BackgroundCognitive flexibility (CF) is defined as the ability to switch efficiently between different concepts or tasks. Empirical evidence of CF in individuals with bulimia nervosa (BN), offers conflicting conclusions, attributed to how CF is conceptualized and operationalized. The aims of the current study were to compare CF performance of women with BN to healthy controls, utilising a CF model that includes three subtypes termed: task switching, switching sets and stimulus-response mapping. In addition, to examine the association between CF subtypes and BN clinical characteristics.MethodsSixty-two women (twenty-eight with BN and thirty-four healthy controls) with a mean age of 24.4, completed a CF cognitive battery. Performance was measured by response time and accuracy.ResultsThe BN group's response time was worse only on task switching, but was significantly more accurate on stimulus-response mapping. There was no significant correlation between CF scores and BN clinical characteristics.ConclusionsWomen with BN present with an impairment only on higher CF demands, whereas their performance at lower-level CF tends to be more accurate. Additionally, CF is independent of clinical characteristics, thus supporting evidence that it may reflect a trait nature in BN.

BackgroundIndividuals with Eating Disorders (EDs) are at an elevated risk for suicidal behaviors (SB). The aim of this study was to explore the relationship between constructs of the Interpersonal Theory of Suicide (IPTS), SB and age among individuals with EDs.MethodsThe study included 140 participants: 77 adolescent girls (ages 12-17) and 63 emerging adult women (ages 18-29). Participants completed a battery of psychological instruments assessing SB, ED symptom severity, non-suicidal self-injury (NSSI), perceived burdensomeness (PB), and thwarted belongingness (TB).ResultsPB levels were higher among emerging adults compared to adolescents while TB levels were similar across groups. PB was significantly associated with SB among adolescents, but not among emerging adults. In contrast, TB was significantly associated with SB among emerging adults, but not among adolescents. No moderating effect of age was found in the relationship between NSSI and SB.ConclusionThese findings support the contribution of IPTS constructs (TB, PB) to SB among females with ED. Moreover, the identification of age-specific mechanisms by which IPTS constructs operate provides novel insight with potential clinical implications. Interventions for adolescents with EDs and SB may benefit from caregiver-focused strategies that reduce adolescents’ sense of burdensomeness, whereas interventions for emerging adults with EDs and SB may be improved by enhancing social integration and strengthening their sense of belongingness.

ObjectiveStudies indicate a significant challenge for therapists in forming a therapeutic alliance (TA) with patients coping with anorexia nervosa (AN). While TA is a significant predictor of treatment outcomes, and AN treatment has low success rates, little is known about factors that affect the formation of an alliance and its quality in the treatment of AN. This study aimed at examining the factors associated with alliance formation, as perceived by patient-therapist dyads throughout AN therapy. MethodsA total of 18 dyads of patients with AN and their therapists were recruited from an eating disorder unit. The semistructured interviews focussed on the TA between the therapist and patient and examined facilitators towards, and barriers to, TA formation. Data analysis followed a thematic approach. ResultsThe data analysis revealed an overarching theme: the mutual wish of the patient and therapist to form a close relationship and related challenges. This theme was divided into subthemes: (1) the role of self-disclosure of affection; (2) the meaning of the therapeutic setting; (3) coping with relationship ruptures; and (4) the importance of empathic acknowledgements. ConclusionA major barrier to TA formation between patients with AN and their therapists is patients' conflict between a need for meaningful relationships and fear of re-experiencing disappointment and pain. Self-disclosures of affection, flexible treatment setting, acknowledgement of therapists' empathic failures and ability to see things from patients' perspectives are perceived by therapists and patients to facilitate alliance formation. This study also presents practical implications derived from these themes.

A large theoretical body of knowledge exists emphasizing the importance of parental mentalizing in the context of anorexia-nervosa (AN). However, the empirical support to these assumptions is still scarce. The aim of the present study was to examine whether parents of patients with AN are characterized by a lower mentalizing ability, and whether it is associated with impaired mentalizing, AN symptomatology and eating disorder (ED) related psychological traits in the daughters. Thirty-two family triads (fathers, mothers, and daughters) of female adolescent and young adult inpatients with AN were compared with thirty-three non-clinical family triads (N = 195). The mentalizing ability of all the participants was assessed using semi-structured interviews and coded using the Reflective Functioning Scale (RFS). Self-report questionnaires were administered to the daughters to evaluate ED symptomatology and ED related psychological traits (e.g., low self-esteem, interpersonal insecurity, emotional dysregulation). Decreased reflective functioning (RF) levels were found among mothers and fathers of patients with AN compared to their control peers. Examining the entire sample, clinical and non-clinical groups together, showed that both paternal and maternal RF were associated with the daughters' RF and each were found to have a significant and distinct contribution to the daughters' RF. Significant associations were found between lower levels of maternal and paternal RF and increased ED symptoms and ED related psychological traits. The use of a mediation model suggested a serial relationship in which low maternal and paternal RF contributes to the daughters' low RF, which in turn is associated with higher levels of psychological maladjustment, and ultimately contributes to the increased severity of ED symptoms. The present results provide strong empirical support for theoretical models that suggest that deficits in parental mentalizing may represent important correlates of the presence and severity of ED symptoms in AN. Furthermore, the results highlight the relevance of fathers' mentalizing ability in the context of AN. Finally, clinical and research implications are discussed. The goal of the study was to examine the relationship between deficits in parents' ability to reflect on their own and others' emotional experience and the severity of their daughter's eating disorder and psychological maladjustment. A clinical group of young female inpatients diagnosed with anorexia-nervosa and both their biological parents was compared to a control group of young females without eating disorder and their parents. Personal interviews assessed the participants' reflective ability and self-report questionnaires assessed the daughters' eating disorder severity and psychological difficulties. The results show that patients with anorexia nervosa and their parents are less able to reflect on their emotional experiences compared to the control group. The parents' reflective ability was found to be related to their daughter's reflective ability. For both fathers and mothers, the less able the parent is to reflect on his or her emotional experiences the higher the severity of the daughter's eating disorder symptoms and psychological maladjustment are. The results imply that deficits in the parents' ability to process their own and others' emotional experiences are related to the severity of eating disorders symptoms and psychological maladjustment among daughters.. The study results highlight the importance of assessing reflective abilities of fathers.

The goal of this study was to validate the Hebrew version of the Movie for the Assessment of Social Cognition (MASC)-an ecological measure for assessing mentalizing ability-among patients with anorexia nervosa (AN) and healthy individuals. We examined the validity of the MASC's general mentalizing ability scale and of its mentalizing impairments subscales using validated measures of mentalizing ability (Reading the Mind in the Eyes test, Cambridge Mindreading Face-Voice Battery, and Reflective Function questionnaire) among female patients with AN (N = 35) and control participants (N = 42). ED symptoms were assessed via self-report questionnaires. The MASCHeb correlated with measures of mentalizing ability and was found to significantly differentiate patients with AN from controls. In addition to differing on general mental ability, the groups differed on hypomentalizing (but not hypermentalizing). Based on our findings, the MASCHeb proved to be an ecologically valid tool for assessing mentalizing ability and impairments among patients with AN. Moreover, our findings demonstrated the role played by general mentalizing ability in EDs and specifically pointed to the importance of hypomentalization in EDs. These findings have therapeutic implications, as outlined in the Discussion section.

Binge-eating disorder) BED) is the most common eating disorder in the United-States. Daily, orally administered topiramate has shown BED treatment efficacy, with two major limitations: frequent and severe side effects and slow time-to-effect. SipNose is a novel non-invasive intranasal direct nose-to-brain drug delivery platform that delivers drugs to the central nervous system consistently and rapidly. Herein, we study a SipNose-topiramate combination product, as an acute “as needed” (PRN) solution for BED management. First, SipNose-topiramate’s pharmacokinetics (PK) and safety was evaluated. The second part aimed to demonstrate its PRN-treatment feasibility in terms of usability and potential efficacy in reducing the number of binge-eating events. Twelve BED patients were studied over three time periods; 2-weeks of baseline monitoring [BL], 8-weeks of treatment [TX], and 2-weeks of follow up [FU]. The PK profile showed peak plasma levels at 90 min post-administration, a t1/2 > 24 h and consistent topiramate delivery with no adverse events. In the second part, 251 treatments were self-administered by the patient participants. There was a significant reduction from baseline to treatment periods in mean weekly binge-eating events and binge-eating event days per week. This was maintained during the follow up period. Efficacy was corroborated by improved patient illness severity scales. There were no adverse events associated with any administered treatments. Patients were exposed to less drug when compared with accepted oral dosing. This study introduces a SipNose-topiramate drug-device combination as a potentially safe, effective, and controlled method for BED management. Its findings introduce a potential approach to BED management both as an intranasal and as a PRN therapy for reducing binge-eating events, with a large-scale reduction in patient drug exposure and side effects and with improved patient quality of life. Further studies are needed with larger patient populations to establish SipNose-topiramate as a mainstream treatment for BED. Trial registration: Registration number and date of registration of the clinical studies reported in this article are as follows: 0157-18-HMO, August 15th 2018 and 6814-20-SMC, December 2nd 2020. Binge eating disorder (BED) is a common eating disorder. Daily oral topiramate treatment has shown efficacy in clinical studies and off-label use, with frequent and severe side effects. SipNose is a novel, rapid and consistent direct nose-to-brain drug delivery platform. This study evaluates a SipNose-topiramate combination product, as an innovative acute “as needed” (PRN) BED treatment solution. SipNose-topiramate's pharmacokinetics (PK) and safety demonstrated consistent, dose-dependent topiramate delivery with no adverse events. SipNose-topiramate was studied vis-à-vis its safety and feasibility as a PRN-treatment for reducing the number of binge-eating events. 12 BED patients were studied (2-weeks baseline monitoring, 8-weeks treatment, 2-weeks follow-up). Patients were instructed to self-administer the drug when they feel an urge to binge-eat. Two hundred fifty-one treatments were administered. When compared with daily oral dosing, lower doses were used with no adverse events and minimal side effects. Baseline to treatment periods showed significant reduction in mean weekly binge-eating events and binge-eating event days-per-week. This was maintained during follow-up. Improved illness severity scales corroborated the improved feasibility outcomes. In conclusion, this study introduces SipNose-topiramate as a potential “as needed” intranasal treatment for BED that is safe, effective, and reduces drug exposure and side effects. Additional studies are needed to validate SipNose-topiramate as a BED management therapy.

During the COVID-19 pandemic in Israel, the number of patients with eating disorders (EDs) seeking treatment increased significantly. The present study sought to evaluate whether, during the pandemic (2020–21), patients with anorexia nervosa (AN) would show more ED-related, comorbid, and COVID-19-related symptoms in comparison to a naturalistic control group, and whether differences would be found between adult and adolescent patients with AN. We also examined attitudes to telemedicine use during the pandemic in patients receiving long-distance interventions. Using online self-report questionnaires, we assessed general and COVID-19-specific symptoms with a secure digital platform (REDCap®) in 36 female adolescents with AN, 35 female adults with AN, and 25 female controls. Compared with controls, patients with AN showed more symptoms of EDs, anxiety, depression, and post-traumatic stress disorder (PTSD), elevated suicidal ideation, more COVID-related emotional-behavioral disturbances, and lower resilience. Adult patients with AN fared worse than adolescent patients on most of these measures. Adult patients using telemedicine during the COVID-19 pandemic showed fewer positive attitudes toward this treatment than adolescents (telemedicine was offered to all, but used by 18/35 adolescents and 21/36 adults with AN). Last, elevated COVID-19-related symptomatology was correlated with more symptoms of ED, anxiety, depression and PTSD, and with lower resilience. Our findings suggest that the emotional-behavioral state of Israeli females with AN, particularly adults, was worse during the COVID-19 pandemic in comparison to controls. Many patients did not use telemedicine for their treatment. Adult patients using telemedicine were less satisfied with it than adolescent patients. The recent COVID-19 pandemic has been associated with increased rates of eating disorders in many countries around the globe, including Israel. Our study evaluated whether Israeli patients with anorexia nervosa would fare worse than a control group during the COVID-19 pandemic, and whether adults and adolescents with anorexia nervosa would differ. For this purpose, we administered questionnaires to 71 females with anorexia nervosa—36 adolescents and 35 adults—and to a control group of 25 adolescent and young adult women. We found that females with anorexia nervosa showed not only more eating-disordered and psychiatrically-related symptoms, but also more pandemic-related disturbances than the control group. Among the patients with anorexia nervosa, adults fared worse than adolescents. Fifty-one percent of adolescents and 58% of adults with anorexia nervosa received treatment via telemedicine, although all were offered this treatment. Adults treated with telemedicine showed fewer positive attitudes toward it than adolescents. Last, more disordered eating and other psychiatric symptoms were associated with more COVID-19-specific disturbances. Our findings suggest that the emotional-behavioral state of female Israeli patients with anorexia nervosa is worse than that of control females during the COVID-19 pandemic, especially in adults.

Patients with anorexia nervosa (AN) display elevated anxiety and attention biases (ABs) in threat processing. Attention bias modification treatment (ABMT) is considered promising for anxiety disorders, but its potential for AN is limited. In this study, 154 young women hospitalised because of AN were assigned to ED-related and anxiety-related threat stimuli, or to a non-ABMT intervention control condition in a randomized control trial. Hundred-and-ten patients completed the study. ABMT was an add-on to the regular inpatient treatment. Research participants completed two pretreatment training sessions and eight biweekly sessions of ABMT. AB, ED-related symptoms, depression, anxiety and stress were assessed before and after ABMT in the research groups, and, similarly, 5 weeks apart, in the controls. We found that despite the different patterns of change in AB between the three groups following ABMT, the reduction in AB, or the between-group differences in AB-reduction, were not significant. While the severity of ED-symptoms, depression, anxiety and stress was reduced following ABMT, or control condition, in all groups, there were no between-group differences in these changes. Changes in AB were not correlated with baseline and pre-post-treatment changes in ED-related and comorbid symptomatology. Methodological and inpatient treatment-related considerations may explain our negative ABMT-related results.

Abstract Background: Binge eating disorder) BED) is the most common eating disorder in the United-States. Chronic, orally administered topiramate has shown BED treatment efficacy, but with two major limitations: frequent and severe side effects and slow time to action. SipNose is a novel-non-invasive-intranasal (IN) direct nose-to-brain (DNTB) drug delivery platform that delivers drugs to the central nervous system (CNS) consistently and fast. Herein, we study SipNose-topiramate combination product, as an acute "as needed"(PRN) solution for BED management. Methods: First, we evaluate the innovative SipNose-topiramate's pharmacokinetics (PK) and safety. The second part aimed to demonstrate SipNose-topiramate's PRN-treatment efficacy in reducing the number of binge-eating episodes in 12-BED patients (2-weeks of baseline monitoring [BL], 8-weeks of treatment [TX], 2-weeks of follow up [FU]). In this part 251 treatments were used by the 12 BED patients participated in the study. Results: The PK profile showed peak plasma levels at 90 minutes post-administration, and a t1/2 > 24hr, and demonstrated consistent topiramate delivery with no AE. In the second part, mean weekly binge events (WBE) and binge event days per week (DPW) showed a significant reduction from baseline to treatment period that was maintained in follow up period. Efficacy was corroborated by improved patient illness severity scales. There were no adverse events during all administered treatments. Patients were exposed to less drug when compared with accepted oral dosing. Conclusions: This study introduces the novel SipNose-topiramate drug-device combination as a safe, effective, and controlled method for BED management. Its findings represent a breakthrough approach to BED management both as an intranasal and "as needed" therapy for reducing binge eating episodes with a large-scale reduction in patient drug exposure and thus side effects and with improved patient quality of life. Further studies are needed with larger patient populations to establish SipNose-topiramate as a mainstream treatment for BED. Trial registration: Registration number and date of registration of the clinical studies reported in this article are as follows: 0157-18-HMO, August 15th 2018 and 6814-20-SMC, December 2nd 2020.

OBJECTIVE:This study had two goals. The first was to validate and examine the potential of the Hebrew version of the Cambridge Mindreading face task (CAMHeb )-an ecological measure of emotional theory of mind (eToM)-to assess eToM in individuals with anorexia nervosa (AN). The second goal was to examine whether interpersonal mistrust would mediate the relation between mentalizing and eToM and the severity of AN.METHOD:The validity of the CAMHeb was examined using well-established measures of mentalizing ability and eToM in 45 young female patients with AN and 53 control participants. Next, the mediation model was assessed using a subsample of 33 AN patients and 34 controls, in which interpersonal mistrust was additionally assessed.RESULTS:The CAMHeb correlated with the measures of mentalizing ability and eToM. The CAMHeb , along with the measure of general mentalizing, significantly differentiated between the AN and control groups. The associations of general mentalizing and CAMHeb with eating disorder (ED) symptoms were mediated by interpersonal mistrust.CONCLUSION:The CAMHeb is a valid measure of deficient eToM in AN. In therapy, an increase in mentalizing ability and accurate eToM may enhance interpersonal trust, which may further contribute to attenuation of AN symptoms.

Anorexia nervosa (AN) has the highest rate of mortality of any psychiatric disorder, and cardiovascular complications occur in up to 80% of patients with AN and account for up to 30% of mortality. A controversy exists as to whether patients with AN are prone to develop electrocardiographic abnormalities related to repolarization. We aim to study previously unexplored T wave morphology markers in medically-treated patients with AN. Fifty-eight patients with AN (32 with restricting type and 26 with binge-eating/purging type) and 82 healthy controls were included in the study. ECGs were conducted under strict conditions and total cosine R-to-T (TCRT) and T-wave morphology dispersion (TMD) were computed according to accepted standards for a random beat and for an averaged beat. Forty-six AN patients were hospitalized (79.3%) during the study for a mean duration of 1.5 +/- 1.1 months. AN patients had comparable QTc, TCRT, mean TMD, TMDpre, TMDpost and TCRTc values to those of healthy adults. Flattened T wave occurred slightly more often among AN patients than in controls (1.57 +/- 1.23 leads affected compared with 1.11 +/- 0.80 leads, respectively, p = 0.017). QTc, TCRT and TMD parameters' values were unaffected by the clinical type of AN. In conclusion, weight-restored AN patients are characterized by T wave flattening, but normal other T wave morphology parameters, which seemingly reflects an overall low risk of repolarization-associated ventricular arrhythmias. Long-term follow-up studies should be conducted to evaluate the prognostic significance of these novel repolarization markers in untreated patients or early in the refeeding phase.

PURPOSE:The allocentric lock theory (ALT) suggests that people with eating disorders have difficulties in multisensory integration in two reference frames-egocentric and allocentric, whereby the egocentric, but not allocentric, is impaired. This leads to a distorted body image that contributes to the development and maintenance of the disorder. The current study aimed to explore a facet of the ALT, namely, the visuo-spatial aspect, and its relation to cognitive flexibility in patients with anorexia nervosa (AN).METHODS:Fifty-five participants took part in the study: 20 AN patients and 35 controls, matched by age and education. The object perspective taking test (OPTT) and the mental rotation test (MRT), tapping egocentric and allocentric representations, respectively, and a set-shifting task were administered. The brief symptom inventory was used to measure overall levels of distress.RESULTS:AN patients showed higher level of distress. They performed poorer on the OPTT and set-shifting task but not on the MRT. The OPTT and MRT were correlated for controls but not for AN patients, while the set-shifting task and body mass index were associated with the OPTT but not with the MRT for the AN patients.CONCLUSIONS:The findings support the ALT by demonstrating impaired visual egocentric representations and intact allocentric visual functions in AN patients, with cognitive flexibility associated only with the egocentric frame. Therefore, egocentric frame impairment in AN patients may be influenced by visual perception and cognitive flexibility deficiency.LEVEL OF EVIDENCE:Level III: case-control analytic study.

Objective To investigate whether binge-eating in patients with eating disorders (EDs) is associated with attentional deficits. Methods We studied ED patients with binge-eating (n = 51), no binge-eating (n = 59) and controls (n = 58). ED patients were assessed following the stabilization of weight and ED pathology. Attention assessment included evaluation of attention deficit hyperactivity disorder (ADHD) diagnosis, the Adult ADHD Self-Report (ASRS) and ADHD Rating Scale-IV-Home Version (ADHD-RS) questionnaires, and attention functioning assessed with neuropsychological tools. The severity of eating-related pathology, depression, anxiety and obsessionality was also monitored. Results Patients with binge-eating showed more ADHD symptomatology on the ADHD-RS compared with non-binge-eating patients. No differences were found between binge-eating and non-binge-eating patients in ADHD diagnosis and neuropsychological functioning. Among the specific ED subtypes, patients with anorexia nervosa binge/purge type (AN-B/P) showed the highest rates of ADHD symptomatology on the ADHD-RS, and were characterized with sustained attention deficits. Conclusion Binge-eating is not associated with attention deficits as measured by objective neuropsychological tools. Nonetheless, it is associated with attentional difficulties as measured with the self-reported ADHD-RS. AN-B/P patients are the only ED category showing objective sustained attention deficits.

The study aimed to examine two constructs: general mentalizing processes and the specific component of affective mentalizing regarding self and others alongside the construct of affect regulation patterns in female adolescent and young adult inpatients with anorexia nervosa (AN; n = 41), depression (n = 20) and controls (n = 53). We further examined the predictive ability of affect regulation to eating-disorder (ED) symptoms beyond that of the mentalizing variables, and their potential role in mediating between mentalizing, depression and ED symptoms. We used tools assessing reflective functioning (RF), complex emotion recognition and theory of mind (ToM), alexithymia, affect regulation, depression, and ED symptoms. The AN and depression groups exhibited lower general mentalizing and higher alexithymia, emotional reactivity, and emotional cutoff patterns than controls, but showed no greater disturbance in ToM. The two clinical groups did not differ on any of these variables. Elevated mentalizing and adequate affect regulation patterns separately predicted lower severity of ED symptoms. Nonetheless, affect regulation did not add to the predictive value of mentalizing variables. Specifically, elevated alexithymia, and depressive symptomatology, but not RF, predicted greater ED symptomatology. Moreover, alexithymia directly accounted for elevated ED symptoms and also indirectly connected with ED symptoms via emotional hyperactivation and elevated depressive symptoms. These findings suggest that deficiencies in mentalization and affect regulation are not unique to AN, but may rather associated with psychopathology in general. Nonetheless, alexithymia and depression may increase ED-related symptomatology. Affect regulation deficiencies are mainly related with depressive symptoms and emotional hyperactivation is indirectly related with AN via the depressive symptoms.

Background: This study examined the moderating role of loss aversion (LA) on the relationship between impulsivity, nonsuicidal self-injury (NSSI), suicidal attempts, and ideations among Eating Disorder (ED) patients. Methods: Data was collected on 81 ED patients and 37 healthy controls. ED patients were divided into 2 groups: 25 AN-Rs, 56 AN-BPs and BNs. Measurements of trait impulsivity, LA, NSSI, suicide attempts, and suicide ideations were collected. Results: The rate of attempting suicide was highest in the AN-BP/BN (34.8%), lower in the AN-Rs (8%), and the lowest in the controls (2.7%). Suicide ideation was also higher in AN-BP/BN compared to both AN-R and controls. NSSI was higher in the AN-BP/BN group compared to both AN-R and control groups. LA scores were lower among participants with EDs compared to controls. BMI and depression were positively associated with suicide ideation and NSSI. Impulsivity was associated to suicide attempt and suicide ideation. Contrary to our hypothesis, LA scores were positively correlated with NSSI and SI. A stepwise regression revealed that contradictory to our hypothesis, higher LA predicted NSSI prevalence severity of NSSI and suicide ideation. Limitations: (1) Cross-sectional design; (2) Relatively small sample size of clinical subjects and only female participants; (3) Heterogeneity of treatment status. Conclusions: EDs are associated with lower levels of LA compared to general population. Although high LA is considered a protective factor against “high damage” decisions, it may serve as a facilitator of lower risk decisions which help the individual soothe and communicate his or her own suffering such as NSSI.

classical psychoanalytic authors have conceptualized EDs to represent a regression from oedipal to pre-oedipal eatingrelated oral anxieties, resulting from the resurgence of sexuality-related fears during adolescence (9). Modern psychoanalytic theories associate the development of EDs with interpersonal factors, e.g., problems in attachment relationships (10) or in mentalization, i.e., lack of an ability to comprehend the internal world of oneself and others (11). These conditions may produce a profound sense of emptiness or disorganization (10). EDs are conceptualized, in this context, to compensate for these impairments and to impose a sense of psychic order (10). According to self-psychology conceptualizations, patients with EDs may feel disappointed with others, or alternatively, that they do not deserve to have others to serve as selfobjects for them. Hence, they turn to food (BN and binge eating disorder [BED]), or to intentional refraining from eating (AN) as potential rewarding/reinforcing selfobjects to fulfill their psychological needs (12). Bruch (13) has suggested that severe ED pathology and faulty cognitive mechanisms may underlie the development and maintenance of many of the core psychopathological features of EDs, alongside the ongoing influence of malnutrition. Somewhat similarly, cognitive behavioral conceptualizations associate the predisposition to an ED with dysfunctional inborn cognitions associated with control, perfectionism and dichotomizing, serving to correct a pervasive sense of vulnerability, worthlessness and ineffectiveness. These distorted cognitions, alongside other vulnerability factors, may increase the risk for the development and maintenance of complex interactions between extreme concern with weight and shape and relentless dieting behaviors, likely culminating in diverse ED presentations (14).

BACKGROUND:We examined the relationship between general ability of mentalization, the specific aspect of affective mentalizing of self and others, emotion regulation strategies, and eating disorder (ED) symptoms.METHOD:Twenty-five female adolescent and young adult inpatients with EDs, and 22 healthy subjects, were administered a semi-structured interview - the Reflective Function (RF) scale, self-rating scales assessing alexithymia, emotion regulation, depression and ED symptomatology, and a neurocognitive measure assessing Theory of Mind.RESULTS:Participants with EDs presented lower levels of RF regarding the self and higher levels of alexithymia, using more emotional suppression and less cognitive reappraisal than controls. Elevated levels of general RF and self RF and attenuated alexithymia, along with elevated cognitive reappraisal and attenuated emotional suppression, were correlated with attenuated ED symptoms. Comorbidity with depressive symptoms predicted greater ED symptomatology.CONCLUSIONS:High mentalization may serve as a coping mechanism to attenuate ED symptoms.

INTRODUCTION The Cloninger's Psychobiological Model of Temperament and Character includes temperamental dimensions such as reward dependence (RD) and harm avoidance (HA). Studies of RD differentiate between sensitivity to reward (SR) versus to punishment (SP). We investigated the interrelationship between HA and RD in acutely ill patients with binge/purge (B/P) type eating disorders (EDs) and following symptomatic stabilization. METHODS Fifty patients with B/P EDs were assessed at admission to inpatient treatment, 36 of whom were reassessed at discharge. Thirty-six controls were similarly assessed. Participants completed Tridimensional Personality Questionnaire (TPQ), Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), and took the Gambling Task. RESULTS Patients with B/P EDs had higher TPQ-RD and lower TPQ-HA accompanied by lower SPSRQ-SR and SPSRQ-SP. SPSRQ-SP correlated positively and negatively with TPQ-HA and TPQ-RD, respectively. CONCLUSIONS Combination of lower TPQ-HA, lower SPSRQ-SP, and greater risk-taking inclination may maintain disordered eating in patients with B/P EDs. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Body image disturbances are a prominent feature of eating disorders (EDs). Our aim was to test and evaluate a computerized assessment of body image (CABI), to compare the body image disturbances in different ED types, and to assess the factors affecting body image. The body image of 22 individuals undergoing inpatient treatment with restricting anorexia nervosa (AN-R), 22 with binge/purge AN (AN-B/P), 20 with bulimia nervosa (BN), and 41 healthy controls was assessed using the Contour Drawing Rating Scale (CDRS), the CABI, which simulated the participants’ self-image in different levels of weight changes, and the Eating Disorder Inventory-2-Body Dissatisfaction (EDI-2-BD) scale. Severity of depression and anxiety was also assessed. Significant differences were found among the three scales assessing body image, although most of their dimensions differentiated between patients with EDs and controls. Our findings support the use of the CABI in the comparison of body image disturbances in patients with EDs vs. controls. Moreover, the use of different assessment tools allows for a better understanding of the differences in body image disturbances in different ED types.