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Common Transdiagnostic Factors in Eating Disorders, Disordered Eating, and Mental Health Symptoms

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 25 April 2026 | Viewed by 1473

Special Issue Editors


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Guest Editor
Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Bellaterra, Spain
Interests: eating disorders; behavioral addictions; methodology; clinical psychology; health sciences
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Level 7, Room 707, Melbourne, VIC, Australia
Interests: restrictive food intake disorder; feeding practices; assessment; neuropsychology; childhood; adolescence; binge-eating disorder; eating disorders

Special Issue Information

Dear Colleagues,

Disordered eating and eating disorders (EDs) are marked by some of the highest levels of comorbidity within the field of mental health, most frequently co-occurring with mood, anxiety, substance use, obsessive–compulsive disorder, autism spectrum conditions, and personality disorders. This pervasive overlap adds substantial complexity to their clinical presentation and poses significant challenges to traditional categorical approaches, which conceptualize disorders as distinct and independent entities. The consistently high rates of co-occurrence suggest that EDs cannot be adequately understood in isolation, but rather as part of a broader network of interconnected psychopathological processes. This complexity highlights the importance of moving beyond rigid diagnostic boundaries and adopting frameworks that more accurately capture the shared features and dynamic interactions across disorders.

An increasing body of research underscores the importance of transdiagnostic perspectives, which emphasize the role of shared etiological and maintenance mechanisms that extend beyond conventional diagnostic categories. Processes such as emotion regulation difficulties, impulsivity, maladaptive perfectionism, problematic interpersonal functioning, intolerance of uncertainty, alexithymia, cognitive inflexibility, and altered interoceptive awareness have been identified as transdiagnostic factors implicated not only in EDs but also across a wide range of other mental states.

The transdiagnostic approach provides an integrative framework for understanding the links between EDs and comorbid symptoms/disorders, while clarifying the mechanisms that sustain symptom clusters across conditions. By targeting these shared vulnerabilities, clinical practice may advance toward more flexible and effective interventions, ultimately improving outcomes across diverse forms of psychopathology.

This Special Issue seeks to move beyond disorder-specific categories by focusing on the shared processes underlying disordered eating and EDs. By integrating insights across clinical, translational, and basic research, it aims to advance a more nuanced and clinically meaningful understanding of these complex psychopathological phenomena. Contributions to this Special Issue have the potential to inform the development of precise measurement tools for the early detection of eating-related symptoms and the identification of ED endophenotypes, as well as to guide the design of effective, evidence-based interventions tailored to the specific needs of individuals affected by disordered eating behaviors. We welcome manuscript submissions including original research articles, systematic reviews, and scoping reviews that address these goals from diverse methodological and theoretical perspectives.

Prof. Dr. Roser Granero
Dr. Isabel Krug
Guest Editors

Manuscript Submission Information

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Keywords

  • disordered eating
  • malnutrition
  • emotional eating
  • nutritional comorbidity
  • eating disorders

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Published Papers (3 papers)

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Research

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15 pages, 1416 KB  
Article
A Combined Network Analysis for Orthorexia Nervosa, Obsessive Compulsive, and Eating Disorder Symptoms
by Caterina Lombardo, Silvia Cerolini, Andrea Zagaria, Mariacarolina Vacca and Rachel F. Rodgers
Nutrients 2026, 18(8), 1179; https://doi.org/10.3390/nu18081179 - 9 Apr 2026
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Abstract
Orthorexia nervosa (ON) is a clinical condition characterized by rigid and inflexible rules about consuming healthy food, potentially leading to harmful consequences for physical and mental health and significant impairment in major life domains. Overlap or independence between ON and other clinical entities, [...] Read more.
Orthorexia nervosa (ON) is a clinical condition characterized by rigid and inflexible rules about consuming healthy food, potentially leading to harmful consequences for physical and mental health and significant impairment in major life domains. Overlap or independence between ON and other clinical entities, like other eating disorders (EDs) or obsessive compulsive disorder (OCD), still needs clarification. Objectives: This study aims to examine the overlap versus independence of core symptoms of ON from these two classes of disorders using a network approach. Methods: A group of 422 university students (71.8% females), with a mean age of 20.70 years (SD = 3.44), completed questionnaires assessing those symptoms. Results: Results revealed that no ON symptoms were nested within the OCD and ED clusters, and vice versa, thereby supporting their empirical distinctiveness. Although the symptoms were organised into distinct communities, ON symptoms were more strongly linked to EDs than to OCD. Bridge symptom analyses revealed that the nodes “Emotional consequences due to healthy eating”, “Worry about healthy food”, and “Obsessing” exhibited the highest bridge strength connecting clusters of ON, EDs, and OCD symptoms. Conversely, the nodes “Food safety” and “Ordering” showed the lowest bridge strength, suggesting that these nodes played only a marginal role in linking ON, EDs, and OCD. Conclusions: From a nosological perspective, the findings provide empirical support for conceptualizing ON as a distinct yet symptomatically related condition within the broader spectrum of eating-related psychopathology, while acknowledging that definitive nosological classification requires further longitudinal and clinical research. Full article
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27 pages, 623 KB  
Article
Who Holds the Plate? Psychotherapists’ Perspectives on Dietary Behavior, Transdiagnostic Evaluation and Interdisciplinary Collaboration in Eating Disorders
by Panagiota Tragantzopoulou, Aikaterini Tragantzopoulou and Vaitsa Giannouli
Nutrients 2026, 18(7), 1030; https://doi.org/10.3390/nu18071030 - 24 Mar 2026
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Abstract
Background/Objectives: Dietary behavior in eating disorders (EDs) is often framed through either nutritional or psychological perspectives, yet emerging evidence suggests that eating may involve a transdiagnostic, emotionally embedded, and relationally negotiated process. While research highlights the role of emotion regulation difficulties, perfectionism, [...] Read more.
Background/Objectives: Dietary behavior in eating disorders (EDs) is often framed through either nutritional or psychological perspectives, yet emerging evidence suggests that eating may involve a transdiagnostic, emotionally embedded, and relationally negotiated process. While research highlights the role of emotion regulation difficulties, perfectionism, control, and overvaluation of weight and shape in ED maintenance, less is known about how these processes are interpreted and managed in clinical practice across different cultural contexts. This study explored psychotherapists’ perspectives on dietary behavior, nutritional assessment, and interdisciplinary collaboration in ED treatment in Greece and the United Kingdom. Methods: Eighteen psychotherapists (9 Greek and 9 British) with experience in treating individuals with EDs participated in in-depth semi-structured interviews. Data were analyzed using reflexive thematic analysis. Results: Three themes were developed. First, therapists conceptualized dietary behavior as reflecting broader transdiagnostic psychological processes, particularly perfectionism, control, emotion regulation difficulties, and body image concerns. Second, nutritional assessment and intervention (e.g., food diaries and meal plans) were experienced as emotionally significant practices that required negotiation of timing, meaning, and clients’ readiness for change. Third, interdisciplinary collaboration was described as involving ongoing negotiation of nutritional authority, with therapists balancing nutritional considerations and psychological safety, influenced by contextual differences between UK and Greek mental health systems. Conclusions: Findings suggest that dietary behavior in ED treatment may benefit from approaches that integrate psychological and nutritional perspectives. Clinicians may consider attending to clients’ emotional readiness, the symbolic meanings of food, and the dynamics of multidisciplinary collaboration, offering insights that can inform clinical practice and future research. Full article
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Review

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20 pages, 764 KB  
Review
Transdiagnostic Neurobiological and Nutritional Factors in Eating Disorders: Implications for Integrative Treatment Models
by Izabela Łucka, Ariadna Dobrzańska, Jolanta Góral-Półrola, Patrycja Leśnicka and Marta Kopańska
Nutrients 2026, 18(7), 1108; https://doi.org/10.3390/nu18071108 - 30 Mar 2026
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Abstract
Eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), are complex psychiatric conditions characterized by high morbidity and mortality. Increasing evidence suggests that beyond disorder-specific symptomatology, shared transdiagnostic mechanisms contribute to their onset and persistence. This narrative review [...] Read more.
Eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), are complex psychiatric conditions characterized by high morbidity and mortality. Increasing evidence suggests that beyond disorder-specific symptomatology, shared transdiagnostic mechanisms contribute to their onset and persistence. This narrative review synthesizes current data on neurobiological and nutritional factors implicated in EDs, with particular emphasis on trait–state interactions and starvation-induced neuroadaptations. Predisposing vulnerabilities such as heightened anxiety, cognitive rigidity, and perfectionism appear to interact with state-dependent biological alterations induced by malnutrition. Chronic dietary restriction is associated with measurable alterations in serotonergic and dopaminergic systems, altered reward processing, and persistent activation of the hypothalamic–pituitary–adrenal (HPA) axis. Experimental studies suggest that acute tryptophan depletion may transiently reduce anxiety in individuals with anorexia nervosa, suggesting that, in some individuals, food restriction may function as a biologically reinforced strategy of affect regulation. Furthermore, disturbances in leptin and ghrelin signaling, along with widespread micronutrient deficiencies—including zinc, iron, selenium, and B vitamins—may exacerbate cognitive inflexibility, mood instability, and impaired decision-making. These metabolic and endocrine adaptations may contribute to a self-perpetuating cycle in which starvation-induced neurochemical changes reinforce restrictive or dysregulated eating behaviors. Importantly, several of these mechanisms extend beyond anorexia nervosa and may represent common transdiagnostic processes across eating disorders and related mental health conditions, including anxiety, depression, and addictive behaviors. Recognition of these biological and nutritional factors has significant implications for treatment. Nutritional rehabilitation should be conceptualized not solely as weight restoration, but as a neurobiological recalibration of stress regulation, reward sensitivity, and affective processing systems. An integrative treatment approach that combines behavioral stabilization with attention to underlying neurobiological and relational mechanisms may offer a more comprehensive framework for long-term recovery. Full article
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