Search Results (312)

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

This study aimed to examine the differences in self-compassion (SC) subcomponents between anorexia nervosa (AN) subtypes, the restricting type (ANR) and binge-eating/purging type (ANBP), with a focus on perceived isolation and self-judgment. This retrospective exploratory study included 40 patients with AN at a Japanese tertiary hospital. The participants completed the Self-Compassion Scale, Patient Health Questionnaire-9, and Eating Disorder Examination Questionnaire. Between-group comparisons were conducted using t-tests, and logistic regression was used to examine associations with the AN subtype. Compared with the ANR group, the ANBP group was older at the time of assessment, had a longer illness duration, and showed significantly more depressive symptoms, more severe eating pathologies, and lower SC scores. Specifically, patients with ANBP had significantly higher scores on the negative SCS subscales of self-judgment and isolation, indicating greater self-criticism and perceived isolation. In logistic regression analyses adjusting for the EDE-Q mean score, higher isolation scores were significantly associated with the ANBP subtype (odds ratio = 3.28, 95% confidence interval: 1.37–9.63, p = 0.01). In this exploratory sample, perceived isolation was more prominent in ANBP and may reflect affective and interpersonal difficulties related to this subtype. These findings should be interpreted as hypothesis-generating and warrant replication in larger (ideally multi-site and longitudinal) samples. If replicated, targeting these self-compassion dimensions may inform the development of subtype-sensitive interventions. Full article

Eating disorders (EDs) disproportionately affect women and are associated with substantial morbidity, chronicity, and mortality. While established psychological models focus on the content of maladaptive cognitions related to body weight, shape, and eating behaviors, growing evidence suggests that additional process-level mechanisms contribute to symptom persistence and treatment resistance. Metacognitive models emphasize how individuals relate to their thoughts, emotions, and internal experiences, highlighting maladaptive beliefs about thinking and the resulting cognitive–attentional patterns (e.g., repetitive negative thinking, self-focused attention, and inflexible attentional control) as potential maintaining factors across psychopathology. This narrative review synthesizes the theoretical and empirical literature on metacognitive dysfunction in EDs, with a focus on mechanisms that may be particularly relevant for women. We integrate epidemiological data and gender-sensitive frameworks, and review evidence on metacognitive beliefs and cognitive–attentional syndrome (CAS)-related processes across anorexia nervosa, bulimia nervosa, and binge-eating disorder. Overall, studies indicate that dysfunctional beliefs about the uncontrollability and danger of thoughts, alongside perseverative cognitive styles, are associated with greater ED symptom severity. We discuss diagnosis-relevant patterns as clinically useful heuristics, interactions with sociocultural and emotional vulnerability factors, and implications for assessment, treatment integration, and prevention. The evidence base is largely correlational and derived from predominantly female samples, underscoring the need for longitudinal research and studies that explicitly test sex/gender as a moderator. Full article

Objective: Adolescence is a high-risk period for problematic eating behaviours, including overeating. However, few studies have explored adolescent perceptions of these eating behaviours and whether there is a shared understanding between adolescents and parents. This study aimed to investigate perceptions of eating behaviours, focusing on overeating, in Australian adolescents and parents. Method: Adolescents aged 13–19 years, and parents of adolescents, participated in two interviews for exploration and thematic deepening of participant perceptions, underpinned by Integrated Knowledge Translation Framework principles. Interviews explored perceptions of overeating and other eating behaviours, including help-seeking and stigma. Data were analysed thematically. Results: Twelve adolescents (59% female) and seven parents (100% female) participated in the interviews, with three major themes emerging. In theme 1, “perceptions of overeating”, interpretations of overeating varied; however, both adolescents and parents associated problematic overeating with increased frequency and impacts on functioning. Discrepancies between adolescent and parent perceptions of overeating terms such as binge eating were present. In theme 2, “beliefs about overeating”, adolescents felt that broaching the topic of overeating and help-seeking for overeating to be more challenging than restrictive eating disorders due to stigma. In theme 3, “perceptions of other eating behaviours”, there were differences between how adolescents perceived healthy eating and dieting compared to parents. Discussion: Differences in adolescent and parent understanding of eating behaviour terminology highlights a need for a shared language to support appropriate detection of problematic eating behaviours. There is a need for prevention and early intervention approaches that promote awareness and accessible support pathways for overeating to prevent progression to an eating disorder. Full article

Background: Research has shown that disordered eating behaviors—including binge eating, night eating syndrome, and food addiction—contribute to the heterogeneity of obesity and assist in phenotyping patients for more tailored interventions. The Eating Behavior Assessment for Obesity (EBA-O) is a recently developed 18-item questionnaire that assesses five pathological eating-behavior domains among individuals with obesity (night eating, food addiction, sweet eating, hyperphagia, and binge eating). The present study aimed to translate, culturally adapt, and validate the Persian (Farsi) version of the EBA-O. Methods: The original English EBA-O was translated into Persian following a standardized forward–backward translation procedure, with cultural adaptations implemented to ensure linguistic accuracy and conceptual clarity. A cross-sectional sample of 278 Iranian adults with overweight or obesity (body mass index [BMI] ≥ 25 kg/m²) completed the Persian EBA-O. Confirmatory factor analysis (CFA) was conducted to verify the five-factor model in the Persian sample. Internal consistency was evaluated using Cronbach’s alpha and composite reliability (CR). Convergent validity was assessed using the average variance extracted (AVE), and discriminant validity was examined with the Heterotrait–Monotrait ratio (HTMT). Model fit indices, including the Comparative Fit Index [CFI], Tucker–Lewis Index [TLI], Normed Fit Index [NFI], Goodness-of-Fit Index [GFI], the Standardized Root Mean Square Residual [SRMR] and relative chi-square value [χ²/df] were used to determine the adequacy of the factor structure. Results: The Persian EBA-O demonstrated a clear and stable five-factor structure consistent with the original instrument. CFA indicated good model fit (CFI = 0.95, TLI = 0.94, NFI = 0.91, GFI = 0.92, SRMR = 0.05, χ²/df = 1.94), confirming the presence of the intended domains. Internal consistency was acceptable to high across all subscales (Cronbach’s α = 0.78–0.86; CR > 0.70), and the total scale showed strong reliability. Three of the five factors demonstrated acceptable convergent validity (AVE = 0.54–0.68), while Food Addiction (AVE = 0.46) and Night Eating (AVE = 0.43) fell slightly below the 0.50 threshold; however, their adequate CR and α values indicate that these constructs remain coherent and psychometrically sound. All inter-factor correlations satisfied discriminant validity criteria (HTMT < 0.90), with the highest association observed between the Binge Eating and Hyperphagia factors. Overall, the psychometric properties of the Persian EBA-O were comparable to those reported in the original validation and subsequent translations. Conclusions: The Persian version of the EBA-O is a valid and reliable instrument for assessing pathological eating behaviors among individuals with obesity. It preserves the original questionnaire’s five-factor structure and demonstrates acceptable internal consistency and construct validity in a Persian-speaking population. This validated tool will support both clinical assessment and research on eating-behavior phenotypes and may contribute to the development of more personalized and effective obesity-management strategies among Persian-speaking individuals. Full article

Background/Objectives: The study aimed to investigate the presence of worry, rumination, and metacognitive beliefs in adolescents with maladaptive eating behaviours. Methods: The study involved 37 adolescents (10 males, 27 females, mean age ± SD: 15.4 ± 1.53 years) with obesity (Body Mass Index, BMI > 97th centile) associated with binge eating disorder (BED) (BES score ≥ 17) and 30 age-matched adolescents (13 males, 17 females, mean age ± SD: 15.2 ± 1.98 years) with essential obesity (i.e., without BED, BES score < 17). Participants completed self-report questionnaires—Penn State Worry Questionnaire (PSWQ), Ruminative Response Scale (RRS), Anger Rumination Scale (ARS), and Metacognitions Questionnaire for Children (MCQ-C)—to assess binge eating, worry, rumination, and metacognitive beliefs, respectively. Results: Patients with obesity and BED showed higher scores on the PSWQ (p = 0.006), RRS (p < 0.001), ARS (p < 0.001), negative Metaworry (p = 0.011), and total MCQ-C (p = 0.027) than those with essential obesity, with a medium-to-large effect size, indicating that the differences between subgroups were meaningful. Conclusions: Our findings highlight that BMI alone is not associated with metacognitive processes and beliefs. The presence of BED in adolescents with obesity is linked to increased levels of worry, rumination, and maladaptive metacognitive beliefs, in comparison with age-matched adolescents with essential obesity. The results of the study underline the need for different psychological approaches in these clinical conditions going forward. Full article

Background: Pride may play a role in eating disorders and related symptomatology. This PRISMA-informed scoping review explores the emotion of pride in eating disorders and in related symptoms. Methods: Four databases (PubMed, PsycINFO, Web of Science, Scopus) were searched (July 2025). This systematic scoping review followed PRISMA guidelines and PICOS procedures. The included reports were written in English language and assessed pride in relation to eating disorder-related symptoms both in diagnosed individuals and in the general population. Results: Twenty-three studies were selected, including sixteen quantitative and seven qualitative studies. Pride was evaluated in various forms, including appearance-related pride, body pride, and LGBT pride. In general population samples, high levels of maladaptive pride and low levels of adaptive pride were associated with greater eating disorder-related symptomatology. In patients, pride was associated with control and illness identification and was found to contribute to illness onset, maintenance, and recovery. Conclusions: Integrating pride experiences in the assessment of eating disorders may be clinically useful and provide guidance for treatment planning. Main gaps consist in the great heterogeneity of the instruments used to assess pride and in the major focus on anorexia nervosa, with only a few studies investigating bulimia nervosa and binge-eating disorder. Full article

Background: Obesity is increasingly recognized as a complex condition characterized by the convergence of metabolic dysregulation and psychological vulnerability. Insulin resistance (IR) has been identified as a biological bridge linking metabolic imbalance with affective symptoms such as anxiety, depression, and disordered eating behaviors. Methods: Fifteen obese adults (mean age = 25 ± 4.3 years) were evaluated through clinical examination, anthropometric assessment (BMI), biochemical assays (fasting insulin, AST, ALT), and standardized psychological assessments (STAI, BDI-II). In parallel, a rapid systematic review (2019–2025) synthesized evidence on the association between IR, affective dysregulation, binge eating disorder (BED), and the clinical role of insulin-sensitizing or incretin-based therapies. Results: Participants exhibited marked hyperinsulinemia (M = 79 μU/mL, SD = 6.61) and elevated anxiety (STAI-Trait = 54.22 ± 22.4) and depression scores (BDI-II = 21.6 ± 7.5). Liver enzymes were within normal limits. Literature synthesis confirmed consistent associations between IR, mood symptoms, and BED, associated with biological processes including inflammation, HPA axis hyperactivity, and dopaminergic imbalance. Integrated treatment approaches combining cognitive-behavioral therapy, medical nutrition therapy, and insulin-sensitizing agents (metformin, GLP-1RA, and GLP-1/GIP RA) were supported as effective and safe options. Conclusions: The coexistence of insulin resistance and emotional dysregulation in obesity is consistent with the hypothesis of a bidirectional metabolic–emotional axis. Early, integrated interventions addressing both metabolic and psychological domains may improve clinical outcomes and reduce progression toward chronic metabolic and psychiatric comorbidity. Full article

Background: Midwives, despite their health-promoting role, face factors that may disrupt eating behaviours and weight regulation. Little is known about their body weight perception or disordered eating attitudes (DEAs). This study assessed body weight perception and eating attitudes across BMI categories among Polish midwives. Methods: A cross-sectional survey of 568 midwives was conducted. BMI was calculated from self-reported measures and classified according to WHO criteria. Body weight perception was assessed using discrepancies between actual and ideal body weight and between self-perceived ideal body weight and ideal body weight. Long-term weight variability was additionally evaluated using the difference between maximum and minimum adult body weight. Eating attitudes were examined using the Polish version of the EAT-26. Group differences were analysed with the Kruskal–Wallis and χ² tests. Results: Among the participants, 62.9% had normal weight, 23.4% were overweight, and 13.7% were obese. Perceived ideal body weight increased with BMI (p < 0.001). Midwives with overweight and obesity demonstrated higher EAT-26 scores than those with normal BMI, with EAT-26 > 20 observed in 8.3% of overweight and 14.1% of obese participants (p = 0.010). Overweight and obese midwives also showed larger discrepancies between actual and ideal body weight and greater lifetime weight variability, and these groups simultaneously presented higher levels of disturbed eating attitudes. Emotional eating, binge-type episodes, and dieting behaviours were more common among overweight and obese participants, while calorie awareness remained consistently high across groups. Conclusions: Midwives with excess body weight often misperceive their body size and show an elevated risk of DEA. Weight perception appears more strongly related to maladaptive eating patterns than BMI alone. These findings highlight the need for targeted, non-stigmatising interventions addressing weight perception, eating attitudes, and occupational stressors, which may support both midwives’ well-being and their professional effectiveness in delivering nutrition and lifestyle counselling. Full article

Background: Eating disorders (EDs) are serious mental health conditions often beginning in adolescence and are associated with significant morbidity and mortality. Although previous research has focused on medical staff, little is known about how EDs are recognised and managed by non-medical mental health professionals within community-based systems. This study examined their awareness, knowledge, and stigmatising beliefs toward EDs in Türkiye, highlighting implications for training and policy development. Methods: A study-specific questionnaire adapted from a validated tool previously used with general practitioners was administered to 42 non-medical professionals (95.2% female; mean age = 33.2 ± 5.6 years) working in community mental health services in Ankara, Türkiye. Participants were randomly assigned to one of six clinical vignettes depicting a young person with anorexia nervosa (AN), bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), depression, or type-1 diabetes. The questionnaire assessed illness perception, causal attributions, emotional reactions, professional knowledge, and stigmatising beliefs. Results: Only 28.6% (n = 12) correctly identified the disorder in their assigned vignette. BED had the highest diagnostic accuracy (50%), while AN and ARFID were most frequently misidentified. Participants commonly believed that EDs mainly affected females, had a short duration, and were less responsive to treatment. Stigmatising beliefs—such as personal blame—were also noted. Conclusions: Findings revealed limited awareness and knowledge of EDs—particularly AN and ARFID—among non-medical mental health professionals. Misconceptions that EDs are self-inflicted may delay recognition and referral. The results underscore the need for targeted education, anti-stigma interventions, and integration of ED content into professional training to improve early detection and community-based support. Full article

Background/Objectives: Obesity results from the complex interplay of biological, psychological, and sociocultural factors. Psychiatric comorbidities and maladaptive eating attitudes are possible contributors to this complexity. Despite accumulating research, current treatment approaches often fail to achieve lasting success, possibly due to the tendency to approach obesity as a uniform condition despite its heterogeneity. This study aimed to identify distinct subgroups of adults with obesity based on their eating behaviors, psychopathology, and food addiction (FA). Methods: The study included 202 adults seeking obesity treatment at Ankara Dışkapı Training and Research Hospital, Turkey. Participants completed the Three Factor Eating Questionnaire-R18, Yale Food Addiction Scale, Night Eating Questionnaire, and Symptom Checklist-90-R (SCL-90-R). Psychiatric diagnoses were confirmed through clinician-administered semi-structured interviews (SCID-5-CV). Two-step cluster analysis was performed using z-standardized variables of eating and psychopathology measures. Subsequent comparisons were conducted between the identified subgroups. Results: Two distinct clusters were identified and described in terms of adaptive and maladaptive eating traits: an Adaptive group (n = 92, 45.5%) and a Maladaptive group (n = 110, 54.5%). The Maladaptive cluster exhibited higher levels of emotional eating, uncontrolled eating, night eating, FA, and general psychopathology (all p < 0.001), along with a greater prevalence of major depressive disorder and binge eating disorder. Conclusions: Our findings indicate that psychopathology and maladaptive eating behaviors meaningfully distinguish two obesity phenotypes. Nearly half of individuals with obesity, characterized by maladaptive eating traits, FA, or elevated psychopathology, may constitute a subgroup that would particularly benefit from psychoeducation or targeted psychiatric intervention. Full article

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed treatment for higher weight and diabetes. Because they also influence appetite and reward processes, these medications may shape eating behaviours, emotions, and body image, raising new challenges for eating disorder (ED) research and clinical care. This narrative review synthesises emerging evidence on the psychological and behavioural effects of GLP-1RA use within a biopsychosocial and equity framework. Method: Using a narrative, non-systematic approach, we conducted targeted searches across major databases (2015–September 2025) with combined GLP-1RA and psychological or ED-related terms, supplemented by cross-referencing. Inclusion criteria focused on empirical, theoretical, and clinically meaningful psychological, behavioural, and sociocultural outcomes, enabling a conceptually driven synthesis of the psychological effects of GLP-1RA use. Results: GLP-1RAs reduce hunger and binge-eating frequency, suggesting possible benefits for binge-type EDs. However, evidence for restrictive EDs remains limited, and appetite suppression may reinforce rigid control or perfectionistic traits. Although short-term reductions in emotional eating have been reported, the long-term psychological safety of GLP-1RAs is unknown. Rapid, medication-driven weight loss may disrupt body perception, while social media discourse glamorises thinness and intensifies stigma. These psychosocial effects intersect with inequities in access, disproportionately affecting adolescents and individuals from culturally diverse or socioeconomically marginalised groups. Conclusions: GLP-1RAs sit at the intersection of medical innovation and psychological risk. To ensure safe and inclusive use, research and clinical practice should integrate developmental, cultural, and lived-experience perspectives. Co-designed research and multidisciplinary monitoring will be essential to reduce stigma, address inequities, and support psychologically informed care. Full article

Background: Autism spectrum disorder (ASD) constitutes a heterogeneous neurodevelopmental condition frequently accompanied by considerable disturbances in feeding behavior and nutritional balance. These difficulties arise from complex and multifactorial mechanisms, exerting a significant impact on physical health, metabolic homeostasis, and psychosocial functioning. The present review aims to provide a critical synthesis of current evidence regarding the underlying biological and behavioral mechanisms of feeding difficulties in ASD and to delineate the spectrum of comorbid eating disorders within this population. Methods: A narrative review of the peer-reviewed scientific literature was undertaken, emphasizing studies investigating the interrelationship between ASD and nutritional functioning in pediatric and adolescent populations. Particular focus was placed on research exploring sensory processing abnormalities, gut microbiota alterations, and the clinical manifestation of eating disorders in individuals with ASD. Results: The analysis revealed that sensory hypersensitivity, behavioral inflexibility, and disturbances within the gut–brain axis constitute principal determinants of atypical eating patterns in ASD. Individuals on the autism spectrum frequently exhibit pronounced food selectivity, neophobia, and symptoms consistent with Avoidant/Restrictive Food Intake Disorder (ARFID). Furthermore, an increased prevalence of anorexia nervosa and orthorexia nervosa has been documented, likely reflecting shared cognitive and behavioral features with ASD. “Emotional eating” tendencies and a marked preference for high-caloric, energy-dense foods—often potentiated by psychopharmacological treatment and reduced physical activity—further contribute to an elevated risk of overweight and obesity. Conclusions: Children and adolescents with ASD display a bimodal distribution of body mass, encompassing both undernutrition and obesity, indicative of a multifaceted interplay among sensory, behavioral, cognitive, and metabolic determinants. A comprehensive understanding of this heterogeneity is crucial for the development of individualized, evidence-based interventions integrating nutritional management with behavioral and psychotherapeutic approaches. Full article

Background/Objectives: Obesity is a multifactorial disease associated with increased consumption of ultraprocessed foods and reduced intake of unprocessed foods. Binge eating, one of the most prevalent eating disorders among adolescents, is closely linked to obesity. Food intake is regulated by both the hedonic system, responsible for reward responses, and the physiological system, which controls hunger and satiety through hormones, such as ghrelin and leptin. The present study aimed to investigate associations between the intake of unprocessed and ultraprocessed foods, neuroendocrine mediators of appetite regulation, and binge eating in adolescents with obesity. Methods: This cross-sectional study included 96 adolescents with obesity who were recruited in São Paulo, Brazil, between 2010 and 2012. Anthropometric and body composition assessments were performed. Binge eating symptoms were evaluated using the binge eating scale (BES), and dietary intake was assessed with a validated Food Frequency Questionnaire, with items classified according to the Nova system. Frequency data were converted into annual consumption scores. Serum levels of ghrelin, leptin, neuropeptide Y (NPY), agouti-related peptide (AgRP), melanin-concentrating hormone (MCH), and alpha-melanocyte-stimulating hormone (α-MSH) were analyzed. Results: Lower consumption of unprocessed foods was associated with higher ghrelin concentrations (p = 0.023), accompanied by a greater percentage of body fat (p = 0.047) and a reduced percentage of lean mass (p = 0.047) compared with adolescents in the second tertile. AgRP was a positive predictor of annual consumption score of ultraprocessed food (β = 0.30; p = 0.04), independent of age, body fat, and binge eating symptoms. Conclusions: In conclusion, lower intake of unprocessed foods was associated with alterations in orexigenic and anorexigenic mediators, suggesting that dietary patterns in adolescents with obesity may influence the neuroendocrine mediators of appetite regulation. Full article