Walter Sapuppo, PsyD,1,3,4 Giovanni M. Ruggiero, MD,1,3 Gabriele Caselli, PhD,1,2,4 and Sandra Sassaroli, MD1,2 1 Sigmund Freud University, Milan, Italy and Vienna, Austria 2 Studi Cognitivi Cognitive Psychotherapy School and Research Center, Milan, Italy and branches in Modena and San Benedetto del Tronto 3 Psicoterapia Cognitiva e Ricerca Cognitive Psychotherapy School and Research Center, Milan, Italy, and a branch in Bolzano 4 School of Applied Sciences, London South Bank University, London, U.K.
Background: Many studies have described perfectionism and low self-esteem as traits associated with eating disorders (ED). More recently, research has shown the role played by worry, rumination, control and metacognitive beliefs. This paper investigates the role played by cognitive and metacognitive variables in the psychopathological mechanism of eating disorders, assuming that not only perfectionism and low selfesteem but also metacognitive beliefs and processes can discriminate between controls and EDs. Method: The Structured Clinical Interview for DSM, the Multidimensional Perfectionism Scale, the Rosenberg Self-Esteem Scale, the Anxiety Control Questionnaire, the Penn State Worry and the Metacognition Questionnaire were administered to the samples. Results: Results suggested that metacognitive factors like negative beliefs about worry, uncontrollability and danger, need for control, and worry should be added to the body of cognitive factors underlying ED composed by the classical couple of cognitive factors including perfectionism and low self-esteem. Conclusions: It is possible that an individual with ED assumes that metacognitive processes like worry and rumination are a further proof of his or her lack of value, capacity to control, and self-control. Such appraisals may reinforce the painful sense of low self-esteem so typical in ED and, in turn, the perfectionistic striving for excellence.