Reflective functioning and maladaptive eating behaviors: Alexithymia as mediator

Background: Several studies highlighted the presence of maladaptive eating patterns and attitudes in individuals with higher eating disorder symptomatology (EDs), whilst previous findings shown that both Reflective Functioning and Alexithymia are relevant aspects of EDs, thus suggesting that these dimensions should be assessed conjointly. This preliminary study sought to test a mediation model of Alexithymia in the relationship between reflective functioning and problematic eating behaviors (namely, emotional eating, restrained eating, external eating, and eating attitudes). Method: Questionnaires were administered to 200 community-dwelling individuals aged between 18 and 30 years (M=22.77, DS= 2.97) to assess Reflective Functioning (Reflective Functioning Questionnaire-8), Alexithymia (Toronto Alexithymia Scale-20), Emotional Eating, Restrained Eating, External Eating (Dutch Eating Behavior Questionnaire), and Eating Attitudes (Eating Attitudes Test-26). Results: Path analysis was conducted to test a model with Reflective Functioning as predictor variable, Alexithymia as mediator, and problematic eating behaviors (emotional eating, restrained eating, external eating, and eating attitudes) as outcomes. Age and gender variables were included as background variables. The model showed acceptable fit indices, χ2(1) = 2.76; p<.01, CFI = .99, RMSEA = .09 (90% CI = .00 – .23). Significant paths were found from Reflective Functioning to Emotional Eating (β= -.20), Alexithymia (β= -.53) and External Eating (β= -.27). Moreover, Alexithymia was related to Restrained Eating (β= .27) and Eating Attitudes (β= .20). Furthermore, a significant indirect effect from Reflective Functioning to Restrained Eating (β= -.14) by Alexithymia. Conclusions: Results highlighted how Alexithymia may determine maladaptive eating patterns. Impaired Reflective Functioning may be related to poor awareness of mental states, which may lead to low self-and other-awareness of emotions and thus the development of EDs as compensatory mechanisms to deal with emotions. Clinical interventions for EDs should thus foster reflective functioning and target one’s alexithymic traits.