Risk factors for binge eating severity among adolescent girls and boys. A structural equation modeling approach.

OBJECTIVE: Parental bonding, low self-esteem, emotion dysregulation, and eating style are correlated with each other and are associated with binge eating among adolescents. However, no studies have yet examined all these variables simultaneously. In the current study, the independent and combined influences of such constructs on binge eating were tested with structural equation modeling. METHOD: A sample of 973 students aged between 12 and 16 (M = 14.17, SD = 1.25) years was screened by means of self-report measures assessing parental bonding, self-esteem, emotion dysregulation, eating styles and binge eating severity. RESULTS: Self-esteem (ß = -0.205) and eating styles (emotional ß = 0.313, external ß = 0.133, and restrained ß = 0.178) had a direct effect on binge eating severity. The model (χ2(22) = 57.679; RMSEA = 0.041; CFI = 0.987; TLI = 0.949; SRMR = 0.024) revealed that the paths from both maternal and paternal care and maternal overprotection to binge eating were mediated through low self-esteem, emotion dysregulation and each eating style, explaining 35% of the variance. DISCUSSION: Findings provide support for a comprehensive theoretical-based model of risk factors for binge eating and suggest the possible mechanisms through which the quality of early parental relationships contribute to developing dysfunctional eating patterns. Treatment and prevention efforts should improve self-esteem and emphasize emotion regulation capabilities.

Does body shame mediate the relationship between parental bonding, self-esteem, maladaptive perfectionism, body mass index and eating disorders? A structural equation model.

PURPOSE: Body shame has been strongly associated with eating pathology. However, less is known about the predisposing factors linked to these feelings and how they interact with other variables in eating disorder development. Thus, the aim of the present study was to provide a preliminary understanding of the relationship between body shame and some of the major risk factors for eating disorder onset, identifying the possible mechanisms of action. Specifically, we tested a structural equation model in which perceived parental bonding, self-esteem, perfectionism, and body mass index are associated with eating disorder risk via body shame. METHODS: 1156 high school students aged 13-20 were screened by means of self-report measures of parental behavior, self-esteem, perfectionism, body shame and eating disorder risk. The height and weight of each individual were measured. RESULTS: In predicting eating disorder risk, parental protectiveness (ß = 0.09), body mass index (ß = 0.18), self-esteem (ß = - 0.14) and body shame (ß = 0.58) had a direct effect on this variable and overall our model accounted for 58% of its variance. The experience of shame related to one's body appeared to have a considerably significant influence on eating disturbances vulnerability and it also serves as a mediator between other risk factors and eating disturbance risk. A series of multi-group analyses indicated no significant difference between males and females. CONCLUSION: The emotion of shame may enhance our understanding of eating disorders, as well as being a salient factor for the development of preventive programs and treatment approaches. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Maternal control and eating styles in children: The mediating role of emotion differentiation.

Introduction: Theoretical accounts and empirical research suggest that mother-child interactions significantly influence the child's eating styles (emotional, external, and restrained eating). However, little or no research has explored the association between maternal psychological control and eating styles and whether other mechanisms may be involved in such association. To address this shortcoming, the present study aimed to investigate the mediating role of difficulties in differentiating emotions between maternal control and eating styles.Methods: Participants were 324 elementary school children (Girls = 172, 53.1%) aged between 8 and 11 years (Mage = 9.13, SD = .89) assessed through self-report measures. Parents provided information about weight and height.Results: Path analysis model showed an acceptable fit to the data (χ2 (3) = 3.966, p = .256; RMSEA = .032; CFI = .990; TLI = .911; SRMR = .018). Difficulties in differentiating emotions significantly mediated the relationship between maternal control and emotional eating (ß = -.071, 95%CI [-.094, -.052]; p < .001). The model was invariant across genders.Conclusions: Our findings support the importance of dyadic interaction in enhancing the risk for dysfunctional eating style during infancy, showing that emotion differentiation deficits may be particularly salient in such relationship. Clinical and practical implications of these findings are discussed.

Muscle Dysmorphia in Gym-Going Men: The Role of Narcissism Vulnerability and Perfectionism.

Objective: Muscle dysmorphia (MD) refers to a pathological preoccupation with the idea that one's body is not lean and muscular enough. Literature suggests that vulnerable facet of narcissism and perfectionism are strongly related to the risk of developing MD symptoms. However, until now, there is a paucity of research exploring their relationship, which is the primary aim of this study. Method: Participants were 135 gym-going Turkish males (Mage=24.99, SD=5.38; range=18-43 years) who completed a packet of self-report questionnaires. Results: Out of the sample, 51 (37.8%) were at risk for MD. A mediation model analysis revealed that vulnerable narcissism has an indirect relationship with the MD risk that is likely to be expressed via perfectionism. Conclusions: Our results showed a higher risk for MD among gym-going males and provided new insight into MD's understanding. It appears that a narcissistic flaw and perfectionistic traits may be particularly salient factors to consider in both preventing and treating MD symptomatology within high-risk populations.

Influence of gender role orientation (masculinity versus femininity) on body satisfaction and eating attitudes in homosexuals, heterosexuals and transsexuals.

OBJECTIVE: The primary aim of this study was to investigate the relationship between gender role orientation and eating disorder attitudes and behaviors and body dissatisfaction in a sample of homosexuals, heterosexuals, and transsexuals. METHOD: We screened 132 homosexuals, 178 heterosexuals (both male and female), and 15 MtF transsexuals by means of an ad hoc socio-demographic schedule; the Eating Disorders Inventory-2 and Symptom Checklist; the Body Uneasiness Test and the Bem Sex Role Inventory. RESULTS: Differences between homosexual, heterosexual, and transsexual participants emerged, but those data seem to be best explained by the constructs of femininity and masculinity than by the biological gender. DISCUSSION: The empirical evidence of a positive correlation between femininity and eating problems, and the negative correlation between masculinity and eating problems, is full of implications. Eating disorders appear to be diseases of femininity; masculinity seems to be a protective factor, independently by the biological gender.

My body and me: self-injurious behaviors and body modifications in eating disorders--preliminary results.

We investigated self-injurious behaviors and body modification practices in eating disorder patients, considering different ED diagnoses and illness severities. Of the total sample, 50.9% showed at least one form of self-injury and 50.9% reported at least one tattoo, piercing, or both. Patients reporting only body modifications showed more positive feelings toward their bodies, higher levels of self-esteem, less impulsivity, depression, and anxiety, and lower levels of social dysfunction than those reporting only self-injury or both self-injury and body modifications. Self-injury was influenced by both diagnosis and severity of disorders.

The permanence of the setting modifications adopted during the covid-19 pandemic in the clinical practice of Italian psychoanalysts.

The research aims to verify if the remote modality, introduced widely by Italian psychoanalysts at the lockdown, remains in clinical practice today, with specific reasons and characteristics. The authors hypothesize that the use of such modality, beyond health limitations, is a point of no return compared to the classical setting. Based on this hypothesis, an ad hoc online questionnaire was proposed; the subjects were also called upon to express an opinion on taleanalysis. Two hundred sixty-seven subjects responded. The results confirm a wide use of remote analysis even in the current situation; they also seem to indicate recognition by psychoanalysts of the emergence of new psychic phenomena in this type of setting, for example, childhood traumas that in the face-to-face analysis were unknown or inelaborate, usable in the treatment process.

The Long-Term Efficacy and Sustainability of the Tabby Improved Prevention and Intervention Program in Reducing Cyberbullying and Cybervictimization.

Although cyberbullying and cybervictimization prevention programs have proved effective in the short term, their effectiveness remains unclear in the long run. Thus, the present study evaluated the long-term effects of the Tabby Improved Prevention and Intervention Program (TIPIP). Participants were 475 middle and high school students (Mage = 12.38; SD = 1.45; F = 241, 51%), of whom, 167 were in the Experimental Group (EG; Mage = 13.15; SD = 1.52; M = 51.5%), and 308 were in the Control Group (CG; Mage = 13.47; SD = 1.35; M = 47.7%). Students completed measures assessing cyberbullying and cybervictimization at three time points: baseline (T1), immediately after the intervention (6 months, T2), and at 1 year (T3). The results showed no significant effects of the TIPIP in reducing both cyberbullying and cybervictimization over time. Overall, our results confirm the lack of effectiveness of long-term preventive programs and emphasize that different curricula should be implemented in future programs to prevent and manage cyberbullying and cybervictimization, also taking into account psychological mechanisms and processes involved in such behaviors.

Affect, Body, and Eating Habits in Children: A Systematic Review.

The present review investigates the complex associations between children's affective states, body perceptions, and eating habits, thus providing crucial insights for potential health interventions. Following PRISMA guidelines, three databases were searched for peer-reviewed studies exploring the relationship between eating habits, emotional states, and body image perceptions in a population of children (5 to 11 years old). A total of seven articles were included. Our findings revealed a pattern of associations between negative emotional states, like anxiety and depressive feelings, and maladaptive eating behaviors. Additionally, explicit influences from parental feeding practices, peer pressure, socioeconomic factors, and children's body perceptions were observed to shape eating habits, with a pronounced tendency among older girls towards dieting and food preoccupation. Our results underline the intertwining nature of age, gender, and emotional states. Furthermore, our findings accentuate the urgency for comprehensive interventions that acknowledge and address the complex interplay of emotional, familial, and socioeconomic factors alongside children's body image perceptions. The criticality of continued research, particularly ones employing longitudinal designs and diverse demographic samples, is highlighted as we strive to understand and navigate such multifaceted relationships to enhance children's health and well-being.

The Impact of the First and Second Wave of the COVID-19 Pandemic on Eating Symptoms and Dysfunctional Eating Behaviours in the General Population: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to examine the prevalence of feeding and eating disorder (FED) symptoms or dysfunctional eating behaviours (DEB) in the general population during the COVID-19 outbreak. METHOD: We searched eligible articles in biomedical databases from 1 January 2020 to 31 March 2022. Prevalence rates of FED or DEB changes between pre-pandemic and pandemic time and correlation with psychological distress were pooled with a meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. A total of 186 studies with 406,076 participants met the inclusion criteria. RESULTS: The more prevalent FED or DEB during the COVID-19 outbreak were: body image concerns (52%, 95% CI 0.38, 0.66), binge eating (40%, 95% CI 0.25, 0.55), and overeating (40%, 95% CI = 0.32-0.48). Pooled data of longitudinal studies (k = 8) only showed a significant difference in the prevalence of weight gain from pre-pandemic to the pandemic time. Finally, increased levels of psychological distress (k = 35) positively correlated with some ED symptoms. CONCLUSION: This meta-analysis evidenced a negative impact of the pandemic on eating symptoms and DEB in the general population.

Self-Esteem and Binge Eating among Adolescent Boys and Girls: The Role of Body Disinvestment.

Although low self-esteem and body disinvestment have been recognized as potential risk factors for disordered eating, no studies have explored how these factors may work together to predict binge eating in adolescents. Therefore, we hypothesized a path model for girls and boys separately to investigate whether the body's investment dimensions (feelings towards the body, physical touch, body care, body protection) mediate the relationship between self-esteem and binge eating, and age moderate such relationships. Participants were 1046 Italian students aged between 11 and 19 years (472 girls, Mage = 14.17; 574 boys, Mage = 14.60) screened through self-report measures. Both models showed an acceptable fit (males: χ2(22) = 30.441; RMSEA = 0.026; CFI = 0.99; TLI = 0.97; SRMR = 0.023; females: χ2(22) = 34.723; RMSEA = 0.35; CFI = 0.98; TLI = 0.95; SRMR = 0.029). Negative body feelings and reduced body protection fully mediated the relationship between self-esteem and binge eating, regardless of gender. Our findings highlight the importance of interventions promoting body emotional investment to reduce adolescents' vulnerability to binge eating.

Paternal rejection, psychological maladjustment, and child emotional eating: Path analysis in 8- to 11-year-old boys and girls.

We examined the impact of paternal rejection (based on father's and children's reports) on the children's emotional eating behavior and if child psychological maladjustment mediated this relationship. Three hundred sixty-nine dyads of fathers and children were screened using self-report measures of demographic data, parental rejection, child psychological maladjustment, and disordered eating behavior. Children's subjective perceptions of relationship with father have more impact on their psychological outcomes and unhealthy dietary patterns than father reported parenting quality. Children's unhealthy psychological adjustment may be an essential underlying mechanism linking perceived paternal rejection of children's emotional eating behaviors.

Non-Suicidal Self-Injury: A School-Based Peer Education Program for Adolescents During COVID-19 Pandemic.

Introduction: Non-suicidal self-injury (NSSI) constitutes a major health concern among youth. However, less is known about the useful ways to prevent NSSI. As such, the NSSI- Peer Education Program (NSSI-PEP) aims to intervene on the vulnerability factors that predispose to NSSI by applying a peer education approach. The NSSI-PEP is grounded on the psychoanalytic tradition's tenets, implementing modules targeting four crucial risk factors for NSSI: pubertal transformation, body image, self-esteem, and emotion regulation. Methods: Selected 8th grade students were trained to serve as peer educators and held a peer-education intervention for 6th and 7th grade students. Pre- and post-intervention assessments were conducted in order to evaluate the program's effectiveness. Results: Results revealed preliminary support for the program's feasibility, as students reported greater emotion regulation abilities (p = 0.038) and significant changes in self-esteem (p<0.001), personal alienation (p = 0.005), body image (p < 0.001), and maturity fear (p < 0.001). Also, NSSI-PEP was positively evaluated by participants. Discussion: Our pilot study provides preliminary empirical support for the NSSI-PEP, representing a promising way to address areas of vulnerability for NSSI onset. Findings may also help current policies to promote targeted preventive activities and produce sizable benefits to society.

Non-Suicidal Self-Injury Among Italian Adolescents: The Role of Parental Rejection, Self-Concept, Anger Expression, and Body Investment.

OBJECTIVE: Parental rejection, poor self-concept, anger expression, and negative body investment have often been associated with non-suicidal self-injury (NSSI). However, research has investigated each factor separately. To address this shortcoming, the main aim of the study was to integrate these factors and test a hierarchical regression to examine the impact of each factor above and beyond the others. METHOD: A cross-sectional sample of 481 Italian high school students aged 13-19 (Mage=15.48; SD=1.46) were screened by self-report measures that assess parental rejection, self-concept, anger expression, body emotional investment, and NSSI. A semi-structured interview was administered in order to assess the characteristics of self-injurious behaviors. RESULTS: After the interview, twenty-three (4.8%) students reported having engaged in NSSI (Mage =12.63; SD=1.58). Neither gender nor age differences were found. The hierarchical regression revealed the NSSI was associated with the inward expression of anger (ORs=1.1-1.7) and the negative body investment (ORs=.037-.281). CONCLUSIONS: These findings point out that the expression of anger inwardly and the emotional investment in the body may be salient factors to consider in understanding the occurrence of NSSI among adolescents. The clinical relevance of these findings was discussed.

Relationships Between Self-Esteem, Interoceptive Awareness, Impulse Regulation, and Binge Eating. Path Analysis in Bariatric Surgery Candidates.

OBJECTIVE: The current study investigates the hypothesis that the effect of low self-esteem on binge eating in bariatric candidates was mediated by both difficulties in the perception of bodily signals and impulse regulation after accounting for gender, age, and body mass index. METHOD: 59 preoperative patients (both male and female) were screened by means of self-report measures of self-esteem, interoceptive deficits, impulse dysregulation, and severity of binge eating. Results: Results indicated that all direct effects were significant, except for the self-esteem on impulse dysregulation and the interoceptive deficits on binge eating. Self-esteem had a significant indirect effect on impulse dysregulation mediated by interoceptive deficits. Impulse dysregulation, in turn, mediates the effect of interoceptive deficits on binge eating. Moreover, the path starting from self-esteem, going first to interoceptive deficits, then going via impulse regulation difficulties to binge eating was significant. RESULTS AND CONCLUSIONS: A potential underlying mechanism through which self-esteem is linked to binge eating has been suggested. Obese individuals who perceived themselves as inadequate may carry a stronger burden by the confusion and mistrust related to bodily functioning and, consequently, may act more impulsively, through binge eating.

Binge Eating Disorder and Related Features in Bariatric Surgery Candidates.

OBJECTIVE: The present study sought to: 1) assess the prevalence of Binge Eating Disorder (BED) and abnormal eating behaviors in bariatric surgery candidates; 2) compare patients with and without BED as regards to eating disturbances, psychological characteristics, and health status; 3) individuate which factors were significantly related to binge eating severity. METHODS: Sixty-three preoperative patients (17 males and 46 females) were screened by means of an ad hoc socio-demographic schedule, the Rosenberg Self-Esteem Scale, the Eating Disorders Inventory-3, the Binge Eating Scale, and the General Health Questionnaire-28. BED diagnosis was performed through a clinical interview. RESULTS: BED and disordered eating, such as episodes of binge eating, sense of lack of control over eating and inappropriate compensatory behaviors, appear common in patients undergoing weight loss surgery. Significant differences between BED and non-BED subjects in relation to eating disturbances and psychological characteristics emerged. Multiple regression analysis revealed that only emotional dys-regulation significantly predicted binge eating vulnerability. CONCLUSION: The recognition of factors involved in the development and maintenance of disordered eating in bariatric patients may support the choice of particular therapeutic strategies and improve bariatric surgery outcome. Further studies on this issue would be useful.

Nonsuicidal Self-injury: A Systematic Review.

Objective: Nonsuicidal self-injury (NSSI) refers to the intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned. Our paper presents an up-to-date overview on nonsuicidal, self-injurious behaviors. Method: In accordance with PRISMA guidelines, a systematic literature search was conducted across two databases, PubMed and PsycARTICLES, regarding the main features of NSSI with a focus on epidemiological and etiologic data, diagnostic criteria, and functions. All English articles, published between 1998 and 2016, were considered, and screened against a priori inclusion/exclusion criteria. The search terms include: self-harm, self-injury, NSSI, epidemiology, comorbidity, gender, functions and DSM. We also examined the references of the retrieved articles. Results: NSSI is most common among adolescents and young adults, and the age of onset is reported to occur between 12 and 14 years. Comorbidity with borderline personality disorder (BPD) and eating disorders is often reported. DSM-5 includes NSSI as a condition requiring further study. This review gives an overview of the prevalence rates (7.5-46.5% adolescents, 38.9% university students, 4-23% adults) and main causes that appear to stem from childhood trauma, comorbidity with many other disorders and several functions of NSSI, and the potential independence of a NSSI disorder. Conclusion: Over the years, interest in NSSI grew to such an extent that an ongoing debate was instigated on whether NSSI should be considered as a diagnosis in its own right and given its own category. This paper provides an up-to-date overview on self-injury, what is known about it and what remains to be done. Clearly, our understanding of the main issues of NSSI has increased in last two decades. However, future researches is needed to examine the developmental trajectories, cultural backgrounds and shed light on the risk factors and functions as well as clarify its role as an independent diagnostic entity.

Identifying Predictors Associated with the Severity of Eating Concerns in Females with Eating Disorders.

Considering how to improve efficacy of therapeutic strategies, the overall objective of the present study was to investigate the extent of eating concerns and to identify predictors associated with the severity of disordered eating symptomatology among people with eating pathologies. We screened 80 female eating disordered patients, ranging from 13 to 40 years, by means of self-report measures of parental behavior as perceived by the offspring, self-esteem, perfectionism, body shame and eating disorder severity. Self-reported weight and height were obtained. The diagnosis of bulimia nervosa resulted to be associated with a greater severity of the eating symptomatology. Maladaptive perfectionism, body shame and self-esteem, significantly predicted the level of eating concerns. The recognition of potential maintaining factors may support the choice of particular therapeutic strategies to improve the treatment of eating pathologies and their outcomes.

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.