Background:Anorexia nervosa (AN) is a severe psychiatric disorder frequently marked by poor treatment response and chronic progression toward rigid, restrictive behaviors. These features highlight the need for innovative strategies targeting core mechanisms and symptoms of the disorder. This feasibility trial evaluates individualized intermittent theta-burst stimulation (iTBS) of the posterior parietal cortex (PPC) as an adjunct to treatment-as-usual, with the goal of identifying patient-specific targets and paving the way for personalized neuromodulation in AN. Methods:Thirty-four adults with AN (≥18 years, illness ≥12 months, ≥1 prior unsuccessful treatment) will be randomized (1:1) to 20 sessions of real or sham iTBS over 4 weeks. Stimulation will be delivered with a MagPro system and a Cool B70 A/P active/sham coil; motor threshold will be estimated with the Stochastic Approximator (SAMT) and re-checked weekly. Individualized stimulation target will be defined based on resting state functional magnetic resonance imaging data to identify the cortical region within the PPC that is maximally functionally connected with the activity of two meta-analytically derived networks representing body representation and implicit behavioral tendencies. Coil placement will be neuronavigated on individual T1 magnetic resonance imaging (MRI). Assessments will take place at baseline (T0), post-treatment (T1), and 4-month follow-up (T2), covering clinical status (body mass index (BMI), psychopathology, and quality of life), experimental tasks (implicit body representation, peripersonal space, approach-avoidance tendencies toward food, interoceptive accuracy, and neurocognitive functioning), and MRI. Feasibility endpoints include recruitment, retention, completion, blinding, and tolerability. Ethics approval: 6168/EST/25; registration: NCT07106645. Discussion:This trial emphasizes individualized PPC targeting and rigorous motor threshold (MT) estimation to advance personalized neuromodulation in AN. Feasibility and effect-size data will guide a confirmatory randomized clinical trial, while mechanistic analyses will test whether targeted iTBS strengthens body-schema circuits and aligns neural changes with clinical improvement, supporting a precision-psychiatry approach to eating disorders. Trail registration:https://clinicaltrials.gov/study/NCT07106645, identifier NCT07106645.

Eating disorders (EDs) and obesity have traditionally been conceptualized as distinct entities, yet accumulating evidence points to overlapping vulnerabilities spanning genetic, neurobiological, behavioral and psychological domains. Shared risk factors suggest convergent mechanisms, particularly in impulse control, reward processing, emotion regulation and body-image representation. In this scenario, functional near-infrared spectroscopy (fNIRS) offers a clinically accessible tool to examine cortical activity, although findings remain dispersed across heterogeneous studies. A systematic search of PubMed, Scopus and Ovid Embase identified peer-reviewed fNIRS studies in individuals with anorexia nervosa, bulimia nervosa, binge eating disorder and obesity. Eligible studies included at least one clinical group, reported original data and applied fNIRS to assess cortical responses. From 990 records, 26 studies met inclusion criteria. Eighteen studies incorporated healthy controls, while eight investigated clinical samples only. Across case-control comparisons, consistent alteration emerged in the prefrontal cortex (PFC). Obesity and binge eating disorders were associated with attenuated PFC activation during inhibitory control, decision-making and food-related paradigms, whereas bulimia nervosa showed condition-dependent alterations linked to loss-of-control symptoms. Findings in anorexia nervosa were mixed, with reduced activation during executive tasks but heightened responses to socially or emotionally salient stimuli. Broader ED samples showed blunted frontal and temporal activation during verbal fluency. Evidence highlights the PFC as a transdiagnostic hub of altered activity in EDs and obesity, consistent with overlapping vulnerabilities. Disorder-specific profiles underscore context-dependent modulation. Standardized, large-scale studies are needed to clarify the utility of fNIRS in delineating common and distinct neural substrates across the ED-obesity spectrum.

AIM:Implicit approach-avoidance biases toward food play a key role in eating behaviors and may contribute to the development and maintenance of eating disorders. Yet, the neural mechanisms underlying these automatic responses remain poorly understood. The intraparietal sulcus (IPS) has been implicated in sensorimotor integration and goal-directed action, suggesting a role in regulating food-related behavioural biases. OBJECTIVE:This proof-of-concept study aimed to investigate the causal role of the IPS in modulating implicit food-related approach-avoidance bias through low-frequency repetitive transcranial magnetic stimulation (rTMS). METHODS:Twenty-two healthy individuals underwent three rTMS sessions in a randomized crossover design: active stimulation over the left and right IPS, and a sham control condition. Each active session consisted of low-frequency stimulation (1 Hz, 1200 pulses, lasting 20 min). After each session, participants completed a mobile version of the Approach-Avoidance Task, which involved pulling or pushing a smartphone in response to high-calorie and low-calorie food stimuli, and neutral objects. RESULTS:Compared to the sham condition, rTMS over both the left and right IPS significantly enhanced approach bias toward high-calorie food stimuli. No significant changes were observed for low-calorie or neutral stimuli. These effects were not accompanied by changes in explicit food wanting ratings or in hunger levels. CONCLUSIONS:These findings provide the first evidence for a causal role of the IPS in modulating implicit food-related behavioural biases. The IPS emerges as a promising neuromodulatory target for interventions aiming to rebalance maladaptive action tendencies in eating disorders and related conditions. Future research should explore the therapeutic potential of IPS-targeted stimulation protocols in clinical populations.

This neuroimaging study sought to characterize differences in cortical gray-white matter contrast (GWC) between individuals with anorexia nervosa (AN) and age-matched healthy controls (HC) and compare these findings with conventional cortical thickness (CT) measures. The study included 58 female participants (29 AN, 29 HC). T1-weighted images were acquired using a 3 T scanner and processed with FreeSurfer. GWC maps were calculated at each cortical vertex. Vertex-wise general linear models assessed group differences in GWC controlling for age only, and controlling for age and vertex-wise CT. A separate model tested CT differences. Models were corrected for multiple comparisons using cluster-wise correction. Spearman correlations related mean GWC in significant clusters to BMI at scan, age at onset, and illness duration. The age-only model revealed two clusters in the left hemisphere with higher GWC in patients with AN, namely the inferior temporal cortex and medial orbitofrontal cortex. No clusters survived in the model controlling for age and CT. The CT analysis revealed no significant group differences. Mean GWC in clusters did not correlate with clinical severity indices in AN. Patients with AN exhibit focal increases in GWC despite the absence of detectable cortical thinning, suggesting that the GWC can provide complementary information in understanding the neurobiology of AN. The elimination of GWC differences when adjusting for CT likely reflects shared variance rather than true absence of effect. Lack of correlations with clinical indices may be due to limited sample size. Future longitudinal and multimodal studies are warranted to determine the underpinnings of GWC alterations.

Eating disorders—including anorexia nervosa (AN), bulimia nervosa and binge-eating disorder—are clinically distinct but exhibit symptom overlap and diagnostic crossover. Genomic analyses have mostly examined AN. Here we conducted a genomic meta-analysis of case–control studies of binge-eating behavior (BE; 39,279 cases, 1,227,436 controls), alongside analyses of AN (24,223 cases, 1,243,971 controls) and its subtypes (all European ancestries). We identified six BE-associated loci, including loci associated with a higher body mass index and impulse-control behaviors. AN genome-wide association studies yielded eight loci, validating six loci. Subsequent polygenic risk score analysis demonstrated an association with AN in two East Asian ancestry studies. BE and AN exhibited similar positive genetic correlations with psychiatric disorders but opposing genetic correlations with anthropometric traits. Most of the genetic signal in BE and AN was not shared with body mass index. We have extended eating disorder genomics beyond AN; future work will incorporate multiple diagnoses and global ancestries. This research identified six areas in the genome that are associated with binge eating, and eight areas that are associated with anorexia nervosa, in people of European ancestry. Binge eating has both shared and distinct genetic features compared with anorexia nervosa.

Body ownership relies on the integration of multisensory signals coming from the environment and the body itself. Considering the substantial neurophysiological and sensory modifications occurring across the lifespan, this study aims to quantitatively evaluate age-related changes in hand ownership and its underlying bottom-up sensory and top-down components from adolescence to advanced aging. Ninety-two healthy women aged 15-83 underwent a virtual-reality based visuo-proprioceptive disparity task in which they performed reiterative reaching movements towards visual targets while observing a virtual-hand that could be spatially congruent or displaced at different disparities from the real hand's position. Ownership was assessed by collecting reaching errors (implicit) and asking ownership judgments toward the virtual-hand (explicit). Errors were modeled using a Bayesian Causal Inference framework in which ownership for the virtual-hand resulted from a weighted average between pure visual and pure proprioceptive guidance according to their relative precision (i.e., bottom-up sensory components), and to the a priori probability that the virtual-hand was one's own (i.e., top-down prior). Results showed that both explicit and implicit ownership towards spatially incongruent virtual-hands was higher with advancing age. Moreover, the sensory components extracted from the model revealed higher proprioceptive and lower visual variability in older adults, suggesting that as proprioception declines, visual input increasingly assumes a dominant role. No age-effect was found on the prior (i.e., top-down component). We concluded that ownership progressively changes from adolescence to old age, mostly driven by a physiological reduction in proprioceptive abilities. The sensory recalibration toward visual reliance might reflect a compensatory mechanism to maintain coherent body ownership despite age-related sensory decline.

The hypothalamus, a central regulator of hunger and metabolism, contains subnuclei responsive to peripheral signals such as leptin and ghrelin, which may be altered in anorexia nervosa (AN) and obesity (OB). This exploratory study employed an advanced neuroimaging tool to segment specific hypothalamic subregions in 127 adult women: 24 with AN, 26 with obesity without eating disorders (OB-ED), 26 with obesity and eating disorders (OB + ED), and 51 healthy controls (HC). Participants underwent clinical assessments, fasting blood samples, and T1-weighted 3-Tesla MRI scans. The AN group showed reduced volumes in the total hypothalamus, as well as in the posterior and inferior tuberal subregions, compared to HC, which remained significant after adjusting for total brain volume (TBV). The OB + ED displayed increased volumes in the inferior tuberal and anterior-inferior subregions compared to the HC and OB-ED groups, but differences did not persist after TBV adjustment. In AN, anterior hypothalamic subregions were negatively correlated with leptin concentrations. In contrast, in OB-ED, the same subregions, along with the superior tuberal hypothalamus, showed a positive association with body mass index (BMI). Additionally, an earlier onset of AN correlated with decreased volumes of several hypothalamic subregions, whereas in OB + ED, disorder duration was positively associated with the anterior-superior subregion. Alterations in the volumes of specific hypothalamic subnuclei may serve as clinical indicators of both the severity of obesity (i.e., BMI) and the onset and duration of eating disorders. Although preliminary, these findings contribute to our understanding of the neurobiological mechanisms involved in extreme eating and weight conditions.

IntroductionAnorexia Nervosa (AN) is a complex psychiatric disorder characterized not only by restrictive eating behaviors and fear of weight gain, but also by emotional dysregulation, cognitive rigidity, and a profound disturbance in bodily experience. While bodily disturbance is clinically central, its multifaceted and pre-reflective nature has made it difficult to investigate experimentally. This scoping review aims to map the experimental case-control literature on AN from the past 15 years, with particular attention to how studies on body representation are represented within the broader field of AN research, both in terms of their prevalence and their subdivision into specific thematic domains.MethodsA systematic search was conducted on PubMed, Scopus, and Web of Science. Studies were included if they involved an experimental task comparing individuals with AN to healthy controls.ResultsThe search yielded six hundred and three eligible studies, each classified into one or more thematic domains: cognition, emotion/social cognition, food-related processing, reward, and body representation. Among these, one hundred and sixty four studies addressed body representation and were further categorized into five subdomains: body image, perception of other bodies, body schema, sensory processing, and interoception.DiscussionWhile studies on cognition, emotion, reward, and food processing often used standardized paradigms and showed moderate methodological consistency, research on the bodily domain was notably heterogeneous. This reflects both the conceptual complexity of corporeality and the lack of unified frameworks for its empirical investigation. A recent shift toward multisensory and embodiment-based paradigms suggests increasing interest in implicit and integrative models of body representation. By identifying patterns, gaps, and emerging trends, this review underscores the need for greater conceptual clarity and interdisciplinary convergence. Advancing the experimental study of body representation in AN may support more comprehensive models of the disorder and enhance our understanding of bodily experience in psychiatric conditions.

The COVID-19 pandemic has profoundly impacted anorexia nervosa (AN), increasing pressure on healthcare services and causing specific psychopathological changes. However, the characterization of changes in presentation patterns across the pandemic remains unclear. This study aimed to address this gap by comparing symptom networks in patients with pre- and post-pandemic AN onset. Data from 189 patients diagnosed with AN from 2016 to 2022 were analyzed. Patients were divided into pre-COVID (n = 101) and post-COVID (n = 88) onset groups. Network analysis was employed to examine interconnections among eating disorder symptoms measured by EDI-1, general psychopathology measured by SCL-90, and perceived social support. Regularized partial correlation networks were estimated and compared. The post-COVID group showed increased centrality of obsessive-compulsive symptoms and body dissatisfaction. Stronger associations were found between interoceptive awareness and obsessive-compulsive symptoms, perfectionism and body dissatisfaction, perceived support by friends and bulimic behaviors. The pre-pandemic group showed a unique connection between drive for thinness and somatization, while the post-pandemic group showed a negative association between family support and drive for thinness. These findings suggest pandemic-related factors have altered AN psychopathology and highlight the peculiar role of social relationships. Understanding these changes can enhance clinical approaches to treating AN amid ongoing and future global challenges.

Psychiatric disorders, including eating disorders (EDs), are characterized by heterogeneity that limits diagnostic accuracy and treatment personalization. Precision psychiatry calls for tools to identify data-driven phenotypes beyond traditional categories. In a large cohort (N=809), we applied an unsupervised clustering pipeline to self-report and clinical variables to uncover ED subgroups. Repeated Spectral Clustering revealed four phenotypes: two aligned with DSM-5 diagnoses (anorexia nervosa restricting-type; bulimia nervosa), and two diagnostically mixed clusters, one characterized by higher psychopathology and trauma exposure, the other by prolonged illness duration. These clusters showed distinct profiles and outcomes. The higher predictability of data-driven clusters compared to DSM-5 categories suggests that unsupervised stratification may offer a complementary perspective on relevant heterogeneity. Our findings highlight how computational phenotyping can advance precision psychiatry by revealing meaningful patterns, informing prognosis, and guiding personalized interventions. This approach may help bridge the gap between clinical presentations and the need for stratified, patient-centered care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the STARS{at}UNIPD funding program of the University of Padova, Italy, through the project: MEDMAX. This project has received funding from the European Union's Horizon Europe research and innovation programme under grant agreement no 101137074 - HEREDITARY. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethical Committee of Padova Hospital gave ethical approval for this work (protocol n. 1598P). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

Eating disorders -including anorexia nervosa (AN), bulimia nervosa, and binge eating disorder-are clinically distinct but exhibit symptom overlap and diagnostic crossover. Genomic analyses have mostly examined AN. We conducted the first genomic meta-analysis of binge eating behaviour (BE; 39,279 cases, 1,227,436 controls), alongside new analyses of AN (24,223 cases, 1,243,971 controls) and its subtypes (all European ancestries). We identified six loci associated with BE, including loci associated with higher body mass index (BMI) and impulse-control behaviours. AN GWAS yielded eight loci, validating six loci. Subsequent polygenic risk score analysis demonstrated an association with AN in two East Asian ancestry cohorts. BE and AN exhibited similar positive genetic correlations with psychiatric disorders, but opposing genetic correlations with anthropometric traits. Most of the genetic signal in BE and AN was not shared with BMI. We have extended eating disorder genomics beyond AN; future work will incorporate multiple diagnoses and global ancestries.

We present a case of vagus nerve stimulation (VNS) in a patient with severe and highly recurrent treatment-resistant depression (TRD) supported by clinical and neuroimaging findings. The patient had a long-lasting diagnosis of bipolar I disorder, a stable polypharmacological regimen, multiple hospitalizations, and had undergone several ECT sessions. Despite achieving satisfactory clinical recovery, the patient was considered a suitable candidate for VNS implantation to prevent further episodes, maintain sustained clinical remission, minimize subthreshold symptoms, and improve quality of life, daily functioning, and overall engagement. After 15 months of follow-up, the patient exhibited increased participation in daily activities, reduced psychomotor retardation, and improved emotional well-being. At follow-up, psychometric scores confirmed clinical improvement and stability, including mood, anhedonia, and functioning, along with regional increases in white matter volume in the limbic and striatal regions.

The neurobiological mechanisms differentiating bipolar disorder type I (BD-I) from type II (BD-II) remain poorly understood. A comprehensive synthesis systematically comparing neuroimaging findings between BD subtypes is lacking. We conducted a systematic review (PubMed, Scopus, up to March 2024), including structural MRI, functional MRI, and diffusion tensor imaging studies, to provide a comprehensive overview of the common and distinct candidate neural signatures that differentiate BD subtypes. Out of the initial 5334 references, 38 MRI studies (41 experiments) were included. Structural MRI studies showed mixed results regarding volumetric and cortical surface differences between BD subtypes. BD-I exhibited widespread gray matter (GM) volume reductions, larger lateral ventricles, and decreases in cortical thickness. Hippocampal and cerebellar volume reductions were observed in both BD subtypes but did not differentiate BD-I from BD-II. While white matter (WM) abnormalities across BD subtypes remain heterogeneous and lack consistent replication, BD-I showed a tendency toward more disrupted WM microstructure and higher WM hyperintensities rates than BD-II. Functional MRI studies revealed distinct differences in task-based and resting-state activity, suggesting differential neural patterns in reward processing and emotion regulation. BD-I displayed a greater disconnection in emotion regulation circuits. While both BD-I and BD-II share some neuroimaging characteristics, the findings suggest BD-I is characterized by more pronounced WM disruptions and emotion dysregulation. In contrast, BD-II shows more remarkable subcortical volume preservation but with distinct connectivity alterations. These results offer insights into the different and shared neurobiological mechanisms of BD subtypes, which may help refine their pathophysiology and inform tailored interventions.

Eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are complex psychiatric conditions with high morbidity and mortality. Neuroimaging and machine learning (ML) represent promising approaches to improve diagnosis, understand pathophysiological mechanisms, and predict treatment response. This systematic review aimed to evaluate the application of ML techniques to neuroimaging data in EDs. Following PRISMA guidelines (PROSPERO registration: CRD42024628157), we systematically searched PubMed and APA PsycINFO for studies published between 2014 and 2024. Inclusion criteria encompassed human studies using neuroimaging and ML methods applied to AN, BN, or BED. Data extraction focused on study design, imaging modalities, ML techniques, and performance metrics. Quality was assessed using the GRADE framework and the ROBINS-I tool. Out of 185 records screened, 5 studies met the inclusion criteria. Most applied support vector machines (SVMs) or other supervised ML models to structural MRI or diffusion tensor imaging data. Cortical thickness alterations in AN and diffusion-based metrics effectively distinguished ED subtypes. However, all studies were observational, heterogeneous, and at moderate to serious risk of bias. Sample sizes were small, and external validation was lacking. ML applied to neuroimaging shows potential for improving ED characterization and outcome prediction. Nevertheless, methodological limitations restrict generalizability. Future research should focus on larger, multicenter, and multimodal studies to enhance clinical applicability. Level of Evidence: Level IV, multiple observational studies with methodological heterogeneity and moderate to serious risk of bias.

Patients with restrictive Anorexia Nervosa (AN-R) severely restrict their food intake, often showing significant food avoidance behavior, especially for diet-goal threatening and high-calorie foods. Still, stringent comparisons of avoidance behaviors in relation to calorie dense foods, low-calorie food and abstract (amodal) food cues are required to better understand the underlying mechanisms. Approach-avoidance behavior was measured in individuals with AN-R (n = 21) and Healthy Controls (HC; n = 19) using a virtual reality stop-signal task. In a virtual environment, participants had to reach a digitally rendered hand toward low-calorie, high-calorie and amodal (packaged) food cues, as well as nonfood cues (shoes). If a stop-sign appeared, they had to inhibit this movement (stop-trials). They also rated how much they liked and wanted each stimulus on a visual analog scale from 0 to 100. Participants showed more approach behavior towards amodal food cues compared to high-calorie concrete food cues (t[39] = 25.38, p <.001, d = 4.01). Furthermore, patients with AN-R reported lower wanting for high-calorie foods (t[37] = 2.13, p =.040, d = 2.13) and greater wanting for nonfood cues (t[37] = -3.35, p =.002, d = 3.35). Across groups, liking was highest for high-calorie food, both packaged (t[39] = 4.03, p =.002, d = 0.40) and unpackaged (t[39] = 3.53, p =.007, d = 0.36). Food presentation can influence approach behavior toward food cues. Future research is needed to determine whether the use of abstract food cues can facilitate food approach behavior in individuals with AN-R. Individuals with anorexia nervosa (AN) tend to avoid calorie-dense foods. This avoidance also extends to food images. However, we do not fully understand which features of food lead to avoidance. In this article, we examine how four different categories - high-calorie food in packaging, high-calorie food unpackaged, low-calorie food unpackaged and nonfood (shoes) - affect avoidance in patients with AN compared to healthy control participants. We found that unpackaged foods were avoided more than packaged foods, but that packaged and unpackaged high-calorie foods were equally wanted and liked by patients with AN. This could indicate that packaged foods are easier to access for individuals with AN. If so, making food more abstract may make it easier for individuals with AN to interact with it. Future studies should thus test if using more abstract food cues could help individuals with AN reduce their avoidance of food cues all together.

We present a case of vagus nerve stimulation (VNS) in a patient with severe and highly recurrent treatment-resistant depression (TRD) supported by clinical and neuroimaging findings. The patient had a long-lasting diagnosis of bipolar I disorder, a stable polypharmacological regimen, multiple hospitalizations, and had undergone several ECT sessions. Despite achieving satisfactory clinical recovery, the patient was considered a suitable candidate for VNS implantation to prevent further episodes, maintain sustained clinical remission, minimize subthreshold symptoms, and improve quality of life, daily functioning, and overall engagement. After 15 months of follow-up, the patient exhibited increased participation in daily activities, reduced psychomotor retardation, and improved emotional well-being. At follow-up, psychometric scores confirmed clinical improvement and stability, including mood, anhedonia, and functioning, along with regional increases in white matter volume in the limbic and striatal regions.

OBJECTIVE:Negative emotional states have been found to predict food cravings and consumption in the general population. People with a persistent tendency to restrict food intake, however, might be eating less when sad, angry, or stressed. In this study, the impact of inducing a negative emotional state through social exclusion on wanting and liking of food pictures was explored in patients with anorexia nervosa. METHOD:43 patients with anorexia nervosa and 22 healthy controls completed a computerised social rejection and food appraisal task. Participants viewed short videos in which a stranger made either a negative comment directed toward them or a neutral comment. After each video, participants rated their affective state, as well as their wanting and liking for pictures of high-calorie foods. RESULTS:Participants in both groups experienced greater negative affect after viewing the negative videos compared to the neutral ones. They also reported lower wanting for high-calorie foods following negative videos, while no significant effects were observed for liking scores. Interestingly, patients with higher body mass index exhibited a greater reduction in both food wanting and liking following negative videos. CONCLUSIONS:These results suggest that negative social interactions can exacerbate restrictive behaviours, especially in patients who are recovering weight during treatment.

ObjectiveEating disorders (ED), including bulimia nervosa (BN) and binge eating disorder (BED), are characterised by dysfunctional eating behaviours and maladaptive emotional regulation tied to concerns about body image. This study investigates the emotional and cognitive impacts of social exclusion and overinclusion on individuals with ED using the Cyberball task, a computerised simulation of social interaction, to examine the role of early maladaptive schemas (EMS) in these responses.MethodThe sample included 124 women: 34 with BN, 26 with BED, and 64 controls, assigned to either an ostracism or overinclusion condition. Emotional responses were measured using PANAS before and after the Cyberball task, and EMS were assessed via the Young Schema Questionnaire. Mediation models were applied to explore EMS effects on emotional responses.ResultsParticipants with ED showed unique emotional patterns compared to controls across both Cyberball conditions. In the overinclusion condition, controls experienced increased positive affect, whereas individuals with ED showed no significant change. During ostracism, ED participants reported reduced negative affect, suggesting complex reactions to social exclusion. EMS were found to mediate emotional responses, particularly in the overinclusion condition.DiscussionThe findings underscore the distinct social-cognitive and emotional effects of interpersonal interactions on individuals with BN and BED, emphasising the importance of addressing EMS and social cognition in treatment. Future research should focus on refining our understanding of social perception and emotional skills in ED populations, particularly within the bulimic spectrum.