The existing evidence on the specific profile and the determinants of empathic and mentalizing abilities in anorexia nervosa (AN) and bulimia nervosa (BN) is not conclusive. Moreover, it is not clear whether patients with eating disorders also exhibit diminished ability to accurately appraise their own empathic skills. We examine in AN and BN: (a) the impairments in various aspects of empathy and theory of mind (ToM), while accounting for the effect of other cognitive functions and (b) the accuracy of self-appraisal of empathy. Self-reported and performance-based empathy, ToM, and cognitive functions were assessed in 46 patients with AN, 30 patients with BN, and 42 healthy controls (HC). Both AN and BN patients reported diminished overall empathic abilities, whereas only BN patients reported reduced cognitive empathy compared to HC. Deficits in performance-based empathy were found in both patient groups. Cognitive ToM was impaired only in AN. Significant correlations between self-reported and performance-based empathy were found in BN and HC but not in AN. Cognitive deficits negatively affected the self-appraisal of empathy in AN but not empathic skills per se. Our findings highlight a double deficit related to empathic responding in AN: diminished performance and inaccurate self-appraisal of empathic abilities, indicating dysfunctional self-reflection.

关于神经性厌食症 (AN) 和神经性贪食症 (BN) 的共情和心理化能力的具体特征和决定因素的现有证据尚无定论。此外，尚不清楚饮食失调患者是否也表现出准确评估自己移情能力的能力下降。我们在 AN 和 BN 中检查：（a）同理心和心理理论（ToM）的各个方面的缺陷，同时考虑其他认知功能的影响和（b）同理心自我评估的准确性。在 46 名 AN 患者、30 名 BN 患者和 42 名健康对照 (HC) 中评估了自我报告和基于表现的同理心、ToM 和认知功能。与 HC 相比，AN 和 BN 患者的整体移情能力均降低，而只有 BN 患者报告认知移情能力降低。在两个患者组中都发现了基于表现的同理心的缺陷。认知 ToM 仅在 AN 中受损。在 BN 和 HC 中发现了自我报告和基于表现的同理心之间的显着相关性，但在 AN 中没有。认知缺陷对 AN 共情的自我评价产生负面影响，但对共情技能本身没有负面影响。我们的研究结果强调了与 AN 中的共情反应相关的双重缺陷：表现下降和共情能力的自我评估不准确，表明自我反思功能失调。