This study examined the associations between childhood trauma, body dissatisfaction, bulimia, and drive for thinness in adolescents, with a specific focus on the roles of narcissistic traits and dissociative experiences as intervening variables. A sample of 439 high school students from Southern Italy completed self-report measures assessing eating-disorder-related symptoms, pathological narcissism, childhood trauma, and dissociation. The hypothesised path model showed significant indirect associations between emotional abuse and both drive for thinness and bulimia through vulnerable narcissism and dissociative experiences. More specifically, depersonalisation was positively associated with bulimia, whereas passive influence was positively associated with drive for thinness. Grandiose narcissism showed a negative association with body dissatisfaction and was not positively associated with the eating-related outcomes. Multi-group analyses indicated that the model was not invariant across males and females. In males, absorption was involved in the indirect association between childhood trauma and body dissatisfaction, whereas this pathway was not observed in females. These findings suggest that childhood trauma may be linked to eating-disorder-related features through different psychological pathways involving narcissistic vulnerability, specific dissociative dimensions, and gender. Because of the cross-sectional design, the findings should be interpreted as associative rather than causal.

BACKGROUND:Multimodal treatment uses evidence-based therapeutic approaches by integrating pharmacotherapy, psychotherapy, physiotherapy, occupational therapy, relaxation techniques and mind body exercises, social/family therapy, and lifestyle interventions in the treatment of mental disorders. This study investigates changes in mental health indicators among patients undergoing multimodal inpatient care, using patient-reported outcomes (PROs) to monitor symptom development and well-being. METHODS:We conducted an exploratory retrospective analysis of patients receiving multimodal inpatient treatment at a ward for psychosomatic medicine between January 2015 and February 2024. We included patients with stress-related mental disorders (F32-34, F40-48, F50, F54). We compared their overall well-being and symptom load at the time of hospital admission and discharge using validated questionnaires, using parametric statistical tests. RESULTS:A total of 395 patients were included in the analysis. A transdiagnostic analysis across all patients showed significant improvements in PRO scores in global, physical, and psychological quality of life, depression severity, illness perception, overall symptom burden, and state anxiety from admission to discharge. In particular, patients with eating disorders and trauma-related conditions experienced the most notable gains in quality of life and reductions in depressive symptoms. Anxiety levels showed the greatest improvement in patients with somatoform disorders, whereas patients with eating disorders experienced smaller reductions. DISCUSSION:This study highlights that patients undergoing multimodal inpatient treatment for stress-related mental disorders showed improvements in symptoms and well-being across diagnostic groups and these improvements can be captured by routine PRO monitoring. In the future, routine PRO monitoring could inform more individualised treatment adjustments within the multimodal program.

Body image and self-esteem are central to psychological health and have been identified as contributing factors in the development and maintenance of psychiatric conditions such as eating disorders, depression, and anxiety. This study investigates the relationship between these variables among university students in India and Italy, contributing to the understanding of how cultural contexts shape these psychological constructs in adult populations. The sample consisted of 767 participants (391 from Lokmanya Tilak Municipal Medical College and 376 from University of Campania Luigi Vanvitelli), aged 18 and above. Participants completed standardized measures, namely the Rosenberg Self-Esteem Scale, Body Investment Scale, and Body Uneasiness Test, through paper-based questionnaires administered in controlled settings. Indian students reported higher self-esteem and more positive body image compared to their Italian counterparts, who exhibited lower self-esteem and higher body dissatisfaction. Across both groups, higher self-esteem was strongly associated with lower body uneasiness. Regression analyses revealed high self-esteem significantly predicted positive body attitudes, with stronger protective effects among Italian participants. Indian students demonstrated broader resilience, potentially linked to cultural values. The findings contribute to psychiatry by emphasizing self-esteem and body image as culturally sensitive psychological constructs that may influence vulnerability to psychiatric distress in young adults. Understanding these factors can support prevention and early intervention strategies in student populations, particularly regarding body dissatisfaction, emotional regulation, and self-concept.

This study examined what is associated with self-objectification, body uneasiness, body investment, and depersonalization in adults who altered their bodies. We tested adults involved in body modification (BM) or plastic surgery (PS), and we compared them to controls to clarify these associations. We conducted an observational cross-sectional study of 235 adults (72.8

This systematic review examines the connections between eating disorders, body image disturbance, self-esteem, and emotion regulation in adults. Following the PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science databases was conducted for articles published between 2010 and June 2024. Studies were included if they involved participants aged 18 years and older, employed validated tools for measuring the variables, and presented original research that specifically addressed these psychological factors. Out of 1117 records, six studies met the inclusion criteria, with mostly female samples and a focus on body image, self-esteem, and emotion regulation in relation to eating disorders. The results indicate that body dissatisfaction is closely related to disordered eating behaviors, with a significant link to lower self-esteem and difficulties in emotion regulation. Obese individuals with binge eating disorder (BED) were found to have more negative attitudes toward obesity and greater levels of depression than their non-BED counterparts. Women with bulimia nervosa showed higher emotion-focused coping, which is associated with low self-worth. Differences in gender were evident, with women exhibiting greater vulnerability to body image dissatisfaction and emotion dysregulation. The results show that treatment for adults with eating disorders should focus on the enhancement of self-esteem, the improvement of body image perception, and the development of adaptive emotion regulation strategies. Lastly, practicing self-compassion techniques in psychotherapy could improve the treatment process for patients suffering from eating disorders, low self-esteem, emotion dysregulation, and body image disturbance. Future studies should investigate these variables in various non-Western cultural contexts for better understanding and clinical intervention for the adult population.

Introduction & Purpose Eating disorders, body image, self-esteem, and emotional issues affect psychological and physical health and often co-occur. Disturbances in body image can trigger and worsen disordered eating behaviours. Emotions and self-esteem are influential factors in both eating disorders and body image issues, impacting their severity and manifestation. The interconnection of eating disorders, body image, emotions, and self-esteem has mostly been studied in adolescents, while there has been less research on the adult population. This systematic review seeks to synthesise existing literature on the comorbidity and coexistence of eating disorders, body image disturbance, emotion, and self-esteem in the adult population. Methods Following the PRISMA guidelines, a systematic search was conducted in scientific databases (PubMed, Scopus, and Web of Science) for articles published between 2010 and 2024 (Figure 1). The selected studies focused on the connections between eating disorders, body image, emotion, and self-esteem in adult populations. Six studies were selected from an initial collection of 1,117 articles, with most female participants representing different racial backgrounds. The study participants were required to be over 18 years old and use standard tools to measure the variables, and only original research with significant results was included. Results Individuals with eating disorders showed higher levels of body dissatisfaction, which was linked with lower self-esteem and emotional dysregulation. Women with bulimia nervosa displayed higher emotion-oriented coping strategies compared to controls, resulting in low self-esteem (Wölfges et al., 2011). Obese patients with binge-eating disorders (BED) had more negative attitudes towards obesity compared to obese individuals without BED, correlating with higher levels of depression and disordered eating behaviours (Barnes et al., 2014). The African American participants reported lower weight bias than white participants (Lewer et al., 2015). Furthermore, body image disturbances were a consistent theme, particularly their role in worsening eating disorders, with findings showing that body dissatisfaction indirectly influenced disordered eating behaviours through its effects on self-esteem and depression (Brechan & Kvalem, 2015). The findings revealed that women are more vulnerable to the negative impacts of body image dissatisfaction and emotional dysregulation on eating disorders (Barnes et al., 2014; Brechan & Kvalem, 2015). Additionally, the impact of weight bias and dissociative experiences during sexual activities, which were linked to binge eating and sexual dissatisfaction, was highlighted (Castellini et al., 2017). Discussion The findings emphasise the connections between self-esteem, body image, emotion, and eating disorders. Professional interventions for eating disorders should consider improving self-esteem and providing adaptive emotion techniques to enhance body image perception. The importance of self-compassion in improving body image and managing eating disorders was also noted (Kelly et al., 2014). More research on adult populations in non-Western countries is needed. Conclusion This review emphasises the relationships between eating disorders, body image, self-esteem, and emotion in adults. Moreover, the combination of strategies that improve emotional regulation, self-esteem, and body image perception within clinical interventions could lead to more practical management of eating disorders in adults. Future research should explore these variables across different cultures with varied research strategies. References Barnes, R. D., Ivezaj, V., & Grilo, C. M. (2014). An examination of weight bias among treatment-seeking obese patients with and without binge eating disorder. General Hospital Psychiatry, 36(2), 177–180. https://doi.org/10.1016/j.genhosppsych.2013.10.011 Brechan, I., & Kvalem, I. L. (2015). Relationship between body dissatisfaction and disordered eating: Mediating role of self-esteem and depression. Eating Behaviors, 17, 49–58. https://doi.org/10.1016/j.eatbeh.2014.12.008 Castellini, G., Lo Sauro, C., Ricca, V., & Rellini, A. H. (2017). Body esteem as a common factor of a tendency toward binge eating and sexual dissatisfaction among women: The role of dissociation and stress response during sex. The Journal of Sexual Medicine, 14(8), 1036–1045. https://doi.org/10.1016/j.jsxm.2017.06.001 Kelly, A. C., Vimalakanthan, K., & Miller, K. E. (2014). Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility. Body Image, 11(4), 446–453. https://doi.org/10.1016/j.bodyim.2014.07.005 Lewer, M., Nasrawi, N., Schroeder, D., & Vocks, S. (2015). Body image disturbance in binge eating disorder: A comparison of obese patients with and without binge eating disorder regarding the cognitive, behavioral and perceptual component of body image. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 21, 115–125. https://doi.org/10.1007/s40519-015-0200-5 Wölfges, R., Legenbauer, T., & Hiller, W. (2011). Überprüfung des aktuellen Stressbewältigungsverhaltens bulimischer Frauen in einer sozialen Interaktion [Examination of the current stress management behaviour of bulimic women in a social interaction]. Verhaltenstherapie, 21(1), 23–29. https://doi.org/10.1159/000324255

Culture affects individuals’ perceptions and experiences of their bodies. In order to provide the most effective solutions to body image-related issues, it is necessary to understand cultures and their influences on body image in various populations. This paper focuses on the effects of culture on body image. Therefore, a systematic literature search following PRISMA guidelines was performed in the PubMed, Scopus, and Web of Science databases, yielding 2064 articles published between 1990 and 2023. After applying inclusion and exclusion criteria, 54 articles were selected. Our findings showed a strong influence of culture on body image, highlighting the impact of societal expectations on individuals’ mental well-being. Western cultures, with their preference for thinness, differ from non-Western ideals. The findings also showed the impact of regional variations within the same culture and society on body image. Furthermore, the study found that the young demographic, especially females, is the most vulnerable to body image issues; however, emerging research within our review also indicates a growing concern among males. This study underscores the necessity of culturally considering interventions to address body image issues, which are integral to improving mental health concerns like body dissatisfaction, eating disorders, depression, low self-esteem, and anxiety.

Introduction: Although evidence suggests a link between vulnerable narcissism and binge eating (BE), an important question remains whether the narcissistic vulnerability has a direct or indirect effect on BE, and which variables may be involved in such associations. The present study aims to explore a mediational trajectory between vulnerable narcissism and BE through emotion dysregulation and dissociation. Methods: Participants were 253 (Mage = 15.63, SD = 1.74; range=12-18 years; F = 172, 68%) Italian students screened by self-report measures assessing narcissism, emotion dysregulation, dissociative states, and BE. Results: Vulnerable narcissism showed an indirect effect on BE with emotion dysregulation and dissociation serving as significant mediators in such a relationship (chi 2 (4) = 6.623; RMSEA = 0.05; SRMR = 0.023; CFI = 0.99; TLI = 0.95), explaining 51 % of the variance in BE. Limitations: Limitations concerned the cross-sectional and self-report nature of the study. Also, the study only included adolescent school students. Discussions: Findings suggest that a psychic fragility of the Ego (vulnerable narcissism) likely has an indirect effect on BE, through emotion dysregulation and dissociative states. BE seems to represent an acting-out occurring in a specific psychic condition defined by feelings of disconnectedness and lack of control. Potential implications for theory, research, prevention and treatment are discussed.

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

EDITORIAL article Front. Public Health, 09 February 2023Sec. Public Mental Health Volume 11 - 2023 | https://doi.org/10.3389/fpubh.2023.1148279

This paper reflects a perspective the author has developed over twenty years of practice as a clinical psychoanalyst and as an academic researcher in the field of eating disorders. Anorexia and bulimia are discussed through the lens of psychoanalytic theory, with the support of empirical evidence in clinical psychology research. The author proposes a new way to consider anorexic and bulimic pathology, assigning primary importance to drive repression and object avoidance and stimulating reflections on the phobic-obsessive displacement onto hunger and food. A brief illustrative vignette is included.

•NSSI and DE only groups share similar risk factors.•Emotion dysregulation and body dissatisfaction were relevant to the co-occurrence.•Body-related concerns have more salience to disordered eating.

•NSSI is highly prevalent in Italian ED patients.•Patients with NSSI show low self-esteem and greater depersonalization.•More work examining the set of NSSI-D criteria is required.

Objective: Parental bonding, low self-esteem, emotion dysregulation, and eating style are correlated with each other and are associated with binge eating among adolescents. However, no studies have yet examined all these variables simultaneously. In the current study, the independent and combined influences of such constructs on binge eating were tested with structural equation modeling. Method: A sample of 973 students aged between 12 and 16 (M = 14.17, SD = 1.25) years was screened by means of self-report measures assessing parental bonding, self-esteem, emotion dysregulation, eating styles and binge eating severity. Results: Self-esteem (beta= -0.205) and eating styles (emotional beta = 0.313, external beta = 0.133, and restrained beta = 0.178) had a direct effect on binge eating severity. The model (chi(2)(( 22)) = 57.679; RMSEA = 0.041; CFI = 0.987; TLI = 0.949; SRMR = 0.024) revealed that the paths from both maternal and paternal care and maternal overprotection to binge eating were mediated through low self-esteem, emotion dysregulation and each eating style, explaining 35% of the variance. Discussion: Findings provide support for a comprehensive theoretical-based model of risk factors for binge eating and suggest the possible mechanisms through which the quality of early parental relationships contribute to developing dysfunctional eating patterns. Treatment and prevention efforts should improve self-esteem and emphasize emotion regulation capabilities.

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

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

This study aims to investigate the criticisms and support factors of the migratory experience of a group of asylum seekers (ASs) hosted in an Italian reception center. Starting from a psychosocial approach that gives importance to the intertwining of the personal history and context, the present study aims to explore the meaning that ASs give to their origins, the relationship of ASs with the host context and with professionals of the refugee centres, along with the representation of the Future. We conducted 27 semi-structured deep interviews with 9 male ASs with an average age of 24,4 years. In line with the research goals, we carried out an analysis of pencil-and-paper content using the interpretative-phenomenological-analysis. Three different types of refugee experience emerged: persecutory, ambivalent and integrated. The three conditions identified can help professionals to better understand the different experiences of ASs, allowing them to develop more effective interventions.

The recognition of factors involved in the development and maintenance of eating disorders (EDs) may support the choice of therapeutic strategies and improve the prevention/treatment of eating pathologies and their outcomes. Based on this consideration, the overall purpose of the chapter is to investigate how some psychological characteristics link to EDs. It is organized as follows. First, the epidemiological aspects, risk, and maintaining factors for ED are outlined. Next, we present the findings from our two studies. The purpose of the first study was to identify predictors associated with the severity of eating symptomatology. Then, the objective of the second study was to provide an understanding of the relationship among perceived parental bonding, self-esteem, perfectionism, body shame, body mass index, and ED risk and mainly to test a predictive ED risk model in a non-clinical sample. In conclusion, the major findings and practical implications are discussed.

Non-suicidal self-injury (NSSI) is defined as the intentional destruction of one’s own body without an intent to die (e.g., self-cutting). On the other hand, indirect forms of self-injury refer to behaviors in which people harm themselves in an indirect way (e.g., substance use). Existing literature suggests that a negative parent–child relationship may increase vulnerability to NSSI and indirect forms of self-injury. However, little is known about the potential mediators that intervene in the aforementioned relationship. Therefore, the present work tests a path model to investigate whether the manner of anger expression—anger-in (redirect anger inwardly) or anger-out (express anger outwardly)—mediates the association between parental rejection and direct (specifically self-cutting) and indirect (specifically substance use) forms of self-injury in a cross-sectional sample of Italian adolescents. We assessed self-injury, parental acceptance/rejection, and the expression of anger using self-report questionnaires in 2464 high school students, aged 13–20 years ( M age = 15.93, SD = 1.49). Additionally, characteristics of NSSI were also assessed using semi-structured interviews. We found that parental rejection was significantly positively associated with both self-cutting and substance use. The aforementioned relationship was mediated through anger-in for self-cutting, and through anger-out for substance use. The current work demonstrated that anger expression might work as a bridge between invalidating caregiving environment (i.e., rejecting), in which an individual feels unloved and uncared for, and the occurrence of self-cutting and substance use. The salient role of anger management in the development of prevention and intervention programs for NSSI and indirect self-injury among adolescents is discussed.