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).

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.

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.

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.

Validation of a self-reported HIV symptoms list: the ISS-HIV symptoms scale.

BACKGROUND: To describe the development and the psychometric properties of the Istituto Superiore di Sanità-HIV symptoms scale (lSS-HIV symptoms scale). METHODS: The ISS-HIV symptom scale was developed by an Italian working team including researchers, physicians and people living with HIV. The development process went through the following steps: (1) review of HIV/AIDS literature; (2) focus group; (3) pre-test analysis; (4) scale validation. RESULTS: The 22 symptoms of HIV-ISS symptoms scale were clustered in five factors: pain/general discomfort (7 items); depression/anxiety (4 items); emotional reaction/psychological distress (5 items); gastrointestinal discomfort (4 items); sexual discomfort (2 items). The internal consistence reliability was for all factors within the minimum accepted standard of 0.70. CONCLUSIONS: The results of this study provide a preliminary evidence of the reliability and validity of the ISS-HIV symptoms scale. In the new era where HIV infection has been transformed into a chronic diseases and patients are experiencing a complex range of symptoms, the ISS-HIV symptoms scale may represent an useful tool for a comprehensive symptom assessment with the advantage of being easy to fill out by patients and potentially attractive to physicians mainly because it is easy to understand and requires short time to interpret the results.

Family Functioning and Dysfunctional Eating Among Italian Adolescents: The Moderating Role of Gender.

The first aim of this study was to examine the association between different dimensions of family functioning and dysfunctional eating in a sample of Italian adolescent boys and girls. The second aim was to investigate whether gender moderates the relationship between family functioning and dysfunctional eating. Seven hundred and twenty seven adolescents (500 boys and 227 girls) with ages ranging from 15 to 18 years completed a survey of self-report measures. Findings from hierarchical multiple regression analysis suggested that aspects of family functioning such as flexibility, cohesion, disengagement, enmeshment, rigidity and chaotic were related to dysfunctional eating in adolescents. Additionally the results indicated differences between boys and girls, in particular dysfunctional eating in adolescent boys seemed to be more affected by dimensions of enmeshment and disengagement than dysfunctional eating in girls. This research highlights the important role of various aspects of family functioning in relation to dysfunctional eating in adolescents.

Are adolescents with anorexia nervosa better at reading minds?

INTRODUCTION: The present study aimed to investigate mindreading abilities in female adolescent patients with AN compared to healthy controls (HCs), analysing differences for emotional valence of facial stimuli. METHODS: The Eating Disorder Inventory) for evaluating psychological traits associated with eating disorders and the Children's version of the Reading the Mind in the Eyes Test for evaluating mindreading abilities were administered to 40 Italian female patients (mean age = 14.93; SD = 1.48) with restrictive diagnosis of anorexia nervosa (AN) and 40 healthy females (mean age = 14.88; SD = 0.56). RESULTS: No significant differences between the AN group and HCs for the Eyes Total score were found. Even when analysing emotional valence of the items, the two groups were equally successful in the facial recognition of positive, negative and neutral emotions. A significant difference was revealed for the percentage of correct responses of item 10 and item 15, where the AN group was less able to correctly identify the target descriptor (Not believing) over the foils than HCs. A significant difference was revealed in discriminating for affective emotions versus cognitive states; only for affective but not for cognitive states, patients with AN were found to perform better than controls on the mindreading task. CONCLUSIONS: Our study highlighted the importance of analysing and discriminating for different valences of facial stimuli when assessing mindreading abilities in adolescents with AN, so that more precise and specific treatment approaches could be developed for female adolescents with AN.

The Psychological Impact of the COVID-19 Pandemic on Alcohol Abuse and Drunkorexia Behaviors in Young Adults.

The COVID-19 outbreak negatively affected young adults' psychological well-being, increasing their stress levels and symptoms of anxiety and depression, and potentially triggering health-risk behaviors. The present study was aimed at investigating the psychological impact of the COVID-19 pandemic on alcohol abuse and drunkorexia behaviors among young adults living in Italy. Participants were 370 emerging adults (63% women, 37% men; Mage = 21.00, SDage = 2.96, range: 18-30) who were recruited through an online survey between November 2021 and March 2022. Participants completed measures of alcohol abuse, drunkorexia behaviors, negative life experiences, and post-traumatic symptoms related to the COVID-19 outbreak. The results showed that the emotional impact and negative life experiences associated with the pandemic predicted both alcohol abuse and drunkorexia behaviors, albeit in different ways. Specifically, the number of negative life experiences during the pandemic and the tendency to avoid COVID-19-related negative thoughts positively predicted alcohol abuse; and the presence of intrusive thoughts associated with the pandemic significantly predicted the frequency of drunkorexia behaviors. Implications for research and clinical practice are discussed.

Individualism-Collectivism and COVID-19 Prevention Behaviors in Young Adults: The Indirect Effects of Psychological Distress and Pandemic Fears.

Stemming on the theoretical framework of individualism-collectivism, this study aims to interpret COVID-19 prevention behaviors in young adults in the light of cultural orientations, hypothesizing the mediating role of two pandemic affects (i.e., fear for COVID-19 consequences and psychological distress during pandemic). Participants were 296 young adults living in Italy (Mage = 23.96, SDage = 3.04; 79.7% women), who completed an online anonymous survey. Data were gathered from December 2020 to May 2021. A path analysis model explored direct and indirect relationships among study variables. Psychological distress significantly reduced the compliance with prevention measures, whereas pandemic fears increased it. The collectivistic orientations (Vertical Collectivism and Horizontal Collectivism) positively predicted prevention behaviors via increasing pandemic fears. The egalitarian dimensions (Horizontal Individualism and Horizontal Collectivism) were positive predictors of compliance via reducing psychological distress during pandemic. Finally, Vertical Individualism was a risk factor that negatively predicted prevention behaviors both directly and indirectly, via increasing psychological distress. The results provide new insights into the emotional mechanisms that link individualism and collectivism orientations to COVID-19 prevention behaviors, with interesting implications for public health policies, prevention, and future research.

Love in Quarantine: Sexting, Stress, and Coping During the COVID-19 Lockdown.

Introduction: This study investigated the relationships of pandemic-related stress and coping strategies with different kinds of sexting (i.e., experimental, risky, and emotional) during the COVID-19 lockdown in the Italian context. Methods: A sample of 1929 emerging adults (Mage = 24.17, SDage = 2.75; 71.6% girls) completed an online survey about their sexting behaviors during the national lockdown in Italy. Data were gathered in April/May 2020, from 6th to 11th week of home confinement due to COVID-19 pandemic. Hierarchical regression and mediation analyses were performed. Results: Pandemic-related stress directly predicted only risky and emotional sexting. Experimental and emotional sexting were positively predicted by social support, and negatively predicted by turning to religion. Risky and emotional sexting were positively predicted by avoidance, and negatively predicted by problem solving. Adaptive coping (i.e., social support) mediated the relationships from pandemic-related stress to both experimental and emotional sexting. Maladaptive coping (i.e., avoidance and problem solving) mediated the relationships from pandemic related-stress to risky and emotional sexting. Conclusions: Sexting was a coping tool during COVID-19 lockdown, showing both adaptive and maladaptive facets. Policy Implications: Findings suggest new directions for implementing programs of sexual education and safer Internet use targeted to young people.

A model to understand COVID-19 preventive behaviors in young adults: Health locus of control and pandemic-related fear.

This study investigated COVID-19 preventive behaviors in young adults, exploring the predictive roles of health locus of control and pandemic fear. A sample of 188 Italian young adults (Mage = 22.76, SDage = 1.95; 85% girls) completed an anonymous online survey assessing preventive behaviors, health locus of control styles (i.e. internal, chance, powerful others), and two dimensions of pandemic fear. Fear for COVID-19 consequences-but not general fear for contagion-significantly predicted prevention behaviors, and it also moderated the relationships between each health locus of control style and preventive behaviors. Our findings have relevant implications for research and social policies.

Drunkorexia: An Examination of the Role of Theory of Mind and Emotional Awareness among Adolescents.

This study aimed to investigate Theory of Mind (ToM) and emotional awareness in drunkorexia, an emerging behavior characterized by calorie restriction when drinking alcohol is planned. A sample of 246 adolescents (148 females, 98 males; range 17-20) completed self-reported measures assessing drunkorexia, ToM and lack of emotional awareness. Drunkorexia was negatively correlated with ToM abilities, with reading neutral emotions, and positively with lack of emotional awareness. ToM and lack of emotional awareness were also found to predict drunkorexia. Findings highlighted that adolescents who engage in drunkorexia may have difficulties in reading others' mental states and being aware of their emotions.

Emotion regulation and alcohol abuse in second-generation immigrant adolescents: The protective role of cognitive reappraisal.

The individual predictors of drinking behaviors among second-generation immigrant adolescents are still understudied. This study investigated emotion regulation strategies and alcohol abuse in 472 adolescents (86 second-generation immigrants and 386 Italian natives; age range: 17-18). The Emotion Regulation Questionnaire and the Alcohol Use Disorder Identification Test were used to assess cognitive reappraisal, emotional suppression, and alcohol abuse, respectively. Immigrants reported lower alcohol abuse than natives. A negative relationship between cognitive reappraisal and alcohol abuse was found for immigrants, but not for natives. Specifically, cognitive reappraisal was a protective factor against alcohol abuse only for immigrant adolescents. Clinical and research implications are discussed.

Drunkorexia: Disordered eating behaviors and risky alcohol consumption among adolescents.

The first goal of our study was to examine the differences on disordered eating and alcohol consumption among heavy, occasional restrictors, and non-restrictors in a sample of 823 adolescents. The second goal was to analyze the relation of drunkorexia between unhealthy eating and alcohol use. Our results showed that heavy restrictors reported more eating disorder symptoms and alcohol use than occasional restrictors and non-restrictors. Similarly, occasional restrictors showed more unhealthy eating and drinking behaviors than non-restrictors. Both disordered eating and alcohol use were significant predictors of drunkorexia, supporting the argument of drunkorexia as an overlapping of dysfunctional eating and drinking patterns.