Metacognitive confidence independently predicts body image delusionality in anorexia and bulimia nervosa.

Cross-sectionalJournal of psychiatric research· Jul 2026

Metacognitive confidence independently predicts body image delusionality in anorexia and bulimia nervosa.

George Konstantakopoulos, Fragiskos Gonidakis, Georgios Georgantopoulos … Aikaterini Fotopoulou

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Eating DisordersCross-sectionalDiagnosisQ1IF 3.6

Confidence in body-size judgments is independently associated with body image delusionality in eating disorders

Metacognitive confidence independently predicts body image delusionality in anorexia and bulimia nervosa.

George Konstantakopoulos … Aikaterini Fotopoulou

Journal of psychiatric research · Jul 2026 · Q1 in Psychiatry

Purpose

Body image beliefs in eating disorders (eating disorders) are often characterized by high conviction and resistance to corrective evidence.

Methods

Ninety-seven adult female patients with eating disorders, 51 with anorexia nervosa (anorexia nervosa) and 46 with bulimia nervosa (bulimia nervosa), were assessed using the Brown Assessment of Beliefs Scale (Brown Assessment of Beliefs Scale).

R2 = 0.34

Results

R2 = 0.34

higher confidence in size judgments independently predicts stronger delusional conviction

More results

Delusional body image beliefs were more frequent in anorexia nervosa than bulimia nervosa (29.4% vs 2.2%).

At the bivariate level, delusionality was associated with current size ratings, body dissatisfaction, misestimation, and confidence.

In hierarchical regression analyses, perceptual indices explained little variance in delusionality.

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Conclusion · 1 of 2

Body image delusionality in eating disorders appears more strongly related to metacognitive confidence than to perceptual distortion.

Conclusion · 2 of 2

These findings support a dimensional account of delusionality and suggest that confidence in body-size judgments may contribute to persistent distorted body image beliefs, although the cross-sectional design precludes causal inference.

Metacognitive confidence independently predicts body image delusionality in anorexia and bulimia nervosa.

Metacognitive confidence independently predicts body image delusionality in anorexia and bulimia nervosa.

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