The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study.

BACKGROUND: A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency. METHODS: An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers-80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors. RESULTS: A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress. CONCLUSIONS: The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.

Inpatient treatments for adults with anorexia nervosa: a systematic review of literature.

PURPOSE: Anorexia nervosa (AN) is a mental disorder for which hospitalization is frequently needed in case of severe medical and psychiatric consequences. We aim to describe the state-of-the-art inpatient treatment of AN in real-world reports. METHODS: A systematic review of the literature on the major medical databases, spanning from January 2011 to October 2023, was performed, using the keywords: "inpatient", "hospitalization" and "anorexia nervosa". Studies on pediatric populations and inpatients in residential facilities were excluded. RESULTS: Twenty-seven studies (3501 subjects) were included, and nine themes related to the primary challenges faced in hospitalization settings were selected. About 81.48% of the studies detailed the clinical team, 51.85% cited the use of a psychotherapeutic model, 25.93% addressed motivation, 100% specified the treatment setting, 66.67% detailed nutrition and refeeding, 22.22% cited pharmacological therapy, 40.74% described admission or discharge criteria and 14.81% follow-up, and 51.85% used tests for assessment of the AN or psychopathology. Despite the factors defined by international guidelines, the data were not homogeneous and not adequately defined on admission/discharge criteria, pharmacological therapy, and motivation, while more comprehensive details were available for treatment settings, refeeding protocols, and psychometric assessments. CONCLUSION: Though the heterogeneity among the included studies was considered, the existence of sparse criteria, objectives, and treatment modalities emerged, outlining a sometimes ambiguous report of hospitalization practices. Future studies must aim for a more comprehensive description of treatment approaches. This will enable uniform depictions of inpatient treatment, facilitating comparisons across different studies and establishing guidelines more grounded in scientific evidence. LEVEL OF EVIDENCE: Level I, systematic review.

An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome.

BACKGROUND: The clinical value of the identification of mood disorders in patients with acute coronary syndrome (ACS) is well established. However, assessment based on DSM criteria presents some limitations. This study aimed to provide an innovative strategy for evaluating the spectrum of mood disturbances in ACS. METHODS: A total of 288 patients with a first episode of ACS underwent interviews based on DSM-IV-TR criteria (major depressive disorder, minor depression, and dysthymia), Diagnostic Criteria for Psychosomatic Research-DCPR (demoralization and type A behavior), and the Clinical Interview for Depression-CID. Additional self-report inventories (psychological well-being and distress) were administered. A total of 100 consecutive patients who satisfied criteria for DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlled trial on a sequential combination of cognitive-behavioral and well-being therapy (CBT/WBT) vs clinical management (CM) and reassessed up to 30-month post-intervention. RESULTS: A total of 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion of demoralization and type A identified psychological distress in 58% of the sample. According to CID, reactivity to social environment, fatigue, depressed mood, and somatic anxiety were the most common symptoms. Somatic symptoms were significantly associated with DSM-IV-TR depression (fatigue and changes of appetite), whereas environmental reactivity with demoralization. Both depression and demoralization were associated with higher distress and lower well-being. Unlike CM, CBT/WBT was significantly associated with decrease of guilt, pessimism, fatigue, and early insomnia (CID). CONCLUSIONS: The findings indicate that standard psychiatric approach identifies only a narrow part of mood disturbances affecting ACS patients. A more articulated assessment unravels specific clinical configurations that may entail prognostic and therapeutic implications.

Association of emotion recognition ability and interpersonal emotional competence in anorexia nervosa: A study with a multimodal dynamic task.

OBJECTIVE: Interpersonal difficulties are evidenced in Anorexia Nervosa (AN) and are thought to contribute to disease onset and maintenance, however, research in the framework of emotional competence is currently limited. Previous studies have often only used static images for emotion recognition tasks, and evidence is lacking on the relationships between performance-based emotional abilities and self-reported intra- and interpersonal emotional traits. This study aimed to test multimodal dynamic emotion recognition ability in AN and analyze its correlation with the psychometric scores of self- and other-related emotional competence. METHOD: A total of 268 participants (128 individuals with AN and 140 healthy controls) completed the Geneva Emotion Recognition Test, the Profile of Emotional Competence, the Reading the Mind in the Eyes Test, and measures of general and eating psychopathology. Scores were compared between the two groups. Linear mixed effects models were utilized to examine the relationship between emotion recognition ability and self-reported measures and clinical variables. RESULTS: Individuals with AN showed significantly poorer recognition of emotions of both negative and positive valence and significantly lower scores in all emotional competence dimensions. Beside emotion type and group, linear mixed models evidenced significant effects of interpersonal comprehension on emotion recognition ability. DISCUSSION: Individuals with AN show impairment in multimodal emotion recognition and report their difficulties accordingly. Notably, among all emotional competence dimensions, interpersonal comprehension emerges as a significant correlate to emotion recognition in others, and could represent a specific area of intervention in the treatment of individuals with AN. PUBLIC SIGNIFICANCE: In this study, we evidence that the ability to recognize the emotions displayed by others is related to the level of interpersonal emotional competence reported by individuals with anorexia nervosa. This result helps in understanding the social impairments in people with anorexia nervosa and could contribute to advancements in the application of the training of emotional competence in the treatment of this disorder.

Easy to get, difficult to avoid: Behavioral tendencies toward high-calorie and low-calorie food during a mobile approach-avoidance task interact with body mass index and hunger in a community sample.

In recent years, different studies highlighted the importance of assessing behavioral tendencies toward different food stimuli in healthy and pathological samples. However, heterogeneities in experimental approaches and small sample sizes make this literature rather inconsistent. In this study, we used a mobile approach-avoidance task to investigate the behavioral tendencies toward healthy and unhealthy foods compared to neutral objects in a large community sample. The role of some contextual and stable subjective variables was also explored. The sample included 204 participants. The stimuli comprised 15 pictures of unhealthy foods, 15 pictures of healthy foods, and 15 pictures of neutral objects. Participants were required to approach or avoid stimuli by respectively pull or push the smartphone toward or away from themselves. Accuracy and reaction time of each movement were calculated. The analyses were conducted using a generalized linear mixed-effect model (GLMMs), testing the two-way interaction between the type of movement and the stimulus category and the three-way interactions between type of movement, stimulus, and specific variables (BMI, time passed since the last meal, level of perceived hunger). Our results evidenced faster approaching movement toward food stimuli but not toward neutrals. An effect of BMI was also documented: as the BMI increased, participants became slower in avoiding unhealthy compared to healthy foods, and in approaching healthy compared to unhealthy stimuli. Moreover, as hunger increased, participants became faster in approaching and slower in avoiding healthy compared to unhealthy stimuli. In conclusion, our results show an approach tendency toward food stimuli, independent from caloric content, in the general population. Furthermore, approach tendencies to healthy foods decreased with increasing BMI and increased with perceived hunger, indicating the possible influence of different mechanisms on eating-related behavioral tendencies.

Negative health outcomes in depressed cardiac patients are associated with both low and high psychological well-being dimensions.

Literature supports the positive effects of psychological well-being (P.W.B.) on health. However, most studies focused on the unitary construct of P.W.B., neglecting the different role played by distinct P.W.B. dimensions on health-related outcomes. The aim of this study was to determine whether unbalanced (i.e. low or high) levels of P.W.B. dimensions could differentially affect cardiac course after acute coronary syndrome (A.C.S.), in terms of participation in secondary prevention (S.P.) and/or survival. The sample included 136 depressed and/or demoralized A.C.S. patients referred for a S.P. program on lifestyle modification, in addition to routine cardiac visits provided by the hospital where they were admitted. Psychological assessment included validated interviews on depression and demoralization, Symptom Questionnaire and Psychological Well-Being scales. 100 patients joined the S.P. program, 36 did not. Logistic regression revealed that older age (B = 0.051; p < 0.05), higher autonomy (B = 0.070; p < 0.05) and lower personal growth (B = -0.073; p < 0.05) levels were associated with non-participation in S.P. Moreover, only among patients who did not join the program, those presenting with an impaired level of P.W.B. 'positive relations' dimension (i.e. below the 25th percentile) showed a worse cardiac prognosis (Log Rank: χ2(1) = 4.654; p = 0.031). Negative health outcomes in depressed cardiac patients, such as non-participation in S.P. and worse cardiac course, are associated with both high and low levels of certain P.W.B. dimensions. Psychotherapeutic approaches geared to a balance in P.W.B. dimensions could represent promising new additions to S.P. programs.

Perfectionism in anorexia nervosa: Associations with clinical picture and personality traits.

Although many researchers addressed the topics, no consistent data are currently available regarding the relationship between perfectionism and personality traits in anorexia nervosa (AN). The present study aimed to assess differences between high- and low-perfectionism groups of patients with AN and to identify which variables show the strongest association with perfectionism. A group of inpatients with AN (n = 193) was recruited and completed a battery of self-report questionnaires regarding eating-related and general psychopathology, perfectionism, and personality. On the basis of perfectionism scores, patients were divided into high- and low-perfectionism groups. High-perfectionist patients displayed higher eating-related and general psychopathology; higher depressive, cyclothymic, irritable and anxious temperament, and lower self-directedness, cooperativeness and self-esteem. Perfectionism was associated with the drive for thinness, cooperativeness, self-esteem and anxious temperament. On the basis of the two personality traits most strongly correlated with perfectionism (i.e., cooperativeness and anxious temperament), patients could be correctly assigned to the high- or low-perfectionism group by an algorithm. The study suggests that perfectionism in AN is related to eating psychopathology, especially of restrictive type, and personality features such as cooperativeness and anxious temperament. These findings confirm the important role of perfectionism in AN, not only concerning eating behaviour but personality as well.

Anorexia Nervosa and Somatoform Dissociation: A Neglected Body-Centered Perspective.

Dissociation in anorexia nervosa (AN) is common (literature reported 29% of dissociative disorders in eating disorders) and higher in patients with binge-purging AN (BP-AN) than in those with restricter AN (R-AN). However, the distinction between somatoform (SomD) and psychoform dissociation (PsyD) is understudied. We aimed to assess the differences in PsyD and SomD, eating-related, general, and body-related psychopathology, and childhood trauma between subtypes of AN. Then, we attempted to describe a subgroup of patients with AN with marked SomD comparing them to patients without SomD, also controlling the results for PsyD and AN subtypes. Inpatients with AN (n = 111; 109 women and 2 men) completed self-reported questionnaires evaluating dissociation, eating-related, body-related, and general psychopathology, and childhood abuses. Patients with BP-AN reported higher SomD and PsyD and a more severe clinical picture than those with R-AN. The SomD-group (n = 41) showed higher eating concerns, trait-anxiety, body-related variables, and sexual/physical abuse compared to the no-SomD group (n = 70), independently of AN subtype and PsyD symptoms. Results described particular features of patients with AN and SomD. Data, clinically, suggest a careful assessment, for both SomD and PsyD, especially when a history of bodily-impacting trauma is present, potentially fostering dissociation-informed interventions.

The oracle of Delphi 2.0: considering artificial intelligence as a challenging tool for the treatment of eating disorders.

In this editorial, we discuss how the diffusion of Artificial Intelligence (AI)-based tools-such as the recently available conversational AIs-could impact and transform eating disorders (EDs) care. We try to envision the possible use of AI by individuals affected by EDs and by clinicians, in terms of prevention, support to treatment, and development of new and actually personalized treatment strategies. We then focus on how the introduction of AI into psychotherapy could either represent an element of disruption for the therapeutical relationship or be positively and creatively integrated into session and inter-sessional dynamics. As technological advancements open scenarios where anyone could have access to a personal and all-knowing "oracle", the ability to formulate questions, individuals' experiences, and the scientific rigor with which clinicians study them must remain at the center of our work. Ethical and legal issues about the use of AI are also considered.

The Nepean Belief Scale (NBS) as a tool to investigate the intensity of beliefs in anorexia nervosa: psychometric properties of the Italian version.

BACKGROUND: People with anorexia nervosa (AN) show a peculiar impairment of insight regarding their condition, often manifesting a denial of extreme emaciation and sometimes hiding or underreporting socially undesirable abnormal eating patterns. Sometimes the intensity of the beliefs held by patients with AN reach a delusional intensity. OBJECTIVES: In this study, the Italian version of the Nepean Belief Scale was applied to a sample of patients diagnosed with AN to investigate the intensity of their beliefs and convictions and its clinical correlates. METHODS: The Nepean Belief Scale (NBS) was translated and adapted to Italian and applied to a sample of patients diagnosed with AN based on the Structured Clinical Interview for DSM-5 (SCID-5). RESULTS: The Italian version of the 5-item NBS showed excellent reliability. Convergent validity was proved by negative association with levels of insight measured with the Schedule for the Assessment of Insight in Eating Disorders. Beliefs of delusional intensity were reported by 10% of participants. Those with a greater intensity of beliefs, either overvalued or delusional ideas, were more likely to report poorer general cognitive performances on the Montreal Cognitive Assessment. No association was observed between NBS score and age, body mass index, symptoms of eating disorders, body dissatisfaction, or levels of depression. Fear of weight gain and control seeking were the most often reported themes at the NBS. CONCLUSIONS: The Italian version of the NBS is a reasonably reliable, valid, and usable tool for the multidimensional assessment of insight in AN. Level of evidence Level III, Evidence obtained from well-designed cohort or case-control analytic studies.

PTSD trajectories across different mental disorders in the second year of the COVID-19 pandemic in Italy: a naturalistic, longitudinal, multicenter study.

The potentially traumatic impact of the COVID-19 pandemic in subjects with pre-existing mental disorders is still unclear, especially regarding its long-term consequences. The aim of this study was to prospectively assess post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in patients with mental disorders, during the 3rd wave of the infection (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A total sample of 527 subjects, with different DSM-5 diagnoses, was consecutively enrolled at nine Italian psychiatric outpatient services. Assessments at T0 included: the Trauma and Loss Spectrum-Self Report (TALS-SR), the Impact of Event Scale-Revised (IES-R) and the Work and Social Adjustment Scale (WSAS). These two latter were repeated at T1. Results showed that at T0, 43.6% of the sample reported symptoms of PTSD, with females (p = .004), younger subjects (p = .011), unemployed/students (p = .011), and living with their parental families (p = .017), resulting more affected. Differences in PTSD rates emerged across diagnostic groups ranging from 10% in patients with psychoses up to 59% in those with feeding and eating disorders. An improvement at T1 emerged in all diagnostic groups for the IES-R scores, while WSAS scores improved only in subjects with mood disorders. In conclusions, subjects with mental disorders presented relevant rates of PTSD and PTSS at 1-year into the pandemic. Further long-term studies are needed to follow-up the course of pandemic traumatic burden especially in patients with severe mental disorders.

The perception of food size and food shape in anorexia nervosa.

Visual perception of food size and shape in anorexia nervosa (AN) is an understudied topic, notwithstanding its relevance in approaching food, key-element in weight restoration. In addition, it is unclear how visual perception in AN is related to the age and the duration of illness. Here, we compared patients with AN to healthy controls (HCs) on their spatial resolution, biases in perceived food size, and holistic processing of food shape. A total of 122 participants were enrolled: 48 adolescents (27 AN and 21 HCs) and 74 adults (33 AN and 41 HCs). Participants at two academic sites (Israel and Italy) completed measures of psychopathology and experiments measuring visual resolution (Just Noticeable Difference), biases in food-size perception (Points of Subjective Equality), and holistic processing of food shape (indicated by the height-width illusion). Adolescents and adults with AN differed in the duration of illness and body mass index but showed comparable eating psychopathology and body measures. Patients with AN showed preserved visual resolution but distorted perception of food size, perceiving food as bigger than non-food objects, in both age groups. Patients with AN, both adolescents and adults, also processed food stimuli in a more analytic fashion, and were immune to the height-width illusion. The preserved perception of non-food stimuli in AN coupled with biases in food-size perception and in analytic processing of food shape highlight patients' real-world difficulties in approaching food. Future treatments on AN may consider taking these differences into account.

Mediation models of anxiety and depression between temperament and drive for thinness and body dissatisfaction in anorexia nervosa.

PURPOSE: Anorexia nervosa (AN) is a life-threatening condition in which temperament, anxiety, depression, and core AN body-related psychopathology (drive for thinness, DT, and body dissatisfaction, BD) are intertwined. This relationship has not been to date disentangled; therefore, we performed a multiple mediation analysis aiming to quantify the effect of each component. METHODS: An innovative multiple mediation statistical method has been applied to data from 184 inpatients with AN completing: Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Eating Disorders Inventory-2, State-Trait Anxiety Inventory, and Beck Depression Inventory. RESULTS: All affective temperaments but the hyperthymic one were involved in the relationship with DT and BD. Only the anxious temperament had a significant unmediated direct effect on DT after the strictest correction for multiple comparisons, while the depressive temperament had a significant direct effect on DT at a less strict significance level. State anxiety was the strongest mediator of the link between affective temperament and core AN body-related psychopathology. Depression showed intermediate results while trait anxiety was not a significant mediator at all. CONCLUSION: Affective temperaments had a relevant impact on body-related core components of AN; however, a clear direct effect could be identified only for the anxious and depressive temperaments. Also, state anxiety was the strongest mediator thus entailing interesting implications in clinical practice. LEVEL OF EVIDENCE: V, cross-sectional study.

Different clusters of perfectionism in inpatients with anorexia nervosa and healthy controls.

Perfectionism is a risk and maintaining factor for anorexia nervosa (AN) but studies on its classification are lacking. This study aimed to classify patients with AN and healthy controls (HCs) according to their perfectionism; to evaluate the association between perfectionism clusters and severity of general and eating psychopathology for both groups; to investigate the relationship between baseline perfectionism and hospitalization outcome for patients. A sample of 207 inpatients with AN and 292 HCs completed: Eating Disorders Inventory-2, Frost Multidimensional Perfectionism Scale, Beck Depression Inventory, and State- Trait Anxiety Inventory. Cluster analyses were run to classify participants according to their perfectionism scores. Three clusters (i.e., high, medium, low perfectionism) emerged for both patients with AN and HCs. The high perfectionism cluster was over-represented among patients. Both groups reported significant differences across clusters in eating-related difficulties. In AN, anxiety and depression severity varied across clusters according to perfectionism, but patients' baseline perfectionism was unrelated to hospitalization outcome. Inpatients with AN and HCs could be grouped in clusters of high, medium, and low perfectionism which also mirrored their eating psychopathology severity. Finally, hospitalization outcome was unrelated to inpatients' baseline perfectionism.

Research in eating disorders: the misunderstanding of supposing serious mental illnesses as a niche specialty.

PURPOSE: Eating disorders (EDs) are mental illnesses with severe consequences and high mortality rates. Notwithstanding, EDs are considered a niche specialty making it often difficult for researchers to publish in high-impact journals. Subsequently, research on EDs receives less funding than other fields of psychiatry potentially slowing treatment progress. This study aimed to compare research vitality between EDs and schizophrenia focusing on: number and type of publications; top-cited articles; geographical distribution of top-ten publishing countries; journal distribution of scientific production as measured by bibliometric analysis; funded research and collaborations. METHODS: We used the Scopus database, then we adopted the Bibliometrix R-package software with the web interface app Biblioshiny. We included in the analyses 1,916 papers on EDs and 6491 on schizophrenia. RESULTS: The ED field published three times less than schizophrenia in top-ranking journals - with letters and notes particularly lacking-notwithstanding a comparable number of papers published per author. Only 50% of top-cited articles focused on EDs and a smaller pool of journals available for ED research (i.e., Zones 1 and 2 according to Bradford's law) emerged; journals publishing on EDs showed an overall lower rank compared to the schizophrenia field. Schizophrenia research was more geographically distributed and more funded; in contrast, a comparable collaboration index was found between the fields. CONCLUSION: These data show that research on EDs is currently marginalized and top-rank journals are seldom achievable by researchers in EDs. Such difficulties in research dissemination entail potentially serious repercussions on clinical advancements. LEVEL OF EVIDENCE: Level V: opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Psychometric properties of the Italian body shape questionnaire: an investigation of its reliability, factorial, concurrent, and criterion validity.

PURPOSE: This study was set up to investigate the reliability, factorial, concurrent, and criterion validity of the Italian version of the 34-item Body Shape Questionnaire (BSQ) and its shorter versions. METHODS: The study included 231 patients diagnosed with an eating disorder and 58 putatively healthy people (comparison sample). The Italian BSQ-34 was administered to participants together with the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. Information on body mass index, caloric intake at baseline, and the number of episodes of self-vomiting per week was also acquired. RESULTS: Cronbach's alpha of BSQ-34 was 0.971 (95% confidence interval [CI] 0.965-0.976) in patients and 0.960 (0.944-0.974) in controls. Test-retest stability in patients (n = 69), measured with intraclass correlation coefficient, was 0.987 (0.983-0.991). Confirmatory factor analysis of the single-factor model yielded acceptable fit for all versions of the BSQ. On all BSQ versions, patients scored higher than controls with a large effect size when calculated as Cliff's delta. BMI and mean caloric intake at baseline had a stronger association with BSQ-34 than levels of anxiety and depression. The analysis with the receiver operating characteristics (ROC) curve showed that the BSQ-34 distinguished patients with an eating disorder from controls with good accuracy (Area Under the Curve = 86.5; 95% CI 82.2-90.7). CONCLUSION: The Italian version of the BSQ possesses good psychometric properties, in both the long and the shortened versions, and it can be applied to measure body dissatisfaction for both clinical and research purposes. LEVEL OF EVIDENCE: Level III, Evidence obtained from well-designed cohort or case-control analytic studies.

Affective cognition in eating disorders: a systematic review and meta-analysis of the performance on the "Reading the Mind in the Eyes" Test.

BACKGROUND: The Reading the Mind in the Eyes Test (RMET) is listed in the National Institute of Mental Health's Research Domain Criteria as a tool apt to measure the understanding of others' mental states. People diagnosed with anorexia nervosa (AN) showed poorer performances on the RMET than healthy controls. Less data are available concerning other eating disorders. METHODS: Systematic review of four major databases from inception to July 15, 2021 following the PRISMA guidelines. Meta-analysis of cross-sectional observational studies comparing the scores of the RMET between patients with eating disorders and age- and-gender matched control groups. RESULTS: Out of 21 studies, we retrieved 29 independent samples of patients diagnosed with an eating disorder. Patients with active AN (n = 580) showed worse performances on the RMET than controls (n = 1019). Year of publication accounted for 61% of the (substantial: I2 = 81%) heterogeneity in the meta-analysis. Earlier studies were more likely to find worse performances on the RMET of patients with active AN than later studies. Patients with bulimia nervosa (n = 185) performed poorly as compared to controls (n = 249), but the results were not statistically significant on the random-effect model. Obese patients with binge-eating disorder (n = 54) did not differ on the RMET from obese controls (n = 52). Patients with eating disorder not otherwise specified (n = 57) showed minimal differences compared to controls (n = 96). Study quality was good in six studies only. CONCLUSIONS: Patients with eating disorders do not suffer from an impaired understanding of others' mental states, except for a still-to-be-identified subgroup of patients with active AN. LEVEL OF EVIDENCE: I, systematic review and meta-analysis.

Obsessive-compulsive symptoms in young women affected with anorexia nervosa, and their relationship with personality, psychopathology, and attachment style.

PURPOSE: Obsessive-compulsive symptoms (OC) are associated with greater morbidity and worse prognosis in anorexia nervosa (AN). We assessed the presence of non-eating OC in participants with AN and related them with their psychopathology, personality, and attachment style features. METHODS: Young women with AN (N = 41, 30 restrictor and 11 binge-purging type) were assessed on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). These participants with AN and 82 healthy controls (HC) completed the Temperament and Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), Symptom Checklist-90 (SCL-90), Toronto Alexithymia Scale (TAS-20), and Attachment Style Questionnaire (ASQ). The association between Y-BOCS scores and indexes of psychopathology, personality, and attachment were examined. RESULTS: AN had significantly higher scores than HC on the EDI-2, SCL-90, TAS-20, ASQ-Need for Approval, and TCI-Harm Avoidance and Self-directedness. The Y-BOCS scores were significantly correlated with ASQ-Need for Approval, TAS-20-Difficulty in Describing Feelings, SCL-90-Phobic Anxiety, and Anxiety, EDI-2-Drive to Thinness, and Asceticism. Need for Approval displayed the strongest correlation with OC symptoms. Difficulty in describing feelings displayed the strongest correlation with compulsive OC symptoms. CONCLUSIONS: OC traits in AN were primarily associated with measures of insecure attachment rather than to their eating disorder or general psychopathology. Therapeutic approaches to correcting insecure attachment may be considered as a possible approach to treating AN patients with OC. The study supports a new psychopathological perspective for understanding the meaning of OC symptoms in AN. LEVEL OF EVIDENCE: III: Evidence obtained from cohort or case-control analytic studies.

What do Italian healthcare professionals think about orthorexia nervosa? Results from a multicenter survey.

PURPOSE: Orthorexia nervosa (ON) is an obsession for healthy and proper nutrition. Diagnostic criteria for ON are lacking and the psychopathology of ON is still a matter of debate in the clinical and scientific community. Our aim was to better understand the Italian clinical and scientific community's opinion about ON. METHODS: Anonymous online survey for Italian healthcare professionals, implemented with the REDCap platform and spread through a multicenter collaboration. Information was gathered about socio-demographic, educational and occupational features, as well as about experience in the diagnosis and treatment of EDs. The main part of the survey focused on ON and its features, classification and sociocultural correlates. RESULTS: The survey was completed by 343 participants. Most responders (68.2%) considered ON as a variant of Eating Disorders (EDs), and 58.6% a possible prodromal phase or evolution of Anorexia Nervosa (AN). Most participants (68.5%) thought the next DSM should include a specific diagnostic category for ON, preferably in the EDs macro-category (82.1%). Moreover, 77.3% of responders thought that ON deserves more attention on behalf of researchers and clinicians, and that its treatment should be similar to that for EDs (60.9%). Participants thinking that ON should have its own diagnostic category in the next DSM edition had greater odds of being younger (p = 0.004) and of considering ON a prodromic phase of another ED, such as AN (p = 0.039). DISCUSSION: Our survey suggests that the scientific community still seems split between those who consider ON as a separate disorder and those who do not. More research is still needed to better understand the construct of ON and its relationship with EDs; disadvantages and advantages of giving ON its own diagnosis should be balanced. LEVEL OF EVIDENCE: V (descriptive cohort study).

The role of prenatal and perinatal factors in eating disorders: a systematic review.

Numerous studies showed that factors influencing fetal development and neonatal period could lead to lasting alterations in the brain of the offspring, in turn increasing the risk for eating disorders (EDs). This work aims to systematically and critically review the literature on the association of prenatal and perinatal factors with the onset of EDs in the offspring, updating previous findings and focusing on anorexia nervosa (AN) and bulimia nervosa (BN). A systematic literature search was performed on Pubmed, PsycINFO, and Scopus. The drafting of this systematic review was conducted following the PRISMA statement criteria and the methodological quality of each study was assessed by the MMAT 2018. A total of 37 studies were included in this review. The factors that showed a more robust association with AN were higher maternal age, preeclampsia and eclampsia, multiparity, hypoxic complications, prematurity, or being born preterm (< 32 weeks) and small for gestational age or lower birth size. BN was only associated with maternal stress during pregnancy. Many methodological flaws emerged in the considered studies, so further research is needed to clarify these inconsistencies. Altogether, data are suggestive of an association between prenatal and perinatal factors and the onset of EDs in the offspring. Nevertheless, given the methodological quality of the available literature, firm conclusions cannot be drawn and whether this vulnerability is specific to EDs or mental disorders remains to be defined. Also, a strong need for longitudinal and well-designed studies on this topic emerged.