From One's Heart to the Mind of Others: A Study in School-Aged Children.

Studies have shown a significant association between effective parasympathetic modulation of the heart and processes linked to social cognition. Particularly, Quintana and colleagues documented a relation between vagally-mediated heart rate variability (vmHRV) and performance on a theory of mind (ToM) task, namely, the Reading the Mind in the Eyes Test (RMET), in a sample of university students. The purpose of the present study was to test whether such result would extend to a sample of school-aged children (7-9 years old) using the child version of the RMET. In addition, the Eyes Test Revised was administered as it is more suitable to evaluate ToM during childhood. Results supported the positive association between vmHRV and ToM abilities, replicating and extending previous results obtained in young adults. The current study adds to the existing literature pointing to HRV as a putative biomarker of social cognition abilities.

Social Anxiety and Drunkorexia Behaviors among Adolescents and Young Adults: The Moderating Role of Resilience.

Background: Existing evidence showed that social anxiety represents a significant factor in eating disorders. However, to our knowledge, no prior study has examined the association between social anxiety and drunkorexia behaviors. Objectives: The present study aimed at exploring the relationship between social anxiety and drunkorexia behaviors, and investigating resilience as a moderator of this relationship. Participants were 333 adolescents and young adults aged 15-24 years (Mage=18.26, SDage= 1.55; 66% females) who completed an online survey. Results: The results indicated that drunkorexia behaviors were positively correlated to three dimensions of social anxiety; however, only fear of negative evaluation had a significant predictive effect. In addition, resilience only moderated the relationship between fear of negative evaluation and drunkorexia behaviors, such that youths reporting high fear of negative evaluation and low resilience showed greater drunkorexia behaviors, whereas youths reporting high resilience showed no correlation between fear of negative evaluation and drunkorexia behaviors. Conclusions: The findings highlight the importance of drunkorexia interventions and preventive measures aimed at strengthening youths' resilience and ability to effectively manage stress and social anxiety (i.e., fear of negative evaluation).

Past body shaming experiences and food and alcohol disturbance in young adults: indirect effects via psychological distress.

PURPOSE: This study investigated the associations between retrospective reports of body image victimization (i.e. body shaming) perpetrated by peers and by parents during childhood or adolescence, and food and alcohol disturbance (FAD) in young adulthood, considering the possible mediating role of psychological distress (i.e. subthreshold symptoms of anxiety and depression). METHODS: The study involved 1624 young adults aged between 18 and 30 (69% women), who completed an online survey. RESULTS: Our findings revealed that participants who reported more frequent body image victimization episodes during childhood and adolescence exhibited higher levels of psychological distress and, in turn, higher scores of FAD in young adulthood. CONCLUSIONS: This result represents a novel contribution to understanding the psychological correlates of FAD in youths. Limitations and implications are discussed. Level of evidence Level V, descriptive study.

Exploring the relationship between dysfunctional metacognitive processes and orthorexia nervosa: the moderating role of emotion regulation strategies.

BACKGROUND: Dysfunctional metacognitive processes and emotional dysregulation have been widely documented in the eating disorder literature. Despite numerous research and recent consensus suggesting the categorization of orthorexia nervosa as a form of eating disorder, no previous study has examined whether aberrant metacognitive processes also correlate with orthorexia nervosa tendencies. This paper investigates potential associations between symptoms of orthorexia nervosa and dysfunctional metacognitive processes while also exploring whether such relationships may be influenced by adaptive/maladaptive emotion regulation strategies. METHODS: We conducted a cross-sectional study in all Lebanese governorates. In total, 423 Lebanese adults completed an online questionnaire including the Teruel Orthorexia Scale, the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale - 16 Item Version, and the Metacognitions Questionnaire - Short Form. RESULTS: Higher physical activity, expressive suppression, emotion regulation difficulties, positive metacognitive beliefs about worry, and need to control thoughts were significantly associated with higher orthorexia nervosa. Additionally, the emotion regulation strategies moderated the relationships between two dysfunctional metacognitive processes and orthorexia nervosa. Specifically, cognitive self-consciousness was negatively related to orthorexia nervosa only in individuals with low (versus higher) emotion suppression (maladaptive emotion regulation strategy). In contrast, negative beliefs about worry uncontrollability and danger positively predicted orthorexia nervosa only in individuals with lower (versus high) cognitive reappraisal (adaptive emotion regulation strategy). Lower socio-economic status and having a university level of education compared to secondary level were significantly associated with lower orthorexia nervosa. CONCLUSION: Our study provides the first empirical evidence for the existence of significant associations between dysfunctional metacognitive processes and orthorexia nervosa. It also highlights that these pathways are considerably modulated by individuals' ability to regulate their emotions adaptively versus maladaptively. Our findings thus suggest that therapies aimed at improving thought monitoring and emotional regulation may be beneficial for individuals with symptoms of orthorexia nervosa.

Body image impact on quality of life and adolescents' binge eating: the indirect role of body image coping strategies.

PURPOSE: The role of body image in adolescent binge eating is widely confirmed, albeit the various facets of this relationship are still mostly unexplored. Within the multidimensional body image framework, this study hypothesized the indirect effects of three body image coping strategies (positive rational acceptance, appearance fixing, avoidance) in the expected relationship between the perceived impact of body image on individuals' quality of life and binge eating symptoms. METHODS: Participants were 715 adolescents aged 15-21 years (49.1% girls) recruited in Italian schools. An anonymous self-report online survey was administered. A multiple mediation model was tested. RESULTS: A more positive perceived impact of body image on quality of life was a negative predictor of adolescents' binge eating, controlling for individual levels of body satisfaction. Three indirect effects were found in this relationship: on one hand, the positive body image impact reduced binge eating via increasing positive rational acceptance (M1), and via reducing avoidance (M2); on the contrary, the positive body image impact also enhanced binge eating via increasing appearance fixing (M3). CONCLUSIONS: The body image impact on quality of life can be alternatively protective-when adaptive coping is solicited, and maladaptive strategies are reduced-or a risk factor, which may increase binge eating by soliciting appearance fixing. LEVEL III: Evidence obtained from cohort or case-control analytic studies.

Emotion regulation and drunkorexia behaviors among Lebanese adults: the indirect effects of positive and negative metacognition.

BACKGROUND: Although metacognition processes are a core feature of restrictive eating and alcohol cravings and entail an individual to control both of his/her emotions and thoughts, yet, to our knowledge, a scarcity of research has examined their potential role in drunkorexia as cognitive and emotional predictors. The following study investigates the different associations between two emotion regulation strategies (i.e. emotional suppression and cognitive reappraisal) and drunkorexia behaviors in a sample of Lebanese adults, exploring the possible indirect effects of positive and negative alcohol-related metacognitions. METHODS: This was a cross-sectional study that enrolled 335 participants (March-July 2021). RESULTS: Higher problematic alcohol use (beta = 5.56), higher physical activity index (beta = 0.08), higher expressive suppression (beta = 0.23), higher negative metacognitive beliefs about cognitive harm due to drinking (beta = 0.75) and higher cognitive reappraisal (beta = 0.20) were significantly associated with more drunkorexic behaviors. The positive metacognitive beliefs about cognitive self-regulation significantly mediated the association between cognitive reappraisal and drunkorexia behaviors. Both the positive metacognitive beliefs about cognitive self-regulation and the negative metacognitive beliefs about the uncontrollability of drinking significantly mediated the association between expressive suppression and drunkorexia behaviors. CONCLUSION: This study demonstrated that emotional and metacognitive processes are associated with drunkorexia, addressing as well the mediating effect between deficient emotional regulation and risky behavioral patterns. Overall, our results would speculate that the lack of emotional and cognitive assets might enhance internal distress perceived out of control, leading individuals to indulge in maladaptive behavioral patterns for managing the underlying impairment.

Problematic alcohol use in young adults during the COVID-19 lockdown in Italy.

This study investigated the individual and contextual correlates of problematic alcohol use among young adults during COVID-19 lockdown in Italy. Participants were 1533 young adults aged 18 to 26 (Mage = 23.12, SDage = 2.11; 73.2% women), who completed an online survey during national lockdown. Inclusion criteria for this study were the age-range (18-26 y. o.), and living in Italy during COVID-19 lockdown. Participants with low or very low socioeconomic levels (vs. higher levels) were more at risk for problematic alcohol use, as well as participants who lived alone or with roommates/friends during lockdown. Conversely, participants who spent the lockdown with their family or partner were less at risk for problematic alcohol use. Finally, participants who had their job suspended due to pandemic (vs. other job conditions) were more at risk for problematic alcohol use during lockdown. Implications for research and clinical practice are discussed.

Food and alcohol disturbance among young adults during the COVID-19 lockdown in Italy: risk and protective factors.

PURPOSE: The COVID-19 lockdown measures have had a significant impact on risk behaviors as alcohol use and disordered eating. However, little is known about a serious health-risk-behavior named "food and alcohol disturbance" (FAD), characterized by engaging in dysfunctional eating on days of planned alcohol consumption. The aim of the present study was to investigate potential factors that may have put young adults at risk or protected against FAD during the COVID-19 lockdown. METHODS: A sample of 447 young adults (280 females, 167 males; range 18-26) completed an online survey during the country's nationwide lockdown composed of self-reported measures assessing FAD behaviors, alcohol consumption, compensatory behaviors, eating and weight concerns, social support, emotion regulation strategies, and living arrangement. RESULTS: Our findings showed that FAD was significantly and positively correlated to alcohol consumption, use of laxatives, self-induced vomiting, eating and weight concerns, and expressive suppression, and negatively correlated to social support and living with family. Hierarchical regression analysis revealed that alcohol consumption, eating concern, and expression suppression positively predicted FAD, while social support and living with family were negative predictors. CONCLUSIONS: Our results suggest that during the COVID-19 lockdown, preoccupation with eating and the use of expressive suppression may have increased vulnerability to FAD; conversely, perceived social support and living with family may have been a source of protection against this dysfunctional behavior. LEVEL OF EVIDENCE: Level V, descriptive study.

Drunkorexia behaviors and motives, eating attitudes and mental health in Lebanese alcohol drinkers: a path analysis model.

BACKGROUND: Drunkorexia refers to limited intake of high-calorie food to avert gaining weight and the need to increase in alcohol excessive consumption. The present study aimed to check for an association between depression, anxiety, and stress with drunkorexia behaviors/motives among Lebanese adults, while evaluating the mediating role of inappropriate eating attitude in those associations. METHODS: Two hundred and fifty-eight participants enrolled in this cross-sectional study, who filled an online survey (September-December 2020). RESULTS: Drunkorexia behaviors were considered as the dependent variable; the path coefficients from stress to anxiety, from anxiety to eating attitudes, from eating attitudes to drunkorexia behaviors and from anxiety to drunkorexia behaviors were all significant. The indirect relationships showed that eating attitudes mediated the association between anxiety and drunkorexia behaviors. When taking the drunkorexia motives as the dependent variable, the path coefficients from stress to anxiety, from anxiety to eating attitudes, from eating attitudes to drunkorexia motives, and from anxiety to drunkorexia motives were all significant. The indirect relationships showed that eating attitudes mediated the association between anxiety and drunkorexia motives. CONCLUSION: This study highlighted that individuals with more psychological problems (depression, anxiety, and stress) and inappropriate eating habits exhibit more drunkorexic motivations and behaviors. LEVEL OF EVIDENCE: Level V, Cross-sectional study.

Binge eating and binge drinking behaviors: the role of family functioning.

Binge eating and binge drinking are two of the most common health-risk behaviors among young people showing to frequently co-occur in nonclinical samples of adolescent boys and girls. The present study examined the role of different dimensions of family functioning in binge behaviors among adolescents. One thousand and twenty young to late adolescents (507 girls and 517 boys) with ages ranging from 16 to 22 years participated in the study and completed a survey of self-report measures. Our findings showed that adolescents who binge eat and drink and adolescents who only binge eat perceived a lower quality of family functioning with lower levels of cohesion, flexibility, communication, satisfaction and higher degree of disengagement compared to adolescents who do not binge and adolescents who only binge drink. Only adolescents who engage in both binge behaviors reported higher levels of chaotic style compared to other binge groups. Furthermore, living in families poorly flexible, highly disengaged and with communication problems among members resulted as risk factors for binge eating behavior. Results suggest the importance for prevention programs to be based on an integrated approach focused on improving family environment such as the ability in changing family structure to deal effectively with developmental problems and defining clear home rules adolescents may stand on.

Exploring the association between psychological distress and drunkorexia behaviors in non-clinical adolescents: the moderating role of emotional dysregulation.

PURPOSE: Although drunkorexia seems to represent a new form of eating disorder, it shares several features with traditional eating disorders. However, very little is known about the association between drunkorexia and a widely studied correlate of eating disorders, such as psychological distress and about mechanisms underlying this association. The present study aimed to investigate the relation between symptoms of anxiety and depression and drunkorexia, and to explore the role of emotional dysregulation as moderator of this relationship. METHODS: The sample was composed of 402 adolescents (222 females, 180 males; range 15-21) who completed self-reported measures: Drunkorexia Motives and Behaviors Scale, which assesses different behaviors and motivations associated with drunkorexia, Emotional dysregulation scale from the Eating Disorder Inventory-3, reflecting difficulties regulating emotions, and Anxiety and Depression scales from the Symptom CheckList-90 Revised, assessing general signs of anxious and depressive symptoms. RESULTS: Anxious symptomatology resulted a significant statistical predictor of drunkorexia behaviors (ß = .28, p = .001). Furthermore, emotional dysregulation moderated the relation between anxiety and drunkorexia; specifically, a positive relation was found both at medium levels (ß = .22, p = .007) and at higher levels of emotional dysregulation (ß = .38, p = .000), whereas at lower levels of emotional dysregulation, this association became nonsignificant. CONCLUSIONS: Findings suggest that adolescents who experience both elevated anxiety and emotional dysregulation may be more likely to turn to drunkorexia to reduce their unregulated negative affect in the absence of more adaptive emotion regulation strategies. Implications for intervention and prevention programs are discussed. LEVEL OF EVIDENCE: Level V, descriptive study.

Psychological characteristics and eating attitudes in adolescents with drunkorexia behavior: an exploratory study.

PURPOSE: Drunkorexia represents an emerging phenomenon that is still understudied especially among adolescents. The present study aimed to investigate the relation between drunkorexia and psychological characteristics relevant and commonly associated with existing forms of eating disorders. METHODS: The sample was composed of 849 adolescents (513 boys, 334 girls, 2 unknown; range 14-22) who completed a survey composed of Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale and Psychological scales of the Eating Disorders Inventory-3. RESULTS: Our findings highlighted that drunkorexia was associated with low self-esteem, personal alienation, interoceptive deficits, emotional dysregulation, and asceticism. Hierarchical multiple regression analysis indicated that difficulties with emotion regulation and ascetic tendencies were significant predictors of drunkorexia among adolescents. CONCLUSIONS: Our findings suggest the importance for programs preventing drunkorexia to be focused on training adolescents in using more adaptive strategies to manage emotions and accepting both emotional and physical signals without feeling guilty or threatened. LEVEL OF EVIDENCE: Level V, descriptive study.

Autonomic response to the Adult Attachment Projective in anorexia nervosa.

PURPOSE: Cardiovascular complications associated with anorexia nervosa (AN) are well recognized. Whether a wide array of studies has investigated autonomic nervous system (ANS) functioning at rest in people with AN, few is yet known on their reactivity ability during stress conditions. The aim of the current study is testing ANS reactivity to a stressful task activating attachment system among adolescents with AN. METHODS: Heart rate (HR) and its variability, as derived by high-frequency-heart rate variability (HF-HRV), were continuously assessed while 13 AN patients and 12 healthy controls (HCs) responded to a set of attachment-related drawings (Adult Attachment Projective, AAP). RESULTS: Findings showed that patients with AN displayed a stronger parasympathetic activity, as indicated by generally a lower heart rate (HR) during the entire task and a higher HF-HRV for drawings eliciting dyadic interactions compared to HCs. CONCLUSION: The study findings suggest a novel understanding of cardiovascular functioning in AN. LEVEL OF EVIDENCE: Level V, descriptive study.

Lobular patterns of cerebellar resting-state connectivity in adults with Autism Spectrum Disorder.

Autism spectrum disorder is a neurodevelopmental disorder characterized by core deficits in social functioning. Core autistics traits refer to poor social and imagination skills, poor attention-switching/strong focus of attention, exceptional attention to detail, as expressed by the autism-spectrum quotient. Over the years, the importance of the cerebellum in the aetiology of autism spectrum disorder has been acknowledged. Neuroimaging studies have provided a strong support to this view, showing both structural and functional connectivity alterations to affect the cerebellum in autism spectrum disorder. According to the underconnectivity theory, disrupted connectivity within cerebello-cerebral networks has been specifically implicated in the aetiology of autism spectrum disorder. However, inconsistent results have been generated across studies. In this study, an integrated approach has been used in a selected population of adults with autism spectrum disorder to analyse both cerebellar morphometry and functional connectivity. In individuals with autism spectrum disorder, a decreased cerebellar grey matter volume affected the right Crus II, a region showing extensive connections with cerebral areas related to social functions. This grey matter reduction correlates with the degree of autistic traits as measured by autism-spectrum quotient. Interestingly, altered functional connectivity was found between the reduced cerebellar Crus II and contralateral cerebral regions, such as frontal and temporal areas. Overall, the present data suggest that adults with autism spectrum disorder present with specific cerebellar structural alterations that may affect functional connectivity within cerebello-cerebral modules relevant to social processing and account for core autistics traits.

Interpersonal and Intrapersonal Differences among Adolescent Nonsmokers, Ex-Smokers, and Smokers.

BACKGROUND: A large body of research has traced tobacco dependence among adolescents to a series of intrapersonal and interpersonal factors. However, there are remaining questions regarding the differences on these factors related to tobacco use. OBJECTIVES: We sought to investigate intrapersonal and interpersonal differences among adolescent nonsmokers, ex-smokers, and smokers. METHODS: We used data from a 3-year project designed to investigate and address tobacco dependence among 1071 students (Mage = 15.76, SD = 1.52; girls = 51.54%) who were recruited from 11 high schools. Participants, filling out a survey, provided information on tobacco use (nonsmoker, ex-smoker, and smoker), tobacco-related experiences (smoking-related risk perception, parental smoking, number of friends who smoke, resisting peer pressure to smoke), cognitive variables (metacognitive skills), and personality traits (disinhibition and impulsivity). RESULTS: Results from a discriminant function analysis showed that smokers and ex-smokers reported more disinhibition, impulsivity, number of friends who smoke and less self-control under peer pressure to smoke compared to nonsmokers. Ex-smokers reported less metacognitive processes, more smoking-related risk perception and were less likely to have parents who smoke. Conclusions/Importance: Interventions and campaigns aimed to persuade adolescents to stop smoking should work to develop adaptive metacognitive skills and an accurate risk perception of tobacco use.

Metacognition, emotional functioning and binge eating in adolescence: the moderation role of need to control thoughts.

PURPOSE: Binge eating is predicted by emotion dysregulation and poor emotional awareness. Dysfunctional metacognition is also implied in several eating disorders, but research has not yet investigated the interactions among emotional and metacognitive processes involved in binge eating. The present study investigated the relation between metacognition and binge eating in a sample of adolescents, testing the interaction effect between the need to control thoughts and the lack of emotional awareness on binge eating. METHODS: Participants were 804 adolescents (age range 15-20; 49.7% female), who completed self-report instruments assessing binge eating, emotion regulation, and metacognition. RESULTS: Binge eating was predicted by gender, BMI, emotion dysregulation, lack of emotional awareness, and dysfunctional metacognition dimensions (cognitive confidence and need to control thoughts). An important moderating effect was found, whereby the relationship between binge eating and lack of emotional awareness was only significant for individuals with a high need to control thoughts. CONCLUSIONS: Results described emotional and metacognitive functioning in binge eating adolescents, suggesting that the need to control thoughts is a risk factor, whereas good metacognitive competencies are protective from binge eating, even in presence of poor emotional awareness. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Resting-State Functional Connectivity Changes Between Dentate Nucleus and Cortical Social Brain Regions in Autism Spectrum Disorders.

Autism spectrum disorders (ASDs) are known to be characterized by restricted and repetitive behaviors and interests and by impairments in social communication and interactions mainly including "theory of mind" (ToM) processes. The cerebellum has emerged as one of the brain regions affected by ASDs. As the cerebellum is known to influence cerebral cortex activity via cerebello-thalamo-cortical (CTC) circuits, it has been proposed that cerebello-cortical "disconnection" could in part underlie autistic symptoms. We used resting-state (RS) functional magnetic resonance imaging (fMRI) to investigate the potential RS connectivity changes between the cerebellar dentate nucleus (DN) and the CTC circuit targets, that may contribute to ASD pathophysiology. When comparing ASD patients to controls, we found decreased connectivity between the left DN and cerebral regions known to be components of the ToM network and the default mode network, implicated in specific aspects of mentalizing, social cognition processing, and higher order emotional processes. Further, a pattern of overconnectivity was also detected between the left DN and the supramodal cerebellar lobules associated with the default mode network. The presented RS-fMRI data provide evidence that functional connectivity (FC) between the dentate nucleus and the cerebral cortex is altered in ASD patients. This suggests that the dysfunction reported within the cerebral cortical network, typically related to social features of ASDs, may be at least partially related to an impaired interaction between cerebellum and key cortical social brain regions.

Persuasion in school-aged children: How does it change if the persuadee is the mother or the peer?

The present study was designed to verify how school-aged children's persuasive tactics changed if the persuadee was the mother or the peer. One hundred and forty-nine children at two grade levels (4th and 5th) were enrolled in the study. Persuasive strategies were investigated using pictures representing two common situations in which each child had to convince his/her playmate and his/her mother to obtain a toy. As predicted, with mothers children engaged more frequently in strategies aimed at encouraging cognitive reappraisal of the situation and offering guarantees. Conversely, with the peers, children adopted a greater variety of persuasive strategies, engaging in lower-order tactics. Implications and limitations of the study were discussed.

Theory of mind in non-suicidal self-injury (NSSI) adolescents.

UNLABELLED: The aim of the present study is to investigate different facets of the theory of mind (ToM), i.e. first vs. third-person, first vs. second-order ToM, egocentric vs. allocentric perspective, in a clinical sample of 20 non-suicidal self-injury (NSSI) adolescent inpatients and 20 healthy controls. METHODS: We investigated whether performance in ToM tasks was related to both the type and frequency of self-injuring behavior and attitude toward life and death, using a semi-structured interview and different self-report questionnaires. RESULTS: NSSI participants performed less well than the control group in all the ToM dimensions investigated. Furthermore, ToM performance was negatively related to Attraction to Death, in terms of both the type and frequency of self-injuring behavior, and it was positively related to Attraction to Life. CONCLUSIONS: These preliminary findings have interesting implications for future clinical investigations, in that they provide previously unavailable information regarding the association between ToM and NSSI behavior.

The moderating role of internalising negative emotionality in the relation of self-regulation to social adjustment in Italian preschool-aged children.

The purpose of this study was to examine the moderating role of internalising negative emotionality (i.e., anxious, concerned, and embarrassed displays) in the association between children's self-regulation and social adjustment. Seventy-four Italian children (44 girls, 30 boys; M age = 35.05 months, SD = 3.57) were assessed using two self-regulation tasks. Internalising negative emotionality was assessed through observations of children's emotion expressions during the tasks. Teachers evaluated children's social competence and internalising and externalising problems. Results demonstrated that among children who exhibited internalising negative emotionality, self-regulation was positively associated with social competence and negatively related to externalising problems. Our results suggest that self-regulation may play a crucial role for social adjustment when children show emotions such as anxiety and embarrassment during challenging situations.