Review · doi:10.1002/erv.999 · Cited by 161 · see citing works
Jewell, T., Collyer, H., Gardner, T., Tchanturia, K., Simic, M., Fonagy, P., & Eisler, I. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22473 · Cited by 139 · see citing works
Skårderud, F. (2007) · European eating disorders review · doi:10.1002/erv.817 · Cited by 130 · see citing works
Eating one's words, Part II: the embodied mind and reflective function in anorexia nervosa—theory
Skårderud, F. (2007) · European Eating Disorders Review · doi:10.1002/erv.778 · Cited by 113 · see citing works
Eating disorders in adolescence: attachment issues from a developmental perspective
Gander, M., Sevecke, K., & Buchheim, A. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01136 · Cited by 110 · see citing works
Morandotti, N., Brondino, N., Merelli, A. A., Boldrini, A., Vidovich, G. Z. D., Ricciardo, S., Abbiati, V., Ambrosi, P., Caverzasi, E., Fonagy, P., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0206433 · Cited by 107 · see citing works
Schimmenti, A. (2016) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2015.1108948 · Cited by 101 · cited 1× · see citing works
“Results of a study involving a large community sample showed that a higher level of dissociative experiences was associated with lower scores on theory of mind and empathy (Schimmenti, 2016a).”
BackgroundUnderstanding the dissociative processes: The contribution of attachment theory
Liotti, G. (1999) · Psychoanalytic Inquiry · doi:10.1080/07351699909534275 · Cited by 100 · see citing works
Review of the Eating Disorder Inventory–3
Cumella, E. J. (2006) · Journal of Personality Assessment · doi:10.1207/s15327752jpa8701_11 · Cited by 95 · see citing works
Broberg, A. G., Hjalmers, I., & Nevonen, L. (2001) · European Eating Disorders Review · doi:10.1002/erv.421 · Cited by 91 · see citing works
Geraci, A., Surian, L., Ferraro, M., & Cantagallo, A. (2010) · Brain Injury · doi:10.3109/02699052.2010.487477 · Cited by 78 · see citing works
The prevalence and impact of trauma history in eating disorder patients
Backholm, K., Isomaa, R., & Birgegård, A. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.22482 · Cited by 71 · see citing works
Palmisano, G. L., Innamorati, M., Susca, G., Traetta, D., Sarracino, D., & Vanderlinden, J. (2017) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2017.1304490 · Cited by 66 · see citing works
The developmental roots of dissociation: A multiple mediation analysis.
Schimmenti, A. (2016) · Psychoanalytic Psychology · doi:10.1037/pap0000084 · Cited by 62 · see citing works
BATEMAN, A. W., & Fonagy, P. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22206 · Cited by 57 · see citing works
Schimmenti, A., Musetti, A., Costanzo, A., Terrone, G., Maganuco, N. R., Rinella, C. A., & Gervasi, A. M. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00079-0 · Cited by 55 · see citing works
The mentalization profile in patients with eating disorders: a systematic review and meta-analysis
Simonsen, C. B., Jakobsen, A. G., Grøntved, S., & Telléus, G. K. (2020) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2019.1707869 · Cited by 53 · see citing works
Reflective Functioning in 70 Patients Suffering from Bulimia Nervosa
Pedersen, S. H., Lunn, S., Katznelson, H., & Poulsen, S. (2012) · European Eating Disorders Review · doi:10.1002/erv.2158 · Cited by 50 · see citing works
A correlation network analysis of dissociative experiences
Schimmenti, A., & Şar, V. (2019) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2019.1572045 · Cited by 50 · see citing works
Relationship between Trauma History and Eating Disorders in Adolescents
Groth, T. D., Hilsenroth, M. J., Boccio, D. E., & Gold, J. R. (2019) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-019-00275-z · Cited by 48 · see citing works
The relationship between alexithymia, defense mechanisms, eating disorders, anxiety and depression
Lenzo, V., Barberis, N., Cannavò, M., Filastro, A., Verrastro, V., & Quattropani, M. C. A. (2020) · Rivista di psichiatria · doi:10.1708/3301.32715 · Cited by 48 · see citing works
Eating Disorders and Attachment: A Contemporary Psychodynamic Perspective
Tasca, G. A., & Balfour, L. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.2.257 · Cited by 42 · see citing works
The relationship between trauma and weight status among adolescents in eating disorder treatment.
White, A. A. H., Pratt, K., & Cottrill, C. (2018) · Appetite · doi:10.1016/j.appet.2018.06.034 · Cited by 32 · see citing works
DISSOCIATION IN ADOLESCENT GIRLS WITH ANOREXIA: RELATIONSHIP TO COMORBID PSYCHOPATHOLOGY
Farrington, A., Waller, G., Neiderman, M., SUTTON, V., Chopping, J., & Lask, B. D. (2002) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200211000-00004 · Cited by 31 · see citing works
Theory of mind in adults with traumatic brain injury: A meta-analysis
Lin, X., Zhang, X., Liu, Q., Zhao, P., Zhang, H., Wang, H., & Yi, Z. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.12.010 · Cited by 25 · see citing works
Schimmenti, A. (2015) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2015.1064507 · Cited by 23 · see citing works
Cortés‐García, L., McLaren, V., Vanwoerden, S., & Sharp, C. (2020) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-020-01017-z · Cited by 22 · see citing works
Baldoni, F., Minghetti, M., Craparo, G., Facondini, E., Cena, L., & Schimmenti, A. (2018) · Attachment & Human Development · doi:10.1080/14616734.2017.1421979 · Cited by 20 · see citing works
Barberis, N., Costa, S., Cuzzocrea, F., & Quattropani, M. C. A. (2018) · Mental Health & Prevention · doi:10.1016/j.mhp.2018.01.003 · Cited by 18 · see citing works
Geraci, A., & Cantagallo, A. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.12.012 · Cited by 12 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Beatson, R. M., Quach, J., Canterford, L. D., Farrow, P., Bagnall, C. L., Hockey, P., Phillips, E., Patton, G. C., Olsson, C. A., Ride, J., et al. (2023) · Educational Research Review · doi:10.1016/j.edurev.2023.100553 · Cited by 74 · see citing works
Sarig‐Shmueli, Y., Kurman, J., Talmon, S., Yoeli, N., Gur, E., Stein, D. J., & Rothschild‐Yakar, L. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2848 · Cited by 10 · see citing works
Lenzo, V., Sardella, A., Musetti, A., Petralia, M. C., Grado, I., & Quattropani, M. C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191911930 · Cited by 10 · see citing works
“Consistently with other studies, our results revealed that hypomentalizing was negatively associated with hypermentalizing, highlighting their opposed meaning [10,11,16,26].”
BackgroundResultPTSD, complex PTSD and the dissociative subtype of PTSD in patients with eating disorders
Brewerton, T. D., Nguyen, C., Bishop, N., & Dennis, K. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01449-x · Cited by 8 · see citing works
Santoro, G., Cannavò, M., Schimmenti, A., & Barberis, N. (2025) · Development and Psychopathology · doi:10.1017/s0954579425100205 · Cited by 6 · see citing works
Rossi, A. A., Tagliagambe, A., Mannarini, S., & Ragione, L. D. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1703521 · Cited by 2 · see citing works
Cipriano, A., Cantone, D., Guerriera, C., Rosato, M. S., Cotrufo, P., & Cella, S. (2024) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2024.100737 · Cited by 2 · see citing works
Sardella, A., Geraci, A., Lenzo, V., Fusar‐Poli, L., Rodolico, A., Quattropani, M. C. A., & Signorelli, M. S. (2023) · Health Psychology Research · doi:10.52965/001c.88937 · Cited by 1 · see citing works
Giunta, S., Mannino, G., Sideli, L., Quattropani, M. C. A., & Lenzo, V. (2024) · Health Psychology Research · doi:10.52965/001c.122543 · Cited by 1 · see citing works
INVESTIGATION OF THE DISEASE-AFFECTING FACTORS IN ADOLESCENTS WITH EATING DISORDERS
Bayraktar, S., Şensoy, Ö., Coşkun, M., Aydın, A., Karayağmurlu, A., Güldiken, G., Özdemir, Y. E., & Ulutaş, E. (2025) · Sağlık Bilimleri Dergisi · doi:10.34108/eujhs.1550532
Wahi, A., Roopesh, B. N., & Kommu, J. V. S. (2026) · Indian Journal of Psychological Medicine · doi:10.1177/02537176261419381 · Cited by 1 · see citing works
Carraturo, F., Abdoli, M., Afzaal, D. F., Cotrufo, P., & Cella, S. (2026) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-026-00958-4
Germani, A., Pizzini, B., Dragone, M., & Picione, R. D. L. (2026) · Current Psychology · doi:10.1007/s12144-026-10209-2
- Authors
- Quattropani, M. C., Geraci, A., Lenzo, V., Sardella, A., & Schimmenti, A.
- Affiliations
- University of Catania (IT)
- University of Trento (IT)
- Università per Stranieri Dante Alighieri (IT)
- Università degli Studi di Enna Kore (IT)
- Corresponding author
- Lenzo, Vittorio
- Venue
- Journal of Child & Adolescent Trauma
- Published
- 2022-04-05
- Volume
- 15
- Issue
- 2
- Pages
- 365-374
- ISSN
- 1936-1521 (ISSN-L)
- 1936-153X
- PMC
- PMC9120272
- OpenAlex
- W4226278461
- Cited by
- 13
- References
- 59
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 1
- FWCI
- 2.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Child & Adolescent Trauma (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- eating disorders, reflective functioning, mentalization, dissociation, adolescents, depersonalization/derealization, eating disorder risk, gender differences, body mass index
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
