Attentional disengagement, craving, and mentalizing: a preliminary experimental study among older-aged male gamblers.

INTRODUCTION: Empirical studies have demonstrated the role that attentional bias, the mutual excitatory relationship between attentional bias and craving, and mentalizing play in problem gambling. Although problem gambling rates among older-aged adults have steadily increased in recent years, research studies among this cohort are scarce. The present study is the first to empirically investigate attentional bias, as well as the joint role of attentional bias, craving, and mentalizing among older-aged gamblers. METHOD: Thirty-six male older-aged gamblers were administered the South Oaks Gambling Screen (SOGS), the Gambling Craving Scale (GACS), and the Reflective Functioning Questionnaire (RFQ-8) to assess gambling severity, craving levels, and mentalizing, respectively. Participants also performed a modified Posner Task to investigate attentional biases. RESULTS: Hierarchical linear regression analysis showed that among older-aged male gamblers, GACS Anticipation and RFQ-8 Uncertainty about mental states, as well as disengagement bias at 100 ms, significantly predicted gambling severity. CONCLUSION: The present study provides the first empirical support for the role of attentional bias, craving, and mentalizing among older-aged gambling. More specifically, a difficult in disengaging attention away from gambling, the anticipation of pleasure deriving from gambling, and hypomentalizing predicted gambling severity among older-aged gamblers. The findings make an important contribution, by identifying the factors responsible for problem gambling among this specific age cohort and suggesting that timely interventions for mentalizing and attentional bias may be necessary to prevent problem gambling in old age.

Explaining Interaction of Guilt and Obsessive-Compulsive Symptoms in Not Just Right Experiences.

Objective: "Not Just Right Experiences" (NJREs) are currently considered a characteristic of Obsessive-Compulsive Disorder (OCD). Significant associations have been found between NJREs and Obsessive-Compulsive (OC) symptoms in nonclinical and clinical populations. Literature support a significant relationship between NJREs, feelings of guilt and OC features. This study aims to clarify the role of the potential interplay between guilt and OC symptomatology in NJREs and verify if high levels of guilt will predict NJREs and OC symptoms and trait guilt levels will positively interact in their prediction of NJREs. Method: One hundred and eighty-nine adults recruited from normal population were assessed with questionnaires of NJREs and OC symptoms and proneness to experience guilt. Results: All the variables involved in the study (NJREs severity, guilt and OCI-R scores) were positively and significantly correlated and showed that guilt and OCI-R scores significantly and positively interact in the prediction of NJREs levels. Guilt predicted NJREs only when levels of OCI-R were high. Conclusions: These results support the association between guilt sensitivity or OC symptoms and NJREs in clinical and nonclinical participants and that a disposition toward high levels of guilt and OC symptoms have a particular sensitivity to NJREs corroborating centrality of guilt in OC symptoms.

Brain hemodynamic response in Examiner-Examinee dyads during spatial short-term memory task: an fNIRS study.

The Corsi Block-Tapping test (CBT) is a measure of spatial working memory (WM) in clinical practice, requiring an examinee to reproduce sequences of cubes tapped by an examiner. CBT implies complementary behaviors in the examiners and the examinees, as they have to attend a precise turn taking. Previous studies demonstrated that the Prefrontal Cortex (PFC) is activated during CBT, but scarce evidence is available on the neural correlates of CBT in the real setting. We assessed PFC activity in dyads of examiner-examinee participants while completing the real version of CBT, during conditions of increasing and exceeding workload. This procedure allowed to investigate whether brain activity in the dyads is coordinated. Results in the examinees showed that PFC activity was higher when the workload approached or reached participants' spatial WM span, and lower during workload conditions that were largely below or above their span. Interestingly, findings in the examiners paralleled the ones in the examinees, as examiners' brain activity increased and decreased in a similar way as the examinees' one. In the examiners, higher left-hemisphere activity was observed suggesting the likely activation of non-spatial WM processes. Data support a bell-shaped relationship between cognitive load and brain activity, and provide original insights on the cognitive processes activated in the examiner during CBT.

Mentalizing Failures, Emotional Dysregulation, and Cognitive Distortions Among Adolescent Problem Gamblers.

Over the past decade, several studies have investigated the relationship between cognitive distortions and emotion regulation among adolescent gamblers, demonstrating the exacerbating role of alcohol consumption when co-occurring with gambling problems. An important construct, that to date has been largely neglected, is mentalizing (i.e. the ability to reflect on one's own and others' mental states). The aim of the present study was (for the first time) to investigate the relative contribution of mentalization, emotional dysregulation, cognitive distortions, and alcohol consumption among adolescent gamblers. A total of 396 students (69.2% females) aged 14-19 years were recruited from secondary schools in Southern Italy. Assessment measures included the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Reflective Functioning Questionnaire (RFQ-8), the Difficulties in Emotion Regulation Scale (DERS), the Gambling Related Cognitions Scale (GRCS), and the Alcohol Use Disorders Identification Test (AUDIT). Regression analysis showed that, along with male gender, the best predictors of adolescent gambling were scores on two GRCS subscales (i.e., 'inability to stop gambling' and 'interpretative bias'), the RFQ-8's 'uncertainty about mental states' dimension, and the DERS 'impulse control difficulties' factor, with the overall model explaining more than one-third of the total variance. The results clearly indicated that, along with gambling-related cognitive distortions, uncertainty about mental states, and difficulties remaining in control of one's behavior when experiencing negative emotions contributed significantly to problematic gambling among adolescents.

Disordered gambling and attentional bias: The mediating role of risk-taking.

BACKGROUND: Previous research has emphasized the importance of attentional bias in the maintenance of both adult and adolescent disordered gambling. There is a substantial body of empirical evidence demonstrating facilitated attention and difficulty in disengagement from gambling stimuli among disordered gamblers, but no study has ever experimentally investigated the association between attentional bias and risk-taking behavior in gambling. The aim of the present study was to examine the interrelationship between attentional bias for gambling stimuli, risk-taking attitude, and severity of gambling involvement. METHODS: The present study recruited 70 male adults from gambling venues to participate in the experiment. Gambling severity, attentional bias, and risk-taking were assessed utilizing the South Oaks Gambling Screen, the Modified Posner Task, and the Balloon Analogue Risk Task, respectively. RESULTS: Disordered gamblers showed greater readiness to detect gambling stimuli and took more risks than non-disordered gamblers. Regression analysis showed that being of a young age, automatic facilitated attention for gambling cues, and risk-proneness significantly predicted problem gambling. Additionally, a path analysis was performed to test if automatic facilitated attention towards gambling was on the path from risk-taking to gambling severity, or if risk-taking mediated the impact of facilitation biases on gambling severity. The results indicated that attentional bias predicted gambling severity both directly and indirectly via risk-taking. LIMITATIONS: The modest sample size and the absence of female gamblers limited the generalizability of the results. CONCLUSIONS: The present findings are compatible with the view that an automatic detection of gambling stimuli is responsible for greater riskiness that, in turn, fosters gambling problems.

The Associations Between Maladaptive Personality Traits, Craving, Alcohol Use, and Adolescent Problem Gambling: An Italian Survey Study.

Although gambling disorder (GD) criteria do not explicitly address craving, it has received increased attention because it has been found to be a significant predictor of gambling severity. Furthermore, recent findings have suggested that both alcohol consumption and maladaptive personality traits may be risk factors among adult GD. To date, no study has evaluated the relative contribution of these factors in adolescent gambling behavior. Consequently, the present study investigated the relationship between gambling severity, craving, maladaptive personality traits, and alcohol use among adolescents. The sample comprised 550 Italian high-school students (50.2% males), aged 14-19 years (mean age = 16.24 years; SD = 1.56). Participants were administered the South Oaks Gambling Screen-Revised for Adolescents, Gambling Craving Scale (GACS), Personality Inventory for DSM-5-Brief Format (PID-5-BF), and Alcohol Use Disorders Identification Test (AUDIT). Results indicated that relative to both non-gamblers and non-problem gamblers, at-risk gamblers and problem gamblers scored higher on GACS, PID-5-BF and AUDIT. Regression analysis showed that Antagonism and Disinhibition PID-5-BF dimensions, Anticipation and Desire GACS subscales, and AUDIT total score were the best predictors of adolescent gambling involvement. These findings provide the first empirical evidence of associations between problematic gambling, craving, alcohol consumption, and maladaptive personality traits in adolescence.

The interplay between chasing behavior, time perspective, and gambling severity: An experimental study.

BACKGROUND AND AIMS: Chasing refers to continued gambling in an attempt to recoup previous losses and is one of the diagnostic criteria for gambling disorder. However, research on the topic is still in its infancy. This study investigated whether chasing behavior mediates the relationship between time perspective and gambling severity. METHODS: Non-problem gamblers (N = 26) and problem gamblers (N = 66) with the same demographic features (age and gender) were compared on the Consideration of Future Consequences and a computerized task assessing chasing. The Italian South Oaks Gambling Screen was used to discriminate participants in terms of gambling severity. RESULTS: Significant correlations were found relating to gambling severity, chasing, and time perspective. More specifically, the results showed that problem gamblers reported more chasing and a foreshortened time horizon. Chasers, compared to non-chasers, were found to be more oriented to the present. Regression analysis showed that male gender, present-oriented time perspective, and chasing were good predictors of gambling severity. Finally, to clarify if present orientation was on the path from chasing to gambling severity or if chasing was the mediator of the impact of present orientation on gambling severity, a path analysis was performed. The results indicated that present orientation had a direct effect on gambling severity and mediated the relationship between chasing and gambling involvement. CONCLUSION: The findings support the exacerbating role of chasing in gambling disorder and for the first time show the relationship of time perspective, chasing, and gambling severity among adults.

The fuzzy future: Time horizon, memory failures, and emotional distress in gambling disorder.

This study aimed to first investigate the interplay among self-rated ability in both retrospective and prospective memory, time perspective, and negative affectivity to gambling severity. Two hundred and three habitual players took part in the study. Participants were administered the South Oaks Gambling Screen (SOGS), the Consideration of Future Consequences scale (CFC-14), the Prospective and Retrospective Memory Questionnaire (PRMQ), as well as the Depression, Anxiety and Stress Scales-21 (DASS-21). Overall, data indicated that the higher the involvement in gambling, the higher the depression levels and the shorter the time horizon. The results of linear regression analysis showed that, along with gender, years of education, depression, and inattention to the future consequences of actual behavior, the negative self-perception of prospective memory functioning represents a significant predictor of gambling severity. Finally, to clarify if depression was on the path from prospective memory to gambling severity or if prospective memory was the mediator of the impact of depression on gambling severity, data were submitted to path analysis. Results indicated that depression has a direct effect on gambling severity and mediates the association between prospective memory and gambling involvement. The relation between gambling severity and prospective memory scores suggests that impairment in prospective memory plays a key role in adult problematic gambling.

Facilitated attention for gambling cues in adolescent problem gamblers: An experimental study.

BACKGROUND: Studies investigating attentional biases in gambling have observed that problem gamblers' attention is biased toward gambling cues. Despite the increase of gambling among adolescents, to date, no study has ever examined the role of attentional bias in adolescent gambling, as well as the relationships between adolescent gambling severity, craving, and alcohol use. METHODS: The present study comprised 87 adolescent participants. Based on South Oaks Gambling Screen Revised for Adolescents (SOGS-RA) scores, participants were assigned to non-problem or problem gamblers groups. Participants performed a modified Posner Task (with cue presentation times at 100 and 500 ms) to assess attentional biases. Following the experiment, participants completed the Gambling Craving Scale (GACS) and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: Compared to non-problem gamblers, problem gamblers displayed facilitation bias for gambling cues at 500 ms and reported higher levels of craving and alcohol consumption. Results also indicated that alcohol use correlated with facilitation bias. LIMITATIONS: The recruitment of a predominantly male sample and the use of an indirect measure of attentional bias may have affected the findings concerning attentional processes. CONCLUSIONS: The present study provides the first empirical evidence of attentional processes in adolescent gambling, and confirms the role of attentional biases, craving, and alcohol use being associated factors in adolescent problem gambling. The results of the present study stress the importance of attentional biases in the initial stages of problem gambling and suggest the need for clinical interventions aimed at reducing attentional bias before they became automatic. Overall, the present study stressed the role of attentional bias as both facilitator and a consequence of gambling involvement.

Non-invasive brain stimulation in generalized anxiety disorder: A systematic review.

In the last years, several studies using non-invasive brain stimulation (NIBS) techniques demonstrated that the dorsolateral prefrontal cortex (DLPFC) plays a key role in the neurobiological bases of anxiety disorders. Both transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) applied primarily over the prefrontal cortex have been shown to modulate anxiety symptomatology and attention allocation in the generalized anxiety disorder. A literature search on PubMed and PsycINFO databases following PRISMA guidelines identified 4 TMS studies (one open-label study and three randomized trials with active/sham conditions) and one tDCS case report study that have applied NIBS in patients with GAD. All the studies targeted the DLPFC except one in which the parietal cortex has been stimulated. Overall, the findings would suggest that NIBS could ameliorate anxiety symptoms and that improvements remained stable in the follow-up. Although a limited number of NIBS studies has been conducted on patients with anxiety disorders, these techniques could represent promising tools for the study of neurofunctional basis of anxiety disorders. Further sham-controlled studies are needed to clarify the mechanisms of action of NIBS in order to optimize stimulation protocols and to verify their effectiveness for treating anxiety symptoms.

An experimental investigation of the role of delay discounting and craving in gambling chasing behavior.

Chasing is a central feature of gambling disorder and refers to the attempt by individuals to recover financial losses by continuing to gamble. Although several efforts have been made to individuate the factors involved in the complex phenomenon of chasing, little is known regarding its association with delay discounting and craving, both considered important in the development and maintenance of gambling disorder. In the present study, the interplay between chasing, delay discounting, and craving (while controlling for gambling severity) was investigated. The sample comprised 128 adult gamblers aged between 18 and 67 years and consisted of non-problem gamblers (n = 58), problem gamblers (n = 18), and pathological gamblers (n = 52) based on the South Oaks Gambling Screen (SOGS) scores. Participants were administered the Monetary Choice Questionnaire (MCQ) and the Gambling Craving Scale (GACS), as well as completing the ChasIT, a computerized task assessing chasing behavior. Participants were randomly assigned to the control and the loss condition of the ChasIT. Results showed that pathological gamblers were more likely to chase and reported more severe chasing persistence. Regression analyses indicated that heightened levels of craving and the inability to tolerate delay in gratification, along with gambling severity, predicted both the decision to chase and chasing persistence. The present study contributes important findings to the gambling literature, highlighting the role of craving and delay discounting in facilitating the inability to stop within-sessions gambling. These findings may provide evidence that chasers and non-chasers represent two different types of gamblers, and that the difference may be useful for targeting more effective therapies.

To chase or not to chase: A study on the role of mentalization and alcohol consumption in chasing behavior.

BACKGROUND AND AIMS: Chasing is a behavioral marker and a diagnostic criterion for gambling disorder. Although chasing has been recognized to play a central role in gambling disorder, research on this topic is relatively scarce. This study investigated the association between chasing, alcohol consumption, and mentalization among habitual gamblers. METHOD: A total of 132 adults took part in the study. Participants were administered the South Oaks Gambling Screen, the Alcohol Use Disorders Identification Test, the Reflective Functioning Questionnaire, and a laboratory task assessing chasing behavior. Participants were randomly assigned to three experimental conditions (Control, Loss, and Win). To deeply investigate chasing behavior, participants were requested to indicate the reasons for stopping or continuing playing at the end of the experimental session. RESULTS: Logistic regression analysis showed that the choice to stop or continue playing depended on experimental condition and alcohol use. Hierarchical linear regression indicated that chasing propensity was affected by experimental condition, alcohol consumption, and deficit in mentalization. The results of path analysis showed that hypermentalizing predicts chasing not only directly, but also indirectly via alcohol consumption. CONCLUSIONS: Overall, these results for the first time showed that hypermentalization plays a key role in chasing behavior over and above gambling severity. Since these findings support the idea that chasers and non-chasers are different subtypes of gamblers, clinical interventions should consider the additive role of chasing in gambling disorder.

Deontological morality can be experimentally enhanced by increasing disgust: A transcranial direct current stimulation study.

Previous studies empirically support the existence of a distinctive association between deontological (but not altruistic) guilt and both disgust and obsessive-compulsive (OC) symptoms. Given that the neural substrate underlying deontological guilt comprises brain regions strictly implicated in the emotion of disgust (i.e. the insula), the present study aimed to test the hypothesis that indirect stimulation of the insula via transcranial direct current stimulation (tDCS) would enhance disgust and morality in the deontological domain. A randomized, sham-controlled, within-subject design was used. Thirty-seven healthy individuals (25 women) underwent 15-min anodal and sham tDCS over T3 in two different days, while their heart rate (HR) was recorded to derive measures of parasympathetic nervous system activity (HR variability; HRV). After the first 10-min of sham or active tDCS stimulation, participants were asked to 1) complete a series of 6-item words that could be completed with either a disgust-related word (cleaning/dirtiness) or neutral alternatives; 2) rate how much a series of vignettes, each depicting a behavior that violated a specific moral foundation, were morally wrong. Levels of trait anxiety, depression, disgust sensitivity, scrupulosity, and altruism as well as pre- and post- stimulation momentary emotional states were assessed. Compared to the sham condition, after active stimulation of T3 a) HRV significantly increased and participants b) completed more words in terms of cleaning/dirtiness and c) reported greater subjective levels of disgust, all suggesting the elicitation of the emotion of disgust. Although the results are only marginally significant, they point to the absence of difference between the two experimental conditions for moral vignettes in the altruistic domain (i.e., animal care, emotional and physical human care), but not in the deontological domain (i.e., authority, fairness, liberty, and sacrality), where vignettes were judged as more morally wrong in the active compared to the sham condition. Moreover, scores on the OCI-R correlated with how much vignettes were evaluated as morally wrong in the deontological domain only. Results preliminarily support the association between disgust and morality in the deontological domain, with important implications for OC disorder (OCD). Future studies should explore the possibility of decreasing both disgust and morality in patients with OCD by the use of non-invasive brain stimulation techniques.

Attentional biases for threat after fear-related autobiographical recall.

BACKGROUND: Previous studies suggested that affective state could enhance stimulus salience and modulate attention allocation for mood-congruent information, but contrasting data have been reported on the effects of mood induction on attentional biases for threat (ABTs) in non-clinical individuals. OBJECTIVE: We aimed to assess whether laboratory-induced negative mood can increase individuals' tendency to allocate attention on threatening stimuli, thus determining a difficulty in attentional disengagement from threat. We also aimed at assessing whether level of trait anxiety could modulate the effect of mood induction on attentional biases. METHODS: We used an autobiographical episode recall procedure for mood induction (fear, happiness and neutral episode recall), and an exogenous cueing task with threatening and non-threatening images to assess attentional biases in 120 undergraduate students. RESULTS: Participants showed a significant difficulty in disengaging attention from threat after recalling fear-related episodes, independently from their trait anxiety level. CONCLUSIONS: These findings clarify that the ABTs are not exclusive to anxiety disorders or high trait anxiety individuals, and could also arise in non-clinical individuals in a fearful context.

The effect of bicephalic stimulation of the dorsolateral prefrontal cortex on the attentional bias for threat: A transcranial direct current stimulation study.

Previous stimulation studies demonstrated that the dorsolateral prefrontal cortex (DLPFC) is involved in threat processing. According to a model of emotional processing, an unbalance between the two DLPFCs, with a hyperactivation of right frontal areas, is involved in the processing of negative emotions and genesis of anxiety. In the present study, we investigated the role of the right and left DLPFC in threat processing in healthy women who also completed the State-Trait Anxiety Inventory (STAI). We simultaneously modulated the activity of the right and left dorsolateral prefrontal cortex by applying bicephalic transcranial direct current stimulation (tDCS) before participants completed a modified version of the classic Posner task using threatening and nonthreatening stimuli as spatial cues. Anodal stimulation on the right DLPFC with a simultaneous cathodal stimulation over the left side induced a disengagement bias in individuals with low STAI scores and a facilitation bias in individuals with high STAI scores. Anodal stimulation on the left DLPFC with the simultaneous cathodal stimulation over the right side did not affect threat processing. The findings of the present study provided specific support to the hypothesis that unbalanced activation between left and right hemispheres with enhanced activation of the right DLPFC is critical in early top-down threat processing in healthy individuals.

The role of the dorsolateral prefrontal cortex in early threat processing: a TMS study.

Previous studies demonstrated that excitatory (high frequency) offline transcranial magnetic stimulation (TMS) over the left and right dorsolateral prefrontal cortex (DLPFC) modulates attention allocation on threatening stimuli in non-clinical samples. These studies only employed offline TMS protocol that did not allow investigating the effect of the stimulation on the early stage of threat processing. In this study, the role of the right and left dorsolateral prefrontal cortex in early threat processing was investigated in high and low anxious individuals by means of an inhibitory single-pulse online TMS protocol. Our results demonstrated the role of the left DLPFC in an early stage of threat processing and that this effect is modulated by individuals' anxiety level. The inhibitory stimulation of the left DLPFC determined a disengagement bias in high anxious individuals, while the same stimulation determined an attentional avoidance in low anxious individuals. The findings of the present study suggest that right and left DLPFC are differently involved in early threat processing of healthy individuals.

Attentional bias in non-problem gamblers, problem gamblers, and abstinent pathological gamblers: An experimental study.

BACKGROUND: Attentional biases have been recognized as factors responsible for the maintenance of gambling problems. To date, no study has ever assessed the attentional biases among problem gamblers that have discontinued gambling (e.g., abstinent gamblers in treatment). METHODS: The sample consisted of 75 participants comprising three groups: non-problem gamblers, problem gamblers, and abstinent pathological gamblers undergoing treatment. The groups were discriminated using South Oaks Gambling Screen scores, with the exception of the abstinent pathological gamblers that already had a DSM-5 diagnosis for gambling disorder. Participants carried out a modified Posner Task for the assessment of attentional bias for gambling stimuli and completed the Depression Anxiety Stress Scale and the Gambling Craving Scale. RESULTS: Abstinent pathological gamblers showed an avoidance bias in the maintenance of attention, whereas problem gamblers exhibited a facilitation in detecting gambling stimuli. No biases were detected in non-problem gamblers. The results also demonstrated that compared to the other groups, abstinent pathological gamblers showed high emotional stress and problem gamblers reported a higher level of craving. LIMITATIONS: The sample size limits the generalizability of results. CONCLUSIONS: The present study demonstrated that attentional biases affect the maintenance and the discontinuation of gambling activities, and that the subjective feeling of craving for gambling may facilitate problem gamblers' attention towards gambling stimuli.

Attentional biases in problem and non-problem gamblers.

BACKGROUND: From a cognitive perspective, attentional biases are deemed as factors responsible in the onset and development of gambling disorder. However, knowledge relating to attentional processes in gambling is scarce and studies to date have reported contrasting results. Moreover, no study has ever examined which component and what type of bias are involved in attentional bias in gambling. METHODS: In the present study, 108 Italian participants, equally divided into problem and non-problem gamblers, were administered a modified Posner Task, an attentional paradigm in which - through the manipulation of stimuli presentation time - it is possible to measure both initial orienting and maintenance of attention. In addition to the experimental task, participants completed self-report measures involving (i) craving (Gambling Craving Scale), (ii) depression, anxiety and stress (Depression Anxiety Stress Scale) and (iii) emotional dysregulation (Difficulties in Emotion Regulation Scale). RESULTS: Analyses revealed facilitation in detecting gambling-related stimuli at the encoding level in problem gamblers but not in non-problem gamblers. Compared to non-problem gamblers, problem gamblers also reported higher levels of craving, emotional dysregulation, and negative mood states. Furthermore, all measures correlated with the gambling severity. LIMITATIONS: The use of indirect measure of attentional bias could be less accurate compared to direct measures. CONCLUSIONS: The facilitation in detecting gambling-related stimuli in problem gamblers and the correlation between subjective craving and facilitation bias suggests that attentional bias could not be due to a conditioning process but that motivational factors such as craving could induce addicted-related seeking-behaviors.

Self-esteem, body shame and eating disorder risk in obese and normal weight adolescents: A mediation model.

OBJECTIVE: To investigate dysfunctional eating behaviors and psychological variables typically associated to eating disturbances such as low self-esteem, perfectionism, shame, perceived parental care and protectiveness in obese and normal weight adolescents and to examine how the main powerful eating disorder risk factors interact with each other which explains eating psychopathology vulnerability. METHOD: 111 high school students (68 males; age range 13-19years) classified as obese and 111 age-, sex- and social status-homogeneous normal weight controls were included in the current study. All participants were asked to fill out self-report measures of parental behavior as perceived by the offspring, eating disturbance attitudes and behaviors, self-esteem, perfectionism and shame. RESULTS: Significant differences between the two groups in relation to dysfunctional eating behaviors emerged. Body shame had the strongest relationship to eating problems vulnerability and acted as a mediator in the relationship between low self-esteem and eating disorder risk among both obese and non-obese youngsters. CONCLUSIONS: These findings further our understanding of a potential underlying mechanism for eating pathology development in youngsters in general and in obese adolescents in particular, which is of great importance in terms of prevention and treatment.