BACKGROUND:Attempts to optimize nutritional intake and eating behaviors in young athletes can increase the risk of developing disordered eating (DE) during an athlete's career. A multitude of factors influencing DE have been identified in the existing literature, encompassing general and sport-specific factors, and have been integrated into a conceptual model based on Petrie and Greenleaf's work and additional research evidence in adults, but has not been proven in young athletes. METHOD:A total of 691 adolescent athletes (m/f: 276/415) aged 14-20 years, completed a set of online questionnaires assessing DE and different influential factors. Two separate structural equation models (SEMs) were tested: one for female athletes and one for male athletes. RESULTS:The initial models showed poor fit; however, respecified models revealed key associations for each gender. Sociocultural pressures and their internalization primarily influenced body dissatisfaction in both genders, which contributed to DE. Additionally, emotion regulation difficulties and low self-esteem were linked to DE in female athletes, whereas sport weight pressures and negative mood were associated with DE in male athletes. CONCLUSION:Sociocultural pressures and body dissatisfaction critically affect DE in both female and male athletes, but etiological models for DE differ slightly between genders. If confirmed, prevention programs should be tailored accordingly.

Die Bulimia nervosa ist eine Essstörung, die durch wiederholte Essanfälle und kompensatorische Verhaltensweisen wie Erbrechen, Fasten oder exzessiven Sport gekennzeichnet ist. Sie tritt vor allem bei weiblichen Jugendlichen und jungen Erwachsenen auf. Die Essstörung führt zur Stagnation der psychosozialen Entwicklung, zu einer ausgeprägten Beeinträchtigung der psychischen Befindlichkeit und zur Entwicklung komorbider psychischer Störungen. Um einer Chronifizierung entgegenzuwirken, sollte die Störung möglichst rasch behandelt werden. Der Leitfaden liefert einen evidenzbasierten Überblick über die Diagnostik und Therapie der Bulimia nervosa im Jugendalter. Zunächst wird der aktuelle Forschungsstand zu Symptomatik, Klassifikation, Epidemiologie, Komorbidität, Pathogenese und Verlauf zusammengefasst. Ausführlich werden dann Leitlinien zur Diagnostik, Verlaufskontrolle und Behandlung der Störung beschrieben. Hierbei steht das wirksamste Behandlungsverfahren bei Bulimia nervosa, die Kognitive Verhaltenstherapie, im Fokus. Die Behandlung umfasst unter anderem die Psychoedukation, die Selbstbeobachtung und das Erstellen eines Mahlzeitenplans, ein Expositionstraining sowie die Förderung eines werteorientierten Umgangs mit dem Körper. Einen weiteren Schwerpunkt der Behandlung bilden Interventionen zur Verbesserung der Emotionsregulation, zur Reduktion der Impulsivität und dysfunktionaler Kognitionen sowie zum Aufbau einer positiven und stabilen Identität. Anhand von Fallbeispielen, Beispieldialogen und konkreten Anleitungen wird aufgezeigt, wie die Umsetzung der Leitlinien in der klinischen Praxis und im Alltag der Jugendlichen gelingen kann. Zudem werden für den Praxisalltag hilfreiche diagnostische und therapeutische Materialien zur Verfügung gestellt.

Poor sleep quality is related to difficulties in regulating emotions and to mental health issues in emerging adults. While prior research has confirmed this link, the role of daily fluctuations in sleep quality and emotions, which may require different regulation strategies, has rarely been examined in previous research. This study used Ecological Momentary Assessment (EMA) for seven consecutive days using Research Electronic Data Capture (REDCap), with four smartphone-based assessments per day administered in the morning after waking, at midday, at 4 p.m., and 1 h before bedtime, to examine how daily average levels (within-person) and average weekly levels (between-person) of emotional processes (affect, perceived stress, and emotion regulation difficulties) are related to sleep quality in a convenience sample of 166 emerging adults recruited from a university student population (Mage = 20.36 years, 80.1% female). Linear mixed-effects models showed that, at the within-person level, higher daily average levels of anger, anxiety, sadness and perceived stress predicted lower sleep quality, whereas higher daily mean levels of happiness predicted higher sleep quality the subsequent night. At the between-person level, higher weekly mean levels of anger, anxiety, sadness and perceived stress, as well as more frequent use of rumination, predicted lower sleep quality, while higher mean levels of happiness predicted better sleep quality. To sum up, both daily average and weekly average levels of emotional processes are associated with sleep quality in emerging adults, with mostly negative emotional processes acting as vulnerability factors and happiness emerging as a protective factor.

BACKGROUND:The Child Eating Behaviour Questionnaire (CEBQ) is an internationally applied, parent-report questionnaire on children's eating behaviors, but has mainly been validated in population-based samples or children with obesity. This study presents a first comprehensive validation of the German version of the CEBQ in a treatment-seeking and community-based sample including anorexia nervosa (AN), avoidant-restrictive food intake disorder (ARFID), loss of control (LOC) eating, attention-deficit/hyperactivity disorder (ADHD), and a healthy control group. METHODS:The German version of the CEBQ was completed by 226 parents of children and adolescents (9 months to 17 years) in Germany and Switzerland. Factorial, convergent, and discriminant validity, internal consistency, as well as sociodemographic correlates were assessed, using objectively measured anthropometrics and well-established clinical interviews and questionnaires on eating disorders and associated psychopathology in parent- and self-report. RESULTS:The original 8-factor structure showed acceptable model fit and acceptable to excellent internal consistency. Convergent validity was mostly supported by weight status and interview- and questionnaire-measured eating behaviors. The CEBQ subscales differentiated between groups associated with overeating (ADHD, LOC eating) versus restrictive eating (ARFID and AN). CONCLUSION:The results support the German version of the CEBQ as a valid and reliable tool for assessing eating behavior in youth with eating disorders and ADHD. Future research using larger and age-specific samples should examine psychometric comparability across developmental stages and may provide norms for the CEBQ to enhance its utility as a screening tool.

Study Objectives:Theoretical perspectives suggest that pre-sleep cognitive processes, including cognitive arousal, rumination, and stress can impair sleep. However, previous studies have relied on cross-sectional designs, limiting insight into how these cognitive processes relate to sleep on a night-to-night basis. In addition, anticipatory stress has received little empirical attention, despite its relevance for poor sleep. To address these gaps, the present study examined the associations of pre-sleep cognitive arousal, pre-sleep rumination, and anticipatory stress with sleep quality, sleep duration, and sleep onset latency both when averaged across 7 days (between-person level) and on a day-to-day basis (within-person level). Methods:A total of 166 emerging adults (Mage  = 20.36 years, 80.1% female) completed smartphone-based surveys during 7 consecutive days, reporting on pre-sleep cognitive processes (cognitive arousal, rumination, anticipatory stress) each evening and sleep outcomes each morning. Results:Linear mixed-effects models showed that, at the between-person level, higher average levels of all three pre-sleep cognitive processes across the week were associated with poorer sleep quality and shorter sleep duration. No significant associations were found for sleep onset latency. At the within-person level, all three pre-sleep cognitive processes were not related to next-morning sleep outcomes. Conclusions:Overall, the findings suggest that stable individual differences in pre-sleep cognitive processes, rather than short-term changes, are linked to sleep quality and duration in emerging adults.

A significant number of youths experience loss of control eating (LOC), characterized by a sense of losing control over eating, regardless of food amount. Binge eating, a common LOC variant, involves consuming large amounts of food in a short period, often accompanied by distress. Previous research suggests that interpersonal and appearance-based rejection sensitivity (RS), the tendency to anxiously expect, readily perceive, and overreact to rejection, may contribute to the development and persistence of LOC variants. This study examined whether baseline levels of interpersonal and appearance-based RS are associated with LOC variants one year later in a youth sample aged 14-24 and enriched for LOC and binge eating by virtue of recruitment strategies. Zero-inflated negative binomial regression models indicate that both interpersonal and appearance-based RS were associated with the occurrence of self-reported monthly binge eating episodes one year later, but not with the frequency of binge eating episodes. The findings highlight RS as a potential influencing factor for the development and maintenance of LOC variants, even in the absence of severe body dissatisfaction or mood disturbances. Early interventions targeting emotional responses to perceived rejection, particularly appearance-related, may help prevent or reduce LOC behaviors during adolescence and emerging adulthood.

Gastric interoception, the sensing of signals from the stomach, plays a central role in regulating hunger, satiety, and fullness and is closely linked to eating behaviors and symptoms of eating disorders (EDs). Gastric motility has been identified as a key mediator of hunger and satiety, with altered gastric rhythms being observed in individuals with EDs. Enhancing gastric interoception by targeting gastric rhythms may therefore offer a promising intervention strategy. This study examined the effects of a novel electrogastrography (EGG)-based gastric biofeedback training delivered using virtual reality (VR) or a two-dimensional (2D) display, compared with a control condition. A sample of predominantly healthy university students (N = 94) participated in four biofeedback sessions over two weeks. We assessed cardiac, gastric, and general interoception, along with selfreport measures of eating behavior (emotional, external, restrained, and intuitive eating) and ED symptoms. We expected biofeedback training to improve interoception, eating behaviors, and to reduce ED symptoms, with the strongest effects in the VR group, followed by the 2D group, and the weakest effects in the control group. Linear mixed model analyses revealed that the 2D condition was the most effective, showing the greatest improvements in gastric and general interoception (specifically satiation and fullness sensing, and body listening), as well as intuitive eating. These findings suggest that 2D gastric biofeedback may be an effective and accessible approach to interoception training which can potentially be applied in home settings. Future research should explore its clinical utility in populations with EDs.

Background Gastric interoception (i.e., the perception of gastrointestinal signals such as hunger, satiety or nausea) in the context of eating has recently gained increasing research attention. Nevertheless, it remains poorly understood how different interoceptive dimensions (e.g., self-report) and organ systems (e.g., cardiac, gastric) relate to each other and to disordered eating behaviors such as emotional, external and restrained eating. We assessed multiple dimensions (behavioral, self-reported, and physiological) in the cardiac domain (interoceptive accuracy, interoceptive self-report, interoceptive insight and objective physiological state) and in the gastric domain (gastric interoceptive sensitivity, gastric attribution of interoceptive sensations, interoceptive self-report, interoceptive insight and objective physiological state). The first goal of this study was to examine the relationship between cardiac and gastric interoception measured via multiple dimensions (behavioral, self-reported, and physiological). The second goal was to investigate whether multidimensional gastric interoception was a more important predictor of emotional, external and restrained eating than multidimensional cardiac interoception. Methods Our sample ( n = 128) was predominantly female ( n = 116), included healthy individuals ( n = 87) and individuals with an eating disorder or sub-clinical eating disorder ( n = 41). Instruments included a heartbeat counting task, the two-step Water Load Test, electrocardiogram, electrogastrogram and the Dutch-Eating Behaviour Questionnaire. We used correlation analysis, multiple regressions, and LASSO regressions. The final sample included in the multiple regression and LASSO regressions resulted in N = 89. Results Results showed cardiac and gastric interoception to be distinguishable, yet not to be entirely independent processes. Results further suggest gastric and not cardiac interoception to be the most important predictor of emotional, external and restrained eating. Specifically gastric attribution of interoceptive sensations played the most important role in all disordered eating behaviors. Conclusions Our findings highlight the importance of the gastric system in the assessment and targeted treatment of disordered eating behaviors. Future research should consider adding additional interoceptive dimensions.

BACKGROUND:Eating disorders such as Anorexia Nervosa (AN) and Bulimia Nervosa (BN) were previously found to partly entail alterations in stress physiology including salivary cortisol (sC), and salivary alpha amylase (sAA) at rest and basal vagal tone (HF-HRV), compared to individuals without mental disorders or with mixed mental disorders (anxiety and depressive disorders), but corresponding data remain scarce and are not entirely consistent. METHOD:HF-HRV, sC and sAA at rest were assessed in a female sample of 58 individuals with AN and 54 individuals with BN before and after psychotherapy and contrasted against measurements from 59 female individuals suffering from mixed disorders and 101female healthy controls. RESULTS:Values for sC were elevated in AN compared to all other groups, those for HF-HRV were highest in both AN and BN and lowest in mixed mental disorders and no differences were found at rest for sAA. During psychotherapy, HF-HRV changed more in AN and BN groups than in HC or mixed samples. sC and sAA remained unchanged. There was no association between BMI and stress physiology. CONCLUSION:Alterations in stress physiology present differently across EDs and mixed mental disorders. Correlates of physiological functioning remained mostly stable throughout 3 months of psychotherapy. Only basal vagal tone was normalized in AN/BN in comparison to HC. This might indicate that physiological changes can occur early, but mostly take longer to change during treatment. Trial registration: Data were assessed during a multi-site cross- and longitudinal experimental trial registered at the German Clinical Trials Registry (trial number: DRKS00005709; see [1] for details).

An increasing number of young females are reporting disturbed eating and compensatory behaviors (DECB), with studies showing that higher levels during adolescence not only persist into early adulthood but also are associated with the onset of subthreshold/threshold eating disorders. Emotion regulation difficulties (ERD) have been identified as one of the most relevant transdiagnostic risk factors associated with the development and maintenance of various DECB. The aim of this study was to explore the mediating mechanisms between ERD and DECB within a newly developed path model. A total of 627 females (mean age 19.90, SD = 2.50) participated in a cross-sectional online questionnaire study. Results: The results highlighted body-related cognitive distortions (TSF-B), either alone (β = 0.160, p < 0.000), or in conjunction with body dissatisfaction (β = 0.124, p < 0.000), as key mediators. This study identifies TSF-B and body dissatisfaction as key mediators in the link between ERD and DECB. These findings emphasize the importance of addressing maladaptive information processing in theoretical models and incorporating corresponding interventions in prevention and intervention programs. Further cross-sectional and longitudinal research across genders and in both clinical and community samples remain crucial. This study explores the increasing prevalence of unhealthy eating behaviors (e.g., restrictive eating, binge eating, excessive exercise) among young females. These eating behaviors often emerge during adolescence and may persist into early adulthood, potentially developing into serious eating disorders. Difficulties with emotion regulation are seen as an important reason why many people develop and continue to engage in unhealthy eating behaviors. This study aimed to better understand the connection between emotion regulation difficulties and unhealthy eating behaviors by looking at the processes in between, using a newly developed path model. To investigate this relationship, 627 young females aged 14 to 24 completed an online questionnaire. Our findings indicate that negative thoughts about one’s body and dissatisfaction with body shape or size significantly predict unhealthy eating behaviors. Gaining a deeper understanding of these relationships can support the development of more effective treatments and targeted therapeutic programs. Continued research on these unhealthy eating behaviors across diverse populations and over time remains essential.

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) has been shown to effectively reduce social worker-assessed child neglect and child problems. However, no research has examined the effects of MST-CAN on parenting behaviors or identified which intervention targets are associated with reductions in child problems. This study examined changes in child internalizing and externalizing problems, parental psychological control, neglectful parenting, and social worker-assessed neglect, accounting for therapist effects, and assessed how parenting and neglect predict child outcomes in 143 parent-child dyads in Switzerland (mean child age = 10.5 years, 54.1% boys). Multilevel regression showed significant reductions in social worker-assessed neglect (b = 14.10, SE = 3.49, p < .001) and child problems (b = 4.97, SE = 0.88, p < .001) with low intraclass correlation coefficients (ICC = .049, ICC = .017). Neglectful parenting (b = 0.03, SE = 0.05, p = .640) and psychological control (b = 0.10, SE = 0.07, p = .140) were not significantly reduced. Parenting and social worker assessed neglect did not affect changes in child problems. Findings demonstrate MST-CAN's effectiveness in reducing social worker-assessed neglect and child problems but highlight the need for targeting psychological control and multi-method and multi-informant assessments of parenting behaviors.

Normal gastric functioning (normogastria) is characterized by rhythmic gastric myoelectric activity, while dysrhythmic gastric activity (bradygastria and tachygastria) is associated with symptoms such as nausea, epigastric discomfort and fullness. Gastric biofeedback using electrogastrography (EGG) has emerged as a promising tool to regulate gastric rhythm, but research remains limited with few experimental studies. The current study (N = 94) tested a novel gastric biofeedback training in virtual reality (VR). We used a randomized controlled study design with three groups: (1) VR gastric biofeedback training, (2) the same training on a 2D screen and (3) a relaxation control group. We examined (1) the trajectory of gastric activity before, during, and after training (2) participants’ ability to increase normogastria and reduce dysrhythmic activity and (3) self-reported experiences (motivation, attention, mood, presence, user acceptance, etc.). Results showed the expected peak in normogastria and a nadir in dysrhythmic activity during training, with a significant reduction in dysrhythmic gastric activity across sessions. Participants reported an improved ability to handle physical discomfort over time. VR and 2D groups reported faster time perception and better concentration than controls. Spatial presence (i.e., the feeling of “being there”) was higher in the VR group than in the 2D group. Enjoyment, concentration, and alertness were initially high but declined over time in all groups. The results demonstrate the general technical feasibility of the paradigm and positive evaluations. Further research is needed to better understand the underlying mechanisms and to determine whether and how training success may relate to beneficial outcomes in clinical populations.

Child obesity is a growing global issue. Preventing early development of overweight and obesity requires identifying reliable risk factors for high body mass index (BMI) in children. Child eating behavior might be an important and malleable risk factor that can be reliably assessed with the parent-report Child Eating Behavior Questionnaire (CEBQ). Using a hierarchical dataset (children nested within child care centers) from a representative cohort of Swiss preschool children, we tested whether eating behavior, assessed with a 7-factor solution of the CEBQ, and BMI at baseline predicted the outcome BMI after 1 year, controlling for socioeconomic status (n = 555; 47% female; mean age = 3.9 years, range: 2.2–6.6; mean BMI = 16 kg/m2, range: 11.2–23; mean age- and sex-corrected z-transformed BMI, zBMI = 0.4, range −4 to +4.7). The statistical model explained 65.2% of zBMI at follow-up. Baseline zBMI was a strong positive predictor, uniquely explaining 48.8% of outcome variance. A linear combination of all CEBQ scales, taken together, explained 10.7% of outcome variance. Due to their intercorrelations, uniquely explained variance by any individual scale was of negligible clinical relevance. Only food responsiveness was a significant predictor, when accounting for all other predictors and covariates in the model, and uniquely explained only 0.4% of outcome variance. Altogether, our results confirm, extend, and refine previous research on eating behavior and zBMI in preschool children, by adjusting for covariates, accounting for intercorrelations between predictors, partitioning explained outcome variance, and providing standardized beta estimates. Our findings show the importance of carefully examining the contribution of predictors in multiple regression models for clinically relevant outcomes.

IntroductionIt is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity.MethodsWe therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later.ResultsResults indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period.Discussion/ConclusionEven though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.

OBJECTIVE:Cognitive behaviour therapy (CBT) online guided self-help programs represent efficacious and accessible treatment options for adults with binge-eating disorder (BED), but research on predictors of treatment outcome is scarce. This study aimed to investigate the predictive value of emotion regulation difficulties relative to that of negative mood on short- and longer-term treatment outcomes in an online guided self-help programme for BED above and beyond other predictors (age, sex, baseline BED severity). METHODS:Participants were 63 adults (87% female, mean age 37.2 years) with BED. Data was analysed using a hierarchical model approach. RESULTS:Emotion regulation difficulties better predicted both weekly binge-eating frequency and eating disorder (ED) pathology at posttreatment than negative mood, after controlling for the effect of age, sex and baseline BED severity. At 6-month follow-up, neither emotion regulation difficulties nor negative mood further added to the prediction of weekly binge-eating frequency, whereas negative mood, but not emotion regulation difficulties, did so for ED pathology. CONCLUSION:These findings indicate that emotion regulation difficulties at treatment begin might be a relevant predictor of immediate treatment outcome in online guided self-help for adults with BED but might have lower impact on longer-term treatment outcome than negative mood. CLINICAL TRIAL REGISTER NUMBER:The clinical trial register number is not given in this version of the manuscript due to anonymisation.

Social stress can emerge from situational as well as dispositional factors. Here we tested in direct juxtaposition how ostracism in a Cyberball game and underlying psychopathology levels both influence subjective and objective stress markers in an interaction with artificial agents in virtual reality (VR) in 80 participants from a student population. Ostracism led to moderately enhanced subjective stress and negative mood but not to alterations on objective markers of stress. By contrast, underlying psychopathology levels were associated with substantially stronger alterations on subjective stress markers and were additionally associated with reduced eye gaze at virtual agents' heads, larger pupil size, larger high-frequency pupil-size variability, higher heart rate and reduced high-frequency heart-rate variability. Effects for social anxiety, general anxiety and depression levels were overall similar with largest effects on objective stress markers linked to general anxiety. These findings contest the suitability of the Cyberball game as a model for real-life ostracism but demonstrate the utility of gaze and physiological data in predicting psychopathology levels during interactions in VR. These findings furthermore highlight the need for data security solutions when using social VR applications where rich data streams are exposed publicly.

Young children's eating behavior is crucial for any further development of healthy eating. Early eating behavior are often assessed through parental report. The Children's Eating Behaviour Questionnaire (CEBQ) is a widely used parental questionnaire that has been validated in families of different gender, age and cultural background. Research has shown that the 8-factor structure has some inconsistencies and sample characteristics such as age, gender, and culture can influence the results. To which extent such sample characteristics might influence results within a multi-lingual culture has not been investigated so far. Therefore, the aim of the study was to evaluate the factor structure of the CEBQ among 511 preschool children of the French and German parts of Switzerland, aged 2 to 6 years (Mean 3.85 years; SD 0.69). Confirmatory Factor Analysis showed a modified structure of the original questionnaire, with a 7-factor structure providing a reasonable fit to the data (TLI = 0.954, CFI = 0.952, RMSEA = 0.063 and SRMR = 0.067). The subscale 'Desire to drink' was removed, and a few items moved to other subscales as they loaded higher on a different subscale compared to the original model. Reliabilities based on the coefficient omega were acceptable to satisfying across the seven factors, ranging from 0.66 to 0.90. There were no significant gender or age differences, but French speaking children showed higher levels of 'Satiety responsiveness' and lower 'Enjoyment of food' than German speaking children. Yet, these effects were small. The German and French CEBQ are valid and reliable versions of the original CEBQ and can be used in a multicultural context.