Search Results (149)

Background: Art therapy is increasingly recognized as a valuable complementary intervention for individuals with eating disorders (EDs), who frequently experience comorbid anxiety and difficulties with emotional regulation. However, few studies have examined its short-term effects on state and trait anxiety within structured clinical settings. Methods: This pilot study involved 19 adolescent females (mean age 17.7 ± 2.1 years) diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) and admitted to the Mariconda Regional Residence for Eating Disorders (ASL Salerno, Italy) in residential or semi-residential treatment. Participants completed a structured six-week cycle of weekly textile-based art therapy sessions, designed to promote emotional expression and body reconnection. State and trait anxiety levels were assessed pre- and post-session using the State-Trait Anxiety Inventory (STAI). Repeated-measures ANOVA was used to analyze state anxiety changes; a linear mixed-effects model was applied to trait anxiety. Results: State anxiety significantly decreased immediately after sessions (p = 0.002). A significant main effect of session (p = 0.01) and a time × session interaction (p = 0.025) indicated variability across sessions. Trait anxiety showed a non-significant trend toward reduction (p = 0.11); however, reductions were significant at sessions 4 (p = 0.015), 5 (p < 0.001), and 6 (p = 0.005). Conclusions: Art therapy may offer immediate reductions in state anxiety and may contribute to a longer-term reduction in trait anxiety with 4–6 sessions. These findings support integrating creative interventions within multidisciplinary ED treatment programs. Future research with larger samples and control groups is needed to confirm and expand upon these preliminary results. Full article

Emerging evidence highlights the critical role of the gut microbiota in the development and progression of eating disorders (EDs), particularly in women, who are more frequently affected by these conditions. Women with anorexia nervosa, bulimia nervosa, and binge eating disorder exhibit distinct alterations in gut microbiota composition compared to healthy controls. These alterations, collectively termed dysbiosis, involve reduced microbial diversity and shifts in key bacterial populations responsible for regulating metabolism, inflammation, and gut–brain signaling. The gut microbiota is known to influence appetite regulation, mood, and stress responses—factors closely implicated in the pathogenesis of EDs. In women, hormonal fluctuations related to menstruation, pregnancy, and menopause may further modulate gut microbial profiles, potentially compounding vulnerabilities to disordered eating. Moreover, the restrictive eating patterns, purging behaviors, and altered dietary intake often observed in women with EDs exacerbate microbial imbalances, contributing to intestinal permeability, low-grade inflammation, and disturbances in neurotransmitter production. This evolving understanding suggests that microbiota-targeted therapies, such as probiotics, prebiotics, dietary modulation, and fecal microbiota transplantation (FMT), could complement conventional psychological and pharmacological treatments in women with EDs. Furthermore, precision nutrition and personalized microbiome-based interventions tailored to an individual’s microbial and metabolic profile offer promising avenues for improving treatment efficacy, even though these approaches remain exploratory and their clinical applicability has yet to be fully validated. Future research should focus on sex-specific microbial signatures, causal mechanisms, and microbiota-based interventions to enhance personalized treatment for women struggling with eating disorders. Full article

Background: Food addiction (FA) is an emerging construct that mirrors the behavioral and neurobiological characteristics of substance use disorders. Despite growing interest, its association with specific psychiatric disorders among bariatric patients remains understudied. Objective: Our aim was to examine the prevalence and strength of associations between FA and seven major psychiatric disorders in individuals who underwent bariatric surgery. Methods: In a sample of 100 post-bariatric patients referred for psychiatric evaluation, FA was assessed using the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0), and psychiatric disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI). Logistic regression models were used to estimate adjusted odds ratios (aORs) for the association between FA and each psychiatric disorder, controlling for sex, age, body mass index (BMI), employment status, the number of children, clinical comorbidities, physical activity, family psychiatric history, and region of residence. Results: FA was present in 51% of the sample. Descriptive analyses revealed a significantly higher prevalence of major depressive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, agoraphobia, obsessive–compulsive disorder, and bulimia nervosa among individuals with FA. Multivariate models showed robust associations between FA and bulimia nervosa (aOR = 19.42, p < 0.05), generalized anxiety disorder (aOR = 2.88, p < 0.05), obsessive–compulsive disorder (aOR = 6.64, p < 0.05), agoraphobia (aOR = 3.14, p < 0.05), social anxiety disorder (aOR = 4.28, p < 0.05) and major depressive disorder (aOR = 2.79, p < 0.05). Conclusions: FA is strongly associated with a range of psychiatric comorbidities in post-bariatric patients, reinforcing the need for comprehensive mental health screening in this population. These findings underscore the potential role of FA as a clinical marker for stratified risk assessment, supporting more personalized approaches to mental health monitoring and intervention following bariatric surgery. Full article

Background: Binge eating is a disordered eating behavior implicated in eating disorders such as binge eating disorder (BED) and bulimia nervosa; it significantly affects an individual’s physical and mental health. Recent studies suggest shared neurobiological mechanisms between binge eating and addictive behaviors. Comorbid addiction (e.g., substance use disorders and behavioral addictions) is also frequently reported in binge-eating patients. However, it is still unclear whether binge-eating individuals with comorbid addictions differ in their cognitive and mental health characteristics from those without comorbid addictions. Objectives: The present study aimed to examine the cognitive and mental health profiles of binge-eating individuals with and without co-occurring addictions. We hypothesized that binge-eating individuals with comorbid addictions would show greater impairments in impulsivity and self-control, as well as elevated depression and emotion dysregulation. Methods: In the present study, we assessed psychometric scales on various cognitive and mental health domains (e.g., impulsivity, behavioral inhibition, self-control, emotion regulation, mood, and anxiety) across 30 binge-eating individuals with co-occurring addictive behaviors (i.e., alcohol, nicotine, gambling, and video games), 32 binge-eating individuals without addiction, and 180 healthy control subjects with neither binge-eating tendencies nor addiction. Results: Both binge-eating groups showed a significant increase in punishment sensitivity, perceived stress, and state/trait anxiety compared to healthy controls, but there was no difference between the two binge-eating groups. Higher impulsivity and lower self-control were observed in both binge-eating groups to a significantly greater degree in the group with comorbid addiction. Notably, significantly increased depression and impaired emotion regulation (reduced use of cognitive reappraisal) were observed only in the binge-eating group with comorbid addiction when compared to the healthy controls. Conclusions: Our findings demonstrated the commonalities and differences in binge-eating populations with and without comorbid addiction. It will help to elucidate cognitive and mental health aspects of comorbid addiction in the binge-eating population and to develop more tailored diagnoses and treatments. Full article

Background/Objectives: Despite the growing awareness of nutrition and the popularity of healthy lifestyles among adolescents, disordered eating behaviors—such as anorexia nervosa, bulimia nervosa, binge eating disorder (BED), and avoidant/restrictive food intake disorder (ARFID)—remain significant public health concerns. ARFID, officially recognized only in 2013, is still poorly understood among youth. This study aimed to assess the relationship between adolescents’ nutritional knowledge, emotional regulation, media influence, and eating behaviors. Methods: A cross-sectional study was conducted in 2024 among 120 students aged 15–17 attending W. Reymont Secondary School No. II in Ostrów Wielkopolski, Poland. Participants completed a custom-designed, paper-based questionnaire consisting of 30 single-choice questions and demographic items. The instrument assessed knowledge of eating disorders, body satisfaction, social media impact, and the emotional determinants of food choices. The tool was developed with expert input but has not undergone formal psychometric validation. While many adolescents demonstrated basic nutritional knowledge—such as awareness of BMI norms and food group distribution—they often failed to apply this knowledge to their dietary behaviors. Results: Significant gender differences were observed: girls were more likely to restrict food intake, report emotional eating, and engage in slimming behaviors, while boys were less emotionally reactive and less influenced by social media. Most participants reported eating one meal daily with family but rarely discussed nutrition at home. Emotional involvement in eating, particularly among girls, emerged as a key factor, more influential than social media in shaping dietary behaviors. Conclusions: The findings highlight a clear gap between nutritional knowledge and actual behavior among adolescents, driven in part by emotional dysregulation and body image concerns. School-based interventions should incorporate not only nutritional education but also emotional regulation strategies and media literacy to effectively support healthy eating behaviors in youth. Full article

Binge eating is the cardinal feature of Binge-Eating Disorder (BED) and is known to be associated with obesity with bidirectional causality. This study aimed to investigate the association of diagnostic specifiers of binge eating, as mandated in the DSM-5 definition of BED, i.e., Criteria B and C (presence of marked distress) and weight/shape overvaluation with body mass index (BMI); and to examine the associations of high BMI with distress, pain, anxiety, and physical and mental health-related quality of life (PHRQoL and MHRQoL). Data for a sub-sample of 255 adults with recurrent binge eating (Criterion A) and without anorexia or bulimia nervosa diagnoses were extracted from the 2017 South Australian Health Omnibus Survey. Bivariate analyses were used to explore the association of DSM-5 BED specifiers with BMI and other measures. This study found that specific BED diagnostic specifiers related to binge eating were associated with higher BMI and distress levels. Additionally, individuals with BED who experience weight/shape overvaluation and higher BMI levels were associated with heigh levels of pain and anxiety, and had poorer PHRQoL and MHRQoL. These findings in relation to the association of higher BMI with different BED specifiers support the clinical significance of the DSM-5 Criterion B and C for BED. Full article

Objectives: Feeding and eating disorders (FED) represent a major public health issue and are the second leading cause of death among psychiatric conditions in children and adolescents. Psychopathological comorbidities play a significant role in the onset and persistence of FED, yet research on their underlying structure remains limited. This study explores the psychiatric comorbidities associated with FED, focusing on common etiopathogenetic factors and their clinical implications. Methods: Data were retrospectively collected from the Italian Regional Center for FED in the Emilia-Romagna Region between June 2023 and April 2024. Diagnoses were assigned following DSM-5 criteria using the Italian version of the semi-structured K-SADS-PL diagnostic interview. Principal component analysis (PCA) was performed to identify latent psychological dimensions underlying FED psychopathology, retaining five components based on the scree plot. Additionally, an analysis of covariance (ANCOVA) was conducted to examine differences in factor scores across FED subtypes, while adjusting for potential confounders. Results: Seventy-two participants were included (mean age: 14.6 years; mean BMI: 18.3 kg/m²; male-to-female ratio: 1:8). Diagnoses were distributed as follows: 63.9% anorexia nervosa (AN), 13.9% other specified feeding and eating disorder (OSFED), 6.9% avoidant restrictive food intake disorder (ARFID), 4.2% binge eating disorder (BED), 4.2% unspecified feeding and eating disorder (UFED), and 2.7% bulimia nervosa (BN). All participants met the criteria for at least one psychiatric comorbidity. Identified psychopathological clusters include the following: (1) mood disorders (66.5%); (2) anxiety disorders (87.5%); (3) obsessive–compulsive and related disorders (47.2%); (4) neurodevelopmental disorders, i.e., attention-deficit/hyperactivity disorder (ADHD) (30.5%); (5) disruptive and impulse-control disorders (13.9%); and (6) psychotic symptoms (40.3%). No instances of tic or elimination disorders were detected. Conduct disorder was more prevalent among UFED, BED, and BN patients compared to other FED (p = 0.005), and moderate/severe ADHD was associated with higher body mass index (BMI) (p = 0.035). PCA revealed distinct psychological dimensions underlying FED, while ANCOVA indicated significant differences in factor scores across FED subtypes, supporting the presence of shared transdiagnostic mechanisms. Conclusions: This study highlights the complex interplay between FED and psychiatric comorbidities, emphasizing the need for early intervention and personalized treatment approaches. The dimensional structure identified through PCA suggests that common psychopathological factors may drive FED development, and ANCOVA findings support their differential expression across FED types. Future research should further investigate these transdiagnostic mechanisms to optimize clinical care. Full article

Background/Objectives: To inform person-centred clinical practice, it is important to know what features may predict or moderate treatment outcomes. Thus, we investigated pre-treatment clinical features and mid-therapy reduction in loss of control over eating (MTLOCE), including impacts on treatment outcomes of a new manualised psychotherapy, a healthy approach to weight management and food in eating disorders (HAPIFED). HAPIFED was developed as an integrated psychological and behavioural treatment for individuals with bulimia nervosa or binge eating disorder, which are co-morbid with a high body mass index (BMI). Methods: In total, 50 participants were randomised to HAPIFED and 48 were randomised to the control cognitive behaviour therapy-enhanced group. Assessments included mental health-related quality of life (MHRQoL), eating disorder symptom severity, binge-eating frequency, BMI, and loss of control over eating (LOCE) at baseline, mid-treatment, end-treatment, and 6 and 12 months end of follow-up (EndFU). These were measured with the SF-12, the EDE-Q, and the LOCES, respectively. Linear and negative binomial mixed models were used. Missing data were imputed multiple times, assuming intention of treatment for the analysis. Results: Pre-treatment eating disorder symptom severity, MHRQoL, and BMI positively predicted eating disorder symptom severity, MHRQoL, and BMI up to 6 and 12 months end of follow-up. Mid-treatment LOCE MTLOCE predicted improved MHRQoL (coefficient = 0.387, 95% CI 0.0824–0.6921, p = 0.004), reduced binge-eating frequency (IRR = 0.5637, 95% CI 0.3539–0.8977, p = 0.0191), and eating disorder symptom severity (coefficient= −0.65, 95% CI −1.0792–−0.2217, p = 0.0139). Neither purging nor illness duration were a significant predictor of any of the outcomes. The effect of HAPIFED was not moderated by baseline weight/BMI but was moderated negatively by MTLOCE for binge-eating frequency (coefficient = −0.636, SE = 0.28, p < 0.05, IRR = 0.529) and eating disorder symptom severity (coefficient = −0.268, SE = 0.13, p < 0.05, Cohen’s d = −0.102). Conclusions: Greater control over eating improved MHRQoL and decreased the frequency of binge-eating episodes and eating disorder symptom severity. These positive effects were moderated by being in the HAPIFED group, supporting previous findings of benefits to people’s mental health through participation in the HAPIFED trial. Full article

This systematic review investigates the effectiveness of virtual reality as a tool in the treatment of eating disorders, either alone or in combination with other therapies. The limitations of traditional therapies, along with the high prevalence of eating disorders, have driven research into the use of virtual reality techniques as a new approach to treatment. The review includes studies published between November 2021 and February 2025, focusing on virtual reality-based interventions for anorexia nervosa, bulimia nervosa, binge eating disorder, and body image disturbances. A total of 228 articles were screened, with eight meeting the inclusion criteria. The studies show that virtual reality interventions, particularly when combined with other therapeutic techniques, can significantly improve psychological and behavioral factors related to eating disorders. Virtual reality exposure and inhibitory control training were the main interventions. The results indicate that virtual reality exposure is effective in reducing body concerns, food anxiety, and attentional bias, while inhibitory control training shows mixed results in binge eating disorder treatment. Despite the promising findings, limitations such as small sample sizes and lack of follow-up highlight the need for further research. Future studies should aim to include larger, more diverse samples and explore the long-term effectiveness of the interventions. Full article

Background/Objectives: Eating disorders (EDs) are complex psychopathological conditions involving dysfunctional eating behaviors, excessive body image concerns, and impaired emotional regulation. Among moral emotions, guilt plays a significant role in ED dynamics, influencing both symptomatology and interpersonal relationships. This study examines specific guilt subtypes (normative and altruistic guilt) using a specific psychometric tool. Methods: Forty-three adults with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were recruited from the Eating Disorder Center of the University of Campania “Luigi Vanvitelli” or referred by psychotherapists. Diagnoses followed DSM-5 criteria. Participants completed the Moral Orientation Guilt Scale (MOGS), assessing guilt subtypes, and the Eating Disorder Inventory-2 (EDI-2), measuring ED symptomatology. Spearman’s rank correlation and stepwise multiple regression analyses were used to identify relationships between guilt dimensions and ED-related symptoms. Results: MOGS subscales were positively correlated with ED symptomatology. Normative guilt was significantly associated with binging and purging (ρ = 0.26, p < 0.05), while altruistic guilt predicted higher interpersonal distrust (t = 3.4, p < 0.01). Regression analysis revealed that age negatively influenced interpersonal distrust (t = −2.9, p < 0.01). Conclusions: In the population examined, guilt significantly influences ED symptomatology and interpersonal functioning, with specific dimensions linked to distinct behaviors and traits. Therapeutic interventions targeting guilt may enhance treatment outcomes by addressing ED emotional underpinnings. However, the results should be interpreted with caution due to the small sample size and lack of longitudinal data to establish causality. Further research with larger samples and longitudinal designs is necessary to validate these findings. Full article

Background/Objectives: The definitions of feeding disorders of infants and young children were historically based on a dichotomic organic/non-organic vision. Since 2019, a new definition of pediatric feeding disorders (PFDs) has reshaped the understanding of these disorders with a global vision. The aim of this study is to obtain a better understanding of the diagnostic criteria for general practice, both by exploring the evolution of classifications and by clearing the actual definition of PFDs and their possible treatments. Methods: We conducted a narrative review of the literature, including 36 articles about PFDs, excluding adolescents, anorexia nervosa, bulimia, pica, rumination, and specific neurodevelopmental or chronic pediatric disorders. We summarized these studies in three parts: the specific classifications for children before puberty, the current definition, and the clinical guidelines. Results: Concerning the history of the classifications, we summarized the studies of Chatoor and Kerzner and the older pediatric vision of failure to thrive. For the definition of pediatric feeding disorders, we presented this new category involving at least one out of four domains: medical, nutritional, feeding skills, or psychosocial. For the main clinical guidelines, we presented recommendations for both severe and common PFDs in each altered domain for use in daily practice. Conclusions: The new definition promotes a transdisciplinary vision of childhood feeding disorders, which considers each of the intricate domains of PFDs. Using common terminology for PFDs could help all healthcare providers, families, and researchers to better understand and address PFDs. Full article

Feeding and Eating Disorders (FEDs) constitute a complex spectrum of psychiatric conditions, impacting physical and psychosocial well-being. This retrospective observational study aimed to dissect the electrocardiographic (ECG) alterations in pediatric patients with FEDs, correlating them with clinical factors, treatment modalities, Refeeding Syndrome (RS) and the reversibility of ECG abnormalities post-treatment. Analyzing records from a third level Italian Regional Center for FEDs in children and adolescents, the study encompassed 150 patients meeting the inclusion criteria. Sinus bradycardia was the prevalent ECG alteration, notably in Anorexia Nervosa (AN) restrictive type. Association analyses revealed links between the severity of AN, hormonal imbalances, and amenorrhea and ECG abnormalities. Pharmacological interventions, particularly antipsychotics, exhibited associations with a QT interval prolongation. RS demonstrated significant correlations with potassium and magnesium imbalances, which were linked to specific ECG changes. This study highlighted the reversibility of ECG abnormalities, concomitant with Body Mass Index improvement. This analysis underscores the critical cardiac implications of FEDs, advocating for multidisciplinary interventions and close cardiac monitoring. Early detection and holistic care are imperative in managing patients with FEDs in the developmental age, offering potential reversibility of cardiac alterations post-treatment. These findings underscore the need for prospective studies to validate these observations and delve deeper into cardiac involvement in FEDs. Full article

Background/Objectives: Feeding and eating disorders (FEDs) constitute an important mental health problem today, especially among youngsters. The Sick, Control, One, Fat, Food (SCOFF) questionnaire was developed 25 years ago and remains the most frequently applied screening tool for FEDs among adults and youngsters. The aim of the present study was to translate and adapt the SCOFF questionnaire to the Greek language, using a tertiary-setting adolescent sample. Methods: A total of 167 adolescents (86 boys, 81 girls) admitted to the pediatric outpatient clinics of the Georgios Gennimatas and Hippokration General hospitals completed the SCOFF questionnaire. Anthropometric indices were measured and dietary intake was recorded. Results: A total of 74 adolescents (44.3% of the sample) were classified as engaging in disordered eating behaviors and as possible patients with FEDs based on the SCOFF questionnaire. No differences were noted in the dietary intake between adolescents who screened positive and those who screened negative for FEDs. The body mass index z-score and obesity status were greater among children screening positive for FEDs compared to those screening negative (p < 0.01). One patient who was later diagnosed with anorexia nervosa was detected as a possible FED case by the questionnaire. Conclusions: The present study revealed that more than two out of five adolescents attending a pediatric clinic exhibited disordered eating behavior. The use of the G-SCOFF questionnaire is feasible and effective for FED triage in the Greek tertiary pediatric setting. Full article

Background-objectives: Multiple dynamic interacting factors contribute to the presence and progression of eating disorders (ED). Empirical research has provided mixed findings regarding the mechanisms explaining the contribution of body mass index (BMI) to the diverse ED endophenotypes. The present study aims to evaluate the underlying processes (direct and indirect effects) contributing to BMI and ED severity, considering the contribution of multiple neuropsychological constructs. Method: Path analysis, implemented through structural equation models (SEM), was applied to a sample of N = 193 ED patients, men and women, aged 17 to 50 years old, and diagnosed with bulimia nervosa, night eating syndrome, binge eating disorder, and other specified feeding. Results: BMI was directly associated with ED severity level. The ED symptom level was also a mediational link into the relationship between BMI with emotion regulation strategies, decision-making capacity, stress levels, and impulsiveness. Multigroup SEM revealed invariance of the structural coefficients by sex, but differences according to the ED subtype. Conclusions: This study provides new empirical evidence on predictors of ED severity, focusing on the role of impaired decision-making and BMI. Our results could contribute to new intervention plans with techniques specifically aimed at improving emotional regulation capacity, decreasing impulsivity levels, and improving reasoning skills. Nutrition education plans may also play a key role for preventing the onset and progression of ED, helping patients understand how food affects their physical and emotional health and how to manage anxiety and fears related to food. Full article

Background/Objectives: The primary aim of this study was to characterize athletes approaching an outpatient interdisciplinary and multidisciplinary consultation structure for athletes with a suspected relative energy deficiency in sport (REDs) cross-sectionally and longitudinally to prove treatment efficacy. Methods: Data of 58 athletes suspected of REDs were collected at the onset (t₀) and completion (t₁) of interdisciplinary and multidisciplinary REDs treatment (clinical practice) between January 2019 and December 2022. The data included extracted information from medical records, anthropometric characteristics, physical performance diagnostics, laboratory values, dietary records, and partially gynecological and psychosomatic diagnostics. Results: The sample primarily consisted of female athletes (97%) under 18 years of age (66%) who were underweight with a body mass index (BMI) < 18.5 kg/m² and BMI percentile below the 10th percentile for their age and gender-specific norms (59%), and experienced menstrual disorders (93%). The dietary behavior is characterized by plant-based and low-energy-dense foods. Eating disorders (anorexia nervosa and bulimia nervosa) were diagnosed in 40% of the athletes according to the International Statistical Classification of Diseases and Related Health Problems 11th revision criteria. During the program, 64% of the athletes exhibited a mean weight gain of 7 (±6) kg (p < 0.001), excluding those still undergoing treatment (36%). Conclusions: The proposed interdisciplinary and multidisciplinary treatment approach proved effective and holds promise for future evidence-based developments in REDs treatment. Full article