Background: Body image disturbance (BID) involves a distorted perception of one’s body, whereas body dissatisfaction (BDS) reflects negative affective evaluation of body appearance. Both are central features of eating disorders such as anorexia nervosa (AN), but their expression in siblings of affected individuals remains underexplored, particularly in younger populations. Methods: This cross-sectional preliminary study included 53 full sisters of adolescent patients with severe AN treated in a tertiary hospital. Participants underwent anthropometric assessment and completed standardized measures of BID, BDS, physical activity, eating-related attitudes, perfectionism, anxiety, and depressive symptoms. Results: Participants exhibited marked body size overestimation (mean relative BID = +45.2%), with 64.2% classified as high overestimators and 3.8% as underestimators. Overestimation was most pronounced in the waist, chest, and calves. BID was not significantly associated with BDS or with anthropometric measures, including body mass index. BDS showed significant positive correlations with depressive symptoms and self-oriented perfectionism, whereas BID was positively associated with physical activity. No significant associations were found between BID or BDS and age, socioeconomic status, or birth order. Conclusions: Sisters of adolescents with severe AN show substantial perceptual distortion of body size without corresponding levels of body dissatisfaction, suggesting partial independence between perceptual and affective components of body image. These findings identify a potentially vulnerable group and highlight the need for longitudinal studies to clarify mechanisms and inform preventive strategies.

Background/Objectives: Anorexia nervosa (AN) is a severe psychiatric-metabolic disorder with high morbidity and mortality, profoundly impacting family systems. Siblings of patients with AN constitute a vulnerable group, yet there is a lack of specific, quantitative evidence on their mental health status, particularly when examined from a sex/gender perspective. This review aimed to synthesize existing evidence on the prevalence of psychiatric symptoms, diagnoses, and other mental health challenges in siblings of individuals with AN and critically analyze it from a sex/gender perspective. Methods: Following PRISMAguidelines, a systematic search was conducted across five databases (April-May 2025). The protocol was registered in PROSPERO (CRD420251025535). Sixteen studies published between 1983 and 2022 met eligibility criteria. Results: Included studies were rated as high or moderate quality, and overall risk of bias was estimated as low-moderate. Only half of the studies included brothers, and overall quality assessment from a sex/gender perspective was modest. Dimensional psychopathology assessments found increased prevalence of both internalizing and externalizing symptoms in siblings compared to controls, although siblings were generally more like controls than affected probands in psychometric evaluations. The few studies based on clinically diagnosed psychopathology state that siblings are at increased risk of several mental health disorders. Conclusions: Specific quantitative evidence on psychiatric diagnoses, psychopathology and other mental health challenges in siblings of individuals with AN is relatively scarce and biased, particularly by systematic exclusion of externalizing symptoms and male siblings. Future translational research should be designed and interpreted using a sex/gender perspective and prioritize systematic assessment by clinicians.

Background: It is common for patients with eating disorders (ED) to report traumatic experiences early in their lifetime. The objective of this study was to explore the presence and types of traumatic events and the comorbidity with Post-Traumatic Stress Disorder (PTSD) in a sample of adolescents with severe ED. Method: A total of 118 adolescents treated at our Eating Disorders Day Care Hospital (EDDCH) were systematically evaluated for depressive symptoms, disordered eating, early traumatic experiences, and presence of PTSD. Likewise, various clinical variables were collected including comorbidities, age upon ED diagnosis, number of hospital admissions, presence of non-suicidal self-injury, and suicide attempts. Results: Seventy-seven (65.3%) of adolescents of the total sample reported exposure to four or more traumatic events (bullying, psychological abuse, and sexual abuse being the most common). Fifty-seven of them (48.3% of the total sample) scored significantly high in PTSD assessment. Patients with ED and comorbid PTSD (PTSD+) presented higher disordered eating (p < 0.001) and depressive symptoms (p < 0.001) and also a higher prevalence of both non-suicidal self-injury (p = 0.031) and suicide attempts (p = 0.004). The depressive symptoms, measured with the CDI, emerged as an independent predictor of belonging to the PTSD+ group, explaining 22.9% of the variance. Conclusions: It is imperative to systematically screen adolescents with severe ED for traumatic events and PTSD, especially in patients presenting with more depressive symptoms and suicidal or non-suicidal self-injury behaviours, since this subset of patients could be at a higher risk of PTSD. Offering specific psychotherapeutic care targeting PTSD and/or posttraumatic symptoms in addition to the ED standard of care could arguably improve the prognosis of the ED in comorbid patients.

Cognitive-behavior therapy (CBT) is effective for obsessive-compulsive disorder (OCD). Because CBT requires significant time and resources, there is an increased interest in developing shorter formats of CBT for OCD (i.e., fewer sessions or in less time). We conducted a randomized single-blind controlled trial to investigate the effectiveness of concentrated CBT (co-CBT; 20 hours of therapist time across one month) compared to a waiting list (WL) in 30 unmedicated children and adolescents with OCD aged 7-17 in routine clinical care. Co-CBT was superior to the WL in reducing OCD symptom severity at posttreatment (primary endpoint; Cohen's d = 1.76) and these results were maintained through the end of a naturalistic 6-month follow-up. Participants initially randomized to the WL were offered co-CBT at the end of the trial and post-hoc analyses showed that they had similar improvements to those initially randomized to co-CBT. In post-hoc predictor analyses, participants aged 7-12, compared to those aged 13-17, and those with higher baseline OCD severity showed better posttreatment outcomes. Co-CBT is an effective intervention for unmedicated children and adolescents with OCD in routine clinical care. Studies including more robust control groups and larger samples are needed to replicate and expand these findings. Trial registration number: NCT04042038.

This study aimed to analyze body size estimates of others by patients with anorexia nervosa (AN) and to identify any differences with the perception of their own body size. Adolescent females (age, 13-17 years) were enrolled into AN (n = 30) and control(n = 23) groups. The Subjective Body Dimensions Apparatus (SBDA) was used to evaluate body size estimates for oneself (self-estimation) and others (other-estimation). Participants also completed questionnaires assessing eating disorders and depressive symptoms. The AN and control groups scored significantly higher in self-estimation than in other-estimation. However, the AN group showed higher self-estimation scores than the control group for all the body parts and for the global silhouette (p < .001). Patients with more severe eating disorder symptomatology showed more distorted self-estimation (p < .05). No statistically significant differences were found in the other-estimation scores between the groups (p = .714), indicating that AN and control patients estimate the body sizes of others similarly. Eating disorder symptomatology correlates with self-estimation scores but not with other-estimation scores in adolescents with AN. No correlations existed between clinical symptomatology and other-estimation.

The Child Obsessive-Compulsive Impact Scale (COIS-R) is a parent- and self-report measure of the impairment related to Obsessive–Compulsive Disorder (OCD) symptoms. Previous research has demonstrated the reliability and validity of the original version of the COIS-R; to date, however, the scale has not been validated for use in Spanish samples of pediatric OCD. The present study aimed to assess the psychometric properties of this in a clinical sample of pediatric OCD (n = 91). Analyses of internal consistency, convergent and divergent validity were conducted. For both the COIS-R report scales estimates similar to those in the original instrument were obtained for internal consistency, test-retest reliability, and convergent validity. Thus, the Spanish version of the COIS-R seems to retain sound psychometric properties of its original version; it appears to be a reliable instrument for the assessment of obsessive–compulsive impairment and the effects of treatment, and can be used in other cultural contexts.

Anorexia nervosa (AN) typically emerges in adolescence. The cortico-striatal system (CSTS) and the default mode network (DMN) are brain circuits with a crucial development during this period. These circuits underlie cognitive functions that are impaired in AN, such as cognitive flexibility and inhibition, among others. Little is known about their involvement in adolescent AN and how weight and symptom improvement might modulate potential alterations in these circuits. Forty-seven adolescent females (30 AN, 17 healthy control) were clinically/neuropsychologically evaluated and scanned during a 3T-MRI resting-state session on two occasions, before and after a 6-month multidisciplinary treatment of the AN patients. Baseline and baseline-to-follow-up between-group differences in CSTS and DMN resting-state connectivity were evaluated, as well as their association with clinical/neuropsychological variables. Increased connectivity between the left dorsal putamen and the left precuneus was found in AN at baseline. At follow-up, body mass index and clinical symptoms had improved in the AN group. An interaction effect was found in the connectivity between the right dorsal caudate to right mid-anterior insular cortex, with lower baseline AN connectivity that improved at follow-up; this improvement was weakly associated with changes in neuropsychological (Stroop test) performance. These results support the presence of CSTS connectivity alterations in adolescents with AN, which improve with weight and symptom improvement. In addition, at the level of caudate-insula connectivity, they might be associated with inhibitory processing performance. Alterations in CSTS pathways might be involved in AN from the early stages of the disorder.

The current study aims to: 1) investigate cognitive differences among adolescents at risk for suicide versus healthy controls (HC) and 2) identify cognitive changes associated with response to psychotherapy among adolescents at high risk for suicide. Thirty-five adolescents at high risk for suicide (HR), and 14 HC adolescents were recruited. Clinical and cognitive assessments were conducted in both groups at baseline and 16 weeks later (after the patients completed psychotherapy). HR and HC adolescents were compared at baseline and at completion of the study. We also conducted further analysis by separating into two groups the HR adolescents who responded to psychotherapy (n=17) and those who did not (n=11). At baseline, the HR group had significantly lower performance on verbal memory and processing speed than the HC group. At week 16, HR adolescents performed as well as HC adolescents in all cognitive domains. Among patients, better performance on visual memory was observed in those who responded to psychotherapy compared to those who did not. We concluded that lower performance on verbal memory and processing speed may be associated with a high risk for suicide among adolescents. Improvement in visual memory might be related to a lower risk for suicide in adolescents.

Purpose Here, we propose an integrative analysis of genome-wide methylation and gene expression to provide new insight into the biological mechanisms of Cognitive behavioral therapy (CBT) in pediatric obsessive-compulsive disorder (OCD). Patients and Methods Twelve children and adolescents with OCD receiving CBT for the first time were classified as responders or non-responders after eight weeks of CBT. Differentially methylated positions (DMPs) and gene co-expression modules were identified using specific R software packages. Correlations between the DMPs and gene co-expression modules were investigated. Results Two genes were enriched with significant DMPs (Δβ > ± 0.2, FDR-adjusted p-value < 0.05): PIWIL1 and MIR886. The yellowgreen module of co-expressed genes was associated with CBT response (FDR-adjusted p-value = 0.0003). Significant correlations were observed between the yellowgreen module and the CpGs in PIWIL1 and MIR886 (p < 0.008). Patients showing hypermethylation in these CpGs presented an upregulation in the genes in the yellowgreen module. Conclusion Taken together, the preliminary results of this systems-level approach, despite the study limitations, provide evidence that the epigenetic regulation of ncRNAs could be a predictor of CBT response. Limitations The sample size limited the statistical power, and given that the study was hypothesis-driven, our results should be seen as preliminary.

Impaired cognitive functioning is associated with high risk for suicide. Previous studies have suggested that some aspects of cognitive functioning improve after psychological therapy. However, few studies have been conducted in adolescent samples. The aim of this study was to identify cognitive changes associated with response to psychotherapy among adolescents at high risk for suicide.

Objective This study is a pragmatic randomized controlled trial, which compares the effectiveness of an adapted form of Dialectical Behavior Therapy for Adolescents (DBT‐A) and treatment as usual plus group sessions (TAU + GS) to reduce suicidal risk for adolescents in a community health mental clinic. Method Thirty‐five adolescents from a community outpatient clinic, with repetitive NSSI alone or with SA over the last 12 months and with current high suicide risk as assessed by the Columbia‐Suicide Severity Rating Scale (C‐SSRS), were enrolled. Participants were randomly assigned to undergo either DBT‐A ( n = 18) or TAU + GT ( n = 17) treatments over a 16‐week period. Primary outcomes were the difference between NSSI and SA recorded during the first 4 weeks and the final 4 weeks of treatment. Secondary outcomes included changes in Children’s Global Assessment Scale (C‐GAS), Suicidal Ideation Questionnaire (SIQ‐JR), and Beck Depression Inventory‐II (BDI‐II). Results Dialectical Behavior Therapy for Adolescents was more effective than TAU + GS at reducing NSSI, use of antipsychotics, and improving C‐GAS. No SAs were reported in the two groups at the end of the treatment. Both treatments were equally effective in decreasing SIQ‐JR and BDI‐II scores. Conclusions These findings support the feasibility and effectiveness of DBT‐A for adolescents at high risk of suicide in community settings.

Objectives: Key neurobiological factors contribute to vulnerability to nonsuicidal self-injury (NSSI) among adolescents and how they respond to treatment targeted to reduce such behaviors. This study aims to examine differences in intrinsic functional connectivity between adolescents with NSSI and healthy controls (HCs) and to identify baseline connectivity markers that predict improvements in NSSI after psychotherapy. Methods: Adolescents aged 12-17 (n = 24) with repetitive NSSI along with demographically similar HCs (n = 16) underwent resting-state functional MRI scanning after which patients received up to 4 months of psychological treatment. A seed-based approach was used to examine baseline between-group differences in intrinsic functional connectivity of the amygdala and the medial prefrontal cortex (mPFC). Further analyses examined the associations between intrinsic functional connectivity at baseline and improvement in NSSI after psychological treatment. Results: Compared with HCs, adolescents with NSSI showed significantly reduced connectivity between the amygdala and the anterior cingulate cortex, subcallosal cortex, and paracingulate gyrus, as well as between the amygdala and a cluster encompassing the right planum temporale and right insula. Adolescents with NSSI, compared with HCs, also showed reduced connectivity between the mPFC and two clusters: one located in the precentral and postcentral gyri and another in the left insula. After treatment, 50% of patients reported fewer NSSI episodes compared to baseline, which was considered as improvement. Stronger negative amygdala-prefrontal connectivity was associated with greater posttreatment improvement in NSSI. Conclusions: Adolescents with NSSI may have aberrant amygdala and mPFC connectivity compared with HCs. Furthermore, stronger baseline negative amygdala-prefrontal connectivity may predict greater improvement in NSSI after psychological intervention. Given that no prior study has used resting-state functional connectivity to predict response to psychological treatment in adolescents with NSSI, replication of these findings is needed.

Studies of set-shifting in adolescent AN present conflicting results, since not all have found differences with regard to controls. To date, no functional Magnetic Resonance Imaging (fMRI) studies have been carried out in adolescent patients, nor have patients been assessed after weight recovery. In this study, 30 female AN patients aged 12-17 and 16 matched control subjects were assessed both at baseline and after six months and renutrition using a structured diagnostic interview, clinical and neurocognitive scales, and fMRI during a set-shifting task. Adolescent AN patients presented similar performance on different neurocognitive tests and also on a set-shifting task during fMRI, but they showed a lower activation in the inferior and middle occipital and lingual gyri, fusiform gyri and cerebellum during the set-shifting task. No correlations were found between decreased activation and clinical variables such as body mass index, eating or depressive symptoms. After six months of treatment and renutrition in AN patients, there were no differences between patients and controls. These results show that adolescent AN patients have lower activation in relevant brain areas during a set-shifting task, and support the use of fMRI with set-shifting paradigms as a biomarker in future studies.

Objective: The aim of the study was to compare two dimensions of perfectionism, namely self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP), in adolescents with anorexia nervosa (AN) or obsessive-compulsive disorder (OCD) and in healthy controls. A further objective was to investigate the influence of perfectionism dimensions on obsessive-compulsive, depressive, and eating symptomatology. Methods: A total of 79 adolescents with AN, 32 with OCD, and 74 healthy controls were recruited. The Child and Adolescent Perfectionism Scale (CAPS) was used to assess SOP and SPP. Measures of depression, obsessive-compulsive and eating symptomatology were administered. Results: The AN group scored higher on SOP than did both the OCD group (p < 0.001) and controls (p < 0.001). In the AN group, SOP accounted for significant variance in scores on the obsessive (p < 0.001), depressive (p < 0.001), and eating symptomatology (p = 0.001), and the interaction between group and SOP was statistically significant when compared with the controls. Mean SPP total score among controls was similar to that in the AN group and higher than that in the OCD group (p = 0.003). Only in the control group did SPP account for significant variance in scores on the measures of obsessive-compulsive (p = 0.002), depression (p = 0.011), and eating symptomatology (p = 0.006). Conclusions: Self-oriented perfectionism seemed more specific to AN than to OCD or controls. It predicted obsessive-compulsive, depressive, and eating symptoms in the AN group. In healthy controls, SPP was related to obsessive-compulsive, depressive, and eating symptomatology.

Low cognitive flexibility (CF) is considered a putative trait marker of anorexia nervosa (AN), independent of body mass index (BMI). CF has been linked to the fronto-striatal circuit, but literature in adolescent samples is conflicting.

Impaired cognitive function is a feature of suicidal behavior. It also might be considered a risk factor in adolescents with high vulnerability to commit suicide. Previous studies have suggested that some aspects of cognitive function improve after psychological treatment. However, to our knowledge, there are no studies that have evaluated the influence of psychological treatment on cognitive functioning in adolescents with suicidal behavior. The aim of this study was to examine changes on neuropsychological functioning in adolescents with suicidal behavior following a psychological treatment with DBT and supportive therapy (ST) compared with healthy control subjects.

The age of onset of some psychiatric disorders may have etiopathogenic and clinical effects and may influence outcome. Following on from previous work by our group where we showed that early onset anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) shared a common genetic background, the aim of the present study is to assess genetic pleiotropy related to the serotonergic system (SLC6A4, 5HTR2A, 5HTR2C, TPH2, SLC18A1), in a common phenotype such as very-early age of onset. One hundred and sixteen adolescents diagnosed with AN and 74 adolescents diagnosed with OCD participated in the present study. We confirmed the existence of a genetic overlap between OCD and AN. Specifically, we described genetic pleiotropy for age at onset across these disorders, associating two SNPs (rs6311, rs4942587) of the HTR2A with the very-early onset phenotype.

Self-harm in adolescents is a major clinical problem and is strongly associated with suicide. DBT was originally developed for adults with suicidal behavior to improve skills and regulate intense emotions. Evidence has shown that DBT is associated with a substantial reduction in self-harm in that population. Currently, DBT has been adapted for youth with suicidal behavior, and there is little evidence in support of its efficacy. However, to date, none of these RCTs has compared DBT with another group therapy. We examined whether DBT is more effective than a combined individual and group supportive therapy (ST) to reduce self-harm in adolescents.

The Children’s Florida Obsessive Compulsive Inventory (C-FOCI) is a promising self-report measure of the presence and severity of obsessive–compulsive symptoms in children and adolescents. Although initial research showed it to have adequate psychometric properties, only one study has been published to date, which dealt exclusively with children. The aim of this report was to examine the psychometric properties of the C-FOCI across clinical and community samples of children and adolescents. The sample consisted of 94 Spanish-speaking patients with obsessive–compulsive disorder (OCD) and 1068 healthy community controls, aged 8–19 years. Factor analysis supported two single and independent factors (severity and symptoms), as well as metric invariance across groups for the symptom checklist and the Severity Scale. Results also indicated good reliability in terms of internal consistency and temporal stability, significant and high correlations with other OCD measures, and acceptable sensitivity and specificity for detect OCD. In summary, the C-FOCI is a promising, brief measure of 22 items for screening OCD symptoms and severity in children and adolescents.

The Obsessive Compulsive Inventory-Child Version (OCI-CV) is a well-established self-report assessment tool and is particularly recommended for the assessment of dimensions of obsessive compulsive disorder (OCD) symptomatology. Although previous studies have shown that the OCI-CV has good psychometric properties to assess dimensions of OCD in clinical and non-clinical samples, a number of aspects remain unexplored: factor invariance across clinical and non-clinical samples, the discriminative validity of the OCI-CV to differentiate clinical from non-clinical samples, and the need for more data concerning the translation and adaptation of the OCI-CV across cultures and languages. Thus, the aim of our study was to provide new data on the validation of the OCI-CV in two community-based samples (n=2138) and clinical samples (n=94) of participants between 10 and 18 years old. The results showed that the OCI-CV has a sound 6-factor structure (Doubting/Checking, Obsessing, Hoarding, Washing, Ordering, Neutralizing) with one second-order factor (general OCD symptomatology), metric invariance across clinical and non-clinical samples, good reliability in terms of internal consistency and temporal stability, significant correlations with other specific measures of OCD, and acceptable sensitivity and specificity for the detection of OCD. The OCI-CV is a well-established measure to assess obsessive–compulsive symptom dimensions in children and adolescents.