Search Results (168)

Background/Objectives: The aim of this study was to show a standardized four-step technique that can offer individually personalized full-mouth therapy for each complex dental patient with erosive tooth wear resulting from bulimia nervosa, focusing on the individualized vertical dimension of occlusion (VDO), functional and aesthetic stability, and patient-reported outcomes, including dental symptoms, nutrition, self-perception, and quality of life. Methods: The following steps are proposed for structured full-mouth rehabilitation. Step 1: Intraoral diagnosis via a single computer-aided impression. Step 2: Determination of a new adequate vertical dimension of occlusion and soft tissue prediction. Step 3: Removable sample dentures—prototypes. Step 4: Non-prep/minimal-prep crowns as the long-term provisional/definitive treatment. Results: Nine adults (11% male) with dental erosion caused by bulimia nervosa (78%), gastro-esophageal reflux (11%), and soft drinks (11%) were part of this cohort. The novel digital workflow enabled restoration of an individualized vertical dimension of occlusion, stable occlusion, appropriate centric and eccentric contacts, biomimetic dental anatomy, harmonious tooth proportions, and optimized red–white aesthetics. Dental problems (hypersensitivity, dental pain), nutritional behavior, body perception, and quality of life improved after the full-mouth rehabilitation. Conclusions: The presented digital workflow offers a promising approach for full-mouth rehabilitation in patients with severe dental erosion, particularly associated with bulimia nervosa, enabling structured restoration planning and stepwise evaluation of the vertical dimension of occlusion and functional adaptation. Prospective studies with larger cohorts are needed to confirm long-term clinical outcomes and patient-reported benefits. Full article

Using the Hierarchical Taxonomy of Psychopathology (HiTOP) as our framework, the current study examines how 13 common psychological disorders can be grouped into different spectra in two groups of adolescents: a community sample (N = 951), and a clinic-referred sample (N = 173). Scores for the disorders were obtained using the parent version of the Child and Adolescent PsychProfiler. Taken together, the findings across the two samples for factor structure, reliability, and discriminant and concurrent validity indicate the most support for a three-factor CFA oblique model with primary factors for neurodevelopment disorders (that include Specific Learning Disorder, Autism Spectrum Disorder, Language Disorder, and Speech Sound Disorder), internalizing disorder problems (that include Generalized Anxiety Disorder, Persistent Depressive Disorder, Separation Anxiety Disorder, Obsessive–Compulsive Disorder, Posttraumatic Stress Disorder, Anorexia Nervosa, and Bulimia Nervosa), and externalizing disorder problems [(that include Attention Deficit/Hyperactivity Disorder (ADHD), and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD)], with a covariance for the error variance for Anorexia Nervosa and Bulimia Nervosa. Additionally, the analysis for Sample 2 supports the concurrent validity of the factors in this model. A modification of this model, with ADHD cross-loading on the neurodevelopment disorders factor, did not produce an admissible solution. The findings indicate support for a neurodevelopmental spectrum in the HiTOP model, with ADHD and ODD/CD showing stronger statistical association with the externalizing factor than with the neurodevelopmental factor in the models tested. This finding pertains to dimensional structure and does not invalidate the neurodevelopmental classification of ADHD in DSM-5-TR. Full article

Background/Objectives: Feeding and Eating Disorders (FEDs) are among the most challenging mental disorders due to their pervasive symptomatology and high relapse rates. While considerable research has focused on the role of personality in the onset and maintenance of FEDs, it remains unclear whether specific personality dimensions and emotion dysregulation mechanisms predict clinical severity and purging behaviors. This study aimed to explore the role of personality dimensions, emotion dysregulation, and purging behaviors in predicting psychological distress in patients with FEDs, adopting a dimensional and integrated perspective. Methods: A sample of cisgender women in a semi-residential treatment for FEDs or obesity (n = 124) was recruited in southern Italy and assessed using a psychodiagnostics survey, including the Eating Disorder Inventory-3 (EDI-3), the Symptom Checklist-90-R (SCL-90-R), and the Personality Inventory for DSM-5 (PID-5). Results: Patients with bulimia nervosa exhibited higher psychological distress compared to patients with other FEDs and Obesity, which was not significantly determined by the co-occurrence of personality disorders. Negative affectivity, detachment, and purging symptoms were significantly related to psychological distress in patients with FEDs and Obesity (p ranging from 0.028 to <0.001). Moreover, the results showed an indirect effect of emotion regulation on the relationship between self-esteem and purging symptoms in patients with FEDs and Obesity (β = 0.107; p = 0.046). Conclusions: These findings suggest that specific personality dimensions, emotion dysregulation, and purging symptoms are associated with psychological distress in individuals with FEDs and Obesity. Therefore, it is necessary to reflect on the impact of these psychological components in planning tailored treatment for FED patients. Full article

Background/Objective: Our current knowledge regarding ethnic/racial differences in the incidence of and risk factors for eating disorder onset is relatively limited. We examined whether the baseline prevalence and incidence of onset of any eating disorder over follow-up and the risk factors that predict future onset of any eating disorder differ for various ethnic/racial groups. Methods: Data were collected from females across a wide age range (N = 1952; White = 61%, Hispanic = 17%, Asian = 14%, Black = 5%, and Native American = 3%; M baseline age = 19.7, SD = 5.7; baseline age range: 13–64) who completed self-report questionnaires and a diagnostic interview at baseline and then annually over 3 years. We ran two chi-square tests that examined how ethnicity/race were related to eating disorders at baseline and future onset as well as a series of logistic regression models that tested whether baseline risk factors and prodromal symptoms were differentially related to future eating disorder onset across ethnic/racial groups. Results: The diagnostic prevalences as well as the predictive relationship of a risk factor and a prodromal symptom with eating disorder onset were very similar across ethnic/racial groups, with only one instance where the magnitude of the predictive effects differed across two ethnic/racial groups; lower zBMI was predictive among White women, whereas higher zBMI was predictive among Black women. Conclusions: Overall, risk factors and prodromal symptoms are similar across the examined ethnic/racial groups, suggesting that we can implement the same prevention programs for women with the same risk factors, regardless of their ethnic/racial identities. Full article

Background: Eating disorders are among serious psychiatric conditions and are associated with an increased risk of mortality and significant psychological distress. Mind–body therapies are attracting increasing attention as complementary interventions aimed at improving psychological well-being. The aim of this meta-analysis is to examine the effects of mind–body therapies on psychological outcomes in adults diagnosed with an eating disorder or exhibiting clinically significant symptoms associated with it. Methods: Randomized controlled trials published between 2003 and 2026 were identified through a systematic search of the PubMed, CINAHL, Web of Science, Cochrane, and Scopus databases. Studies were included that involved participants aged 18 years and over who had received a diagnosis of an eating disorder according to standard diagnostic criteria (e.g., DSM-IV, DSM-IV-TR, DSM-5) or who exhibited clinically significant symptoms associated with an eating disorder. Mind–body interventions were compared with control conditions. Methodological quality was assessed using the Joanna Briggs Institute assessment tool. Statistical analyses were performed using Stata 16.0 software. Results: Nine randomized controlled trials involving a total of 688 participants were included in the meta-analysis. It was found that mind–body interventions significantly reduced levels of depression (Hedges’ g = −0.44, 95% CI: −0.67 to −0.20). Similarly, significant reductions were observed in levels of inadequate self (g = −0.51, 95% CI: −0.84 to −0.18) and self-hated (g = −0.56, 95% CI: −0.89 to −0.23). Although an effect in the direction of an increase was observed for self-compassion (g = 0.31, 95% CI: 0.07–0.54), this effect was not found to be statistically significant following the correction applied for multiple comparisons. In contrast, anxiety (g = −0.19, 95% CI: −0.39 to 0.02), stress (g = −0.48, 95% CI: −1.05 to 0.09), and self-esteem (g = 0.29, 95% CI: −0.16 to 0.73). Conclusions: Mind–body therapies are associated with improvements in certain psychological outcomes among adults with a diagnosis of an eating disorder or those exhibiting clinically significant symptoms. However, the current findings should be interpreted with caution, as the included studies largely relied on waiting-list or usual-care control groups. Full article

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

Background: Fibromyalgia (FM) and eating disorders (ED) represent distinct clinical entities traditionally managed within separate medical specialties, yet emerging evidence suggests significant comorbidity and potential shared pathophysiological mechanisms. Both conditions disproportionately affect women, involve complex multifactorial etiologies and substantially impair quality of life. Despite documented clinical overlaps, the mechanistic connections linking these conditions remain poorly characterized, and integrated treatment approaches are lacking. Objective: This narrative review examines the role of oxidative stress and nuclear factor erythroid 2-related factor 2 (Nrf2) pathway dysfunction as a unifying molecular mechanism connecting fibromyalgia and eating disorders, with emphasis on implications for integrated rehabilitation strategies. Methods: We synthesized current evidence on oxidative stress pathophysiology in fibromyalgia and eating disorders, focusing on Nrf2-Keap1 pathway function, clinical comorbidity patterns and rehabilitation interventions targeting antioxidant defense mechanisms. In PubMed, representative search strings included “(fibromyalgia [MeSH] OR fibromyalgia [Title/Abstract]) AND (“eating disorders” [MeSH] OR “anorexia nervosa” [MeSH] OR “bulimia nervosa” [MeSH])” and “fibromyalgia AND (“oxidative stress” OR Nrf2 OR “redox”)”. Articles in English published through December 2025 were considered, with additional records identified by manually screening reference lists. Results: Fibromyalgia patients exhibit elevated oxidative stress markers, impaired antioxidant enzyme function and compromised Nrf2 activity correlating with disease severity, with studies reporting approximately 30–50% reductions in coenzyme Q10 levels compared with healthy controls. Similarly, eating disorders demonstrate mitochondrial dysfunction and oxidative stress dysregulation, though patterns differ across eating disorder phenotypes. Nrf2 serves as the master regulator of cellular antioxidant defense, coordinating expression of over 500 genes involved in detoxification, cytoprotection, inflammation modulation and metabolic regulation. Evidence suggests Nrf2 activity is regulated by energy balance, potentially linking nutritional status with cellular stress responses. Rehabilitation interventions, including graduated exercise and nutritional optimization with Nrf2-activating foods (cruciferous vegetables, polyphenols, omega-3 fatty acids), offer mechanism-based therapeutic approaches through hormetic Nrf2 activation and direct Keap1 modification. Conclusions: Multidisciplinary rehabilitation programs integrating physical therapy, exercise prescription and nutritional strategies targeting Nrf2 activation offer evidence-based, mechanism-driven approaches to address shared oxidative stress pathophysiology. Nrf2 pathway dysfunction represents a promising and biologically plausible molecular target that may help to unify our understanding of fibromyalgia and eating disorders pending confirmation from prospective clinical studies in comorbid populations. Future research should prioritize prospective clinical trials testing Nrf2-targeted interventions in comorbid populations and collaborative patient-centered care models. 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: Mental health (MH) comorbidity is elevated in individuals who identify as gender-diverse (GD) and in individuals with an eating disorder (ED). GD individuals with an ED may have significantly higher MH comorbidity than individuals with just one of these conditions. Gender Minority Stress Theory suggests that experience of stressful events associated with gender minority status may increase risk of developing MH difficulties and may explain the elevated risk of ED diagnosis in GD populations. Method: This is a cross-sectional analysis of survey data. Using data from a sample of 334,957 American university and college students, we compared MH comorbidities of 1885 GD individuals with an ED to demographically matched samples of non-GD individuals with an ED and GD individuals with no ED diagnosis. Results: Even following stringent demographic matching, GD participants with an ED had significantly more comorbid MH diagnoses (M = 4.23, SD = 2.23) than non-GD individuals with an ED (M = 2.86, SD = 1.98). Similarly, GD participants with an ED had significantly higher MH comorbidity than demographically matched GD individuals without an ED (M = 1.96, SD = 1.84). In GD individuals, ED diagnosis was associated with increased odds of experiencing minority stress events (OR: 2.19 95% CI [1.91–2.51]) and associated distress (OR: 2.17 95% CI [1.89–2.50]). Conclusions: We find that GD individuals with an ED report significantly elevated MH comorbidity, including serious MH disorders. Prompt intervention and proactive screening have an important role to play in supporting young adults in this vulnerable population. Full article

Background: Emotional dysregulation (ED) is a transdiagnostic construct implicated in a broad range of psychiatric conditions. However, the influence of gender on ED remains understudied, particularly among adolescents with severe mood and behavioral disorders. Furthermore, few studies have controlled for confounding effects of specific psychiatric diagnoses. Methods: We assessed 182 adolescents (80.8% female; mean age 15.7 years) referred to our clinical institution. Participants completed the Cyclothymic–Hypersensitive Temperament Questionnaire (CHTQ), the Reactivity, Intensity, Polarity, and Stability Questionnaire (RIPoSt-Y), and the K-SADS-PL interview. Results: Females reported significantly higher levels of CHTQ mood lability (7.53 vs. 5.94, p = 0.012), RIPoSt-Y affective instability (62.33 vs. 53.31, p = 0.023), and interpersonal sensitivity (30.80 vs. 24.97, p < 0.001). They also exhibited higher rates of cyclothymic–hypersensitive temperament (46.6% vs. 14.7%, p = 0.001). Regression analysis revealed that gender and specific psychiatric diagnoses exerted significant independent effects on ED dimensions. Mood lability/hypersensitivity was significantly predicted by bipolar disorder (p = 0.001), depressive disorder (p = 0.002), and female sex (p = 0.025). Affective instability was independently predicted by bulimia nervosa (p = 0.019), depressive disorder (p = 0.004), and female sex (p = 0.033). Significant predictors for interpersonal sensitivity included female sex (p = 0.002), depressive disorder (p = 0.008), bulimia nervosa (p = 0.044), and the absence of conduct disorder (p = 0.048). Conclusions: Female adolescents with severe psychiatric presentations exhibited higher levels of ED, specifically regarding mood lability, affective instability, and interpersonal sensitivity. These associations persisted independently of current mood disorder diagnoses or comorbidities. While findings from this clinical cohort may not be fully generalizable to the general population, they highlight the need for gender-informed clinical interventions for adolescents characterized by severe ED. 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: Self-compassion (SC) and shame-proneness (SP) are likely transdiagnostic factors implicated in the onset and maintenance of eating disorders (EDs). However, limited research has examined how these variables vary across distinct ED symptom profiles. To address this gap, this exploratory study aimed to identify latent symptom profiles among individuals diagnosed with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) and assess whether SC and SP levels and their association differ across classes. Methods: A clinical sample of 55 women with AN or BN completed self-report measures for assessing drive for thinness (DT), bulimia (BUL), body dissatisfaction (BD), self-compassion (SC), and SP. Latent Profile Analysis (LPA) was conducted, followed by ANOVA and moderation analysis. Results: LPA revealed three distinct profiles: (1) Low-symptom (i.e., low DT and BUL, moderate BD), (2) Restrictive (i.e., high DT and BD, low BUL), and (3) Multi-symptomatic (i.e., medium-high DT, BUL, and BD). SC significantly differed across profiles, with the Low-symptom group reporting higher SC than the others. No significant differences in SP were found. SC was negatively associated with ED symptoms and significantly moderated the relationship between SP and BD, but not DT or BUL. Conclusions: Findings highlight the heterogeneity of ED symptomatology and the importance of SC as a protective factor, particularly against body dissatisfaction. 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: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to (1) examine the course of ED symptoms from conception to postpartum, (2) evaluate pregnancy outcomes and children’s health and developmental milestones, and (3) assess ED status approximately four years after the initial evaluation. Methods: Thirty women with a prior ED diagnosis (21 with anorexia nervosa, 9 with bulimia nervosa) were evaluated at two time points. Time 1 with the Eating Disorders Examination and the Oxford Risk Factors for Eating Disorders: Interview Schedule; Time 2, approximately four years later, with the Eating Disorders Examination and the Clinical Interview on Reproductive History and Eating Behavior that also included clinical data related to mother’s health and baby’s health and development accessed through the Pregnant Women’s Health Bulletin and the Child and Youth Health Bulletin using the national health records. Results: ED symptoms (dietary restriction, self-induced vomiting, laxative misuse) persisted from conception through postpartum. BN participants reported more severe symptoms and higher rates of pregnancy complications (hyperemesis gravidarum, gestational diabetes, preeclampsia), while premature births occurred only in AN participants. Children of mothers with AN more frequently showed delays in developmental milestones (sitting, walking, speaking, sphincter control) compared to those of BN mothers. Conclusions: A substantial proportion of women with prior ED continued to experience symptoms during and after pregnancy, and nearly half still met diagnostic criteria four years later and are still in treatment. Cognitive features such as body dissatisfaction persisted despite partial symptom remission. These findings highlight the chronicity of ED and underscore the need for systematic screening, psychological support, and interdisciplinary follow-up during pregnancy and early motherhood. Full article

Background/Objectives: Eating disorders (EDs) frequently emerge during critical stages of childhood and adolescence, when identity development and emotional regulation are still maturing. Disturbances in self-concept clarity and identity integration may transform the body into a symbolic battlefield for autonomy, belonging, and self-worth. This review synthesizes developmental, psychosocial, neurocognitive, and therapeutic perspectives on the role of identity disturbance in EDs. Methods: A narrative review was conducted (2010–2025) using combinations of terms related to identity, self-concept clarity, self-discrepancy, objectification, interoception, and eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). Results: Findings indicate that identity vulnerability (expressed as low self-concept clarity, heightened self-discrepancies, and self-objectification) mediates the association between early adversity, sociocultural pressures, and ED symptoms. Neurocognitive studies reveal altered self-referential processing, default mode network connectivity, and interoceptive signaling. Clinically, comorbid borderline personality features further exacerbate identity disturbance and complicate recovery. Evidence-based treatments such as enhanced cognitive-behavioral therapy (CBT-E) effectively target core maintaining mechanisms, while adjunctive interventions (mentalization-based therapy, schema therapy, narrative approaches, and compassion- or acceptance-based methods) show promise in addressing identity-related processes and improving outcomes. Conclusions: Identity disturbance provides a unifying framework for understanding why ED symptoms become entrenched despite adverse consequences. Integrating identity-focused approaches with nutritional and medical care may enhance recovery and reduce chronicity in youth. Future research should adopt longitudinal and mechanistic designs to clarify pathways linking identity change to clinical improvement and test identity-specific augmentations to standard ED treatments. Full article