Collection of abstracts written by members of the Italian Society for the Study of Eating Disorders

A1 Improving eating disorder treatment: insights and challenges from the “Mariconda” Regional Residential Structure in Salerno

Landi¹, A. Longobardi¹, A. Caputo¹, M. Di Pierro¹, A. Boccia¹, I. Forte¹, R. Bonifacio¹, A. Vignapiano¹, E. Ferrara¹, S. Palermo¹, A. Mainardi¹, F. Monaco¹, G. Corrivetti¹

¹Department of Mental Health, ASL Salerno, Salerno, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A1

Keywords: Eating disorder, Department of Mental Health Salerno, Outcomes

Introduction: The "Mariconda" Regional Residential Structure for Eating Disorders (ED), based in Salerno, is the only operational center for residential care in Campania.

Aim of the study: Our study aims to evaluate the initial outcomes of the comprehensive and integrated treatment provided at this Center.

Materials and methods: We adopted a comprehensive approach to assess treatment effectiveness. This involved considering clinical, anthropometric factors, and patients' psychopathological history. To quantitatively assess improvement, we utilized standardized evaluation scales, including: SCL-90, BUT, CIA, EDI3, EDE-Q, EDS. Our study focused on a subgroup of 31 patients who successfully completed the residential program from January 2022 to June 2023. These individuals were evaluated at the beginning of the program (T0) and at its conclusion (T1).

To statistically measure the impact of the treatment, we applied a one-way ANOVA.

Results: Our results showed substantial improvements across various domains, underpinning the efficacy of the residential treatment pathway. Striking improvements were observed in psychopathological measures. Furthermore, a relevant and highly significant improvement in BMI was evaluated between admission and end of the program.

Discussion: This study also incorporated new assessment instruments such as the MMPI-2 and the MMPI-A. Future challenges include enlarging the sample size and conducting a 6-month post-treatment follow-up.

Conclusions: The analysis of the preliminary data highlights significant results showing clinical, psychopathological and symptomatological improvement of the eating disorder, which indicate a clear efficacy of the residential treatment.

References

• 1. van Eeden, A. E., et al., (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current opinion in psychiatry, 34(6), 515–524.

• 2. Taquet, M., et al., (2022). Incidence and outcomes of eating disorders during the COVID-19 pandemic. The British Journal of Psychiatry, 220(5), 262–264.

Declaration of conflict of interest: None.

Table 1 Sample description (abstract A1)

Table 2 Symptom Check List 90 (SCL) (abstract A1)

Table 3 The body uneasiness test (BUT) (abstract A1)

Table 4 The Clinical Impairment Assessment Questionnaire (CIA) (abstract A1)

Table 5 Eating Disorder Examination Questionnaire (EDEQ) (abstract A1)

Table 6 Eating Disorder Inventory 3 (EDI3) (abstract A1)

Table 7 Exercise Dependence Scale (EDS) (abstract A1)

Table 8 BMI (abstract A1)

A2 “A Bell Jar of Emotions”: the influence of comorbid depressive symptoms in treating patients with eating disorders

M. Mirabella¹, L. Muzi², M. A. Rugo³, A. Franco³, A. Urgese³, N. Tattini³, M. Riboldi³, A. M. Speranza¹, V. Lingiardi¹

¹Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy; ²Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Italy; ³Eating Disorder Clinic "Residenza Gruber", Bologna, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A2

Keywords: Eating disorders; Depression; Treatment outcome

Introduction: Previous findings have shown that comorbid depressive symptoms play a central role in determining clinical manifestations and symptom severity in patients with eating disorders (EDs) (Garcia et al. 2020; Martin et al. 2019). However, there is a lack of studies investigating how depressive symptoms may influence treatment outcomes, especially in residential settings. The main aim of this study was to evaluate if there would be significant differences between ED patients with or without comorbid depressive symptoms in terms of change in ED symptoms and overall psychopathology.

Materials and methods: A national sample of N = 100 ED patients [N = 60 with anorexia nervosa (AN) and N = 40 with bulimia nervosa (BN)] treated in a multidisciplinary residential treatment setting completed the Beck Depression Inventory (BDI) to evaluate depressive symptoms, the Eating Attitudes Test (EAT) to evaluate eating symptoms, and the Outcome Questionnaire-45.2 (OQ-45.2) to assess overall psychopathology at both intake and discharge.

Results: A total of 50 patients exhibited clinical levels of depression above the cutoff (BDI > 30). Patients with comorbid depressive symptoms at intake showed more severe ED and psychopathological symptoms at discharge. Moreover, comorbid depression at intake have been found to predict the degree of change in overall psychopathological severity. Notably, no significant effects were detected for DSM-5 categories of AN and BN.

Discussion and conclusions: These results suggest the pivotal role of comorbid depression when treating individuals with EDs. Then, there is an increasing need to consider both the presence and the severity of comorbid depression as a facet of a comprehensive ED treatment. Exploring the influence of depressive symptoms on eating disorder’s severity and treatment outcomes could be a be a key aspect in promoting more accurate and clinically useful treatment and "tailored" multidisciplinary therapeutic interventions focused on the specific characteristics of ED individuals.

Declaration of conflict of interest: None.

References

• 1. Garcia, S. C., Mikhail, M. E., Keel, P. K., Burt, S. A., Neale, M. C., Boker, S., & Klump, K. L. (2020). Increased rates of eating disorders and their symptoms in women with major depressive disorder and anxiety disorders. International Journal of Eating Disorders, 53(11), 1844–1854.

• 2. Martín, J., Arostegui, I., Loroño, A., Padierna, A., Najera‐Zuloaga, J., & Quintana, J. M. (2019). Anxiety and depressive symptoms are related to core symptoms, general health outcome, and medical comorbidities in eating disorders. European Eating Disorders Review, 27(6), 603–613.

A3 A case series of disordered eating in type 1 diabetes adult patients: “diabulimia” and beyond

V. Frattina¹, M. D’Amico², F. Cimini¹, F. Ricci¹, E. Barbiera¹, V.a Quirino², C. Piciocchi¹, C. Lombardo², L. M. Donini¹

¹Department of Experimental Medicine, Sapienza University of Rome, Italy; ²Department of Psychology, Sapienza University of Rome, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A3

Keywords: Type 1 diabetes; Adults; Disordered eating; Eating disorders; Diabulimia

Introduction: Type 1 diabetes (T1D) is a chronic disease with a great impact on the quality of life, and eating behavior and habits. Feeding and eating disorders (FED) [1] can occur more frequently in patients with T1D than in the general population [2–5]. The most studied condition, especially in young women, is “diabulimia’’, which refers to a pattern characterized by concern about body shape and weight and by insulin restriction (reduction or omission of prescribed doses) with the purpose of controlling body weight [6–10]. However, disordered eating (DE) in T1D often does not meet the formal criteria of FED, leading to an underdiagnosis [4, 11, 12].

Aim of the study: Describing two different phenotypes of adult patients affected by T1D and DE/FED.

Materials and methods: Three female patients (AF, AM, MD) with T1D, aged between 42 and 66, were addressed to the Integrated Experimental Service for Eating Disorders at Sapienza University of Rome, for suspected FED. Anthropometric, nutritional and clinical parameters were examined (Table 1); the patients were asked to fill out a 3-day food diary and a diary of glycaemia and insulin doses. The presence of FED was evaluated in a clinical interview through EDE 17.0D (Table 2). Questionnaires have been administered to assess eating behavior and other psychological characteristics (Table 3).

Results: All three patients presented a considerably high level of HbA1c (Table 1) and clinical complications. AF presented insulin misuse, and concern about body shape, EDE results and clinical observation were consistent with “diabulimia”. AM and MD, thus not reporting symptoms consistent with any FED diagnosis, presented restrictive eating, eating concern, psychological distress (MD) and difficulties with insulin doses and carb counting (AM and MD), which appeared to be secondary to concern about health.

Discussion and conclusions: Patients with T1D can present different forms of DE secondary in some cases to shape and weight concerns and in some other cases to health concerns. Eating behavior and psychological status should be evaluated in T1D to assess the presence of FED or DE to avoid or minimize the impact on health status.

Declaration of competing interest: The authors have no conflict to declare.

References

• 1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, 2013.

• 2. L. Wisting, T. Skrivarhaug, K. Dahl-Jørgensen, and Ø. Rø, “Prevalence of disturbed eating behavior and associated symptoms of anxiety and depression among adult males and females with type 1 diabetes,” J. Eat. Disord., vol. 6, no. 1, p. 28, Dec. 2018, https://doi.org/10.1186/s40337-018-0209-z.

• 3. S. E. Coleman and N. Caswell, “Diabetes and eating disorders: an exploration of ‘Diabulimia’.,” BMC Psychol., vol. 8, no. 1, p. 101, Sep. 2020, https://doi.org/10.1186/s40359-020-00468-4.

• 4. R. Murphy and A. Pigott, “Eating disorders and type 1 diabetes,” Clin. Child Psychol. Psychiatry, vol. 26, no. 3, pp. 589–594, Jul. 2021, https://doi.org/10.1177/13591045211028165.

• 5. L. Indelicato and B. Longo, “I disturbi dell’alimentazione e del peso nelle patologie endocrine e metaboliche,” in Psicologia e salute. Teorie e ambiti di intervento, Dicembre 2., P. Gremigni and A. Gorini, Eds. Carocci Editore, 2022, p. 496.

• 6. L. Yan, “‘Diabulimia’ a growing problem among diabetic girls.,” Nephrol. News Issues, vol. 21, no. 11, pp. 36, 38, Oct. 2007, [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/17970504.

• 7. J. Davidson, “Diabulimia: how eating disorders can affect adolescents with diabetes,” Nurs. Stand., vol. 29, no. 2, pp. 44–49, Sep. 2014, https://doi.org/10.7748/ns.29.2.44.e7877.

• 8. A. M. Callum and L. M. Lewis, “Diabulimia among adolescents and young adults with Type 1 diabetes,” Clin. Nurs. Stud., vol. 2, no. 4, Jul. 2014, https://doi.org/10.5430/cns.v2n4p12.

• 9. P. A. Colton, M. P. Olmsted, H. Wong, and G. M. Rodin, “Eating Disorders in Individuals with Type 1 Diabetes: Case Series and day Hospital Treatment Outcome,” Eur. Eat. Disord. Rev., vol. 23, no. 4, pp. 312–317, Jul. 2015, https://doi.org/10.1002/erv.2365.

• 10. A. P. Winston, “Eating Disorders and Diabetes,” Curr. Diab. Rep., vol. 20, no. 8, pp. 1– 6, 2020, https://doi.org/10.1007/s11892-020-01320-0.

• 11. M. M. Broadley et al., “25 Years of psychological research investigating disordered eating in people with diabetes: what have we learnt?,” Diabet. Med., p. dme.14197, Dec. 2019, https://doi.org/10.1111/dme.14197.

• 12. L. Priesterroth, J. Grammes, E. A. Strohm, and T. Kubiak, “Disordered eating behaviours and eating disorders in adults with type 1 diabetes (DEBBI): rational and design of an observational longitudinal online study,” BMJ Open, vol. 12, no. 9, p. e064863, Sep. 2022, https://doi.org/10.1136/bmjopen-2022-064863

Table 1 Participant characteristics and clinical data (abstract A3)

Table 2 Eating behavior assessed by Eating Disorder Examination 17.0D (EDE 17.0D) (abstract A3)

Table 3 Psychological characteristics (assessed by self-reported questionnaires) (abstract A3)

A4 A cross-sectional study on the moderating and mediating effect of depression on the relationship between eating disorder and non-suicidal self-injurious behaviors

M. R. Juli^1,2, L. Dalla Ragione³, E. Camisasca¹, V. Covelli¹, G. M. Manzoni¹

¹eCampus University, Noverdrate (Como), Italy; ²Centro Biolife (Cosenza), Italy; ³Campus University Bio-Medico (Roma), Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A4

Keywords: Eating disorders, Anorexia, Bulimia, Non-suicidal self-harm, Depression

Introduction: Scientific studies agree on the comorbidity between eating disorders and non-suicidal self-harm (NSSI). Common factors among the two behaviours are corporeal dissatisfaction and seeing the body as an object of disdain. Underlying motives of the self-harm action are the necessity of exiting a perceived state of profound emptiness in order to re-connect with reality. Persuasive evidence claim that NSSI is more strongly linked with eating disorders of the binge/elimination subtype than to the restrictive subtype

Aim of the study: The following study has the purpose of inspecting the relationships between having a diagnosis of bulimia, anorexia, depression, and the NSSI behaviours Self-harm behaviours are higher in affected by bulimia nervosa than in those affected by anorexia nervosa. The hypothesis are:

• NSSI behaviors are higher in people with eating disorders than in the control group;

• Subjects affected by anorexia nervosa or bulimia nervosa with high levels of depression have higher NSSI behaviours contrary to subjects affected by anorexia and bulimia nervosa with low levels of depression.

• The association between having an eating disorder and the NSSI behaviours is mediated fully or partially by depression.

Materials and methods: The recruitment is being made among patients which have received a diagnosis of anorexia or bulimia (based on DSM-5) at the Biolife center in Cosenza and at Nido delle Rondini in Todi. Recruitment includes 100 patients, between the ages of 14 and 26 of only female sex, the presence of a control group is involved. All the participants will be subjected to: informed consent; Eating disorder Inventoiry-3; Ottawa Self-injury Inventor; Beck Depression Inventory-II.

Expected results: The expectations of this study are to confirm the hypothesis.

Discussion and conclusions: If the study will confirm the relationships between eating disorders, depression and the self-harm behaviours in young adolescent patients and especially if a higher percentage of said behaviours is detected in subjects affected by bulimia nervosa in opposition to anorexia nervosa then it will be necessary to include among the protocols of evaluation, in the assessment phase, some questionnaires which investigate self-harm behaviours and to include a phase of treatment of NSSI.

References

• 1. Luxardi G, Manuale di Psicologia Preventiva F. Angeli, Milano, Becciu M., Colasanti A.R., Pozzi M, 2015.

• 2. Rodríguez LA, Rodríguez OE, Romero GB. Non-suicidal self-injury in patients with eating disorders: nuclear aspects. Colomb Med (Cali). 2021.

Conflict of interest: The authors declare no conflicts of interest.

A5 A network analysis of psychological facets of eating disorders in individuals with food addiction: a preliminary study

A. A. Rossi^1,2 A. Tagliagambe³, A. Scuderi³, L. Montecchiani⁴, D. Giorcelli³, M. Ricco³, S. Mannarini^1,2, L. Dalla Ragione⁵

¹Department of Philosophy, Sociology, Education, and Applied Psychology Section of Applied Psychology, University of Padova, Padova, Italy; ²Center for Intervention and Research Studies on the Family, University of Padova, Padova, Italy; ³Residence Cabrini DCA, Pontremoli (MS), Italy; ⁴Eating Disorders Services-USL N1 “Nido delle Rondini”, Todi, Perugia, Italy; ⁵Food Science and Human Nutrition Unit, University Campus Biomedico of Rome, Rome, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A5

Keywords: Food addiction; Eating disorders; Network analysis; Disorder eating behaviors

Introduction: The construct of food addiction (FA) has surged in prominence over the last decade [1–6] suggesting that FA might constitute a foundational construct within different diagnostic clusters of eating disorders (EDs) [7, 8]. At the same time, a new data analysis technique—network analysis—has gained increasing popularity in recent years due to its ability to reveal relationships within constellations of symptoms [9, 10]. However, no study has attempted to explore the relationship between the main facets of EDs within a sample of individuals with FA.

Aim of the study: Using a psychometric network analysis approach, within a clinical sample of patients diagnosed with AF, the present study aims to identify the relationships between symptomatic aspects of a psychological nature related to EDs by highlighting the most important of them.

Materials and methods: A sample of 178 patients with a diagnosis of FA was enrolled at ‘Residence Madre Carbini DCA’, Pontremoli, Italy. Patients were diagnosed for FA using the Yale Food Addiction Scale 2.0 (YFAS2.0) [1, 11, 12] and they were evaluated with the Eating Disorder Inventory—3 (EDI-3) [13].

Results: The network model estimated with the GLASSO algorithm showed several moderate statistically significant positive relationships between facets of EDs (Fig. 1). The heaviest edge was between Interpersonal Insecurity (II) and Interpersonal Alienation (IA) (0.371). The second thicker edge was between Low Self-Esteem (LSE) and Personal Alienation (PA) (0.336). Lastly, the third heaviest edge was the negative relationship between Asceticism (A) and Drive for Thinness (DT) (0.335). Centrality indices revealed that PA, A, and LSE had the highest node “strength” and “expected influence” (Fig. 2).

Discussion and conclusions: These results revealed—for the first time—the structure of relationships among the key facets of EDs, suggesting that low self-esteem and feelings of detachment, discontent, estrangement, and lack of trust in others are central within a group of patients diagnosed with FA.

Conclusions: This study allows the observation of relationships and central nodes associated with EDs in patients diagnosed with FA. These findings could assist in formulating or enhancing increasingly precise intervention plans for individuals with this diagnostic condition.

Conflicts of interest: None.

References

• 1. Manzoni, G.M., et al., Structural validity, measurement invariance, reliability and diagnostic accuracy of the Italian version of the Yale Food Addiction Scale 2.0 in patients with severe obesity and the general population. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 2021. 26(1): p. 345–366.

• 2. Manzoni, G.M., et al., Validation of the Italian Yale Food Addiction Scale in postgraduate university students. Eating and Weight Disorders, 2018. 23(2): p. 167–176.

• 3. Meule, A. and A.N. Gearhardt, Food addiction in the light of DSM-5. Nutrients, 2014. 6(9): p. 3653-71.

• 4. Meule, A. and A.N. Gearhardt, Ten Years of the Yale Food Addiction Scale: a Review of Version 2.0. Current Addiction Reports, 2019: p. 1–11.

• 5. Rossi, A.A., et al., Disordered Eating Behaviors Related to Food Addiction/Eating Addiction in Inpatients with Obesity and the General Population: The Italian Version of the Addiction-like Eating Behaviors Scale (AEBS-IT). Nutrients, 2023. 15(1): p. 104.

• 6. Rossi, A.A., et al., Eating Compulsivity in Inpatients with Severe Obesity and the General Population: The Italian Version of the Measure of Eating Compulsivity (MEC10-IT). Nutrients, 2023. 15(6): p. 1378.

• 7. Rossi, A.A., My Sweet Gluttony. Exploring Food Addiction: Measures, Networks, and Profiles, in Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology2021, University of Padova: Padua, Italy.

• 8. Rossi, A.A., et al., Many facets of eating disorders: profiling key psychological features of anorexia nervosa and binge eating disorder. Eating and Weight Disorders, 2022. Under review.

• 9. Epskamp, S., Network psychometrics (Unpublished doctoral dissertation), 2017, University of Amsterdam: Amsterdam, the Netherlands.

• 10. Epskamp, S., D. Borsboom, and E.I. Fried, Estimating psychological networks and their accuracy: A tutorial paper. Behav Res Methods, 2018. 50(1): p. 195–212.

• 11. Aloi, M., et al., Validation of the Italian version of the Yale Food Addiction Scale 2.0 (I-YFAS 2.0) in a sample of undergraduate students. Eat Weight Disord, 2017. 22(3): p. 527–533.

• 12. Gearhardt, A.N., W.R. Corbin, and K.D. Brownell, Development of the Yale Food Addiction Scale Version 2.0. Psychol Addict Behav, 2016. 30(1): p. 113–21.

• 13. Garner, D.M., Eating Disorder Inventory-3. Professional manual2004, Lutz, FL: Psychological Assessment Resources.

Fig. 1

Network analysis (abstract A5)

DT = drive for thinness; B = bulimia; BD = body dissatisfaction; LSE = low self-esteem; PA = personal alienation; II = interpersonal insecurity; IA = interpersonal alienation; ID = interoceptive deficits; EmoD = emotion dysregulation; P = perfectionism; A = asceticism; MF = maturity fear

Fig. 2

Centrality plot (abstract A5)

DT = drive for thinness; B = bulimia; BD = body dissatisfaction; LSE = low self-esteem; PA = personal alienation; II = interpersonal insecurity; IA = interpersonal alienation; ID = interoceptive deficits; EmoD = emotion dysregulation; P = perfectionism; A = asceticism; MF = maturity fear

A6 A qualitative evaluation of a psycho-education group for parents of young girls suffering eating disorders

C. Pancisi¹, B. Calderone¹

¹AUSL of Romagna, DSM-DP of Forlì-Cesena, Mental Health Center of Forlì-Cesena

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A6

Keywords: Qualitative evaluation, ED, New Maudsley Model, Psychoeducation, Family

Introduction: In the Local Health Agency of Forlì–Cesena, we organized psychoeducational groups for some years for family members of young patients with eating disorders according to the New Maudsley Model. The main feature is to develop care with families in a collaborative perspective that enhances all family members in helping against food difficulties and promote change.

Aims of the study: The aim of the study was to evaluate the quality of a psychoeducational group of young ED patients’ parents, from their point of view.

Materials and methods: At the end of the course (8 meetings), we asked parents to fill an anonymous questionnaire: a brief semi-structured interview.

Results: We gave the questionnaires to a sample of 20 participants: 12 mothers and 8 fathers. The first open question asked to described the group with 3 words. We found only positive words, such as “interesting, useful, important”. The most associated word is “useful”. The second parents’ choice are most personal words: “confidence, emotionally involving and demanding, healing, comforting”. In the third step, participants described the course through emotions: “awareness, emotional, enriching, it helped me to listen my daughter’s silence, I understood better my daughter’s feelings, essential to have hope and trust”. The most appreciated thing and the less one. The help received from practitioners in understanding and manage better the ED, such as the possibility of share emotions and experiences in a group are the most appreciated elements. On the other side, they judged the group to much theoretical. Beside these open-end free parts, we asked parents to evaluate also 6 specific elements with Likert scale.

Please evaluate the following elements of your experience From 0 = “not at all” to 4 = “very very much”	Average value
Subjects were interesting	3.5
Practitioners were competent	3.8
I felt involved by practitioners	3.5
Subjects were useful to manage my daily relations	3.3
I feel more competent in my daughter’s care	2.9
To share problems with other parents improved my mood and increase confidence	3.2

Discussion and conclusions: It was very interesting to involve the parents in a qualitative evaluation. It allowed them to reflect and give value to their commitment, as well as to that of the conductors. It allows conductors on positive and negative aspects to improve future courses.

References

• 1. Langley, J., Treasure, J., & Todd, G. (2018). Caring for a loved one with an eating disorder: The new Maudsley Skills-Based Training Manual. Routledge.

• 2. Treasure, J., Parker, S., Oyeleye, O., & Harrison, A. (2021). The value of including families in the treatment of anorexia nervosa. European Eating Disorders Review, 29(3), 393–401.

A7 Therapeutic education and ketogenic intervention in an adult patient with type III spinal muscular atrophy and type 2 diabetes mellitus (T2DM)

F. Mercuri¹, G. Budriesi¹, L. Pozzi¹, V. Fasoli¹, D. Ballardini¹

¹Fondazione Gruber-Centro Gruber, Accredited Center for Food Science, Service for the Diagnosis and Treatment of Eating Behavior Disorders (Bologna)

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A7

Keywords: DMT2, SMA III, Neurological disease, VLCKD diet

Introduction: Spinal muscular atrophy (SMA) is a congenital neurodegenerative condition characterized by the selective loss of motor neurons. Patients with certain forms of SMA may exhibit altered distribution and increased fat mass with metabolic abnormalities, dyslipidemia, hepatic steatosis, and glucose metabolism defects. These alterations represent a clinically significant issue and further worsen the patient's quality of life (1–3).

Aim of the study: We present the case of a 42-year-old female patient with SMA III and T2DM who underwent a ketogenic diet regimen. In order to access an experimental treatment for SMA with risdiplam, it was necessary to discontinue metformin therapy due to its interactions with the experimental drug. Hence, the need to implement an alternative therapeutic approach to address the significant glycometabolic changes.

Materials and methods: The patient followed the active phase of the ketogenic diet for 5 weeks. At the end of the active phase, there was a reintroduction phase with a hypocaloric, low-carbohydrate diet. Each phase of the treatment was personalized (formulation of an individualized daily program to guide the patient, personalized recipe book based on preferences, nutritional counseling, personalized therapeutic education to produce and maintain dietary and lifestyle changes). The patient gave their informed consent for their information to be published in an open access journal.

Results: At the end of the ketogenic diet treatment, a weight loss of 10% was observed, with a significant improvement in glycometabolic control, thus enabling the continuation of the experimental drug therapy.

Discussion and conclusions: The study suggests that a specialized approach of integrated therapeutic education and nutritional counseling along with a ketogenic dietary regimen can yield positive results and create additional therapeutic opportunities in highly complex patients. It remains crucial to further research the use of the ketogenic diet in treating metabolic abnormalities in chronic neuromuscular degenerative diseases.

Declaration of conflict of interest: The author does not have any conflict of interest to declare.

References

• 1. Watson, K. S., Boukhloufi, I., Bowerman, M., & Parson, S. H. (2021). The Relationship between Body Composition, Fatty Acid Metabolism and Diet in Spinal Muscular Atrophy. Brain sciences, 11(2), 131. https://doi.org/https://doi.org/10.3390/brainsci11020131

• 2. Li, Y. J., Chen, T. H., Wu, Y. Z., & Tseng, Y. H. (2020). Metabolic and Nutritional Issues Associated with Spinal Muscular Atrophy. Nutrients, 12(12), 3842. https://doi.org/https://doi.org/10.3390/nu12123842

• 3. Deguise, M. O., Chehade, L., & Kothary, R. (2021). Metabolic Dysfunction in Spinal Muscular Atrophy. International journal of molecular sciences, 22(11), 5913. https://doi.org/https://doi.org/10.3390/ijms22115913.

A8 Analysis and results of the work of multidisciplinary eating disorders' equipe for adult patients in Community Health House near Forlì in AUSL Romagna

C. Pancisi ¹, F. Salvaro¹, R. Liverani², M. Montanari², S. Gordini¹, G. Giannini¹

¹AUSL della Romagna—DSMDP di Forlì-Cesena—Servizio Salute Mentale di Forlì; ²AUSL della Romagna—Servizio di Nutrizione Clinica e Dietetica di Forlì

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A8

Keywords: Eating disorder, Multidisciplinary equipe, Community Health House, Hospitalizations

Introduction: Eating disorders (ED) are complex diseases with multifactorial origin that need a multidisciplinary treatment, provided by a multiprofessional equipe. In the Mental Health Center of Forlì, equipe for ED is composed by a psychologist, a psychiatrist, a nutritionist doctor and a dietician. We operate in a Community Health House near Forlì, where we offer medical, nutritional and psychologic assessment and treatment to people affected by anorexia and bulimia nervosa. The choice to make the visits in a different place from the Mental Health Center is aimed to reduce stigma for new patients. In fact stigma contribute to a diagnosis delay may be related to worsen clinical outcomes [1]. The first psychiatric-psychological visit and the nutritional one are carried out on the same day; at the end all the professional figures gathered return a diagnosis and propose a treatment. This methodology makes it possible to integrate both the somatic and psychic aspects of the patient's disorder.

Aim of the study: The aim of the study is to take a picture of the impact of the multiprofessional equipe in the treatment of adult's ED in Forlì. We use as indicator the number of inpatients for metabolic emergency.

Materials and methods: We use data derived from the computerized medical records provided by our AUSL Romagna, from 2019 to 2022.

Results: Medical records indicate a growing number of patients being treated for ED. Despite the growing number of outpatients, the trend of hospitalizations due to metabolic emergency in our district has maintained a clear reduction in the last two years, going from 12% of patients under treatment in 2019 to 1.6% in 2022.

Discussion and conclusions: During the preceding quadrennial interval, we have observed a progressive ingrowth of primary encounters concerning ED. This trend has engendered a supposition that the spatial repositioning of the multiprofessional equipe has streamlined accessibility to the medical service, thereby mitigating the societal stigma inherent within the local milieu. Moreover, the conspicuous abatement in instances of hospitalization due to metabolic emergencies, occurred only in the district where we are operating, ostensibly implies the prospective efficacy of an approach characterized by a multiprofessional modality in constituting an optimal therapeutic stratagem for the management of ED.

References

• 1. PA 198 "PDTA Disturbi del Comportamento Alimentare" AUSL Romagna (PA 198 DEL. 499-29/12/2021) Percorso clinico aziendale per la diagnosi ed il trattamento dei disturbi della nutrizione e dell’alimentazione, adottato con delibera dell’AUSL della Romagna N° 499 del 29/12/2021.

• 2. Austin, A. Flynn, M, Richards, K, et al. Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature. Eur Eat Disorders Rev. 2021; 29: 329–345. https://doi.org/https://doi.org/10.1002/erv.2745.

Table 1 (abstract A8)

Patients in care
Year 2019	Year 2020	Year 2021	Year 2022
25	43	48	62

Table 2 (abstract A8)

Hospital patients
Year 2019	Year 2020	Year 2021	Year 2022
3 (12%)	3 (6.9%)	0 (0%)	1 (1.6%)

A9 Anorexia nervosa in twins: a case series

T. Antici¹, C. Piciocchi¹, M. V. Ievolella¹, F. Ricci¹ F. Camardella¹, G. Imperatore¹, F. Frigerio¹, L. Tanase², D. Accorrà², A. Cotugno², M. P. Casini³, M. Ferrara³, L. M. Donini¹, E. Poggiogalle¹

¹Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; ²Hospital of Santa Maria Della Pietà, ASL Rome 1, Rome, Italy; ³Department of Pediatrics and Child and Adolescent Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A9

Keywords: Anorexia nervosa, Twins

Introduction: Anorexia nervosa (AN) is a severe eating disorder characterized by low body weight, extreme reduced energy intake, intense fear of gaining weight and distorted body perception. Study of clinical course in twins provides insight into the role of these factors on the expression of disease. The aim of this case series is to describe nutritional status of two sets of twins affected by AN.

Materials and methods: Four 15-year-old dizygotic twins were referred to our outpatient service by Psychiatric Institute in Rome, because of weight loss, restricted energy intake and body dysmorphism. They underwent a comprehensive nutritional status assessment. The patients’ guardians gave their informed consent for their information to be published in an open access journal.

Results: Twins A. A1 and A2, both females, reported the onset of symptoms six months earlier, after a viral acute infection that involved both. They experienced menarche at the age of 11 and were affected by functional hypothalamic amenorrhea. Sertraline and aripiprazole were prescribed to A1, due to the major clinical and psychological compromission. They both restricted their energy intake up to consume about 550 kcal/day and used to train 1.5 h/day. At the time of the visit, we found severe hypotension and bradycardia and reduced resting metabolic rate based on indirect calorimetry. Twins B. B1 and B2 were males and started refusing to eat in the last six months. No compensatory behaviors were reported. They both started decreasing portion sizes, excluding foods high in fat and carbohydrate and increased exercise up to 2 h/day to lose weight and gain muscle. B1 had a history of aggressiveness. Vital signs were within normal limits, but dual-energy X-ray absorpiometry (DXA) showed a reduced bone mineral density particularly severe in B1.

Discussion and conclusions: A1 and B1 were found to be clinically and psychologically more compromised, then their counterparts, showing higher rate of weight loss, lower BMI, and handgrip strength test values. Despite a similar duration of the illness, males exhibited a greater impairment of bone tissue compared to females, but showed conversely a better cardiovascular condition. The studies in twins emphasize the evidence that not only environmental and genetic factors, which can be similar among siblings, but also psychological, physiological, and biological factors can influence the impact and progression of the disease.

References

• 1. Sokol MS, Carroll AK, Heebink DM, et Al. Anorexia nervosa in identical triplets. CNS Spectr. 2009.

Declaration of conflict of interest: None.

Table 1 (abstract A9)

	A1	A2	B1	B2
Sex	F	F	M	M
Weight	41.2	41.5	49.7	52.5
Body mass index (BMI) kg/m2	16.4	17.96	17.1	17.7
BMI Z-score	− 2SDe-1SD	− 1SD	− 1e−2SD	− 1SD
BMI percentile	5*pctile	15pctile	< 15°pctile	15*pctile
Blood pressure (mmHg)	75/60	85/50	110/68	120/72
Heart rate (bpm)	45	40	59	72
%Fat mass (DXA)	19.3	19	17.7	19.4
Appendicular lean/height2	6.24	6.63	7.07	7.08
Lumbar spine Z-score	0.0	− 0.4	− 2.3	− 1.4
Left hip Z-score	− 0.1	0.1	− 0.6	− 0.9
Right handgrip	16.7	17.9	18.6	22.9
Max value
Left handgrip max value	18.4	17.5	20	23.7
Triceps skinfold (mm)	8.5	8.4	8.2	8.4
	(5°–10°pctile)	(5–10 pctile)	(50–75°pctile)	(50°–75°pctile)
Biceps skinfold (mm)	6	4.4	5.4	5.6
RMR (kcal/24 h)	973	888	1376	1271
	76%	70%	88%	79%
	Of predicted	Of predicted	Of predicted	Of predicted
	According to	According to	According to	According to
	Schofield eq	Schofield eq	Schofield eq	Schofield eq
SitToStand test core	10.8	10.6	10.35	11.22
Total body water (BIA)%	66.3	64	73.1	68.7
Phase angle (BIA)	5.8	6.1	5.4	5.5

A10 Application of Body Project in an Italian eating disorder centre: a pilot study

F. Marchiol¹, M. Mariuz¹, V. Fasciano²

¹Centro per I disturbi alimentari. Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento (PN). Italy; ²SC di Pediatria e Neonatologia. Azienda Sanitaria Friuli Occidentale, Pordenone. Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A10

Keywords: Body Project, Cognitive dissonance, Body dissatisfaction, Eating disorders, Treatment

Introduction: Body Project (BP) (Stice et al. 2007) is a dissonance-based prevention program aimed at promoting body acceptance and reducing thin-ideal internalization. Recently, a number of studies have shown the effectiveness of BP in reducing body dissatisfaction in patients with ED (Stice et al. 2015; Maas et al. 2023). To our knowledge, no study has been carried out in Italian clinical context.

Aim. Because of the need of interventions targeting body dissatisfaction in a specialized treatment setting, this study aimed to examine the efficacy of BP in a group of 4 patients (between 15 and 16 years of age) recruited in the Eating Disorder Centre of San Vito al Tagliamento (PN).

Materials and methods: The program was carried out in four 1.5-h sessions conducted over four consecutive weeks. SCL-90, EDI-II and BUT scales were administered to participants pre- and post- intervention and after a month there was a follow-up meeting.

Results: Only three persons (75%) completed the project. t test showed a significant reduction on EDI Body Dissatisfaction scale, BUT Global Severity Index and Body Image Concerns scales, SCL-90 Interpersonal sensitivity scale. Moreover, at the limit of significance, analysis showed a reduction on BUT Weight Phobia scale. No differences were found at one month follow-up.

Discussion and conclusions: BD seems to be effective specifically to reduce body dissatisfaction in patients with ED over the time. It should represent a novel approach to reduce specific core symptoms of ED to be implemented in clinical setting. Future studies, with larger samples, are needed to confirm these results.

References

• 1. Maas, J., Simeunovic-Ostojic, M. & Bodde, N.M.G. Is a dissonance-based group intervention targeting thin-ideal internalization a successful potential add-on for specialized eating disorder care? A randomized feasibility and acceptability pilot study. J Eat Disord 11, 68 (2023).

• 2. Stice, E., & Presnell, K. (2007). The body project: Promoting body acceptance and preventing eating disorders. Oxford University Press.

• 3. Stice, E., Rohde, P., Butryn, M., Menke, K. S., & Marti, C. N. (2015). Randomized controlled pilot trial of a novel dissonance-based group treatment for eating disorders. Behaviour Research and Therapy, 65, 67-75.

Conflict of interest statement: The authors declare that they have no competing interests.

A11 Association between binge eating, emotional eating, and uncontrolled eating in Brazilian adults

A. M. Feoli¹, T. Lopes Da Silva¹, J. Urbanetto¹

¹Eating Behavior Group, Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brazil

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A11

Keywords: Binge eating, Emotional eating, Eating behavior

Introduction: The Three-Factor Eating Questionnaire (TFEQ) comprehensively assesses eating-related behaviors, categorizing them into cognitive dietary restraint, emotional eating, and uncontrolled eating. Meanwhile, binge eating has garnered attention, particularly in the DSM-V. Research suggests that interpersonal stressors, negative emotions, dietary restrictions, and body image concerns are linked to this disorder. Consequently, further investigation is required to understand the intricate interplay between eating behavior and psychological factors.

Aim of the study: To explore the relationship between different aspects of eating behavior and the presence and severity of binge eating disorder (BED) in a Brazilian sample.

Materials and methods: This study adopts a cross-sectional approach. To assess eating behavior traits, the TFEQ was used. To identify the intensity of binge eating, the Binge Eating Scale (BES) was employed, with cut-off points being: ≤ 17 (absence of binge eating), 18–26 (moderate binge eating), and ≥ 27 (severe binge eating), in addition to collecting data such as age, weight, and height. Spearman's correlation analysis was performed. The study was approved by the Research Ethics Committee.

Results: The sample comprised 189 adults (18–72 years old) who underwent an assessment of their eating behavior. The mean body mass index (BMI) was calculated at 26.15 ± 5.22 kg/m². Weight distribution revealed proportions of 2.6% underweight, 43.4% normal weight, 30.2% overweight, 17.5% obesity grade I, 4.8% obesity grade II, and 1.1% obesity grade III. Binge eating disorder (BED), screened through the BES, revealed that 5.8% had severe BED, 15.9% had moderate BED, and 78.3% had no BED. Correlation analyses highlighted significant associations: there was a strong correlation between BES and the Emotional Eating domain (0.703, p < 0.001), as well as with the Uncontrolled Eating domain (0.715, p < 0.001). Furthermore, a moderate to strong correlation was observed between the Emotional Eating and Uncontrolled Eating dimensions of the TFEQ (0.659, p < 0.001), and a weak correlation between the Uncontrolled Eating dimension and BMI (0.338, p < 0.001).

Discussion and conclusion: The results offer valuable insights into the connection between binge eating and TFEQ subscales, emphasizing the complexity of these interconnected factors.

References

• 1. 2. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition, and hunger. J Psychosom Res 1985;29(1):71–83.

• 2. Freitas S, Lopes CS, Coutinho W, Appolinario JC. Translation and adaptation into Portuguese of the Binge Eating Scale. Rev Bras Psiquiatr 2001;23(4):215–20.

Conflict of interest declaration: The authors have no conflict to declare.

A12 Body dysmorphic disorder and psychological features in an Italian community sample need a medical aesthetic therapy

S. Mattiello¹, D. Ballardini², V. Fasoli², E. Bartoletti³, D. Centofanti⁴

¹Member of Italian Society of Aesthetic Medicine, Rome, Italy; ²Gruber Center, Outpatient Treatment Center for Feeding and Eating Disorders, Service of Diagnosis and Therapy of Eating Disorders, Bologna, Italy; ³ Outpatient Service of Aesthetic Medicine, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, Rome, Italy; ⁴ Outpatient Service of Aesthetic Medicine, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, Rome, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A12

Keywords: Assessment; Body dysmorphic disorder; Psychological features; Psychopathological features; Questionario sul Dismorfismo Corporeo; Body Dysmorphic Disorder Questionnaire

Introduction: Body dysmorphic disorder (BDD) is a psychiatric condition characterized by preoccupation for one or more defects of their appearance not identifiable to the others. The prevalence of BDD across the adult population is estimated to be 1–2%, increasing to 5–15% in patients who require medical-aesthetic procedures. The scientific community is still discussing regarding the status of BDD that could be contraindicated for cosmetic surgery.

Aim of the study: The aim of the study was to perform an assessment of BDD using validated questionnaires.

Materials and methods: A group of 205 patients has been evaluated with a test, including one general information form and two questionnaires: Questionario sul Dismorfismo Corporeo (QDC), in order to assess BDD phenomenology and linked clinical features; Body Dysmorphic Disorder Questionnaire (BDDQ), regarding concerns about body appearance.

Results: The group was made by women (97%), married (43.4%), with a high level of education (31.7%) and full-time job (76.1%). In the sample group, 12.2% showed a test outcome with QDC > 130 and, consequently, a tendency to body dysmorphic syndrome. Significant correlation have been found between QDC and psychological disorders and between QDC and concern for physical appearance assessed by BDDQ.

Discussion and conclusions: The QDC represents a reliable questionnaire for the early recognition of BDD. This study has showed that dysmorphophobic patients required more often medical-aesthetic procedures than the rest of the patients tested. The BDD was often associated with further psychological disorders and these patients have showed extreme concern for their physical appearance that impacts in social interaction.

Table 1 Demographic features (abstract A12)

Table 2 Clinical features (abstract A12)

Table 3 Reasons for medical aesthetic advice (abstract A12)

Table 4 Classes of QDC (abstract A12)

Table 5 QDC classes and BDDQ questions (abstract A12)

Table 6 Association between QDC classes and perceived defects (abstract A12)

Fig. 1

QDC analysis (abstract A12)

Fig. 2

QDC and presence of psychopathologies (abstract A12)

Fig. 3

QDC and concern for physical defects (abstract A12)

Fig. 4

Analysis of the association between QDC classes and BDDQ questions (abstract A12)

References

• 1. Alavi M, Kalafi Y, Dehbozorgi GR, Javadpour A. Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates. J Plast Reconstr Aesthet Surg. 2011 Jun;64(6):738–41

• 2. Bellino S, Zizza M, Paradiso E, Rivarossa A, Fulcheri M, Bogetto F. Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery. Psychiatry Res. 2006; 144: 73–78.

• 3. Bouman TK, Mulkens S, van der Lei B. Cosmetic Professionals' Awareness of Body Dysmorphic Disorder. Plast Reconstr Surg. 2017 Feb;139(2):336–342.

• 4. Buhlmann, U., Glaesmer, H., Mewes, R., Fama, J. M., Wilhelm, S., Brähler, E., & Rief, W. (2010). Updates on the prevalence of body dysmorphic disorder: a population based survey. Psychiatry Research, 178, 171–175.

• 5. Cerea S, Bottesi G, Granziol U, Ghisi M. Development and validation of the questionario sul dismorfismo corporeo in an Italian community sample. Journal of Evidence-Based Psychotherapies, Vol. 17, No. 1, March 2017, 51–65.

• 6. De Brito MJA, Nahas FX, Cordás TA, Tavares H, Ferreira LM. Reply: The Continuous Nature of Body Dysmorphic Symptoms and Plastic Surgery. Plast Reconstr Surg. 2016 Sep;138(3):554e–555e.

• 7. Dey JK, Ishii M, Phillis M, Byrne PJ, Boahene KD, Ishii LE. Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic: measuring prevalence, assessing comorbidities, and validating a feasible screening instrument. JAMA Facial Plast Surg. 2015 Mar-Apr;17(2):137–43.

• 8. França K, Roccia MG, Castillo D, ALHarbi M, Tchernev G, Chokoeva A, Lotti T, Fioranelli M. Body dysmorphic disorder: history and curiosities. Wien Med Wochenschr. 2017 Oct;167(Suppl 1):5–7.

• 9. Gunstad J, Phillips KA. Axis I comorbidity in body dysmorphic disorder. Compr Psychiatry. 2003 Jul-Aug;44(4):270–6.

• 10. Gupta R, Huynh M, Ginsburg IH. Body dysmorphic disorder. Semin Cutan Med Surg. 2013 Jun;32(2):78–82.

• 11. Hardardottir H, Hauksdottir A, Bjornsson AS. Body dysmorphic disorder: Symptoms, prevalence, assessment and treatment. Laeknabladid. 2019 Mar;105(3):125–131. Icelandic.

• 12. Lee K, Guy A, Dale J, Wolke D. Adolescent Desire for Cosmetic Surgery: Associations with Bullying and Psychological Functioning. Plast Reconstr Surg. 2017 May;139(5):1109–1118.

• 13. Lekakis G, Picavet VA, Gabriëls L, Grietens J, Hellings PW. Body Dysmorphic Disorder in aesthetic rhinoplasty: Validating a new screening tool. Laryngoscope. 2016 Aug;126(8):1739–45.

• 14. Mortada H, Seraj H, Bokhari A. Screening for body dysmorphic disorder among patients pursuing cosmetic surgeries in Saudi Arabia. Saudi Med J. 2020 Oct;41(10):1111–112.

• 15. Kyle A. Body Dysmorphia and plastic surgery. Plast Surg Nurs, 32. 2012, pp. 96–98.

• 16. Phillips KA, Dufresne RG Jr. Body dysmorphic disorder: a guide for primary care physicians. Prim Care. 2002 Mar;29(1):99–111, vii.

• 17. Phillips KA, Hart AS, Simpson HB, Stein DJ. Delusional versus nondelusional body dysmorphic disorder: recommendations for DSM-5. CNS Spectr. 2014 Feb;19(1):10–20.

• 18. Pollice R, Bianchini V, Giuliani M, Zoccali G, Tomassini A, Mazza M, Ussorio D, Giordani Paesani N, Roncone R, Casacchia M. Early diagnosis of dysmorphophobia and others dysmorphic disorders: a possible operative model. Clin Ter. 2009;160(1):5–10.

• 19. Ribeiro RVE. Prevalence of Body Dysmorphic Disorder in Plastic Surgery and Dermatology Patients: A Systematic Review with Meta-Analysis. Aesthetic Plast Surg. 2017 Aug;41(4):964–970.

• 20. Siegfried E, Ayrolles A, Rahioui H. Body dysmorphic disorder: Future prospects of medical care. Encephale. 2018 Jun;44(3):288–290. French.

• 21. Sarwer DB, Spitzer JC, Sobanko JF, Beer KR. Identification and management of mental health issues by dermatologic surgeons: a survey of American Society for Dermatologic Surgery members. Dermatol Surg. 2015 Mar;41(3):352–7.

• 22. Sarwer DB, Spitzer JC. Body image dysmorphic disorder in persons who undergo aesthetic medical treatments. Aesthet Surg J. 2012 Nov;32(8):999–1009.

• 23. Spriggs M, Gillam L. Body Dysmorphic Disorder: Contraindication or Ethical Justification for Female Genital Cosmetic Surgery in Adolescents. Bioethics. 2016 Nov;30(9):706–713.

• 24. Sweis IE, Spitz J, Barry DR Jr, Cohen M. A Review of Body Dysmorphic Disorder in Aesthetic Surgery Patients and the Legal Implications. Aesthetic Plast Surg. 2017 Aug;41(4):949–954.

• 25. Veale, D., 2000. Outcome of cosmetic surgery and ‘DIY’ surgery in patients with body dysmorphic disorder. Psychiatrist 24, 218–220.

• 26. Veale D, Gledhill LJ, Christodoulou P, Hodsoll J. Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image. 2016 Sep; 18:168–86.

• 27. Ziglinas P, Menger DJ, Georgalas C. The body dysmorphic disorder patient: to perform rhinoplasty or not? Eur Arch Otorhinolaryngol. 2014 Sep;271(9):2355–8.

A13 Body image perception in overweight or obese adolescents: a cross-sectional study in southern Brazil

A. M. Pandolfo Feoli1, M. Streda Walker1, C. dos Santos de Andrades1, T. Schossler Richrot1, A. da Silva Gustavo1, M. V. Fagundes Donadio1, M. da Silva Oliveira1

¹Pontifical Catholic University of Rio Grande do Sul, Brazil

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A13

Keywords: Adolescent; Obesity; Body image; Body dissatisfaction

Introduction: Adolescence is characterized by the acceleration of body growth due to puberty, involving bodily changes. Thus, various situations can occur in which the individual feels vulnerable and, as a result, develops concerns related to their body and appearance, possibly leading to dissatisfaction with their body image. Due to the major bodily and emotional changes faced by this age group, studies investigating body dissatisfaction in this population are needed.

Aim of the study: To analyze the perception of body image in overweight or obese adolescents in southern Brazil.

Materials and methods: This is a cross-sectional study with data from a randomized clinical trial. Adolescents aged between 15 and 18 who were overweight or obese were included. Data were collected on age and gender, as well as weight and height. To analyze body image perception, the Stunkard Silhouette Scale was used, consisting of a sequence of nine silhouettes. The magnitude of body dissatisfaction was calculated as the difference between the number of images of the current silhouette and the desired silhouette chosen by the participants. The Statistical Package for the Social Sciences 21.0 software was used for statistical analysis, and results with P < 0.05 were considered significant. The study was approved by the Research Ethics Committee.

Results: A total of 133 adolescents took part in the study, the majority of whom were female (73.68%) with a mean age of 16.4 years ± 1.1. With regard to the perception of body image, the mean current body image reported by the participants was 6.42 ± 1.10, while the mean desired body image was 3.91 ± 1.09, showing a significant difference of 2.51 ± 1.10. The boys showed greater body dissatisfaction, that is, their mean difference was significantly higher than the girls.

Discussion and conclusions: Further studies including a representative sample of the Brazilian population should contribute to the early identification of adolescents who are dissatisfied with their body image, which in turn can help prevent eating disorders and promote a healthy lifestyle. There is a high level of body dissatisfaction among overweight or obese adolescents, and the magnitude of this dissatisfaction was greater among the male participants.

References

• 1. Leal, G. V. D. S., Philippi, S. T., & Alvarenga, M. D. S. (2020). Unhealthy weight control behaviors, disordered eating, and body image dissatisfaction in adolescents from São Paulo, Brazil. Brazilian Journal of Psychiatry, 42, 264–270.

• 2. Scagliusi, F. B., Alvarenga, M., Polacow, V. O., Cordás, T. A., de Oliveira Queiroz, G. K., Coelho, D., … & Lancha Jr, A. H. (2006). Concurrent and discriminant validity of the Stunkard's figure rating scale adapted into Portuguese. Appetite, 47(1), 77–82.

Conflict of interest declaration: The authors have no conflict to declare.

A14 Body representation and anorexia nervosa: data from the sixth finger illusion

F. Brusa^1,2,3, D. Cadete⁴, A. Sedda^5,6, V. Villa^1,3, E. Apicella^1,2, E. Ventura^1,2, G. Castelnuovo^3,7, L. Mendolicchio^1,2, M. Longo⁴

¹U.O. di Riabilitazione dei Disturbi Alimentari e della Nutrizione, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Piancavallo; ²Laboratorio sperimentale di ricerche di neuroscienze metaboliche, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Piancavallo & Meda, Milano; ³Laboratorio di Psicologia, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Piancavallo; ⁴Department of Psychological Sciences, Birkbeck, University of London; ⁵Psychology Department, School of Social Sciences, Heriot-Watt University, Edinburgh; ⁶Centre for Applied Behavioural Sciences, School of Social Sciences, Heriot-Watt University, Edinburgh; ⁷Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milano

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A14

Keywords: Anorexia nervosa, Body representation; Embodiment; Multisensory illusion; Supernumerary body parts

Introduction: The ability to imagine our body in our mind is called body representation [1]. This ability is grounded in sensory and perceptual processes [2]. Body representation can be explored using behavioural tasks such as motor imagery tasks [3] as well as body illusions [4].

In patients affected by anorexia nervosa (AN), motor imagery does not occur, and patients treat their body like it is an object [5]. Similarly, when subjected to illusions of ownership, patients with AN experience the illusion more strongly [6]. This evidence suggests that in AN the representation of the body is more malleable, while at the same time being more detached from physical constraints.

Aim of the study: Evaluate the presence of differences in the malleability of the body representation, explored through the body illusion of the sixth finger [please see 7–9], between a group of people with AN [10] and a group of normal weight people (HC), taking into account the biomechanical constraints that characterize the physical and mentally represented body.

Materials and methods: Forty-six participants (AN: 23 females, age: 28 (SD 7), BMI: 14.40 (SD 2); HC: 23 females, age: 30 (SD 7), BMI: 21 (SD 2)) were recruited.

Participants experienced the sixth finger illusion, in 4 different orientations of the visual–tactile stimuli: 0°, 90°, 135°, 180°, and the control condition [7–9].

Results: Patients and controls both experienced the 6th finger in all of the orientations (p < 0.001) with no differences between groups (p > 0.05). Interestingly, AN and HC participants experienced the 6th finger up to 90°, showing a decrease of the experience of illusion for 135° and 180°.

Discussion and conclusions: Differently from what expected, our results highlight flexibility for embodying a sixth finger in an incongruent position (i.e. 90), which is not what happens with hands [11], in both groups AN and HC. This shows that incongruency may not be a limitation for embodiment after all, at least for fingers (i.e. embodiment occurs in fingers oriented at 90° rotation from the hand).

References

• 1. de Vignemont F (2010) Body schema and body image-Pros and cons. Neuropsychologia 48(30):669–680. https://doi.org/https://doi.org/10.1016/j.neuropsychologia.2009.09.022

• 2. Holmes NP, Spence C (2004) The body schema and multisensory representation(s) of peripersonal space. Cogn Process 5(2):94–105. https://doi.org/https://doi.org/10.1007/s10339-004-0013-3

• 3. Brusa F, Kretzschmar L, Magnani FG, Turner G, Garraffa M, Sedda A. Talking with hands: body representation in British Sign Language users. Exp Brain Res. 2021 Mar;239(3):731–744. https://doi.org/10.1007/s00221-020-06013-4. Epub 2021 Jan 3. PMID: 33392694.

• 4. Brusa F, Erden MS, Sedda A. Influence of the Somatic Rubber Hand Illusion on Maximum Grip Aperture. J Mot Behav. 2022 Jul 24:1–19. https://doi.org/10.1080/00222895.2022.2099342. Epub ahead of print. PMID: 35876173.

• 5. Scarpina F, Bastoni I, Villa V, Mendolicchio L, Castelnuovo G, Mauro L, Sedda A. Self-perception in anorexia nervosa: When the body becomes an object. Neuropsychologia. 2022 Feb 10;166:108158. https://doi.org/10.1016/j.neuropsychologia.2022.108158. Epub 2022 Jan 14. PMID: 35033502.

• 6. Eshkevari E, Rieger E, Longo MR, Haggard P, Treasure J. Increased plasticity of the bodily self in eating disorders. Psychol Med. 2012 Apr;42(4):819–28. https://doi.org/10.1017/S0033291711002091. Epub 2011 Oct 5. PMID: 22017964.

• 7. Cadete, D., Alsmith, A. J. T., & Longo, M. R. (2022). Curved sixth fingers: Flexible representation of the shape of supernumerary body parts. Consciousness and Cognition, 105, 103413. https://doi.org/https://doi.org/10.1016/j.concog.2022.103413

• 8. Cadete, D., & Longo, M. R. (2020). A continuous illusion of having a sixth finger. Perception, 49(8), 807–821. https://doi.org/https://doi.org/10.1177/0301006620939457

• 9. Newport, R., Wong, D. Y., Howard, E. M., & Silver, E. (2016). The Anne Boleyn illusion is a six-fingered salute to sensory remapping. I-Perception, 7(5), 2041669516669732. https://doi.org/https://doi.org/10.1177/2041669516669732

• 10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM‐5). Washington, DC: American Psychiatric Association; 2013.

• 11. Tsakiris, M. (2010). My body in the brain: a neurocognitive model of body-ownership. Neuropsychologia, 48(3), 703–712.

Conflict of interest statement: The authors have no conflicts of interest to declare.

A15 Celiac disease and eating and weight disorders: assessment of risk factors for the development of altered eating behaviors in a sample of women with celiac disease

E. Roncarati¹, E. Bottecchia², G. Zannoni³, M. Gualandi⁴, E. Manzato⁵

¹Dietitian, University of Ferrara, dietitian of Eating and Weight Disorders "L’Albero", Private Hospital "Salus", Ferrara; ²Dietitian, SISDCA; ³Psychologist, SISDCA; ⁴Medical Doctor, former head of Day Hospital of Internal Medicine and Eating Disorders, University Hospital S. Anna, Ferrara; ⁵Psychiatrist, former University of Ferrara and head of Eating and Weight Disorders "L’Albero", Private Hospital "Salus", Ferrara

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A15

Keywords: Celiac disease; Eating and weight disorders; Gluten-free diet

Introduction: Over the past decade, the study of the relationship between celiac disease (CD) and eating and weight disorders (EWD) has increased. Individuals with chronic illnesses that require attention to dietary intake are at a high risk of engaging in unhealthy weight control behaviors. Specifically, evidence shows that the focus on food and food habits, as well as the level of adherence (poor or extreme) to the gluten-free diet (GFD), may be associated with an increased risk of psychosocial problems and patterns of eating disorders in individuals with CD.

Aim of the study: To assess the presence of risk factors for the development of altered eating behavior and behavior at risk for eating and weight disorders in a sample of women with celiac disease.

Materials and methods: 112 adult women with a medical diagnosis of celiac disease, after providing informed consent, anonymously completed a self-administered questionnaire and validated psychometric tests (CDAT, CD-QOL, CD-FAB, EAT-26, BES, SCOFF-Q) that investigated body perception, eating behaviors, dieting, adherence to the GFD, quality of life related to celiac disease, weight history, and history of eating and weight disorders.

Results: While 68% of the sample is within the normal weight range and 74% have body perception consistent with BMI, 62% express a desire to lose weight. 46% of the sample reports eliminating foods to control their body shape and weight. Dieting is present in 41% of the sample. 58% of the sample reports having experienced overweight (20%) and/or an eating disorder (21%) and/or dysfunctional eating behaviors such as grazing (34%), hyperphagia (15%), and night eating (4%) during their lifetime. Regarding psychometric tests, in the sample, women with low adherence to the GFD according to the CDAT test have: a poorer quality of life based on the CD-QOL test (p value < 0.00001; PCC -0.42); a higher risk of developing altered eating attitudes and EWD based on the EAT-26 test (p value < 0.00001; PCC 0.45) and SCOFF-Q test (p value < 0.00005; PCC 0.37); a higher risk of developing binge eating according to the BES test (p value < 0.00008; PCC 0.36).

Discussion and conclusions: The study results confirm the currently available data in the literature, highlighting the importance in patients with CD (and in general when a physical illness requires a focus on nutrition) to use a multidisciplinary approach that also investigates the risk of developing EWD.

References

• 1. Abber SR, Burton Murray H. Does Gluten Avoidance in Patients with Celiac Disease Increase the Risk of Developing Eating Disorders? Dig Dis Sci. 2023 Jul;68(7):2790–2792. https://doi.org/10.1007/s10620-023-07915-3. Epub 2023 Apr 18. PMID: 37071245.

• 2. Nikniaz Z, Beheshti S, Abbasalizad Farhangi M, Nikniaz L. A systematic review and meta-analysis of the prevalence and odds of eating disorders in patients with celiac disease and vice-versa. Int J Eat Disord. 2021 Sep;54(9):1563–1574. https://doi.org/10.1002/eat.23561. Epub 2021 May 27. PMID: 34042201.

• 3. Gholmie Y, Lee AR, Satherley RM, Schebendach J, Zybert P, Green PHR, Lebwohl B, Wolf R. Maladaptive Food Attitudes and Behaviors in Individuals with Celiac Disease and Their Association with Quality of Life. Dig Dis Sci. 2023 Jul;68(7):2899–2907. https://doi.org/10.1007/s10620-023-07912-6. Epub2023 Apr 6. PMID: 37024737; PMCID: PMC10079145.

Conflict of interest: Authors do not declare any conflicts of interest.

A16 Clinical severity: eating disorders (EDs) and Covid-19. A study on a clinical sample of patients (10-18 years) diagnosed with ED at the 2nd level center of the AUSL of Romagna (Ravenna) in the years 2021 and 2022

G. D’Alessandro¹, M. Di Stani², L. Biserna¹, S. Brandolini¹, G. Fabbri⁴, F. Di Tante⁴, C. Vannini⁴, F. C. Egitto⁴, A. Zaccarini⁴, V. Ortelli⁴, A. Menghi³, I. Mucci², F. Lacchini²

¹U.O di Dietetica e Nutrizione Clinica; ²Ambulatorio Disturbi Comportamento Alimentare; ³U.O Complessa di Pediatria e Neonatologia; ⁴Ambulatorio DCA UONPIA

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A16

Keywords: Eating disorders (EDs), Clinical severity, Covid-19

Introduction: Since the early 2020s, the COVID-19 pandemic has had a major impact on global public health.

Because of and as a result of this, we have seen an increase in EDs, Depression and Anxiety Disorders over the past two years. EDs are complex multifactorial pathologies characterized by eating and weight control behaviors that are detrimental to physical health and psychosocial functioning (APA, 2014).

Aim of the study: The aim is to study the behavioral and psychological consequences of the pandemic and its restrictive measures, after the first lockdown (March–May 2020), on patients aged 10-18 years, belonging to the 2nd level Center (Ausl Romagna-Ra) in 2021 and 2022 for suspected ED, subsequently confirmed.

Materials and methods: The medical records of patients diagnosed with ICD-10 were analyzed through a multidisciplinary and psychodiagnostic evaluation (EDI-3, CDI 2, CBCL, BES, BUT, CATS, SAFA, MASC2, SCL-90, SCID, SAFA, MMPI). We also conducted a structured interview with parents to investigate their perspective on the following eating and non-eating behaviors of their children, in particular:

• Body and weight control;

• Level of physical activity;

• Use of social networks;

• Sleep quality;

• Mood.

The data that emerged produced a picture of the situation of child neuropsychiatry for the context.

Results: This analysis revealed: practices of weight and body shape control, exacerbated after the lockdown, but partly present before; a change in mood, probably caused by the pandemic situation, but also by the different food choices made during this period (reduced intake of carbohydrates, exclusion of whole food categories, reduction of fats); greater use of social networks, especially by following pages on "healthy" diets "/"high protein" and a deterioration in the quality of sleep.

The following graphs show some of the key research data, comparing before and after the lockdown (2020) in the 2021 and 2022 clinical samples.

Fig. 1 (abstract 16)

Fig. 2 (abstract 16)

Fig. 3 (abstract 16)

Fig. 4 (abstract 16)

Fig. 5 (abstract 16)

Fig. 6 (abstract 16)

Fig. 7 (abstract 16)

Fig. 8 (abstract 16)

Fig. 9 (abstract 16)

Fig. 10 (abstract 16)

Discussion and conclusions: We can therefore conclude that the isolation and quarantine implemented at the beginning of the pandemic had a strong impact on patients with ED and exacerbated an underlying ED, resulting in an overall greater clinical severity of the disorders.

References

• 1. American Psychiatric Association (APA-2014). DSM-5 Manuale Diagnostico E Statistico Dei Disturbi Mentali- Raffaello Cortina Editore

• 2. Dalle Grave, R., Coronavirus Disease 2019 And Eating Disorders, 2020.

• 3. EMDR Italia, Rivista Di Psicoterapia EMDR, Anno XIX, febbraio 2021-N 39

• 4. G. Castellini, E. Cassioli, E. Rossi, M. Innocenti, V. Gironi, G. Sanfilippo, F. Felciai, A. M. Monteleone, V. Ricca, The Impact Of COVID-19 Epidemic On Eating Disorders: a longitudinal observation Of pre versus post Psychopathological Features In A Sample Of Patients With Eating Disorders And A Group Of Healthy Controls, 2020.

• 5. M. Shah, M. Sachdeva, H. Johnston, Eating Disorders In The Age Of COVID-19, 2020.

• 6. Quaderni Del Ministero Della Salute, N. 29 Settembre 2017-Linee Di Indirizzo Nazionali Per La Riabilitazione Nutrizionale Nei Disturbi Dell’alimentazione.

• 7. Vulnerability To Food Insecurity Since The COVID-19 Lockdown-Hps://Foodfoundaon.Org.Uk/Wp-Content/ Uploads/2020/04/ Report_COVID19FoodInsecurity-Final.Pdf

• 8. World Health Organization, ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Volume 2, Instruction manual, 2010 Edition, http://www.who.int/classifications/icd/en/

Conflicts of interest: There are no conflicts of interest.

A17 Couple and parenthood: a look at the son with DAN

S. Danti¹, S. Lucchesi¹

¹Istituto Specchidacqua Montecatini Terme (PT)

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A17

Keywords: DAN, Psychoanalytic psychotherapy, Clinical sexology, Developmental age, Couple therapy, Parenting

Introduction: “Our children in love with life exasperate those who are greedy for tenderness. With their complacent smiles, resting on the shoulders of mothers and fathers, they make Spring appear” (G. Crocetti 2007). This work stems from the desire and the need to bring an even more precise tool for reflection and reading about the integrated multidisciplinary psychotherapeutic approach specific to DAN in the developmental age.

Materials and methods: Based on theoretical references and the use of clinical cases, this work uses a type of integrated multidisciplinary team intervention for the treatment of DAN in the developmental age and provides for a parallel management: couple and parenting, with clinical interviews on a fortnightly and monthly basis.

Results, discussion, and conclusions: "Children want the couple" (G.Crocetti 2009), "children are relationships" (Winnicott 1986, Balint 1950) and if a child is not an enjoyed and shared presence, he will fall ill. This work responds to the criteria of adaptability and treatability of treatments and falls into the concreteness of daily clinical realities. When looking at the child is not enough, the therapeutic work is on the parental couple but if the parental couple "fails" or "doesn't exist", it is necessary to integrate it with the therapeutic work on the couple. Essential and not always visible is the gaze of the son who is lost in the DAN: "I feel as I have been heard and I think of myself as I have been thought of" by the mother couple.

Psychotherapist specialized in childhood and adolescence and clinical sexologist dialogue together.

References

• 1. G. Crocetti. Legami Imperfetti 1997 Cortina Editore, Roma.

• 2. G. Crocetti, G. Pallaoro, Manuale di pratica clinica e teoria della tecnica infanzia 2007, Armando Editore, Roma.

• 3. C. Simonelli, L’approccio integrato in sessuologia clinica. 2006, Franco Angeli, Milano.

• 4. Y. Reisman, H. Porst, L. Lowenstein et al. The ESSM Manual of Sexual Medicine. 2015, Medix Publishers, Amsterdam.

• 5. C. Simonelli, A. Fabrizi, R. Rossi, M.F. Tripodi, Sessuologia Clinica. Diagnosi, Trattamento e Linee Guida Internazionali. 2019, Franco Angeli, Milano.

A18 Day service as a model of effectiveness, efficiency and feasibility in the treatment of eating disorders

G. Giuranno¹, M. Martelli¹, G. D’Anna¹, L. Lazzeretti¹, I. Giunti¹, F. Volpones¹, S. Lucarelli¹

¹Unità Funzionale Complessa Disturbi dell’Alimentazione e della Nutrizione-Azienda USL Toscana Centro

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A18

Keywords: Eating disorders, Psychopathology, Anorexia nervosa (AN)

Introduction: Rapidity of access to appropriate care and length of the period of absence of treatment are among the main prognostic factors of eating disorders (ED). Obstacles to seek an appropriate treatment are: feelings of shame or fear, beliefs about ED, lack of access or availability, characteristics of treatment processes. Given that the speed of reaching a nutritional balance is one of the main prognostic factors with respect to the risk of chronicisation and that the superiority in terms of efficacy and costs of intensive non-hospital treatment has been demonstrated, it is reasonable to direct the planning of services towards an intensive outpatient model, such as Day Service (DSe). DSe wants to be functional to the need for complex clinical situations for which hospitalization is inappropriate but such as to still require taking charge of the patient for rapid care management. It is a clinical path that manages the medium complexity of care, in continuity with the outpatient path and closely integrated with the levels of higher intensity of care, in accordance with the most recent guidelines.

Aim of the study: To explore the efficacy and efficiency of DSe in the treatment of ED.

Materials and methods: This study involved patients with AN referred to the Day Service of the UFC Servizio DA Toscana Centro from May 2022 to August 2023. The main activities of the rehabilitation program were: enteral nutrition (NG tube) and assisted meals; medical and weight monitoring.

Results: The outcomes regarding clinical and anthropometric parameters (BMI), psychopathological correlates and comorbidities, will be discussed in depth during the presentation of the study.

Discussion and conclusions: Based on what emerged from the data in our possession, DSe may represent a valid resource in terms of effectiveness, efficiency and feasibility for the treatment of ED in an intensive outpatient setting.

References

• 1. Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. Int J Eat Disord. 2015 Nov;48(7):946–71. https://doi.org/10.1002/eat.22411. Epub 2015 Jul 14. Erratum in: Int J Eat Disord. 2016 Apr;49(4):432-3. PMID: 26171853.

• 2. Regan P, et al. Initial treatment seeking from professional health care providers for eating disorders: A review and synthesis of potential barriers to and facilitators of "first contact". Int J Eat Disord. 2017 Mar;50(3):190–209. https://doi.org/10.1002/eat.22683. Epub 2017 Jan 30. PMID: 28134980.

• 3. Guarda AS, Schreyer CC, Fischer LK, Hansen JL, Coughlin JW, Kaminsky MJ, Attia E, Redgrave GW. Intensive treatment for adults with anorexia nervosa: The cost of weight restoration. Int J Eat Disord. 2017 Mar;50(3):302–306. https://doi.org/10.1002/eat.22668. Epub 2017 Jan 27. PMID: 28130794.

• 4. Crone C, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. Am J Psychiatry. 2023 Feb 1;180(2):167–171. https://doi.org/10.1176/appi.ajp.23180001. PMID: 36722117.

Disclosure of interests. All authors declare the absence of any potential conflicts of interest.

A19 Eating disorders: nutrition psycho-education group. Dietitian intervention in the context of rehabilitation groups aimed at users of the DCA AUSL Modena Program

S. Bellei¹, R. Covezzi¹, A.Mora¹

¹AUSLModena-Programma DCA Dipartimento Salute Mentale e Dipendenze Patologiche

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A19

Keywords: Eating disorders, Groups, Rehabilitation, Psycho-education, Dietitian intervention

Introduction: Nutrition and eating disorders are complex, multifactorial and long-lasting pathologies. Their treatment must be based on a multidisciplinary therapeutic model and articulated in different treatment settings.

In exercising their profession, the dietician can take care of the management of psycho-rehabilitative groups inserted as part of the treatment setting in which they operate.

This study was based on the elaboration and sharing of 10 nutrition psychoeducation group meetings led by dietitians, included in the context of the daycare center of the Modena AUSL DCA Program.

Aim of the study: The project aims to creating a structured path, offered cyclically to the patients, which would provide them with accurate knowledge and skills in nutrition. This would allow patients to improve their relationship with nutrition as a whole, and to analyse and enhance the path itself.

Materials and methods: The procedures used included the elaboration and sharing of food-themed presentations based on solid scientific evidence. Patients were also invited to work on a final collaborative activity and to fill out anonymous questionnaires.

Discussion and conclusions: From the evaluation of the 108 questionnaires collected in the 25 meetings held, the structured path has proved to be a useful tool available to patients. The DCA Program of AUSL Modena has expressed its intention to continue using the presentations. It is significant to mention the results obtained from the collaboration with a culinary expert outside the healthcare sector, the Michelin-starred Chef Luca Marchini.

Given the characteristics of the care setting, one of the main criticalities encountered during the meetings was structuring a path for a group of different ages, different stages of treatment, and different levels of prior knowledge and motivation for change. To address these differences, it was necessary to structure the meetings so that they were independent but at the same time connected by a common thread.

References

• 1. Ministero della salute. Appropriatezza clinica, strutturale e operativa nella prevenzione, diagnosi e terapia dei disturbi dell’alimentazione. Published online; 2013.

• 2. Ministero della salute. Linee di indirizzo nazionali per la riabilitazione nutrizionale nei disturbi dell’alimentazione. Published online; 2017.

• 3. Donini, L.M., et al. (2017). SISDCA Manuale per la Cura e la prevenzione dei disturbi dell’Alimentazione e delle Obesità (DA&O). Milano, Italia: SICS Editore.

• 4. Ozier AD, Henry BW; American Dietetic Association. Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders. J Am Diet Assoc. 2011 Aug;111(8):1236–41. https://doi.org/10.1016/j.jada.2011.06.016. PMID: 21802573.

• 5. American Psychiatric Association, Work group on eating disorders: Yager J. Devlin C.M.J. Halmi K.A. Herzog D.B. Mitchell J.E. Powers P. Zerbe K.J. Practice guideline for the treatment of patients with eating disorders. 3. ed. American Psychiatric Association; 2006.

• 6. National Institute for Clinical Excellence (NICE). Eating disorders: recognition and treatment. National Institute for Clinical Excellence; 2017.

A20 Early onset psychosis in a female adolescent with atypical anorexia nervosa: a case report and literature review

M. Giardino¹, A. Squarcia¹, C. De Panfilis^1,2

¹Child Neuropsychiatry Unit, Azienda USL Parma, Parma, Italy; ²Unit of Neuroscience, Department of Medicine and Surgery, University of Parma c/o Ospedale Maggiore, pad. 21 Braga, 43126 Parma, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A20

Keywords: Eating disorders (ED), Atypical anorexia nervosa (atypical AN), Early onset psychosis, Adolescence, Comorbidity

Introduction: Psychosis in childhood and adolescence is a rare condition with an incidence less than 0.04% (1). Psychotic episodes have been described in 10% of ED patients of all ages (2). Nevertheless, the comorbidity of ED and psychosis in childhood and adolescence is poorly described in the literature, except for some sporadic clinical cases (3–5) and some isolated studies (2, 6) related to anorexia nervosa and bulimia nervosa. Despite restrictive anorexia nervosa, in particular, and schizophrenia share some neurocognitive deficits (7) and dopaminergic pathway abnormalities (8), as well as despite a shared genetic liability between schizophrenia and binge eating behaviors of ED (9), the association between these two psychiatric entities in adolescents is not fully defined. Only one recent study in a large sample of English adolescents, shows that psychotic experiences in early adolescence are longitudinally associated with a more severe ED characterized by binge eating and purging behaviors at age 18 years, suggesting a significant temporal association between these conditions in a continuum (10). No results were found on the comorbidity of Atypical AN or other specified ED and psychosis.

Aim of the study: To describe the case of a female adolescent patient affected by Atypical AN and psychotic symptoms in order to discuss, given the lack of literature on this topic in adolescence, clinical features and treatment.

Materials and methods: Clinical and psychodiagnostic assessment of a female 15-year-old patient, admitted to our Service on May 2023, with currently ICD 10 (11) diagnosis of atypical AN and unspecified psychosis (F50.1, 29).

The patient’s guardians gave their informed consent for their information to be published in an open access journal.

Results: Results are shown in Tables 1 and 2.

References

• 1. Driver DI et al. Childhood-Onset Schizophrenia and Early- onset Schizophrenia Spectrum Disorders: An Update. Child Adolesc Psychiatr Clin N Am. 2020 Jan;29(1):71–90.

• 2. Miotto P et al. Symptoms of psychosis in anorexia and bulimia nervosa. Psychiatry Res. 2010 Feb 28;175(3):237–43.

• 3. Imran N et al. Comorbid Schizophrenia and Anorexia nervosa in an adolescent male. Pak J Med Sci 2018; 34:1297–1299.

• 4. Lyon ME, Silber TJ: Anorexia nervosa and schizophrenia in an adolescent female. J Adolesc Health Care 1989; 10:419–420.

• 5. Rojo-Moreno L et al. Auditory hallucinations in anorexia nervosa. European eating disorders review. J Eat Disord Assoc 2011; 19:494–500.

• 6. Mensi MM et al. (2020). Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis. European Psychiatry, 63(1), e80, 1–6.

• 7. Sarró S. Transient psychosis in anorexia nervosa: review and case report. Eat Weight Disord. 2009 Jun–Sep;14(2–3):e139–43.

• 8. Barbato G. et al.2006. Increased dopaminergic activity in restricting-type anorexia nervosa. Psychiatry Research 142, 253–255.

• 9. Solmi F et al. Polygenic risk for schizophrenia, disordered eating behaviours and body mass index in adolescents. Br J Psychiatry. 2019 Jul;215(1):428–433

• 10. Solmi F et al. Longitudinal associations between psychotic experiences and disordered eating behaviours in adolescence: a UK population-based study. Lancet Child Adolesc Health. 2018 Aug;2(8):591–599.

• 11. ICD-10: international statistical classification of diseases and related health problems: tenth revision, 2nd ed. World Health Organization.

• 12. Clausen L et al. Validating the eating disorder inventory-3 (EDI-3): a comparison between 561 female eating disorders patients and 878 females from the general population. J Psychopathol Behav Assess. 2011;33:101–10.

• 13. Garner DM et al. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982 Nov;12(4):871–8.

• 14. Cuzzolaro, M. et al. (2006). The Body Uneasiness Test (BUT): Development and validation of a new body image assessment scale. Eating and Weight Disorders, 11(1), 1–13.

• 15. Derogatis, L.R., 1994. SCL-90-R: Symptom Checklist-90-R. Administration, scoring and procedures manual, 3rd ed. National Computer Systems, Minneapolis, Minnesota.

• 16. Fusar-Poli P et al. Reliability and validity of the comprehensive assessment of the at risk mental state, Italian version (CAARMS-I). Curr Pharm Des. 2012;18:386–91.

• 17. Parnas J et al. EASE: Examination of Anomalous Self-Experience. Psychopathology. 2005 Sep-Oct;38(5):236–58.

• 18. Shaffer D et al. A children’s global assessment scale (CGAS). Arch Gen Psychiatry. (1983) 40:1228–31 Congresso Nazionale SISDCA 2023-Integrazione tra Ricerca, Clinica, Formazione e Assistenza

Table 1 Clinical features (abstract A20)

Table 2 Assessment (abstract A20)

A21 Effectiveness of group family psychoeducation with the New Maudsley Method for treating eating disorders in adolescents and young adults

L. Ragozino¹, M. S. Rosato¹, B. Saetta¹, F. Carizzone¹, W. Milano¹

¹UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027, Napoli, NA, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A21

Keywords: Eating disorders, Family-based treatment, Maudsley method, Psychoeducation

Introduction: This study examines the efficacy of group family psychoeducation using the New Maudsley Method (NMM) to treat eating disorders in adolescents and young adults, aiming to enhance home dynamics and reduce reinforcing behaviors. Psychoeducation is crucial for eating disorders, as informing parents about underlying factors, symptoms, and management strategies improves their understanding, minimizing guilt and confusion, and fostering a supportive environment. Furthermore, psychoeducation equips parents with tools to support recovery, collaborating with experts for a comprehensive therapeutic approach.

Aim of the study: (a) Evaluate NMM's impact on caregivers and family climate regarding eating disorders from baseline (T0) to one month after completion (T1). (b) Assess changes in psychopathology, eating disorder severity, and body image in treated patients.

Materials and methods: The study includes 35 parents (mothers = 20) of children (n = 20) with eating disorders. Parents completed EDSIS before and after group psychoeducational therapy. Patients completed EDI-3 and BUT questionnaires.

Results: After NMM treatment, parents reported reduced disorder impact (EDSIS decrease: t(34) = 3.529, p = 0.001), improved social isolation (t(34) = 2.053, p = 0.048), decreased guilt (t(34) = 4.661, p = 0.000), enhanced meal-related issues (t(34) = 2.168, p = 0.037), and improved control over daughters' behavior (t(34) = 2.253, p = 0.031). Patients exhibited decreased severity (t(11) = 2.392, p = 0.036) and body image concerns (t(15) = 6.390, p < 0.001).

Table 1 (abstract A21)

	T0	Tl
EDESIS	M (DS)	M (DS)	t (gl = 34)	p
Social isolation	4.51 (3.58)	3.86 (2.95)	205	048
Guilt	11.26 (2.98)	9.34 (2.58)	466	000
Nutrition	14.34 (5.29)	13.63 (5.11)	216	037
Uncontrollable behavior	6.29 (3.04)	6.00 (2.96)	225	031
Total	36.40 (10.48)	32.83 (8.94)	352	001

Discussion and conclusions: NMM positively impacts caregivers' experience and family climate, reducing disorder dynamics and enhancing support. Patients show significant improvements in body image and severity. NMM enhances family functioning and patient care.

References

• 1) Family therapy and eating disorders in young patients: state of the art. Couturier J., Kimber M., Szatmari P. (2013).

• 2) Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. The International Journal of Eating Disorders, 46(1), 3–11. Eisler I. (1995).

• 3) Family models of eating disorders. Szmukler GI, Dare C, Treasure J, editors.

• 4) Handbook of eating disorders: theory, treatment and research. London: Wiley; p. 155–76. Gilbert A.A., Shaw S.M., Notar, M.K. (2000).

• 5) The impact of eating disorders on family relationships. Eating Disorders; 8(4), 331–345. Goddard E., Macdonald P., Sepulveda A.R., Naumann U., Landau S., Schmidt U., Treasure J. (2011).

Conflicts of interests: The authors declare no conflicts of interest related to this research.

Fig. 1

The AMC model, a familiar model as a source of maintenance of DAN characteristics (Treasure et al. 2008) (Abstract A21)

A22 Emotion dysregulation and eating disorders: the role of Dialectical Behavior Therapy skills training in the multidisciplinary treatment of complex cases

G. D’Anna¹, L. Moroni¹, G. Vazzano¹, L. Lazzeretti¹, I. Giunti¹, S. Lucarelli¹

¹Unità Funzionale Complessa Disturbi dell’Alimentazione e della Nutrizione-Azienda USL Toscana Centro

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A22

Keywords: Emotion dysregulation, DBT, Psychotherapy, Psychopathology, Bulimia nervosa

Introduction: Dialectical Behavior Therapy (DBT) was developed to target emotion dysregulation in chronically suicidal patients and severe personality disorders [1]. The original model was later adapted to treat different psychopathological conditions, including eating disorders (EDs) [2], in which dysfunctional personality traits and suicidality are common.

Aim of the study: To explore the feasibility, acceptability, and efficacy of DBT skills training in the multidisciplinary treatment of outpatients suffering from bulimia nervosa (BN) or binge eating disorder (BED).

Materials and methods: A baseline assessment of ED psychopathology severity (EDE-Q) and emotion dysregulation (DERS, Difficulties in Emotion Regulation Scale) was conducted for all patients first entering the EDs Service of Azienda USL Toscana Centro, and correlation analyses were carried out. At the beginning of the multidisciplinary treatment, patients were offered DBT skills training. Longitudinal analyses were carried for BN and BED patients before and after the Emotion Dysregulation module of the training.

Results: In the overall ED sample (N = 721), EDE-Q total score was correlated with DERS total score (r = 0.48, p < 0.001) and subscales (r = 0.43, p < 0.001 for the “Limited access to emotion regulation strategies” subscale). Results were confirmed in the BN and BED subgroups. Among BN (n = 37) and BED (n = 69) patients who were followed prospectively, dropout rates were < 10%. Significant improvements in DERS total scores and subscales were observed (p < 0.001) in the BN subgroup.

Discussion and conclusion: Given the longitudinal interplay of emotion dysregulation and ED psychopathology—with remarkable prognostic implications [3]—DBT skills training groups may represent a feasible, acceptable, and efficient therapeutic resource for the multidisciplinary treatment of EDs in large-scale, real-world settings.

References

• 1) Linehan MM, Korslund KE, Harned MS, et al. (2015) Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry 72:475–482.

• 2) Ben-Porath D, Duthu F, Luo T, et al. (2020) Dialectical behavioral therapy: an update and review of the existing treatment models adapted for adults with eating disorders. Eat Disord 28:101–121.

• 3) McClure Z, Messer M, Anderson C, et al. (2022) Which dimensions of emotion dysregulation predict the onset and persistence of eating disorder behaviours? A prospective study. J Affect Disord 310:123–128.

Disclosure of interests. All authors declare the absence of any potential conflicts of interest.

A23 Emotion regulation and childhood obesity: co-designing a mobile app for school-aged children

M. S. Rosato¹, A. Cipriano¹, M. Abdoli¹, R. Napolano¹, P. Cotrufo¹, S. Cella¹

¹Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31, 81100, Caserta, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A23

Keywords: Emotion regulation, Childhood obesity, Obesity prevention, Co-design, Serious game

Introduction: Due to its increasing prevalence and many associated health risks and consequences, and overall impact on health-related quality, childhood obesity is one of the most imperious health issues of the twenty-first century, challenging worldwide public health. The influence of self- and emotional regulation in the genesis of childhood obesity is well known. Lifestyle changes, such as diet and exercise, are typically the first approach, but they may not always be effective. Technology-based interventions are valuable tools to face obesity in children.

Aim of the study: Develop ERA, an Emotion Regulation App for children through the co-design approach.

Materials and methods: This study will be only about the co-design phase of a broader project. 4 groups of 10 to 18 participants (6 to 8 years old) were involved in 2-hour weekly co-design activities via 5 focus groups (FG). Moderators facilitated the discussion, feedback, and ideas. Using a semi-structured, open-ended protocol, participants engaged in various tasks (i.e. associating emotions, colors, expressing story preferences, evaluating graphical settings). Notes and visuals documented each stage of the process.

Results: ERA emerged from insights gathered during FG sessions. It will be designed around a young alien who suppresses and denies its emotions in a galactic world of emotions. Players will confront challenges tethered to fundamental emotions distributed across 6 distinctive planets to help the main character release the emotions to rebuild his/her world. The galaxy keeper, a guide through the emotional maze, will hold containment and interpretation functions to promote the development of rudiments of a mental metabolism functioning and, in turn, emotional regulation abilities. Children are led through structured planetary phases, from essential recognition of emotions to understanding and managing them.

Discussion and conclusions: Children enabled to collect of personalized material to develop an app calibrated to the needs of school-age children, potentially promoting more engaging interventions. ERA is expected to improve self-awareness and emotion regulation skills, promoting autonomy and responsible decision-making toward dietary behaviors, reducing the risk of developing complications related to overweight and obesity.

References

• 1) Armstrong, S. C., & Skinner, A. C. (2016, October 1). Defining “Success” in Childhood Obesity Interventions in Primary Care. Pediatrics, 138(4). https://doi.org/https://doi.org/10.1542/peds.2016-2497

• 2) Darling, K. E., & Sato, A. F. (2017, October). Systematic Review and Meta-Analysis Examining the Effectiveness of Mobile Health Technologies in Using Self-Monitoring for Pediatric Weight Management. Childhood Obesity, 13(5), 347–355. https://doi.org/https://doi.org/10.1089/chi.2017.0038

• 3) Garcia, A. (2020). Examining Maternal Emotion Regulation in Children with and without ADHD: A Multimodal Approach. FIU Digital Commons. https://doi.org/https://doi.org/10.25148/etd.fidc009008

• 4) Hu, R., Fico, G., Cancela, J., & Arredondo, M. T. (2014, June). Gamification system to support family-based behavioral interventions for childhood obesity. IEEE-EMBS International Conference on Biomedical and Health Informatics (BHI). https://doi.org/https://doi.org/10.1109/bhi.2014.6864334

• 5) Kelsey, M. M., & Daniels, S. R. (2010, October 1). Childhood Obesity Is the Fuel That Fires Adult Metabolic Abnormalities and Cardiovascular Disease. Childhood Obesity; Mary Ann Liebert, Inc. https://doi.org/https://doi.org/10.1089/chi.2010.0504

• 6) Quelly, S. B., Norris, A. E., & DiPietro, J. L. (2015, October 22). Impact of mobile apps to combat obesity in children and adolescents: A systematic literature review. Journal for Specialists in Pediatric Nursing, 21(1), 5–17. https://doi.org/https://doi.org/10.1111/jspn.12134

• 7) Willem, C., Gandolphe, M. C., Roussel, M., Verkindt, H., Pattou, F., & Nandrino, J. L. (2019, June 26). Difficulties in emotion regulation and deficits in interoceptive awareness in moderate and severe obesity. Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity; Springer Science + Business Media. https://doi.org/https://doi.org/10.1007/s40519-019-00738-0

Conflicts of interests: The authors declare no conflicts of interest related to this research.

A24 Emotional burden and family dynamics of caregivers of a subject with eating disorders: protocol study

R. Di Lorenzo¹, R. Covezzi¹, I. Rubini², C. Bottone², M. Rovatti³

¹Dipartimento Salute Mentale e Dipendenza Patologiche, AUSL-Modena; ²Scuola di Specializzazione in Psichiatria, Università degli Studi di Modena e Reggio Emilia; ³Corso Infermieristica di Modena, Università degli Studi di Modena e Reggio Emilia

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A24

Keywords: Eating disorder, Burden caregiver, Family dynamics, Emotional load, Depression and anxiety

Introduction: The involvement of a caregiver is fundamental taking in care of a person affected by an eating disorder (ED). A long term assistance represents the caregiver burden (CB), which can has an impact on caregiver’s life, compromising his/her psychological health due to stressful conditions, which could potentially induce depression and anxiety. This condition of caregiver can further compromise the assistance of people with ED. The CB is often associated with conflicting familiar relationships lit to worsened condition of subject with ED.

Aim of the study: To evaluate the familial relationships between the patient and the caregiver of reference, and the repercussions on the function. The study has been approved by Comitato Etico dell'Area Vasta Nord in data 19/04/2023 (n. Prot. 12,376/2023) authorized by AUSL-Modena.

Materials and methods: This study was planned for a duration of 12 months.

The following scales will administer to the caregivers of subjects taken in care of ED Service of Modena, with the goal of analysing the emotional load and the familial and relational dynamics.

Beck Inventory Scale, which evaluates the level of depression. Caregiver Burden Inventory, which analyses the stress of the caregiver.

Family Assessment Device, which takes in consideration the function of the family nucleus.

Depression, Anxiety, and Stress-scale, which studies the changes in time and the gravity of the disorders related to generalised anxiety, stress, and depression.

The data will be statistically analysed to better highlight the caregiver burden and his/her personal and familial consequences.

References

• 1) Beck At, Ward Ch, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961 Jun;4:561–71. https://doi.org/10.1001/archpsyc.1961.01710120031004.

• 2) Bertelli, S., Ferrara, P., Di Modica, S. et al. Adaptation and validation of the Caregiver Burden Inventory in eating disorders. J Eat Disord 10, 34 (2022). https://doi.org/https://doi.org/10.1186/s40337-022-00560-7.

• 3) Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9(2), 171–180. https://doi.org/https://doi.org/10.1111/j.1752-0606.1983.tb01497.x.

• 4) Mansfield, AK, Keitner, GI e Dealy, J. (2014). Il dispositivo di valutazione familiare: un aggiornamento. Processo familiare, 54(1), 82–93. https://doi.org/10.1111/famp.12080.

A25 Exploring the link between vegetarianism and eating disorders (ED): a critical review of the literature

L. Valzolgher¹, S. Tessadri¹, F. Rungger, M. Kob¹

¹Division of Dietetics and Clinical Nutrition, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A25

Keywords: Veganism, Vegetarianism, Eating disorder, Anorexia nervosa, Bulimia nervosa

Introduction: Several studies have demonstrated a link between ED and vegetarian diets (VegD), but the existence of a causal relationship has not been confirmed.

Aim of the study: Critical analysis of the literature regarding the association between ED and VegD.

Materials and methods: Systematic review of related articles published in PUBMED up to 16.8.2023.

Results: Out of the 28 studies included, 21 reported a positive association between VegD and ED. Only 4 studies analyzed the temporal relationship between the initiation of the VegD and the onset of ED, and in only 1 of those the ED occurred after transitioning to a VegD. 4 out of 28 studies indicated higher ED risk in semi-vegetarians vs. strict vegetarians. 14 studies investigated diet adherence motivations: weight/health-motivated vegetarians exhibit a higher risk for ED compared to those driven by ethical and/or environmental motivations.

Discussion and conclusions: Although most studies demonstrated a correlation between ED and VegD, no causal link could be determined. Vegans motivated by ethical and environmental reasons were unlikely to develop ED, while subjects with preexisting weight obsession may choose a (semi)-vegetarian diet as a legitimation of the restrained eating. Additionally, questionnaires used in most studies (EAT-26, EDE-Q) appear to have limited applicability among vegetarians, as disordered eating could be overrated in people who do not adhere to a conventional (omnivorous) eating pattern.

Healthcare providers working with ED must consider questioning VegD choice motives, especially as semi-vegetarians with weight focus could be at high-risk. Further research is needed to assess the cause–effect relationship and to evaluate the suitability of the current available ED diagnostic tools in vegetarians.

References

• 1. Collins, M., & Quinton, S. (2020). The inter‐relationship between diet, selflessness, and disordered eating in Australian women. Brain and Behavior, 10(9), e01774.

• 2. Dorard, G., & Mathieu, S. (2021). Vegetarian and omnivorous diets: A cross-sectional study of motivation, eating disorders, and body shape perception. Appetite, 156, 104972.

• 3. Gilbody, S. M., Kirk, S. F., & Hill, A. J. (1999). Vegetarianism in young women: another means of weight control?. International Journal of Eating Disorders, 26(1), 87–90.

• 4. Gwioździk, W., Krupa-Kotara, K., Całyniuk, B., Helisz, P., Grajek, M., & Głogowska-Ligus, J. (2022). Traditional, Vegetarian, or Low FODMAP Diets and Their Relation to Symptoms of Eating Disorders: A Cross-Sectional Study among Young Women in Poland. Nutrients, 14(19), 4125.

• 5. Mazzolani, B. C., Smaira, F. I., Esteves, G. P., Santini, M. H., Leitão, A. E., Gualano, B., & Roschel, H. (2023). Disordered Eating Attitudes and Food Choice Motives Among Individuals Who Follow a Vegan Diet in Brazil. JAMA Network Open, 6(6), e2321065–e2321065.

• 6. McLean, C. P., Moeck, E. K., Sharp, G., & Thomas, N. A. (2021). Characteristics and clinical implications of the relationship between veganism and pathological eating behaviours. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 1–6.

• 7. Paslakis, G., Richardson, C., Nöhre, M., Brähler, E., Holzapfel, C., Hilbert, A., & de Zwaan, M. (2020). Prevalence and psychopathology of vegetarians and vegans–Results from a representative survey in Germany. Scientific reports, 10(1), 6840.

• 8. Sieke, E. H., Carlson, J. L., Lock, J., Timko, C. A., Neumark-Sztainer, D., & Peebles, R. (2022). To meat or not to meat: disordered eating and vegetarian status in university students. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 27(2), 831–837.

• 9. Zickgraf, H. F., Hazzard, V. M., O’Connor, S. M., Simone, M., Williams‐Kerver, G. A., Anderson, L. M., & Lipson, S. K. (2020). Examining vegetarianism, weight motivations, and eating disorder psychopathology among college students. International Journal of Eating Disorders, 53(9), 1506–1514.

• 10. Bardone-Cone, A. M., Fitzsimmons-Craft, E. E., Harney, M. B., Maldonado, C. R., Lawson, M. A., Smith, R., & Robinson, D. P. (2012). The inter-relationships between vegetarianism and eating disorders among females. Journal of the Academy of Nutrition and Dietetics, 112(8), 1247–1252.

• 11. Barrack, M. T., West, J., Christopher, M., & Pham-Vera, A. M. (2019). Disordered eating among a diverse sample of first-year college students. Journal of the American College of Nutrition, 38(2), 141–148.

• 12. Baş, M., Karabudak, E., & Kiziltan, G. (2005). Vegetarianism and eating disorders: association between eating attitudes and other psychological factors among Turkish adolescents. Appetite, 44(3), 309–315.

• 13. Fatima, W., & Ahmad, L. M. (2018). Prevalence of disordered eating attitudes among adolescent girls in Arar City, Kingdom of Saudi Arabia. Health psychology research, 6(1).

• 14. Fatima, W., Fatima, R., & Anwar, N. (2018). Subclinical eating disorders and association with vegetarianism in female students of Saudi Arabia: A cross-sectional study. J. Nurs. Health Sci, 7, 2320.

• 15. Fisak, B., Peterson, R. D., Tantleff-Dunn, S., & Molnar, J. M. (2006). Challenging previous conceptions of vegetarianism and eating disorders. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 11, 195–200.

• 16. Hansson, L. M., Björck, C., Birgegård, A., & Clinton, D. (2011). How do eating disorder patients eat after treatment? Dietary habits and eating behaviour three years after entering treatment. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 16, 1–8.

• 17. Heiss, S., Coffino, J. A., & Hormes, J. M. (2017). Eating and health behaviors in vegans compared to omnivores: Dispelling common myths. Appetite, 118, 129–135.

• 18. Kadambari, R., Cowers, S., & Crisp, A. (1986). Some correlates of vegetarianism in anorexia nervosa. International Journal of Eating Disorders, 5(3), 539–544.

• 19. Klopp, S. A., Heiss, C. J., & Smith, H. S. (2003). Self-reported vegetarianism may be a marker for college women at risk for disordered eating. Journal of the American Dietetic Association, 103(6), 745–747.

• 20. Lindeman, M., Stark, K., &amp; Latvala, K. (2000). Vegetarianism and eating-disordered thinking. Eating Disorders, 8(2), 157–165.

• 21. McLean, J. A., &amp; Barr, S. I. (2003). Cognitive dietary restraint is associated with eating behaviors, lifestyle practices, personality characteristics and menstrual irregularity in college women. Appetite, 40(2), 185–192.

• 22. Michalak, J., Zhang, X. C., &amp; Jacobi, F. (2012). Vegetarian diet and mental disorders: results from a representative community survey. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 1- No analisi statistica su DE perché prevalenza bassa.

• 23. Norwood, R., Cruwys, T., Chachay, V. S., & Sheffield, J. (2019). The psychological characteristics of people consuming vegetarian, vegan, paleo, gluten free and weight loss dietary patterns. Obesity science & practice, 5(2), 148–158.

• 24. O’Connor, M. A., Touyz, S. W., Dunn, S. M., & Beumont, P. J. (1987). Vegetarianism in anorexia nervosa? A review of 116 consecutive cases. Medical journal of Australia, 147(11–12), 540–542.

• 25. Perry, C. L., Mcguire, M. T., Neumark-Sztainer, D., & Story, M. (2001). Characteristics of vegetarian adolescents in a multiethnic urban population. Journal of Adolescent Health, 29(6), 406–416.

• 26. Timko, C. A., Hormes, J. M., & Chubski, J. (2012). Will the real vegetarian please stand up? An investigation of dietary restraint and eating disorder symptoms in vegetarians versus non-vegetarians. Appetite, 58(3), 982–990.

• 27. Trautmann, J., Rau, S. I., Wilson, M. A., & Walters, C. (2008). Vegetarian students in their first year of college: Are they at risk for restrictive or disordered eating behaviors?. College Student Journal, 42(2).

• 28. Yackobovitch‐Gavan, M., Golan, M., Valevski, A., Kreitler, S., Bachar, E., Lieblich, A., & Stein, D. (2009). An integrative quantitative model of factors influencing the course of anorexia nervosa over time. International Journal of Eating Disorders, 42(4), 306–317.

• 29. Zuromski, K. L., Witte, T. K., Smith, A. R., Goodwin, N., Bodell, L. P., Bartlett, M., & Siegfried, N. (2015). Increased prevalence of vegetarianism among women with eating pathology. Eating behaviors, 19, 24–27.

Conflict of interests: None declared.

A26 Exploring the perceived benefit of cooking lab in rehabilitation of anorexia nervosa: a qualitative pilot study

M. Furpi¹, L. Tironi¹, C. Cappelletti¹

¹Centro per la Diagnosi e la cura dei Disturbi del Comportamento Alimentare Casa di Cura Beato Palazzolo-Bergamo

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A26

Keywords: Anorexia nervosa, Cooking lab, Sensory exploration, Five senses

Introduction: In this work, we want to analyze the perceived usefulness of a cooking workshop conducted by a professional chef, a dietitian and a psychotherapist on patients suffering from AN.

Materials and methods: We enrolled 10 patients with AN treated at the CDCA, aged between 17 and 25 years (mean age 21.4), 9 females, 1 male; 7 in outpatient follow-up after rehabilitation hospitalization, and 3 referred to the center's outpatient clinic.

These patients attended the "cooking lab" 5 times, every 2 weeks.

We proposed the preparation of dishes included in the prescribed food scheme in a creative way.

The meetings lasted 2 h dedicated to the presentation of the raw materials by the chef and to the preparation of the dish all together.

A moment was dedicated to tasting a small portion of the cooked dish; through the use of the 5 senses, the patients experimented the sensory exploration of food and finally they ate it.

At the end they filled in a self-administered questionnaire concerning their "thoughts about food", "body sensations about food" and "emotions about food" before during and after” the workshop.

Results: In patients answers we found:

• 1) Thoughts: at the beginning of the lab the patients referred obligation, good food/bad food, food seen as its negative consequence about weight gain; at the end the global attitude was less judgmental towards food.

• 2) Body sensations at the beginning were related to nausea, tension. At the end the sensations were globally more positive; attention increased in general to the 5 senses.

• 3) Emotions at the beginning were fear, sadness, anger. At the end there was an increase in positive emotions related to the taste of food.

Discussion and conclusions: We state the positive impact of this workshop. Patients reported improvement of overthinking about food and better acceptance of bodily sensations.

We believe that the experience of the Cooking Lab in patients diagnosed with AN who have already been treated in multidisciplinary outpatient/residential setting may have provided a further tool for food awareness and management.

References

• 1) “Mindful Eating-per riscoprire una sana e gioiosa relazione col cibo” Jan Chozen Bays, Enrico Damiani Editore, 2021

• 2) https://www.fblabacademy.org/cookingtherapy-mindfulcooking

• 3) Nederkoorn C, Theiβen J, Tummers M, Roefs A. Taste the feeling or feel the tasting: tactile exposure to food texture promotes food acceptance. Appetite 2018

• 4) Food, eating, and the gastrointestinal tract. Nutrients 2020

Conflict of interests: None declared.

A27 Hospitalization of patients with eating disorders: a retrospective analysis at the Central Hospital Bolzano during the period 2021–2022

L. Valzolgher¹, S. Tessadri¹, S. Mirpourian¹, E. Gastaldo¹, M. Schrei¹, E. Callegari¹, L. Vedovato¹, S. Dallagiacoma¹, M. Kob¹

¹Division of Clinical Nutrition, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A27

Keywords: Eating disorders, Anorexia nervosa, Bulimia nervosa, Hospitalization, Complications

Introduction: The exacerbation of eating disorders during the COVID pandemic has resulted in higher number of patients taken care by health-services at all levels, including hospital treatment for medical stabilization (Image 1: levels of treatment in our local area).

Aim of the study: To retrospectively analyze hospitalization for eating disorders at our central hospital during 2021 and 2022.

Materials and methods: From 19/12/2020 to 9/1/2023 24 patients with ED were admitted to hospital for severe malnutrition. We collected anthropometric data, medical records and different parameters related to hospital stay (length of stay, discharge modality). Patients were divided into adults or minors according to age (> 18 or < 18 y) at admission. For minors % mBMI was calculated using Cacciari growth charts for the Italian population.

Results: The results are displayed in Table 1.

Table 1 Demographic, anthropometric data, diagnosis, length of stay and discharge modality in patients with ED admitted to Bolzano Hospital 2021–2022 (abstract A27)

Discussion and conclusions: The number of hospital admissions among adults outnumbered those of minors. The majority of patients were female, except for 2 male adults. Diagnosis was AN in most cases, beside 1 case of BN among adults. The use of Enteral Nutrition was similar between adults and minors, while there were major differences in treatment setting and length of stay. Minors stayed in the pediatric department while adults were admitted to the psychiatric or internal medicine ward. After hospital discharge 53% of the adults were referred to outpatients’ therapy compared with 22% of minors. On the opposite 20% of adults were transferred to other specialistic inpatient hospital care compared with 56% of minors. There was one death among adults due to medical complications. The hospital stay resulted longer among adults (63 ± 79 days) vs. minors (19 ± 12 days).

Hospital admissions increased in the 2-year time considered, more than doubling in 2022. Comparing adults with minors there were differences in the length of stay and discharge modality. These could be explained in our observations by the different presentation characteristics of patients and by the different specialistic setting and organization of healthcare services between children/adolescents and adults.

Fig. 1 (abstract A27)

References

• 1) “Linee di indirizzo nazionali per la riabilitazione nutrizionale nei disturbi dell’alimentazione. Quaderni del Ministero della Salute, n. 29 settembre 2017”

• 2) “Interventi per l’accoglienza, il triage, la valutazione ed il trattamento del paziente con disturbi della nutrizione e dell’alimentazione. Percorso lilla in pronto soccorso (Revisione 2020)”

• 3) Cacciari E, et al. Italian cross-sectional growth charts for height, weight and BMI (6-20 y). Eur J Clin Nutr. 2002 Feb;56(2):171-80

• 4) Schlapfer L, et al. Hospitalization patterns for adolescents with eating disorders during COVID-19. J Eat Disord. 2023 Aug 16;11(1):137

Conflict of interest: None declared.

A28 Impact of Floryan^® probiotic supplementation on abdominal symptoms in anorexia nervosa

B. M. Saetta¹, F. Carizzone¹, L. Ragozino¹, M. Scotto Rosato¹, W. Milano¹

¹UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80,027, Napoli, NA, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A28

Keywords: Probiotics; Anorexia nervosa; Abdominal symptoms; Floryan®; Clinical study

Introduction: The literature reports the presence of gastrointestinal symptoms (dyspepsia, constipation, bowel disturbances, bloating, abdominal pain) in approximately 80% of patients with anorexia nervosa (AN). It has been hypothesized that these complications may be linked to alterations in the intestinal microbiota and persistent inflammation, either preceding or following the onset of the disorder. Recent studies have indeed highlighted significant differences between the microbiota of healthy individuals and that of patients with AN. However, it remains unclear whether intestinal dysbiosis constitutes a risk factor for AN or is a consequence of the disease (malnutrition, dysfunctional behaviors such as self-induced vomiting, prolonged use of laxatives, etc.). Taking a broader perspective, intestinal dysbiosis could potentially serve as both a risk factor and a sustaining factor for eating disorders.

Aim of the study: The aim of this study was to assess the impact of supplementation with specific probiotics on abdominal symptom distress in AN.

Materials and methods: Twenty young women (aged 18–24) with restrictive AN (duration > 1 year) were monitored for persistent gastrointestinal symptoms and emotional state at baseline (T0) and after 30 days (T1) of treatment with Floryan® (1 capsule/day). The participants were divided into two groups: 10 patients received Floryan^®, and 10 were in the control group. Parameters, including bloating, abdominal pain, concerns about gut and bowel health, and concerns about what and how much to eat, were assessed using the self-administered IBS Quality of Life Questionnaire. Group comparisons were made using the independent samples t-test.

Results: With respect to the total score, there was a statistically significant difference at T1 (p < 0.001) between the Floryan® group and the Control group. Among the individual questionnaire items, significant differences were observed in bloating (p < 0.001), abdominal tension (p < 0.001), concerns about gut/bowel health (p < 0.001), and concerns about what/how much to eat (p = 0.005).

Discussion and conclusions: In AN, the use of Floryan^® reduced distress related to abdominal symptoms and improved gut function and regularity. This suggests a positive impact on patients' eating behavior and adherence to nutritional treatment plans.

References

• 1. Santonicola A, Gagliardi M, Guarino MPL, Siniscalchi M, Ciacci C, Iovino P “Eating Disorders and Gastrointestinal Diseases” Nutrients 2019.

• 2. Kyle Staller, Sophie R Abber, Helen Burton Murray “The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide” Lancet Gastroenterol Epatol 2023.

• 3. Guido K W Frank, Neville H Golden, Helen Burton Murray “Introduction to a special issue on eating disorders and gastrointestinal symptoms-The chicken or the egg?” Int J Eat Disord 2021.

Conflicts of interests: The authors declare no conflicts of interest related to this research.

A29 Indications to pharmacological treatment in feeding and eating disorders

E. Tappeti², G. Peroni^1,2, P. Cappelletto^1,2, S. Caini³, L. Bonvini¹, T. Pisano¹

¹A.O.U. Meyer I.R.C.C.S; ²Università degli Studi di Firenze; ³Istituto per lo Studio, la Prevenzione e la Rete Oncologica Toscana

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A29

Introduction: The use of psychiatric drugs in patients with anorexia nervosa (AN) and bulimia nervosa (BN) is widely debated. Although guidelines indicate fluoxetine alone in the treatment of BN (1), the use of psychiatric drugs is widespread in clinical practice (1). To date, there is no unanimously accepted protocol, and most medical personnel rely on their own clinical experience rather than guidelines.

Aim of the study: This single-center, retrospective, observational and epidemiological study aims to conduct an accurate and comprehensive analysis of the prevalence of psychotropic drug use, their tolerability and efficacy in terms of weight gain percentage and hospitalization time in patients with AN and BN, admitted to the SOSA of Psychiatry of Childhood and Adolescence and Neurorehabilitation (SPIAN), AOU Meyer Florence.

Materials and methods: The study population consisted of 40 patients between the ages of 10.8 and 17.5 years admitted to ordinary inpatient or intensive day hospital settings, diagnosed with AN and BN, during the period from January 2020 to December 2020. Data were collected by retrospectively consulting clinical reports. The analysis involved the tolerability of psychotropic medications and efficacy in terms of the relationship between mean percent weight gain, different drug therapies, and psychiatric comorbidities. Finally, the relationship between inpatient time and the use of psychotropic drugs during it was evaluated.

Results: The prevalence of psychiatric medication use was found to be 57.5%. Analysis of the variables showed that there was a correlation between the mean percentage increase in weight and 2 drug associations BDZ + SSRI + antipsychotic 2nd and SSRI + antipsychotic 2nd + antidepressant. A correlation was also found between psychotropic drug intake and shorter hospitalization. Finally, it was observed that patients with extreme AN, thus with a pBMI < 1°, benefit more from psychopharmacological therapy. An interesting finding regarding tolerability was that only one patient needed to discontinue therapy due to the occurrence of side effects. Thus, excellent tolerability of the psychopharmacological drugs used was shown in our study.

Discussion and conclusions: The present study provides important information regarding the use, tolerability, and efficacy of psychotropic drugs in patients with nutrition and eating disorders. Aripiprazole, sertraline and benzodiazepines in combination appear to be the most effective drugs. The validity of drug therapy also appears to be supported by shorter hospitalization and lower relapse rates in individuals taking drugs.

References

• 1. Psychotropic medications in adult and adolescent eating disorders: clinical practice versus evidence-based recommendations. Garner DM, Anderson ML, Keiper CD, Whynott R, Parker L. Sep 2016, Eat Weight Disord, p. 395-402.

• 2. National Institute for Clinical Excellence Guidelines (NICE 2017).

• 3. American Psychiatric Association Guidelines. 2006.

A30 Interoceptive awareness in patients with eating disorders: a comparative analysis using the Multidimensional Assessment of Interoceptive Awareness (MAIA) Scale

P. Aroni, Z. Braglia², D. Minneci, G. Artoni¹, V. Donelli¹, F. Scita¹

¹Eating Disorders Unit, Maria Luigia Hospital, Parma, Italy; ²Unimore-University of Modena and Reggio Emilia, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A30

Keywords: Interoceptive awareness, Eating disorders, MAIA, Body trusting, Self-regulation

Introduction: Interoception, the perception of internal bodily sensations, is increasingly acknowledged as a pivotal construct in the understanding of psychiatric disorders. This is particularly relevant for Eating Disorders (EDs)1–4 where a problematic relationship with one's own body is well-documented5,6 Previous research has explored interoceptive awareness using the Multidimensional Assessment of Interoceptive Awareness (MAIA)7. In our study, we specifically focus on hospitalized ED patients using the Italian version of the MAIA8. To our knowledge, this is the first study that offers a comprehensive comparison across multiple MAIA studies involving ED patients.

Aim of the study: We aim to explore the facets of interoceptive awareness in hospitalized ED patients and offer a unique comparative lens by including four major studies.: Brown et al. (2017), Perry et al. (2021), Monteleone et al. (2021), and Phillipou et al. (2022) [9–12].

Materials and methods: We evaluated 69 inpatients diagnosed with EDs at Maria Luigia Hospital in Monticelli Terme, Parma, using the MAIA at admission. All statistical evaluations were executed using R version 4.2.1.

Results: Based on the provided statistical data, our findings indicate significant deficits in multiple MAIA subscales among ED patients. The most pronounced impairments are seen in the Self-Regulation (t = − 12.79, p < 0.001, Cohen's d = − 1.54) and Trusting (t = − 13.32, p < 0.001, Cohen's d = − 1.32) subscales. Additionally, substantial deficits were also found in the Attention Regulation (t = − 9.13, p < 0.001, Cohen's d = − 1.1), Emotional Awareness (t = − 4.45, p < 0.001, Cohen's d = − 0.5), and Body Listening (t = − 7.23, p < 0.001, Cohen's d = − 0.87) subscales. In contrast, the Noticing, Not Distracting, and Not Worrying subscales did not display statistically significant differences. These numerical insights are further contextualized when compared to other studies, offering a nuanced understanding of varying severity levels in ED patients assessed with MAIA.

Discussion and conclusions: Significant deficits in "Attention Regulation" are apparent in our patient cohort, a trend also observed in Perry et al. (2021) [9]. This suggests a broad issue in sustaining attention to bodily sensations, particularly among those with more severe forms of ED (Fig. 1). The "Self-Regulation" subscale shows strikingly low scores in our study, corroborated by findings in Phillipou et al. (2022) [11]. This points to a common struggle in managing physiological stress through bodily awareness across EDs (Fig. 7).

The "Trusting" subscale scores are alarmingly low, aligning with Perry et al. (2021) and Phillipou et al. (2022)[9,11]. This indicates a pervasive issue of mistrust in bodily sensations, which may be integral to ED psychopathology (Fig. 8). The "Body Listening" subscale, though not as severely impacted, also shows lower scores, consistent with other studies. This implies an overarching difficulty in utilizing bodily sensations for emotional understanding among ED patients (Fig. 2). Lower scores in the "Emotional Awareness" subscale in our study and others suggest a potential disconnection between emotional and bodily awareness, warranting further attention (Fig. 3).

Our study reinforces that the most problematic areas for hospitalized ED patients are "Attention Regulation", "Self-Regulation", and "Trusting". These deficits are generally corroborated by other studies, suggesting targeted interventions may be beneficial. "Body Listening" and "Emotional Awareness" are also areas of concern and should not be ignored in therapeutic strategies.

Our research offers a comprehensive comparative analysis across existing MAIA-based research in EDs. We identify significant deficits in interoceptive awareness, particularly in the "Self-Regulation" and "Trusting" subscales, which showed the most considerable effect sizes. These findings may have important implications for shaping future therapeutic interventions and underscore the need for more research.

Ethical Statement: The study was approved by the Ethics Committee of the Area Vasta Emilia Nord under the protocol "Studio pilota sul ruolo della consapevolezza interocettiva nei disturbi dell'alimentazione" (Prot. 26091, June 21, 2022). All procedures were in compliance with the Declaration of Helsinki. The authors declare no conflicts of interest.

References

• 1. Martin, E., Dourish, C. T., Rotshtein, P., Spetter, M. S. & Higgs, S. Interoception and disordered eating: A systematic review. Neurosci Biobehav Rev 107, 166–191 (2019).

• 2. Khalsa, S. S. et al. Interoception and Mental Health: A Roadmap. Biol Psychiatry Cogn Neurosci Neuroimaging 3, 501–513 (2018).

• 3. Paulus, M. P. & Stein, M. B. Interoception in anxiety and depression. Brain Struct Funct 214, 451–463 (2010).

• 4. Palaniyappan, L., Mallikarjun, P., Joseph, V. & Liddle, P. F. Appreciating symptoms and deficits in schizophrenia: right posterior insula and poor insight. Prog Neuropsychopharmacol Biol Psychiatry 35, 523–527 (2011).

• 5. Scita, F. & Artoni, P. Corpo e Autolesionismo: spunti di riflessione sui Disturbi dell’Alimentazione e sull’Autolesionismo in tempi di pandemia da SARS CoV-2. Rivista Sperimentale Di Freniatria 146, 105–123 (2022).

• 6. Artoni, P. et al. Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case–control efficacy study. Eating and Weight Disorders 26, 499–514 (2021).

• 7. Mehling, W. E. et al. The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS One 7, e48230 (2012).

• 8. Calì, G., Ambrosini, E., Picconi, L., Mehling, W. E. & Committeri, G. Investigating the relationship between interoceptive accuracy, interoceptive awareness, and emotional susceptibility. Front Psychol 6, 150835 (2015).

• 9. Perry, T. R., Wierenga, C. E., Kaye, W. H. & Brown, T. A. Interoceptive Awareness and Suicidal Ideation in a Clinical Eating Disorder Sample: The Role of Body Trust. Behav Ther 52, 1105–1113 (2021).

• 10. Brown, T. A. et al. Psychometric Evaluation and Norms for the Multidimensional Assessment of Interoceptive Awareness (MAIA) in a Clinical Eating Disorders Sample. Eur Eat Disord Rev 25, 411–416 (2017).

• 11. Phillipou, A., Rossell, S. L., Castle, D. J. & Gurvich, C. Interoceptive awareness in anorexia nervosa. J Psychiatr Res 148, 84–87 (2022).

• 12. Monteleone, A. M. et al. Confidence in one-self and confidence in one’s own body: The revival of an old paradigm for anorexia nervosa. Clin Psychol Psychother 28, 818–827 (2021).

Table 1 * p-value < 0.05; ** p-value < 0.001 (abstract A30)Fig. 1 (abstract A27)

Table 2 In Perry 2021, 'IS' refers to patients with suicidal ideation, while 'no-IS' refers to patients without suicidal ideation (abstract A30)

Fig. 1

Attention regulation (abstract A30)

Fig. 2

Body listening (abstract A30)

Fig. 3

Emotional awareness (abstract A30)

Fig. 4

Not distracting (abstract A30)

Fig. 5

Not worrying (abstract A30)

Fig. 6

Noticing (abstract A30)

Fig. 7

Self-regulation (abstract A30)

Fig. 8

Trusting (abstract A30)

A31 Intuitive eating and mindful eating: emerging sources for prevention and treatment of eating disorders

E. Fadelli¹

¹Dietitan, Ospedale di Monfalcone, Monfalcone, Italy.

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A31

Keywords: Eating disorders, Intuitive eating, Mindful eating, Nutritional rehabilitation, Self-compassion

Introduction: Nutritional rehabilitation of eating disorders (EDs) guidelines are mostly based on expert consensus and best practice standards, therefore level of evidence is low.

In the last decades, new approaches, like intuitive eating (IE) and mindful eating (ME), are emerging towards food, body weight and body shape. These approaches focus on self-compassion and stand opposite to diet culture.

Aim of the study: This review summarizes current evidence related to applying intuitive eating and mindful eating and mindfulness-based interventions (MBIs) in prevention and treatment of EDs. Methods: Literature research was focused on systematic reviews that investigate role of IE, ME and MBIs on prevention and treatment of Eds.

Results: Positive outcomes of IE were identified on quality of life, body image and body appreciation, however little evidence was found on applying this approach in treatment and preventions of EDs. Strong evidence occurs on applying MBIs on many biopsychosocial conditions, but evidence on the effects on EDs is inconclusive. Although there is some preliminary evidence on the positive effect of MBIs in prevention, third-wave behavior therapies are still not superior to cognitive behavior therapy (CBT) in treatment.

Discussion and conclusions: Evidence of positive outcomes is still insufficient, due to a small number of RCTs, lack of long-term effects, shortage of specific protocols and great heterogeneity of intervention types. However, these approaches can easily be integrated with other treatments and show promising results on reducing risk factors. Further research is necessary.

References

• 1. Babbot K.M., Cavadino A., Brenton-Peters J., Consedine N.S., Roberts M. Outcomes of intuitive eating interventions: a systematic review and meta-analysis. Eat Disord. 2023;31(1):33–63. Cadena-Scham L., Lopez-Guimerà G. Intuitive eating: An emerging approach to eating behavior. Nutr Hosp. 2016;31(3):995–1002.

• 2. Linardon J, Fairburn CG, Fitzsimmons-Craft EE, Wilfley DE, Brennan L. The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. Clin Psychol Rev. 2017;58:125–40.

• 3. Linee di indirizzo nazionali per la riabilitazione nutrizionale nei disturbi dell’alimentazione. Quaderni del Ministero della Salute n. 29, 2017.

• 4. Tapper K. Mindful eating: what we know so far. Nutr Bull. 2022;47(2):168–85.

• 5. Zhang D, Lee EKP, Mak ECW, Ho CY, Wong SYS. Mindfulness-based interventions: an overall review. Br Med Bull. 2021;138(1):41–57.

Conflict of interest statement: None.

A32 Management of patients with severe anorexia nervosa (AN) in the transitional age: a case report

G. D’Alessandro¹, M. Di Stani², L. Biserna³, S. Brandolini¹, A. Proto², G. Fabbri⁴, F. Di Tante⁴, C. Vannini⁴, F. C. Egitto⁴, A. Zaccarini⁴, I. Mucci², F. Lacchini²

¹U.O di Dietetica e Nutrizione Clinica; ²Ambulatorio Disturbi Comportamento Alimentare; ³U.O Complessa di Pediatria e Neonatologia; ⁴Ambulatorio DCA UONPIA

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A32

Keywords: Eating disorders (EDs), Adolescence, Continuity of care

Introduction: Most psychiatric disorders have an onset in adolescence, so early intervention and continuity of care are important for the person’s development. The need to maintain therapeutic continuity in this age group, for a period of treatment that may be extended over time, requires planning for the stability of the therapeutic team. The availability of treatment slots at all levels of assistance should also guarantee continuity of care, regardless of the differentiation of services between adolescents and adults.

Aim of the study: The aim is to present the complexity of managing the clinical case, both in terms of age and severity of the ED. The clinical complexity was reflected in the difficulty of management between pediatric and adult teams in the levels of care.

Materials and methods: A. (17 years and 6 months) presents to the child neuropsychiatry service with severe weight loss. A.'s diagnosis is AN restrictive type in comorbidity with depression.

The family situation is characterized by several critical relationships with traumatic experiences.

Due to her age and severity, she was hospitalized in the gastroenterology service with a NG tube. The transitional phase created a waiting period (2 months) for psychotherapeutic treatment.

The treatment lasted 2 years:

• Family treatment according to the New Maudsley Model,

• Clinical psychiatric treatment with pharmacological therapy,

• Individual and group psychotherapeutic treatment (CBT),

• Psychonutritional treatment,

• Educational intervention.

When the goals were achieved, the educational intervention continued, with general psychiatric visits and medical–nutritional follow-ups at 4 and 8 months.

The patient or their guardians gave their informed consent for their information to be published in an open access journal.

Results: Thanks to the treatment path, the following goals were achieved:

• Recovery of healthy BMI,

• Improved of body image and self-esteem,

• Improvement of interpersonal and family relationships,

• Recovery of a healthy and balanced food style.

Discussion and conclusions: In the management of complex cases, the success of the treatment is possible thanks to the collaboration of teams that facilitate and guarantee the continuity of care at several levels.

References

• 1. Azienda Unità Sanitaria Locale della Romagna. Rev. 00 del 06/12/2021. PA 198. PDTA Disturbi del Comportamento Alimentare.

• 2. American Psychiatric Association (APA-2014). DSM-5 Manuale Diagnostico E Statistico Dei Disturbi Mentali- Raffaello Cortina Editore

• 3. World Health Organization, ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Volume 2, Instruction manual, 2010 Edition, http://www.who.int/classifications/icd/en/

• 4. Quaderno del Ministero della Salute n. 29, Linee di indirizzo nazionali per la riabilitazione nutrizionale nei disturbi dell’alimentazione. (Settembre, 2017).

Conflicts of interest: There are no conflicts of interest.

A33 Mediation of anger rumination on pathways from trait mindfulness to binge eating symptoms and general distress

N. Barberis¹, V. Saladino², V. Verrastro¹, D. Calaresi¹, M. Cannavò¹

¹Dipartimento di Scienze della salute. Università Magna Graecia di Catanzaro; ²Dipartimento di Scienze umane,, sociali e della salute. Università degli studi di Cassino e del Lazio Meridionale

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A33

Keywords: Trait mindfulness, Anger rumination, Binge eating symptoms, General distress, Adolescents

Introduction: Anger rumination (AR) could be defined as a set of repetitive and negative thoughts about specific situations and past feelings (Nolen-Hoeksema, 1991). AR has been associated with dysregulated behaviors, such as binge eating (BE) (Wakeford et al., 2018) and an increase in stress and negative mood among individuals (Krys & Reininger, 2023). In this context, trait mindfulness (TM) could serve as a protective factor to reduce AR and its related negative consequences (Eisenlohr-Moul et al., 2016).

Aim of the study: Our study aims to investigate the hypothesis that anger rumination can mediate the relationship between trait mindfulness, binge eating symptoms and general distress (GD).

Materials and methods: 494 participants (58% girls) aged between 14 and 17 years old (M = 15.81; SD = 1.02) completed an online cross-sectional survey, including the following measures: Children’s Anger Rumination Scale (CARS; Smith et al., 2016) to assess AR, the Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006) to evaluate TM, the Depression, Anxiety & Stress Self-report-21 (DASS-21, Lovibond & Lovibond, 1995) to measure GD, and the Binge Eating Scale (BES; Gormally et al., 1982) to assess BE symptoms.

Results: Structural equation modelling (SEM) with latent variables was used to test a model with TM as predictor, AR as a mediator, and BE and GD as outcome. The model showed good fit indices: χ²(48) = 135.82; p > 0.001, CFI = 0.97, RMSEA = 0.06 (90% CI = 0.05–0.07), SRMR = 0.04. Significant paths were found from TM to AR (β = − 0.36), BE (β = − 0.27), and GD (β = − 0.34). Furthermore, significant paths were found from AR to BE (β = 0.36), and GD (β = 0.53). In addition, indirect effects were found from TM to BE by AR (β = − 0.13), and from TM to GD by AR (β = − 0.19).

Discussion and conclusions: Mindful-based interventions, by promoting awareness and acceptance of emotions (Dimidjian & Segal, 2015), could help individuals respond to distress in healthier ways and could reduce the tendency to engage in maladaptive behaviors like AR and BE. Moreover, treatments focusing on reducing AR (Takebe & Sato, 2023) could break the cycle of negative thoughts, potentially nurturing more adaptive coping strategies and fostering a positive shift in psychological well-being.

Conflict of interest: Authors declare no conflict of interest.

References

• 1. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/https://doi.org/10.1177/107319110528350

• 2. Dimidjian, S., & Segal, Z. V. (2015). Prospects for a clinical science of mindfulness-based intervention. American Psychologist, 70(7), 593–620. https://doi.org/https://doi.org/10.1037/a0039589

• 3. Eisenlohr-Moul, T.A., Peters, J.R., Pond, R.S. et al. (2016). Both Trait and State Mindfulness Predict Lower Aggressiveness via Anger Rumination: a Multilevel Mediation Analysis, Mindfulness, 7, 713–726. https://doi.org/https://doi.org/10.1007/s12671-016-0508-x

• 4. Gormally, J., Black, S., Daston, S., Rardin, D. (1982). The assessment of binge eating severity among obese persons. Addictive Behaviors, 7 (1), 47–55. https://doi.org/10.1016/0306-4603(82)90024-7

• 5. Krys, S., Reininger, K.M. (2023). Appraisal, Coping, Psychological Distress, and Personal Growth: The Role of Rumination. Trends in Psychology, 1–21. https://doi.org/https://doi.org/10.1007/s43076-023-00294-8

• 6. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation of Australia

• 7. Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582. https://doi.org/https://doi.org/10.1037/0021-843X.100.4.569

• 8. Smith, S. D., Stephens, H. F., Repper, K., & Kistner, J. A. (2016). The relationship between anger rumination and aggression in typically developing children and high-risk adolescents. Journal of Psychopathology and Behavioral Assessment, 38(4), 515–527. https://doi.org/https://doi.org/10.1007/s10862-016-9542-1

• 9. Takebe, M., & Sato, H. (2023). A mindfulness-based intervention for Japanese non-clinical adolescent anger: A pilot study. Current Psychology, 42(4), 3091–3097. https://doi.org/https://doi.org/10.1007/s12144-021-01645-3

• 10. Wakeford, G., Kannis-dymand, L., & Statham, D. (2018). Anger rumination, binge eating, and at risk alcohol use in a university sample. Australian Journal of Psychology, 70(3), 269–276. https://doi.org/https://doi.org/10.1111/ajpy.12187

Table 1 Descriptive analysis and correlations (abstract A33)

Table 2 Path estimates, SEs and 95% Cis (abstract A33)

Fig. 1

Structural mediation model (abstract A33)

A34 Mindfulness and cognitive flexibility in eating disorders: results of a preliminary survey

I. Blanco¹, M. R. A. Muscatello¹

¹Department of Biomedical, Dental Sciences and Morphological and Functional Images (BIOMORF), University of Messina

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A34

Keywords: Mindfulness, Cognitive flexibility, Eating disorders

Introduction: Several studies confirm that the presence of eating disorders is associated with reduced cognitive flexibility. Furthermore, a variety of evidence confirms that levels of cognitive functioning can be partially improved through mindfulness-based meditation practices.

Aim of the study: The study presented here, the preliminary results of which are reported, aims to compare eating disorders with levels of cognitive flexibility and mindfulness.

Materials and methods: A survey was conducted on a general population by means of an online, over a period from April to August 2023, in which 136 users aged between 15 and 72 years, mainly residing in Italy, participated. The following reliable and validated questionnaires were selected: the 24-item Five-Facet Mindfulness Questionnaire Short-Form (FFMQ-SF), to measure levels of mindfulness, the 26-item Eating Attitude Test (EAT-26), to measure the characteristic symptoms of eating disorders, and the Cognitive Flexibility Scale (CFS), to investigate cognitive flexibility.

Results: Among all test takers, 27.9% showed low levels of mindfulness, 14.7% showed a score above 20 on the EAT-26 indicating a potential risk of developing an eating disorder and 29.4% showed low levels of cognitive flexibility. Statistical analyses revealed a significant association between both levels of mindfulness and eating disorder symptomatology (p = 0.0001) and cognitive flexibility and eating disorder symptomatology (p = 0.003). Spearman's correlation coefficient showed a negative correlation between both levels of mindfulness and eating disorders (rs = − 0.21) and between levels of cognitive flexibility and eating disorders (rs = − 0.39).

Discussion and conclusions: The research presented here suggests that individuals at risk of developing eating disorders show lower levels of mindfulness and cognitive flexibility. Consequently, the introduction of mindfulness-based meditation practices could be an excellent aid to help all those individuals at risk of developing eating disorders, while at the same time enhancing cognitive functioning. Further research would be of great help to further investigate these associations and to explore the role of mindfulness practices as a therapeutic tool for eating disorders and improved cognitive flexibility.

References

• 1. Edwards, C.; Walk, A.; Thompson, S.; Mullen, S.; Holscher, H.; Khan, N. Disordered Eating Attitudes and Behavioral and Neuroelectric Indices of Cognitive Flexibility in Individuals with Overweight and Obesity. Nutrients 2018, 10 (12), 1902. https://doi.org/https://doi.org/10.3390/nu10121902.

• 2. Mang, L.; Ridout, N.; Dritschel, B. The Influence of Mood and Attitudes towards Eating on Cognitive and Autobiographical Memory Flexibility in Female University Students. Psychiatry Research 2018, 269, 444–449. https://doi.org/https://doi.org/10.1016/j.psychres.2018.08.055.

• 3. Sala, M.; Vanzhula, I.; Roos, C. R.; Levinson, C. A. Mindfulness and Eating Disorders: A Network Analysis. Behavior Therapy 2022, 53 (2), 224–239. https://doi.org/https://doi.org/10.1016/j.beth.2021.07.002.

• 4. Sleimen-Malkoun, R.; Devillers-Réolon, L.; Temprado, J.-J. A Single Session of Mindfulness Meditation May Acutely Enhance Cognitive Performance Regardless of Meditation Experience. PLoS ONE 2023, 18 (3), e0282188. https://doi.org/https://doi.org/10.1371/journal.pone.0282188.

• 5. Zou, Y.; Li, P.; Hofmann, S. G.; Liu, X. The Mediating Role of Non-Reactivity to Mindfulness Training and Cognitive Flexibility: A Randomized Controlled Trial. Front. Psychol. 2020, 11, 1053. https://doi.org/https://doi.org/10.3389/fpsyg.2020.01053.

Declaration of conflict of interest: The authors declare that they have no conflict of interest.

A35 Multidisciplinary intervention in a sample of patients with obesity: preliminary results

M. D’Amico¹, S. Cerolini¹, A. Zagaria¹, E. Mocini², G. Monda¹, F. Frigerio², L. M. Donini², C. Lombardo¹

¹Department of Psychology, Sapienza University of Rome, Italy; ²Department of Experimental Medicine, Sapienza University of Rome, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A35

Keywords: Obesity; Altered nutritional status; Weight loss; Eating disorders

Introduction: Obesity increases the risk of mortality and developing other medical or psychiatric diseases and is often associated with Feeding and Eating Disorders (FED). The Ministry of Health recommends for the clinical management of patients with FED "the integrated multidimensional, interdisciplinary, multi-professional approach" in accordance with international guidelines.

Aim of the study: The present work aims to test whether a multidisciplinary intervention targeting patients with altered nutritional status, within the project "Determinants of quality of life in a sample of patients with altered nutritional status before and after integrated multidisciplinary nutritional rehabilitation treatment" is effective in reducing BMI in a group of patients with obesity.

Materials and methods: 30 patients with obesity (53.3% female; age = 43.4 ± 18.1; BMI = 38.5 ± 5.92) altered nutritional status and suspected FED, as measured by two brief screening scale (SCOFF, [4, 5] and BEDS-7[6]), enrolled at the Policlinico Umberto I between March 2021 and July 2023, extracted from a bigger sample, were included at baseline. After receiving medical nutrition therapy based on the Mediterranean diet, patients participated in monthly appointments with medical and psychological professionals, consisting of eating behaviour evaluation, bio-medical assessment, and nutritional and psychological counselling. Weight was measured at baseline, at about one month (t1), two months (t2) and three months (t3) after starting the treatment.

Results: Repeated measures ANOVA showed a significant weight reduction (p = 0.009) with a moderate effect (η² = 0.176). Post hoc comparisons indicate significant differences between baseline and t2 (mean difference = 2.54; p = 0.019) and baseline and t3 (mean difference = 3.487; p = 0.013). paired samples T-Test between baseline and third level showed significant differences with a medium effect size (Cohen’s d = 0.484; p = 0.006).

Discussion and conclusions: Preliminary findings show a significant weight reduction in patients enrolled thus suggesting that the sustainable multidisciplinary intervention proposed may be effective in supporting weight reduction in patients with altered nutritional state (obesity) associated with FED. However further research is needed including a bigger sample, a control group and longer follow-ups for assessing effectiveness, and to assess the effects of the intervention on overall medical condition, nutritional status, eating behaviour and its psychological correlates.

Declaration of competing interest: The authors have no conflict to declare.

Fig. 1

Descriptive plot showing mean weight difference between baseline and t3 (abstract A35)

References

• 1. G. De Virgilio et al., “Conferenza di consenso. Disturbi del Comportamento Alimentare (DCA) negli adolescenti e nei giovani adulti,” Istituto Superiore di Sanità, Roma, 2013. [Online]. Available: https://www.iss.it/documents/20126/45616/tredici6web.pdf/90bffa8d-af30-ebd5-4515-575400e7255d?t=1581099713985.

• 2. F. Bevere et al., “Appropriatezza clinica, strutturale e operativa nella prevenzione, diagnosi e terapia dei disturbi dell’alimentazione. Quaderni del Ministero della Salute,” 2013. [Online]. Available: www.quadernidellasalute.it.

• 3. NICE, “Eating disorders: recognition and treatment,” NICE Guid., vol. 62, no. May 2017. pp. 1–42, 2020, [Online]. Available: www.nice.org.uk/guidance/ng69.

• 4. M. Di Fiorino, L. Pannocchia, and M. Giannini, “Contributo alla validazione della versione italiana dello SCOFF: studio su una popolazione psichiatrica,” Psichiatr e Territ, vol. 24, pp. 1–2, 2007.

• 5. J. F. Morgan, F. Reid, and J. H. Lacey, “The SCOFF questionnaire: assessment of a new screening tool for eating disorders,” Bmj, vol. 319, no. 7223, pp. 1467–1468, 1999.

• 6. B. K. Herman, L. S. Deal, D. B. DiBenedetti, L. Nelson, S. E. Fehnel, and T. M. Brown, “Development of the 7-Item Binge-Eating Disorder Screener (BEDS-7),” Prim. Care Companion CNS Disord., Apr. 2016, https://doi.org/10.4088/PCC.15m01896.

A36 Organizational flexibility in the application of psychoeducational group for family members according to the New Maudsley Model and personalized individual support to participants

C. Pancisi¹

¹Psychotherapist Psychologist, AUSL of Romagna, DSM-DP of Forlì-Cesena, Mental Health Center of Forlì

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A36

Keywords: ED, New Maudsley Model, Psychoeducation, Family, Flexibility

Introduction: New Maudsley Model is a treatment for eating disorders (ED) that involves the active collaboration of family members in the treatment (Treasure et al., 2021). For the effectiveness of the result, the ED clinic in Forlimpopoli organizes psychoeducational groups based on this model aimed at family members, with the aim of encouraging change in the person with ED (Langley et al., 2018).

Aim of the study: The study aims to describe how the organizational flexibility of the meetings and personalized individual support to participants, can allow greater participation and satisfaction of family members with the treatment received.

Materials and methods: Meetings involved the family members of patients from 4 psychiatric services: child neuropsychiatry of Forlì and Cesena, adult psychiatry of Forlì and Cesena.

The clinic is in the middle between Forlì and Cesena. The 8 meetings were held on a weekly basis, including an in-depth meeting attended by the local ED family members' association.

To encourage participation, two groups were organized with different times in the same days, so a person can choose.

In case of absence at the first three meetings, the participants were reconstituted: there was personalized and individual support and replay of the lost meeting to participants for first arguments.

Satisfaction with the course was assessed with a qualitatively satisfaction questionnaire.

Results: 20 family members took part in the meetings (relatives of 13 outpatients, with an average age of 18 years).

Attendance, including recovered meetings, was 90% against 60% the previous year, in which the groups had been organized differently.

Satisfaction analysis revealed that along the way they found comfort and reached a greater degree of awareness.

Discussion and conclusions: Greater organizational flexibility and recovery of absences in individual way, has made it possible to achieve a high percentage of presence for family members and a high degree of satisfaction with the process.

Involving the teams and the local ED family members’ association, has promoted a link between services and networking.

References

• 1. Langley, J., Treasure, J., & Todd, G. (2018). Caring for a loved one with an eating disorder: The new Maudsley Skills-Based Training Manual. Routledge.

• 2. Treasure, J., Parker, S., Oyeleye, O., & Harrison, A. (2021). The value of including families in the treatment of anorexia nervosa. European Eating Disorders Review, 29(3), 393–401.

A37 Outpatient treatment for patients with eating disorders (EDs): the experience of the Center for ED of Ravenna, AUSL Romagna

M. Di Stani¹, A. Proto¹, I. Mucci¹, A. Catanzani¹, S. Comai¹, M. Consoli¹, N. Costa¹, L. Toniolo¹, F. Lacchini¹

¹Ambulatorio Disturbi Comportamento Alimentare. Ospedale S. Maria delle Croci, Via Missiroli 10, 48121 Ravenna, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A37

Keywords: EDs, Diagnostic Therapeutic Assistance Path (PDTA), Multiprofessional team, Evidence-based treatments, Outpatient

Introduction: EDs have a high risk of organic consequences and are disabling in terms of psychological and social functioning, with strong consequences also for the families. The Italian national consensus document [1] indicates outpatient treatment as the first choice level for ED. The organizational model proposed by the Emilia-Romagna Region is the PDTA [2, 3].

Aim of the study: The aim is to ensure that patients with ED receive the most appropriate diagnostic-therapeutic procedure, multidisciplinary evidence-based treatment [4] and the continuity of interventions from developmental age to adulthood care system and across different levels of care.

Materials and methods: Quantitative analysis of the personal data variables of the patients who access the clinic, formulation of a database that records the influx, taking charge, the request for collaboration with other services and finally the outcome of the treatments to allow analysis and meta-analysis effectiveness with other outpatient clinics in the area.

Results: Patients with open PDTA for ED in Ravenna in 2022 were 225, 149 adults. All patients were treated with motivational interventions, psychoeducation and nutritional rehabilitation; 36% did psychopharmacological management and 68.5% did individual Cognitive Behavioral Therapy-Enhanced (CBT-E) [5]. Total adult hospitalizations were 8.05% (3 in Gastroenterology, 3 in Clinic, 6 in Psychiatric Diagnosis & Treatment Service). 19.5% have an integrated path in Mental Health Center, 59.7% of patients were discharged due to the achievement of objectives while 5.4% dropped.

Table 1 Description of groups conducted in 2022 (abstract A37)

Discussion and conclusions: The best outpatient multidisciplinary treatment avoids inpatient treatment, promotes the healing of the person in his/her life context and reduces social costs. A future research objective will be: to relate some variables, through a longitudinal analysis of the clinic and a transversal analysis with the other clinics (diagnosis and outcome/treatment duration, age of onset and outcome/duration of treatment, etc.).

Declaration of competing interest: The authors have no conflict to declare.

References

• 1. Istituto Superiore di Sanità (ISS), Conferenza di Consenso. Disturbi del Comportamento Alimentare (DCA) negli adolescenti e nei giovani adulti, Roma, 24–25 October 2012, https://www.iss.it/documents/20126/45616/tredici6web.pdf/90bffa8d-af30-ebd5-4515-575400e7255d?t=1581099713985

• 2. Azienda Unità Sanitaria Locale della Romagna. Rev. 00 del 06/12/2021. PA 198. PDTA Disturbi del Comportamento Alimentare.

• 3. Regione Emilia-Romagna DGR n. 1298/2009. PROGRAMMA PER LA ASSISTENZA ALLE PERSONE CON DISTURBI DEL COMPORTAMENTO ALIMENTARE IN EMILIA-ROMAGNA 2009–2011.

• 4. National Institute for Clinical Excellence, NICE guideline [NG69], Eating disorders: recognition and treatment, Published: 23 May 2017, Last updated: 16 December 2020, https://www.nice.org.uk/guidance/ng69

• 5. Fairburn, C. G. (2010). La terapia cognitivo comportamentale dei disturbi dell'alimentazione. Firenze: Eclipsi.

• 6. Lock, J., Le Grange, D., Agras, W.S., & Dare, C. (2001). Treatment Manual for Anorexia Nervosa. A Family-Based Approach. New York: The Guilford Press.

• 7. Treasure, J., Smith, G., & Crane, A. (2007). Prendersi cura di una persona cara affetta da disturbo alimentare Come diventarne capaci, Nuovo Metodo Maudsley. Trad. It. (2014), a cura di Martinetti M.G., Stefanini M.C. Firenze: SEID.

• 8. Safer, D.L., Telch, C.F., Chen, E.Y. (2009). Dialectical behavior therapy for binge eating and bulimia. Guilford Press.

• 9. Stice, E., & Presnell, K. (2011). Progetto corpo: Promuovere l'accettazione del corpo e prevenire i disturbi dell'alimentazione. Verona: Positive Press.

A38 Passiflora incarnata in the treatment of anxiety symptoms and insomnia in children and adolescents with feeding and eating disorders in the developmental age

J. Pruccoli^1,2, A. La Tempa^1,2, G. Ferraiuolo^1,2, B. Pranzetti^1,2, A. Parmeggiani^1,2

¹IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della, Nutrizione e dell’Alimentazione in età evolutiva, UOC Neuropsichiatria dell’Età Pediatrica, Bologna, Italy; ²Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A38

Introduction: Feeding and eating disorders (FED) are serious mental conditions with frequent onset in childhood or adolescence, whose prevalence is constantly increasing (1). FEDs present frequent psychiatric and organic comorbidities; an association with anxiety symptoms and insomnia has been widely reported (2). Phytotherapy has been documented as a potential emerging option for the treatment of both anxiety symptoms and insomnia in the developmental age (3). Recent research suggests the effect of Passiflora incarnata, a GABAergic-acting molecule, on anxiety symptoms and insomnia (4). This study aims to describe the impact of Passiflora incarnata on anxiety symptoms and insomnia in children and adolescents with FED.

Materials and methods: Retrospective observational study, conducted in a Regional Center for FED in the developmental age. Inclusion criteria were: a) a diagnosis of FED and b) a received treatment with Passiflora incarnata lasting at least one month.

Results: The sample included 76 patients (90.7% females, mean age: 15.0 years). The prevalent FED diagnoses were anorexia nervosa (81.5%) and bulimia nervosa (n = 5.6%). Passiflora incarnata was used at a dosage of 200 mg of dry extract (equivalent to 700–1000 mg of passionflower). The range dose was 1–2 tablets per day (n = 32, 42.1% assumed 1 tablet/day; n = 44, 57.9% assumed 2 tablets/day). Forty-three patients (56.5%) were in a concurrent treatment with selective serotonin reuptake inhibitors, 19 (25.0%) with an atypical antipsychotic, and 6 (7.8%) with benzodiazepines (in 3 cases assumed as needed and no one succeeded in suspending medication with benzodiazepines). Reasons for introduction were anxiety symptoms in 52 patients (68.4%) and insomnia in 27 (35.5%). No side effects were reported. Forty-three patients (56.6%) had specific retrospective data on Passiflora-related outcomes. Among those, 13 (30.2%) reported subjective improvements in anxiety and 10 (23.3%) for insomnia.

Discussion: This is the first study to assess the use of Passiflora incarnata on anxiety symptoms and insomnia in children and adolescents with FED. Further prospective and controlled research is required.

References

• 1. Hornberger LL, Lane MA, The Committee On Adolescence, et al. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics. 2021;147(1):e2020040279. https://doi.org/10.1542/peds.2020-040279

• 2. Allison KC, Spaeth A, Hopkins CM. Sleep and Eating Disorders. Curr Psychiatry Rep. 2016;18(10):92. https://doi.org/10.1007/s11920-016-0728-8

• 3. Borrás S, Martínez-Solís I, Ríos JL. Medicinal Plants for Insomnia Related to Anxiety: An Updated

• 4. Review. Planta Med. 2021 Aug;87(10–11):738–753. https://doi.org/10.1055/a-1510-9826. Epub 2021 Jun11. PMID: 34116572.

• 5. Miyasaka LS, Atallah ÁN, Soares B. Passiflora for anxiety disorder. Cochrane Common Mental Disorders Group, ed. Cochrane Database Syst Rev. Published online January 24, 2007. https://doi.org/10.1002/14651858.CD004518.pub2

A39 Predictive value of psychopathology and dysfunctional eating behaviors in Southern Italian female patients

M. S. Rosato¹, L. Ragozino¹, F. Carizzone¹, B. Saetta¹, W. Milano¹

¹UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027, Napoli, NA, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A39

Keywords: Psychopathology, Dysfunctional eating behaviors, SCL-90, EDE-Q, Regression analysis

Introduction: Eating disorders tend to have a complicated etiology that includes biological, psychological, social, and cultural factors. Delving into which feature of psychopathology best predicts the severity of eating disorders could lead to personalization of treatment, early intervention, efficient allocation of resources, development of innovative therapies, prevention, and advancement of research knowledge thus improving patient care and overall health.

Aim of the study: This study focuses on the specific psychopathological symptoms that contribute to the severity of eating disorders to investigate the predicted relationships between psychopathology and dysfunctional eating practices.

Materials and methods: Participants were 38 female patients (age range = 14–56; Mage = 22 ± 8.59) recruited in their first access to the UOSD Eating Disorder Unit in Naples, Southern Italy. The SCL-90 subscales were used to measure psychopathological symptoms, while the EDE-Q composite score was used to examine dysfunctional eating patterns. Age was used as a covariate in correlation and regression analysis to find the predictive coefficients of the various psychopathological symptoms on the overall EDE-Q score.

Results: The model is significant (F(11) = 2.500; p = 0.027) and explains 51.4% of the variance. Regression analysis revealed significant predictive coefficients for psychopathological symptoms in relation to the composite EDE-Q score. Phobic anxiety (p = 0.005), obsessions-compulsions (p = 0.028), interpersonal sensitivity (p = 0.034), and anxiety (p = 0.036) showed significant noteworthy contributions.

Discussion and conclusions: The study sheds light on the relationship between the severity of eating disorders and psychopathological symptoms. The research emphasizes the combined impact of various symptoms on dysfunctional eating, with SCL-90 and EDE-Q accounting for more than 51% of the variance. Obsessions-compulsions, phobic anxiety, social sensitivity, and anxiety play a major role. This advances our knowledge of the psychological factors influencing eating disorders. Further research into the underlying mechanisms may help to improve intervention techniques and enhance the general wellbeing of those who are affected.

References

• 1. Derogatis, L. R., Lipman, R. S., & Covi, L. (1977). SCL-90. Administration, scoring and procedures manual-I for the R (revised) version and other instruments of the Psychopathology Rating Scales Series. Chicago: Johns Hopkins University School of Medicine.

• 2. Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. Lancet (London, England), 361(9355), 407–416. https://doi.org/https://doi.org/10.1016/S0140-6736(03)12378-1.

• 3. Luce, K. H., & Crowther, J. H. (1999). The reliability of the eating disorder examination—Self‐ report questionnaire version (EDE‐Q). International Journal of Eating Disorders, 25(3), 349–351.

Conflicts of interests: The authors declare no conflicts of interest related to this research.

Table 1 Correlations. *p < 0.05; **p < 0.01 (abstract A39)

Table 2 Model summary (abstract A39)

Table 3 Coefficients (abstract A39)

A40 Prevalence of decreased grip strength in a sample of female patients with anorexia nervosa

C. Piciocchi¹, T. Antici¹, F. Ricci¹, V. Frattina¹, G. Imperatore¹, F. Frigerio¹, L. Tanase², D. Accorrà², A. Cotugno², I. Marini³, M. Pasquini³, M. P. Casini⁴, M. Ferrara⁴, C. Segura-Garcia⁵, L. M. Donini¹, E. Poggiogalle¹

¹Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; ²Hospital of Santa Maria Della Pietà, ASL Rome 1, Rome, Italy; ³Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; ⁴Department of Pediatrics and Child and Adolescent Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; ⁵Department of Medical and Surgical Sciences, University "Magna Graecia", Catanzaro, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A40

Keywords: Muscle strength; Handgrip strength test; Anorexia nervosa; Dynapenia

Introduction: The reduction of muscle mass and of handgrip strength are two conditions that often occurs in anorexia nervosa (AN). Muscle strength is a crucial parameter of nutritional status; its impairment (namely, dynapenia) is related to worse prognosis and decreased life expectancy. The aim of the present study was to determine the prevalence of decreased muscle strength in a sample of female patients with AN.

Materials and methods: This is an observational study carried out at the University Sapienza of Rome. We recruited a sample of female patients from the Department of Experimental Medicine, Sapienza University (Rome), the Departments of Psychiatry and Infant Neuropsychiatry, Policlinico Umberto I (Rome), the Clinic of Eating Disorders in Santa Maria Della Pietà Hospital (Rome) and the University Hospital Mater Domini (Catanzaro).

All participants underwent medical history assessment, anthropometry and handgrip strength test (HGST), three trials per arm; BMI, BMI Z-scores (for patients ≤ 18 years old) and HGST percentiles (pc)^1,2 were calculated.

Results: We enrolled 81 female AN patients aged 13–53 years (age, mean ± SD: 19.8 ± 7.5 years), BMI ranging from 12.7 to 18.4 kg/m².

In the 13–18 year age group, 37% of patients had a handgrip strength < 5th percentile (see Fig. 1 for more details), whereas in the adult group, approximately three-quarters of patients were < 5th percentile.

Fig. 1

Distribution of HGST percentiles in the 13–18 year age group (abstract A40)

Fig. 2

Distribution of HGST percentiles of right arm (RA) in the 19–53 year age group (abstract A40)

Fig. 3

Distribution of HGST percentiles of left arm (LA) in the 19–53 year age group (abstract A40)

Discussion and conclusions: The results showed an important reduction of handgrip strength among AN female patients. Therefore, it is crucial that physical examination in AN patients includes functional assessment.

References

• 1. Iglesias-Soler E, Rúa-Alonso M, Rial-Vázquez J, et al. Percentiles and Principal Component Analysis of Physical Fitness From a Big Sample of Children and Adolescents Aged 6-18 Years: The DAFIS Project. Front Psychol. 2021;12:627834.

• 2. Huemer MT, Kluttig A, Fischer B, et al. Grip strength values and cut-off points based on over 200,000 adults of the German National Cohort—a comparison to the EWGSOP2 cut-off points. Age Ageing. 2023;52(1):afac324.

Declaration of conflicts of interest: None.

A41 Psychological factors predictive of food addiction in individuals with binge eating disorder and bulimia nervosa: a preliminary study

A. A. Rossi^1,2 A. Tagliagambe³, A. Scuderi³, L. Montecchiani⁴, D. Giorcelli³, M. Ricco³, S. Mannarini^1,2, L. Dalla Ragione⁵

¹Department of Philosophy, Sociology, Education, and Applied Psychology Section of Applied Psychology, University of Padova, Padova, Italy; ²Center for Intervention and Research Studies on the Family, University of Padova, Padova, Italy; ³Residence Cabrini DCA, Pontremoli (MS), Italy; ⁴Eating Disorders Services-USL N1 “Nido delle Rondini”, Todi, Perugia, Italy; 5Food Science and Human Nutrition Unit, University Campus Biomedico of Rome, Rome, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A41

Keywords: Food addiction; Eating disorders; Anorexia nervosa; Bulimia nervosa; Binge eating disorder

Introduction: Food addiction (FA) has gained a lot of popularity in the last 15 years [1–6]. Moreover, several studies showed that FA is related to different eating disorders (ED) such as binge eating disorder (BED; ≈ 80%) and bulimia nervosa (BN; ≈ 95%) [4]—suggesting that FA should be considered an underlying construct of ED conditions [7, 8]. However, the literature has not yet explored which specific psychological facets of EDs are most likely to predict a diagnosis of FA.

Objective: Using a logistic regression analysis approach (backward), the present study aims to identify psychological features and core ED symptoms [9] in clinical samples of patients with BED and BN—highlighting the main differences between these diagnostic clusters.

Materials and methods: A sample of 150 patients with a diagnosis of ED was enrolled at ‘Residence Madre Carbini DCA’, Pontremoli, Italy: 80 patients with BED and 70 patients with BN. Psychological facets of EDS were evaluated with the Eating Disorder Inventory – 3 (EDI-3) [10] and FA was diagnosed using the Yale Food Addiction Scale 2.0 (YFAS2.0) [1, 11, 12].

Results: Considering patients with BED, only the Bulimia scale (β = 0.124, p = 0.003; OR = 1.132) and the Body Dissatisfaction scale (β = 0.078, p = 0.036; OR = 1.081) were predictors of FA (Nagelkerke R² = 0.366). Considering patients with BN, the Body Dissatisfaction scale (β = 0.427, p = 0.036; OR = 1.533), the Personal Alienation scale (β = 0.364, p = 0.038; OR = 1.438), the Interpersonal Insecurity scale (β = − 0.313, p = 0.030; OR = 0.731), the Interpersonal Alienation scale (β = 0.662, p = 0.039; OR = 1.938), the Asceticism scale (β = − 0.711, p = 0.034; OR = 0.491) were predictors of FA (Nagelkerke R² = 0.592).

Discussion and conclusions: These results show that the diagnosis of FA is predicted by different components between different diagnostic clusters. These findings suggest a different conceptualization of FA through ED diagnoses—that could explain some structural differences in EDs as well as in treatment outcomes.

For the first time, this study used the main psychological facets of EDs to predict the diagnosis of FA. This might inform classification approaches and could have important implications for the development of intervention protocols for patients with EDs.

References

• 1. Manzoni, G.M., et al., Structural validity, measurement invariance, reliability and diagnostic accuracy of the Italian version of the Yale Food Addiction Scale 2.0 in patients with severe obesity and the general population. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 2021. 26(1): p. 345–366.

• 2. Manzoni, G.M., et al., Validation of the Italian Yale Food Addiction Scale in postgraduate university students. Eating and Weight Disorders, 2018. 23(2): p. 167–176.

• 3. Meule, A. and A.N. Gearhardt, Food addiction in the light of DSM-5. Nutrients, 2014. 6(9): p. 3653–71.

• 4. Meule, A. and A.N. Gearhardt, Ten Years of the Yale Food Addiction Scale: a Review of Version 2.0. Current Addiction Reports, 2019: p. 1–11.

• 5. Rossi, A.A., et al., Disordered Eating Behaviors Related to Food Addiction/Eating Addiction in Inpatients with Obesity and the General Population: The Italian Version of the Addiction-like Eating Behaviors Scale (AEBS-IT). Nutrients, 2023. 15(1): 104.

• 6. Rossi, A.A., et al., Eating Compulsivity in Inpatients with Severe Obesity and the General Population: The Italian Version of the Measure of Eating Compulsivity (MEC10-IT). Nutrients, 2023. 15(6): 1378.

• 7. Rossi, A.A., My Sweet Gluttony. Exploring Food Addiction: Measures, Networks, and Profiles, in Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology2021, University of Padova: Padua, Italy.

• 8. Rossi, A.A., et al., Many facets of eating disorders: profiling key psychological features of anorexia nervosa and binge eating disorder. Eating and Weight Disorders, 2022. Under review.

• 9. Rossi, A.A., et al., Many Facets of Eating Disorders: Profiling Key Psychological Features of Anorexia Nervosa and Binge Eating Disorder. Behavioral Sciences, 2023. 13(3): p. 276.

• 10. Garner, D.M., Eating Disorder Inventory-3. Professional manual2004, Lutz, FL: Psychological Assessment Resources.

• 11. Aloi, M., et al., Validation of the Italian version of the Yale Food Addiction Scale 2.0 (I-YFAS 2.0) in a sample of undergraduate students. Eat Weight Disord, 2017. 22(3): p. 527-533.

• 12. Gearhardt, A.N., W.R. Corbin, and K.D. Brownell, Development of the Yale Food Addiction Scale Version 2.0. Psychol Addict Behav, 2016. 30(1): 113–21.

Conflicts of interest: None.

A42 Psychomotor intervention for people with substance use disorders (SUD) and eating disorders (ED) in therapeutic communities (TC): a pilot study

A. Cutaia¹, A. Cereda¹, C. Gulino², C. Lamartina², E. Fischetti¹, A. Truscelli¹

¹Department of Pathological Dependencies and Residential Therapeutic Programme, Association Casa Rosetta Onlus, Caltanissetta; ²Department of Neuropsychomotor Rehabilitation and Psychomotricity, Association Casa Rosetta Onlus, Caltanissetta.

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A42

Keywords: ED, SUD, Psychomotor skills

Introduction: Residential treatment in TC activates adaptation and learning processes taking care of patients with SUD and ED. Psychomotor and psychotherapy activities can help to build a bridge between the body, movement, and emotions, in order to improve communication and relationships with oneself and with others.

Aim of the study: The efficacy of psychomotor activities, in the therapeutic program, concerning psychophysical well-being, adherence to the rehabilitation program, and dropout rate.

Materials and methods: We have examined a population of 85 people with SUD (Table 1) in order to make an observational case–control study. Psycho-diagnostic tools for ED (BUT, EAT-26, BES), alexithymia (TAS-20) and depression (BDI) as well as the psychomotor examination at T0 were used. The study design will provide for evaluation at a given time T1, and T2. The evaluation of the results from the in-treatment group (psychomotor activities) and control group will be performed.

Results: The psychological evaluation of the whole population at time T0 showed clinically significant body discomfort and possible eating disorders; data relating to alexithymia, depression are significant too. The psychomotor examination showed some compromised psychomotor areas such as emotional control and rhythm.

Discussion and conclusions: Preliminarily we expect an improvement of the outcome at time T1 and T2 in the in-treatment group, due to the psychomotor activities, that are aimed at conceiving the body no longer only as a means to satisfy substance dependence, but as the center of a new emotional, relational and communicative experience.

References

• 1. Nizzoli, U. (2018). Comorbilità fra disturbi da uso di sostanze, addiction, disturbi dell’alimentazione e altri disturbi mentali: una sfida per la pratica clinica. Link, 1(2), 68–78. https://www.fisppsicologia.it/comorbilità-fra-disturbi-da-uso-di-sostanze,-addiction,-disturbi-d ell’alimentazione-e-altri-disturbi-mentali

• 2. Constant, A., & Exposito, C. (2019). La question des addictions et l’approche psychomotrice. In Vachez-Gatecel, A., & Valentin-Lefranc, A. Le Grand Livre des pratiques psychomotrices (pp. 311–325). Dunod.

Disclosure declaration: The authors declare they have no conflict of interest.

Table 1 Socio-demographic features and history of DUS of the sample (abstract A42)

Fig. 1 (abstract A42)

Fig. 2 (abstract A42)

Fig. 3 (abstract A42)

Fig. 4 (abstract A42)

Fig. 5 (abstract A42)

A43 Psychopathological predictors of nutritional therapeutic progress in adolescents with feeding and eating disorders: an outpatient prospective study of self-monitoring forms

B. Valeriani¹, E. Barbieri^2,3, J. Pruccoli^2,3, C. Capozzi², F.Rossi², A.Parmeggiani^2,3

¹IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure—Clinical Nutrition and Metabolism Unit, Bologna, Italy; ²IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell’Alimentazione in età evolutiva, U.O. Neuropsichiatria dell’età pediatrica, Bologna, Italy; ³Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A43

Keywords: Eating disorder, Self-monitoring, Children and adolescents, Nutritional assessment, EDI-3

Introduction: Despite the use of Self-monitoring Forms (SMF) is prescribed by international and national guidelines (1,2,3), data concerning their use in children and adolescents with Feeding and Eating Disorders (FED), as well as their use for predictors of therapeutic progress, are lacking.

Aim of the study: SMF has been adopted to assess the nutritional therapeutic progress of adolescents with FED within 6 months of outpatient psychonutritional treatment, documenting potential psychopathological predictors.

Materials and methods: Prospective, observational study, conducted on patients who accessed to a Regional Italian Center for FED in developmental age. All patients were evaluated for: nutritional data, initially assessed at the first visit (T0) using a 24-h dietary recall (24hDR). Subsequent assessments (after the first evaluation—T1, after 6 months—T2) were conducted using standardized SMF consisting of 6 columns. The patient was instructed to report in real-time: when, what, and where they ate, binging, compensatory behaviors, and events that influenced eating behavior.

Anthropometric data (BMI, %BMI) and bioimpedance (% fat mass, free fat mass) (T0-1-2);

Psychopathology using Eating Disorder Inventory-3 (EDI-3), Body Uneasiness Test (BUT), and Symptom Checklist (SCL-90-R) (T0).

Results: Fifty-seven adolescents (15.6 ± 1.2 years, F = 100%) were enrolled and completed the SMF. After 6 months (Table 1), caloric, lipid, and carbohydrate intake significantly increased across T0, T1, and T2. Concurrently, protein and simple sugar intake increased, though not significantly (Fig. 1).

EDI-3 Interpersonal Problems Composite (IPC), aggregating Interpersonal Insecurity and Interpersonal Alienation scales, emerged as a significant predictor for nutritional improvement, particularly of caloric intake (F = 182.527, p = 0.002). No predictive role for BUT or SCL-90-R was found.

Table 1 (abstract A43)

Nutritional variables	TO	Tl	T2	Statistics
Caloric intake, kcal	1228 ± 280	1476 ± 292	1554 ± 378	F = 7.615
				p = 0.005*
Proteins, g	76.0 ± 20.7	82.6 ± 18.7	80.0 ± 18.0	F = 0.536
				p = 0.595
Lipids, g	34.2 ± 16.7	42.4 ± 15.8	53.8 ± 21.4	F = 3.830, p = 0.044*
Glucides, g	152.0 ± 44.6	186.2 ± 45.9	187.1 ± 54.3	F = 5.347, p = 0.017*
Sugars, g	58.4 ± 40.2	70.0 ± 28.2	79.7 ± 39.0	F = 2.361
				p = 0.126

Fig. 1 (abstract A43)

Discussion and conclusions: This is the first study to prospectively assess psychopathological predictors for nutritional therapeutic progress in the outpatient treatment of children and adolescents with FED. Interpersonal problems were found as a predictor of nutritional changes over time. Furthermore, outpatient psychonutritional intervention has shown to be beneficial in young patients but warrants further investigation.

References

• 1. Wilson, G. T., & Vitousek, K. M. (1999). Self-monitoring in the assessment of eating disorders. Psychological Assessment, 11(4), 480–489.

• 2. National Institute for Health and Care Excellence. (2017). Eating Disorders: Recognition and Treatment.

• 3. Linee di indirizzo nazionali per la riabilitazione nutrizionale nei disturbi dell’alimentazione (2017). Quaderni del Ministero della Salute.

All the authors declare they have no conflict of interest. The study was not founded by any public or private company.

A44 Psychopharmacology in BED patients with associated psychiatric disorders: effects on intensive rehabilitation treatment

G. L. Cesa¹, I. Del Gobbo¹, D. Battani¹, F. Martino¹, V. Zaccheroni¹

¹Centro Obesità e Nutrizione Clinica Villa Igea, Ospedali Privati Forlì—Forlì (FC)

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A44

Keywords: BED, Obesity, Psychiatric disorders, Psychopharmacology

Introduction: Binge eating disorder (BED) is the most prevalent eating disorder in individuals with obesity and is associated with poor physical and mental health outcomes. Patients with BED often present high comorbidity with other medical conditions and psychiatric disorders. BED co-occurred significantly with bipolar disorder, major depressive disorder, most anxiety and fibromyalgia. Psychological and behavioral interventions have been a mainstay of treatment and pharmacologic agents have become promising treatment options for some patients.

Aim of the study: The aim of the study is to evaluate the effectiveness of psychopharmacology for treating binge eating disorder and correlated psychopathology.

Materials and methods: 243 subjects mean age 57.33 ± 10.99, mean weight 137.1 kg and mean BMI 49,75 kg/m² receiving in-patient treatment at the Ospedali Privati Forlì Villa Igea in Forlì (FC). All patients were administered a pre–post treatment psychometric test consisting of PGWBI. The variables considered for statistical analysis were PGWBI scores, weight, BMI, waist circumference and glycemia. The rehabilitation program consists of 4 weeks of individual psychotherapy, psychoeducational groups, group nutrition counseling, medical supervision and intensive physical activity.

Results: BED was 45.16% of total sample and depression was the most frequent psychiatric disorder associated (52.83%). Fluoxetine was the most utilized medication (35.71%). Statistical analysis pre–post treatment showed the effectiveness of rehabilitation treatment compared to the considered variables. The results obtained to assess the effect of the psychopharmacology showed that there are differences in the two subgroups with respect to the PGWBI, waist circumference and glycemia; this shows that fluoxetine is more effective to improve psychological well-being, waist circumference and glycemia in patients with BED associated with depression respect to all others types of psychopharmacological medication scores.

Discussion and conclusions: Our findings highlight the effectiveness of fluoxetine in producing significant changes in the variables considered in patient with BED and associated depression. In particular, efficacy is best seen in BED with depression obese subjects treated with fluoxetine, who show greater improvement in the PGWBI scores, waist circumference and glycemia than the BED obese with depression treated with other types of psychiatric medications.

References

Crow SJ, Pharmacologic Treatment of Eating Disorders. Psychiatr Clin North Am. 2019 Jun;42(2):253–262.

Monteleone AM, Pellegrino F, Croatto G, Carfagno M, Hilbert A, Treasure J, Wade T, Bulik CM, Zipfel S, Hay P, Schmidt U, Castellini G, Favaro A, Fernandez-Aranda F, Il Shin J, Voderholzer U, Ricca V, Moretti D, Busatta D, Abbate-Daga G, Ciullini F, Cascino G, Monaco F, Correll CU, Solmi M, Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neurosci Biobehav Rev. 2022 Nov;142

Muratore AF, Attia E, Psychopharmacologic Management of Eating Disorders. Curr Psychiatry Rep. 2022 Jul;24(7):345–351

Fornaro M, Mondin AM, Billeci M, Fusco A, De Prisco M, Caiazza C, Micanti F, Calati R, Carvalho AF, de Bartolomeis A, Psychopharmacology of eating disorders: Systematic review and meta-analysis of randomized controlled trials. J Affect Disord. 2023 Oct 1;338:526–545

The authors have no competing interests to declare that are relevant to the content of this article.

A45 Relationship between intuitive eating and body mass index in southern Brazilian university students

A. M. Pandolfo Feoli¹, A. Yavorivski¹, A. Ruiz¹, W. de Lara Machado¹, H. D´Avila²

¹Eating Behavior Group, Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul, Brazil; ²Postdoc at Santa Cruz do Sul University (UNISC), Brazil

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A45

Keywords: Intuitive eating; Eating behavior; Weight gain; Obesity

Introduction: University students undergo a highly stressful period with a high risk of weight gain, as result of changes in eating behavior. Intuitive eating (IE) aims to establish a healthy relationship with food.

Aim of the study: To analyze the associations between intuitive eating and BMI in a sample of southern Brazilian undergraduates and graduates.

Materials and methods: Participants (n = 495) were university students (mean age 26.2 ± 7.5 years), 83.2% female, 58,9% normal weight, 24% overweight, 11.1% obesity and 5.8% underweight. The participants responded to online sociodemographic questionnaires and the Intuitive Eating Scale (IES-2), adapted and validated for the Brazilian population, between 2020 and 2021. Mean differences between groups were calculated with one-way ANOVA, post hoc (Games–Howell) and Kruskal–Wallis tests with JASP. This study was approved by the Research Ethics Committee.

Results: Normal weight group showed higher IE than overweight (p = 0.010) and obesity groups (p = 0.014). Underweight group showed higher Reliance on Hunger and Satiety Cues than overweight (p = 0.021) and obesity groups (p < 0.001), as well as the normal weight group compared to overweight (p < 0.001) and obesity groups (p < 0.001). Only the normal weight group had higher Body–Food Choice Congruence than the overweight group (p = 0.041), and lower Eating for Physical Rather than Emotional Reasons compared to the overweight group (p = 0.048). There was no difference in Unconditional Permission to Eat.

Discussion and conclusions: Previous studies have also reported individuals with higher BMI having lower levels of IE. Eating intuitively could help to prevent weight gain in university students, possibly through building trust on hunger and satiety cues, the domain that showed the most significant associations within the BMI ranges.

Higher IE is associated with lower BMI in students in the south of Brazil, which indicates that IE could be a strategy to maintain body weight even in stressful contexts.

References

Linardon, J., Tylka, T. L., & Fuller‐Tyszkiewicz, M. (2021). Intuitive eating and its psychological correlates: A meta‐analysis. International journal of eating disorders, 54(7), 1073–1098.

da Silva, W. R., Neves, A. N., Ferreira, L., Campos, J. A. D. B., & Swami, V. (2018). A psychometric investigation of Brazilian Portuguese versions of the Caregiver Eating Messages Scale and Intuitive Eating Scale-2. Eating and Weight Disorders, 25(1), 221–230. https://doi.org/https://doi.org/10.1007/s40519-018-0557-3

Conflict of interest declaration: No conflict of interest.

A46 The consequences of the Covid-19 pandemic on eating disorders (ED): study on a clinical sample of patients (10–18 years) with ED belonging to the 2nd level Center of the Romagna AUSL (Ravenna) in 2021 and 2022

G. D’Alessandro¹, M. Di Stani², L. Biserna³, S. Brandolini¹, G. Fabbri⁴, F. Di Tante⁴, C. Vannini⁴, F. C. Egitto⁴, A. Zaccarini⁴, V. Ortelli⁴, A. Menghi³, I. Mucci², F. Lacchini²

¹U.O di Dietetica e Nutrizione Clinica; ²Ambulatorio Disturbi Comportamento Alimentare; ³U.O Complessa di Pediatria e Neonatologia; ⁴Ambulatorio DCA UONPIA

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A46

Keywords: Eating disorders (EDs), Childhood, Adolescence, Covid-19

Introduction: Since 2020, the COVID-19 pandemic has had a major impact on global public health. Social distancing, mandatory face masks, and the lockdown had serious mental health implications, leading to an increase in anxiety and depressive symptoms in most of the population. This had even more severe consequences for patients with ED. By 2020, a worsening of ED, depression and anxiety disorders was observed.

Aim of the study: The aim of the work is to study the psychological and behavioral consequences of the restrictive measures following the first lockdown (March–May 2020) on patients aged 10–18 years, belonging to the 2nd level Center in 2021 and 2022 diagnosed with ED.

Materials and methods: The access data and medical records of patients with ED at the Center of AUSL Romagna (Ravenna) in 2021 and 2022 were recorded and analyzed. These data produced an account of the situation in child neuropsychiatry for the reference context.

Results: The number of NPI accesses (not only ED) increased exponentially from 2019 to 2022, almost tripling from 33 accesses in 2019 to 82 in 2022, demonstrating the discomfort experienced during this period.

The age distribution of patients confirms an increasingly earlier onset (from 13 to 16 years), in line with literature data. The most common diagnoses in 2021 and 2022 were anorexia nervosa and ED unspecified.

In 2021, the number of hospitalizations due to metabolic emergencies in pediatrics (patients with ED) was very high, equal to 46%. In 2022, hospitalizations decreased to 12%.

In the 2021 sample, 58% of patients have a full-blown psychiatric dual diagnosis. The psychiatric comorbidities found in most of the sample were: anxiety disorder, depressive disorder, post-traumatic stress disorder, mixed conduct and adjustment disorder, obsessive-compulsive disorder, childhood adjustment and emotional disorder.

In the 2022 sample, the proportion of psychiatric patients with matching dual diagnoses increased to 74.5%.

Discussion and conclusions: These data have highlighted the need to implement preventive measures, early detection of cases, timely and evidence-based treatment and follow-up, always taking into account the complexity of the cases, the risk of comorbidity and the socio-relational context of belonging.

References

• 1. Dalle Grave, R., Coronavirus Disease 2019 And Eating Disorders, 2020

• 2. G. Castellini, E. Cassioli, E. Rossi, M. Innocenti, V. Gironi, G. Sanfilippo, F. Felciai, A. M. Monteleone, V. Ricca, The Impact Of COVID-19 Epidemic On Eating Disorders: A Longitudinal Observation Of Pre Versus Post Psychopathological Features In A Sample Of Patients With Eating Disorders And A Group Of Healthy Controls, 2020

• 3. Laura Della Ragione Maria Vicini, Chiara De Santis, Silvia Ferri, I Disturbi Dell’alimentazione e Della Nutrizione: Un’epidemia Nascosta, Pag. 135–140

• 4. Ministero Della Salute. Interventi Per L’accoglienza, Il Triage, La Valutazione ed Il Trattamento del paziente con Disturbi Della Nutrizione e Dell’alimentazione: “Raccomandazioni In Pronto soccorso per un codice lilla”, 2018

• 5. P. Monteleone, Eating Disorders In The Era Of The COVID-19 Pandemic: What Have We Learned, 2021

• 6. Quaderni Del Ministero Della Salute, N. 29 Settembre 2017-Linee Di Indirizzo Nazionali Per La Riabilitazione Nutrizionale Nei Disturbi Dell’alimentazione-

• 7. W. Spettigue, N. Obeid, M. Erbach, S. Feder, N. Finner, M. E. Harrison, L. Isserlin, A. Robinson, M. L. Norris, The Impact Of COVID-19 On Adolescents With Eating Disorders: A Cohort Study, 2021

• 8. World Health Organization, ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Volume 2, Instruction manual, 2010 Edition, http://www.who.int/classifications/icd/en/

Conflicts of interest: there are no conflicts of interest.

A47 The experience of group treatment for young adults with eating disorders (EDs) in the Center for ED in Ravenna, AUSL of Romagna: preliminary data

A. Proto¹, M. Di Stani¹, I. Mucci¹, A. Catanzani¹, F. Lacchini¹, M. Consoli¹

¹Ambulatorio Disturbi Comportamento Alimentare. Ospedale S. Maria delle Croci, Via Missiroli 10, 48,121 Ravenna, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A47

Keywords: Eating disorder (ED), Group treatment, Young adult, CBT-ED, DBT

Introduction: Eating disorders (EDs) are a public health problem of growing importance due to their prevalence: recent data from the last national epidemiological survey in Italy [1] showed an increase in the pathology spread throughout the national territory and the difficulty of access to treatment in many regions, with serious consequences for prognosis. The NICE guideline [2] includes CBT-ED among the recommended evidence-based psychological treatments for eating disorders. In the literature, in addition to CBT-ED [3–6], DBT has shown promising results [7, 8], and cognitive interventions such as the “Body Project” [9] have shown good results in the area of selective and indicate prevention [10, 11].

Aim: The aim of this study is to share an experience of integrated group treatments in young adults with ED and to show some preliminary data.

Materials and methods: The group interventions included young adults (17–30 years) with a diagnosis of ED. The group treatment was structured by integrating evidence-based CBT-E, DBT techniques specific to EDs and the “Body Project” program. It was divided into 4 modules with weekly sessions of 90 min each. This study examined 15 groups conducted from October 2020 to March 2023. The group is cyclically open and new participants can be added at the beginning of each module. Self-report tests will be administered before and after treatment (at the end of each module).

Table 1 Group organization (abstract A47)

Table 2 Sample description (abstract A47)

AN: anorexia nervosa; BN: bulimia nervosa; ED-NOS: eating disorders-not otherwise specified; BED: binge eating disorder

Results: After treatment, comparing pre and post averages of self-report tests of each module, most participants showed improvements in emotional and stress regulation skills, interpersonal effectiveness, perception of self-body image and self-esteem.

Discussion and conclusions: This preliminary study shows encouraging results regarding the integration of group intervention experiences in ED treatment. Further studies are needed to implement and validate standardized group ED treatments that can accelerate and reinforce individual treatment in complex cases or replace individual treatment in less severe cases of ED allowing health services to provide increasingly efficient and sustainable treatments.

Declaration of competing interest: The authors have no conflict to declare.

References

• 1. Istituto Superiore di Sanità (ISS), Press Release No. 20/2022—Day of the Lilac Ribbon on eating disorders, updated the map of health services, to date there are over one hundred accredited centers, Published 15 March 2022, Edited 18 March 2022, https://www.iss.it/en/primo-piano/-/asset_publisher/3f4alMwzN1Z7/content/id/6778881

• 2. National Institute for Clinical Excellence, NICE guideline [NG69], Eating disorders: recognition and treatment, Published: 23 May 2017, Last updated: 16 December 2020, https://www.nice.org.uk/guidance/ng69

• 3. Jason M. Nagata & Stuart B. Murray (2021) Updates in the treatment of eating disorders in 2020: a year in review in eating disorders. The journal of treatment & prevention, Eating Disorders, 29:2, 123–133.

• 4. MacDonald, D.E., McFarlane, T., Dionne, M.M., Trottier, K., & Olmsted, M.P. (2020). Development, Feasibility, and Acceptability of a Brief, Adjunctive Cognitive-Behavioral Intervention Aimed at Encouraging Rapid Response to Intensive Eating Disorder Treatment. Cognitive and Behavioral Practice.

• 5. Hagan, K. E., & Walsh, B. T. (2021). State of the Art: The Therapeutic Approaches to Bulimia Nervosa. Clinical therapeutics, 43(1), 40–49. https://doi.org/https://doi.org/10.1016/j.clinthera.2020.10.012.

• 6. Muratore, A. F., & Attia, E. (2021). Current Therapeutic Approaches to Anorexia Nervosa: State of the Art. Clinical therapeutics, 43(1), 85–94. https://doi.org/https://doi.org/10.1016/j.clinthera.2020.11.006

• 7. Ben-Porath, D., Duthu, F., Luo, T., Gonidakis, F., Compte, E. J., & Wisniewski, L. (2020). Dialectical behavioral therapy: an update and review of the existing treatment models adapted for adults with eating disorders. Eating disorders, 28(2), 101–121. https://doi.org/https://doi.org/10.1080/10640266.2020.1723371

• 8. Rozakou-Soumalia, N., Dârvariu, Ş., & Sjögren, J. M. (2021). Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis. Journal of Personalized Medicine, 11(9), 931. MDPI AG. Retrieved from http://dx.doi.org/https://doi.org/10.3390/jpm11090931

• 9. Stice, E., & Presnell, K. (2011). Progetto corpo: Promuovere l'accettazione del corpo e prevenire i disturbi dell'alimentazione. Verona: Positive Press.

• 10. Becker, C. B., & Stice, E. (2017). From efficacy to effectiveness to broad implementation: Evolution of the Body Project. Journal of Consulting and Clinical Psychology, 85(8), 767–782. https://doi.org/https://doi.org/10.1037/ccp0000204

• 11. Ghaderi, A., Stice, E., Andersson, G., Enö Persson, J., & Allzén, E. (2020). A randomized controlled trial of the effectiveness of virtually delivered Body Project (vBP) groups to prevent eating disorders. Journal of Consulting and Clinical Psychology, 88(7), 643–656. https://doi.org/https://doi.org/10.1037/ccp0000506

• 12. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26, 41–54.

• 13. Cuzzolaro, M., Vetrone, G., Marano, G., & Garfinkel, P. (2006). The Body Uneasiness Test (BUT): development and validation of a new body image assessment scale. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 11, 1–13.

• 14. Reas, D. L., Whisenhunt, B. L., Netemeyer, R., & Williamson, D. A. (2002). Development of the body checking questionnaire: A self‐report measure of body checking behaviors. International Journal of Eating Disorders, 31(3), 324–333.

• 15. Bohn, K., & Fairburn, C. G. (2008). The clinical impairment assessment questionnaire (CIA). Cognitive behavioral therapy for eating disorders, 315–317.

• 16. Thompson, M. A., & Gray, J. J. (1995). Contour drawing rating scale. Exacting beauty: Theory, assessment, and treatment of body image disturbance, 76, 43–57.

• 17. Pilkonis, P. A., Kim, Y., Proietti, J. M., & Barkham, M. (1996). Scales for personality disorders developed from the Inventory of Interpersonal Problems. Journal of Personality Disorders, 10(4), 355–369.

• 18. Arrindell, W. A., & Van der Ende, J. (1985). Cross-sample invariance of the structure of self-reported distress and difficulty in assertiveness: Experiences with the scale for interpersonal behaviour. Advances in Behaviour Research and Therapy, 7(4), 205–243.

• 19. Rosenberg, M. (1965). Rosenberg self-esteem scale (RSE). Acceptance and commitment therapy. Measures package, 61(52), 18–23.

A48 The experience of the Emilia-Romagna Region in treatment of eating disorders: The Diagnostic Therapeutic Assistance Path (PDTA)

M. Di Stani¹, I. Toniolo¹, N. Costa¹, A. Proto¹, F. Lacchini¹

¹Ambulatorio Disturbi Comportamento Alimentare. Ospedale S. Maria delle Croci, Ravenna, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A48

Keywords: Eating disorders (ED), The Diagnostic Therapeutic Assistance Path (PDTA), Multiprofessional team, Emilia-Romagna Region (RE-R)

Introduction: EDs represent an increasingly relevant medical, psychiatric and social emergency: 1.4 million new cases in 2022 in Italy.

The organizational model of care must be multidimensional, interdisciplinary, integrated multiprofessional and age specific. The structuring of the interventions guarantees the best quality.

The PDTA implements the guidelines to the local context (DGR 1298/09 RER).

Aim of the study: Since 2014, the AUSLs of RE-R are applying or planning PDTA (Image 1). This model envisages an interdisciplinary team in each provincial area as the nucleus of the care system, as responsible for the continuity and coherence of treatments in the various settings/levels of care.

Fig. 1 (abstract A48)

Materials and methods: From the application of the PDTA we expect:

Adequate diagnostic–therapeutic procedure through a multidisciplinary approach; weekly or bimonthly meetings of the ED multidisciplinary team; uniformity of access and care in the various territorial areas with PDTA opening in the computerized file; no first ED visits/N° patients ED taken care with open PDTA > 80%; continuity of interventions in the transition from childhood to adulthood and in the passage of levels of care; dropouts < 5%; periodic monitoring of the therapeutic-assistance path; no of hospitalizations in extensive social-rehabilitative residences out of total patients < 10%.

Results: Data from the Romagna AUSL (managed by the regional program coordinator) are presented, as an example of application of the PDTA, to highlight the growing number of patients with DNA taken care of with PDTA (Image 2). Results achieved coincide with results expected from the application of the PDTA.

Image 2 (abstract A48)

Discussion and conclusions: The application of PDTA has made interventions increasingly targeted and specialized. We will work to promote and monitor the application of PDTA, integrating it with specific focuses for updating guidelines and contingent needs, for example educational intervention in patients with ED to counteract hospitalizations.

Declaration of competing interest: The authors have no conflict to declare.

References

• 1. American Psychiatric Association (APA) (2013), DSM-5. Manuale diagnostico e statistico dei disturbi mentali, tr. it. Raffaello Cortina, Milano, 2014.

• 2. Conferenza di consenso Disturbi del Comportamento Alimentare (DCA) negli adolescenti e nei giovani adulti Istituto Superiore di Sanità Roma, 24–25 ottobre 2012.

• 3. Linee di indirizzo nazionali per la riabilitazione nutrizionale nei disturbi dell’alimentazione, Quaderni del Ministero della Salute, n. 29 settembre 2017.

• 4. National Institute for Clinical Excellence, NICE guideline [NG69], Eating disorders: recognition and treatment, Published: 23 May 2017, Last updated: 16 December 2020, https://www.nice.org.uk/guidance/ng69

• 5. Regione Emilia-Romagna DGR n. 1298/2009. Programma per la assistenza alle persone con disturbi del comportamento alimentare in emilia-romagna 2009–2011.

• 6. Regione Emilia-Romagna DGR n. 2200, 22 NOVEMBRE 2019, Linee di indirizzo per la definizione e ruolo della rete trasversale di nutrizione preventiva e clinica della regione emilia-romagna.

• 7. https://piattaformadisturbialimentari.iss.it/

• 8. Azienda Unità Sanitaria Locale della Romagna. Rev. 00 del 06/12/2021. PA 198. PDTA Disturbi del Comportamento Alimentare.

A49 The experience of videoconferencing-based group treatment for patients with binge eating disorder (BED) in the Center for ED in Ravenna, AUSL of Romagna: preliminary data

A. Proto¹, M. Di Stani¹, I. Mucci¹, S. Comai¹, F. Lacchini¹, M. Consoli¹

¹Ambulatorio Disturbi Comportamento Alimentare. Ospedale S. Maria delle Croci, Via Missiroli 10, 48121 Ravenna, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A49

Keywords: BED, Videoconference group treatment, CBT-ED, DBT, Mindfulness

Introduction: Eating disorders (EDs), including BED, are a public health problem of increasing importance due to their prevalence, early onset and multifactorial etiology, as reported in a recent Italian epidemiologic survey [1]. Compared to other EDs, BED is often at risk of being underestimated, although it can lead to long-term psychophysical problems if not adequately treated.

Aim of the study: The aim of this study is to report some preliminary data from 7 group treatments for the management of binge eating (BE), associated with individualized nutritional interventions in our multidisciplinary service for EDs.

Materials and methods: The treatment is based on CBT-E, as indicated in the NICE guideline [2] and integrates evidence-based DBT techniques specific to BED and bulimia nervosa (BN) [3, 4]. It consists of eight 2-h weekly videoconference group sessions. The intervention provides mindfulness exercises, cognitive behavioral coping strategies for emotional-stress regulation through self-observation materials and group discussion.

This study will examine 7 groups conducted from February 2021 to July 2023. The sample consists of 83 patients (86% female; 18–72 years old), screened by the Binge Eating Scale and individual motivational interviews. Most participants have a diagnosis of BED (7% BN; 8% EDNOS). 47 patients completed the post-test therefore only the pre–post data of these participants will be analyzed. Finally, patient satisfaction and feedback will be collected and discussed.

Results: Preliminary data suggest that group treatment reduces overall BE symptoms and emotional distress. Patients report improved self-observation skills and increased awareness of the relationship between their thoughts, emotions and eating behaviors.

Discussion and conclusion: The implementation of individualized nutritional treatment with CBT-ED/DBT group interventions in patients with BE or eating dysregulation could lead to overcoming BED and improve patient engagement in their own treatment and lifestyle changes. Further studies and standardized data analysis, as long-term follow-up, could lead to the creation of more focused and efficient integrated health care pathways.

Declaration of competing interest: The authors have no conflict to declare.

References

• 1. Istituto Superiore di Sanità (ISS), Press Release No. 20/2022—Day of the Lilac Ribbon on eating disorders, updated the map of health services, to date there are over one hundred accredited centers, Published 15 March 2022, Edited 18 March 2022, https://www.iss.it/en/primo-piano/-/asset_publisher/3f4alMwzN1Z7/content/id/6778881

• 2. National Institute for Clinical Excellence, NICE guideline [NG69], Eating disorders: recognition and treatment, Published: 23 May 2017, Last updated: 16 December 2020, https://www.nice.org.uk/guidance/ng69.

• 3. Safer, D.L., Telch, C.F., Chen, E.Y. (2009). Dialectical behavior therapy for binge eating and bulimia. Guilford Press.

• 4. Chang, P. G., Delgadillo, J., & Waller, G. (2021). Early response to psychological treatment for eating disorders: a systematic review and meta-analysis. Clinical psychology review, 86, 102032.

• 5. Gormally, J. I. M., Black, S., Daston, S., & Rardin, D. (1982). The assessment of binge eating severity among obese persons. Addictive behaviors, 7(1), 47–55.

• 6. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26, 41–54.

• 7. Evans, C., Connell, J., Barkham, M., Margison, F., McGrath, G., Mellor-Clark, J., & Audin, K. (2002). Towards a standardized brief outcome measure: Psychometric properties and utility of the CORE–OM. The British Journal of Psychiatry, 180(1), 51–60. https://doi.org/10.1192/bjp.180.1.51

A50 The importance of involving family members in the care of adolescent and young adults with eating disorders

M. R. Troiani¹, M. Martelli¹, G. Bugli¹, V. D’Angelo¹, G. Giuranno¹, G. D’Anna¹, F. Volpones¹, L. Lazzeretti¹, I. Giunti¹, S. Lucarelli¹

¹Complex Departmental Functional Unit, Eating Disorders-Azienda USL Toscana Centro

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A50

Keywords: Eating disorders, Interpersonal maintenance factors, Family members, New Maudsley Model

Introduction: Studies show eating disorders in one of family members changes the quality of relationships among all members, reduces their adaptive behaviors and contributes to the maintenance of symptoms in patients. Most recent guidelines [1] recommend to involve families in the care of eating disorders.

At UFC EDs Toscana Centro Service parents of adolescents and young adults patients are invited to join a group based on the New Maudsley Model [2], which has been adapted to our context of care and to the characteristics of our patients and their families.

Aim of the study: The group training (Network Florence) has the goal to counteract the disorder interpersonal maintenance factors helping families to discover their resources and to find new strategies to approach their loved ones.

Materials and methods: Each group training consists of 7 weekly sessions. We observed the number of participants noting adherence to the treatment and dropout rate. At the end of the training, we collected information from the participants on subjective perceived improvements through a structured telephone interview.

Results: The sample consists of 430 participants from September 2020 to July 2023. They are parents of 261 patients with a diagnosis of anorexia nervosa and bulimia nervosa. The obtained data will be analyzed and discussed in the presentation of this work.

Discussion and conclusion: Family members participate in the training group with a good adherence to treatment, only a few of them dropped out. The content of the training was perceived as markedly useful by the participants and they would highly recommend it to a friend. Family members perceive a moderate impact of their changes on those of their children. It is not possible to establish a significant correlation between the patient's progress and the group training for family members. However, we believe including family members in this path can decrease their sense of helplessness and isolation and reduce the strength of maintenance factors.

References

• 1. Crone C, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. Am J Psychiatry. 2023 Feb 1;180(2):167-171. https://doi.org/10.1176/appi.ajp.23180001. PMID: 36722117.

• 2. Langley J, Todd G, Treasure J (2019) Caring for a loved one with an eating disorder. The New Maudsley Skills-based training manual. Ed Routledge, London

Disclosure of interests: All authors declare the absence of any potential conflict of interest.

A51 The mediating role of internalized weight stigma in the relationship between pressures from health professionals to maintain a healthy weight and binge eating symptoms

E. Mocini^1*, M. D’Amico^2*, F.Frigerio¹, C. Lombardo², L. M. Donini¹, S. Cerolini²

¹Department of Experimental Medicine, Sapienza University of Rome, Italy; ²Department of Psychology, Sapienza University of Rome, Italy

*Both authors contributed equally.

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A51

Keywords: “Overweight”; “Obesity”; “Binge eating”; “Eating disorders”; “Weight stigma”; “Health professionals”; “Pressure”

Introduction: Patients with obesity often face pressures for weight loss from various societal actors. This may inadvertently lead to disordered eating patterns, specifically binge eating behaviors [1,2]. Weight stigma plays a key role, affecting the psychological well-being of those with obesity [3,4]. Health professionals can intensify these pressures, further exacerbating the issue [5,6]. This study investigates the link between professional pressures, weight stigma, and binge eating symptom severity.

Materials and methods: Patients were recruited at the Integrated Experimental Service for Eating Disorders at Sapienza University of Rome. Inclusion criteria were the risk of having an eating disorder as measured by a brief screening scale (SCOFF, [7]) and a BMI of 28 or higher. Patients completed a series of questionnaires assessing: binge eating symptoms (BES, [8]), sociocultural influences toward healthy weight (namely, social exposure and pressure, SITHS, [9]), internalized weight stigma (WBIS, [10]) and psychological distress (SCL-90-R, [11]). Biomedical parameters, including weight and height, were assessed through clinical evaluation. Finally, 121 patients (71% female; age = 44.29 ± 16.18; BMI = 37.99 ± 6.93) were included in the study.

Results: Results from the mediation model tested, showed that pressures by health professionals to maintain a healthy weight predicted binge eating symptoms toward the mediation of internalized weight stigma (indirect effect β = 0.26, p < 0.01; total effect β = 0.37, p < 0.01), independently of the BMI. The model was no longer significant when examining exposure to health professionals discussing a healthy weight. The mediation model is shown in Fig. 1.

Discussion and conclusions: Our findings show that pressures by health professionals for weight loss can potentially amplify weight stigma in those with obesity. This stigma, in turn, intensifies binge eating behaviors. Such a cycle suggests that these pressures might exacerbate internalized weight stigma, further worsening BED symptoms, potentially leading to further weight gain and challenges in addressing weight loss.

These findings stress the importance of careful weight loss communication in obesity care. Prescribing weight loss could lead to internalized weight stigma, which could therefore trigger harmful behaviors. A holistic approach to obesity requires discussions in a supportive, stigma-free environment, guided by trained professionals in eating and weight disorders.

Declaration of competing interest: The authors have no conflict to declare.

References

• 1. Puhl, R., & Suh, Y. (2015). Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment. Current Obesity Reports, 4(2), 182–190.

• 2. Jackson, S. E., Beeken, R. J., & Wardle, J. (2015). Perceived weight discrimination and changes in weight, waist circumference, and weight status. Obesity, 23(12), 2485–2488.

• 3. Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and update. Obesity, 17(5), 941–964.

• 4. Schaumberg, K., Anderson, D. A., Anderson, L. M., Reilly, E. E., & Gorrell, S. (2016). Dietary restraint: what's the harm? Who is harmed? And what can be done about it? Journal of Eating Disorders, 4, 24.

• 5. Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326.

• 6. Puhl, R., & Brownell, K. D. (2006). Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity, 14(10), 1802–1815.

• 7. Di Fiorino, M., Pannocchia, L., & Giannini, M. (2007). Contributo alla validazione della versione italiana dello SCOFF: studio su una popolazione psichiatrica. Psichiatr e Territ, 24, 1–2.

• 8. Imperatori, C., Innamorati, M., Lamis, D. A., Contardi, A., Continisio, M., Castelnuovo, G., Manzoni, G. M., & Fabbricatore, M. (2016). Factor Structure of the Binge Eating Scale in a Large Sample of Obese and Overweight Patients Attending Low Energy Diet Therapy. European Eating Disorders Review, 24(2), 174–178.

• 9. Choquette, E. M., Schaefer, L. M., Lowy, A. S., Thompson, J. K., Rodgers, R. F. Development and Validation of the Sociocultural Influences Towards “Healthy” Weight Scales (SITHS)- (work submitted for publication)

• 10. Innamorati, M., Imperatori, C., Lamis, D. A., Contardi, A., Castelnuovo, G., Tamburello, S., Manzoni, G. M., & Fabbricatore, M. (2017). Weight Bias Internalization Scale Discriminates Obese and Overweight Patients with Different Severity Levels of Depression: the Italian Version of the WBIS. Current Psychology, 36(2), 242–251.

• 11. Prunas, A., Sarno, I., Preti, E., Madeddu, F., & Perugini, M. (2012). Psychometric properties of the Italian version of the SCL-90-R: A study on a large community sample. European Psychiatry, 27(8), 591–597.

Fig. 1

Mediation model (abstract A51)

Bold lines represent significant relationships; dashed lines represent non-significant relationships. All values are controlled for BMI

Table 1 Sample characteristics (abstract A51)

Table 2 Direct effects. Mediation model (abstract A51)

Table 3 Indirect effects. Mediation model (abstract A51)

Table 4 Total effects. Mediation model (abstract A51)

Table 5 Path coefficients. Mediation model (abstract A51)

Table 6 R-squared. Mediation model (abstract A51)

A52 The online experience of feeding and eating disorders: a survey on TikTok and messaging apps use among children and adolescents referring to a third-level Regional Italian Center

C. Visconti^1,2, J. Pruccoli^1,2, M. Moriani^1,2, A. Parmeggiani^1,2

¹IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell’Alimentazione in Età Evolutiva, U.O. Neuropsichiatria dell’Età Pediatrica, Bologna, Italy; ²Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A52

Keywords: TikTok, Messaging apps, Eating disorders, Group chats, Developmental age

Introduction: Recent research show how the Internet, and specifically the social media (SM), TikTok, and messaging apps (MA) represent for teenagers an important source of information and comparison about feeding and eating disorders (FED). However, the literature investigating the consequences of this phenomenon is still scarce, especially in developmental age.

Methods and materials: In February–March 2023, we conducted an anonymous paper survey in our Italian third-level Regional Center for ED for childhood and adolescence. The use of TikTok and its consequences on FED. The influence of a shared peer experience of the FED on MA was also explored.

Results: Seventy-eight patients (91.3% females, mean age 15.3 years) were enrolled in the study: 89.7% declared to use TikTok, while only 18% of the sample is part of a Group Chat (GC) about FED topics on MA.

The majority of cases (66.7%) follow TikTok stories about FED and 26.9% report creating FED-related stories. Included patients tend to spend from 1 to 3 h/day on TikTok and its algorithm presents them with the most liked and researched content by the users themselves. A significant correlation between some contents and motivation in weight loss or recovery emerged: patients who more frequently like “What I Eat In A Day” contents tend to be more willing to lose weight (p = 0.012). Those who frequently appreciate content like “Fear Food Experience” tend to be more motivated in the recovery process (p = 0.008). TikTok users tend to be more passive than active users: only 23.0% publish content and of these, 16.0% presents FED-related content.

The need for confrontation (20.0%) and a strong sense of loneliness (33.3%) seem to drive adolescents with FED to look for GC on MA, where they seek diet advice (42.8%), restrictive behaviors (35.7%), or compensation behaviors (21.4%), but also support in recovery (57.1%). Not always the GC represents a safe space: 35,7% of the patients using GC FED-related report being insulted by other GC users because of their weight. Patients still feel significantly more understood (p = 0.005) by the medical team than GC users.

Discussion and conclusions: This study documents how the virtual interaction of patients with FED can influence the pathology course. Further studies are needed to assess the psychopathological consequences and factors behind this phenomenon.

References

• 1. “You see yourself like in a Mirror”: the effects of Internet-mediated personal networks on body image and Eating Disorders F. Pallotti, P. Tubaro, A. Casili, Thomas W Valente

• 2. Estimating determinants of attrition in eating disorder communities on Twitter: An instrumental variable approach T. Wang, E. Mentzakis, M. Brede, A. Ianni

• 3. The Paradox of Tik Tok Anti-Pro-Anorexia Videos: How Social Media Can Promote Non-Suicidal Self-Injury and Anorexia G. Logrieco, M.R. Marchili, M. Roversi, A. Villani

• 4. How a moderated online discussion forum facilitates support for young people with eating disorders S. Kendal, S. Kirk, R. Elvey, R. Catchpole, S. Pryjmachuk

• 5. The use of TikTok among children and adolescent with Eating Disorders: experience in a third-level public Italian center during the SARS-CoV-2 pandemic, J. Pruccoli, M. De Rosa, L. Chiasso, A. Perrone, A. Parmeggiani

• 6. Eating Disorders and the Internet: a descriptive cross-sectional study monitoring the pro-ana phenomenon in an Italian sample L. Rossi, P. Tizzano, E. Malaspina, F. Moscano, P. Gualandi, F. Rossi, V. Francia, A.R. Atti, A. Parmeggiani

Conflict of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

A53 The role of animal-assisted therapy in the improvement of anthropometric parameters in patients with eating disorders

P. Toma¹, C. Pagano², E. Manzato³

¹Biologa nutrizionista, Spec. Scienze alimentazione, Master Disturbi Alimentari Università “la Sapienza” Roma; ²Department of Public Health and Pediatrics, University of Torino, Via Santena 9, 10126 Turin, Italy; ³Psychiatrist, former University of Ferrara, Chief of Eating and Weight Disorders Center, Private Hospital “Salus”, Ferrara (Italy)

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A53

Keywords: Animal assisted therapy; Eating disorders; Anthropometric parameters, BIA

Introduction: Animal-assisted therapy (AAT) has demonstrated positive effects for patients, families and health care providers, thanks to its role in rehabilitation processes. The therapeutic use of animals has been debated for many years and its use explored in a variety of settings and populations. However, not many studies have investigated the relation between pet-therapy and eating disorders (EDs).

Aim of the study: The aim of our study was to evaluate the effects of a dog-assisted therapy on the EDs symptoms in adolescent patients. We considered the positive effects that the behavioral stimuli of AAT could produce on the nutritional therapy.

The evaluation was focused on the improvement of the anthropometric parameters.

Materials and methods: The study involved nine adolescents suffer from binge eating disorder (BED) and anorexia nervosa (restricting type) assigned to an experimental group (treated with AAT) and to a control group (without AAT). The AAT interventions were performed according to the main steps previously established. The main outcome measures compared were: body mass index (BMI), anthropometric measurements and bioimpedancemetry.

Results: We observed a significant improvement in BMI and in other anthropometric measurement in the experimental group with AAT compared to controls (increase/decrease relative BMI ≃ 1.13–1.35/0.95–0.83). Comparing the BIA between the two groups, we estimated an appreciable result in the increase/decrease of FM in AAt group. Furthermore, we reported representative result about the recovery of a good physical condition trough Biavector nomograms and three-compartmental models.

Discussion and conclusions: In this work, EDs adolescents of the experimental group with AAT reported a faster and more effective improvement in anthropometric parameters than controls.

Conflict of interest: The authors declare no potential conflict of interest.

References

• 1. Ahnert, L., Gunnar, M., Lamb M., Barthel, M. 2004 Transition to child care: Associations with infant–mother attachment, infant negative emotion, and cortisol elevations. Child Develop 75:639-650.

• 2. Beetz, A., Kotrschal, K., Turner, D., Hediger, K., Uvnas-Moberg, H. 2011 The effect of a real dog, toy dog and friendly person on insecurely attached children during a stressful task: An exploratory study. Anthrozoös 24, 349–368

• 3. Carloni, E. 2011 Attaccamenti e legami gli altri animali tra affetto e opportunismo. Psiche, Riv Cult Psic 1:19.

• 4. Charnetski, C., Riggers, S., Brennan F. 2004 Effect of petting a dog on immune system function. Psychol Rep 95:1087–91.

• 5. Cole, K., M., Gawlinski, A., Steers, N., Kotlerman, J. 2007 Animal-assisted therapy in patients hospitalized with heart failure. Amer Jour of Crit Care 16:575–585.

• 6. Diamond, L. M. 2001 Contributions of psychophysiology to research on adult attachment: Review and recommendations. Person and Soc Psych Rev 5:276–295.

• 7. El-Alayli, A., Lystad, A.L., Webb, S.R., Hollingsworth, S.L., Ciolli, J.L. 2010 Reigning cats and dogs: a pet-enhancement bias and its link to pet attachment, pet-self similarity, self-enhancement, and well-being. Bas and App Soc Psyc 28(2): 131–143.

• 8. Giuliani, F., Jacquemettaz M. 2017 Animal-assisted therapy used for anxiety disorders in patients with learning disabilities: An observational study. Europ Journ of Integr Med 13–19.

• 9. Lavín-Pérez, A.M., Martín-Sánchez, C., Martínez-Núñez, B., Lobato-Rincón, L.L., Villafaina, S., González-García, I., Mata-Cantero, A., Graell, M., Merellano-Navarro, E., Collado-Mateo, D. 2021 Effects of dog-assisted therapy in adolescents with eating disorders: a study protocol for a pilot controlled trial. Animals 11(10): 2784.

• 10. Must, A., Mulè, C.M., Linder, D.E., Cash, S.B., Folta, S.C., 2021 Animal-Assisted Intervention: a promising approach to obesity prevention for youth whit autism spectrum disorder. Front Vet Sci 8:646081

A54 The voice of anorexia: a software-based, multiparametric, case–control analysis of the voice of children and adolescents with anorexia nervosa

G. Rocco di Torrepadula³, J. Pruccoli^1,2, L. Bergonzini^1,2, V. Genovese^2,3, A. Parmeggiani^1,2

¹IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell’Alimentazione in età evolutiva, UOC Neuropsichiatria dell’Età Pediatrica, Bologna, Italy; ²Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy; ³Corso di Laurea di Logopedia, Direzione Infermieristica e Tecnica, Ausl Romagna

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A54

Introduction: Disturbances in the quality and modulation of the voice (dysphonia) in individuals with anorexia nervosa (AN) have occasionally been reported due to organic and psychopathological factors. This study aims to provide a software-based analysis of the voice of girls with AN, compared to healthy controls (HC).

Materials and methods: Case–control study. The voice of the involved individuals was studied with the University of Amsterdam’s “Praat” (“talk”) software. The Acoustic Voice Quality Index (AVQI), Fundamental Frequency (F0), Yanagihara’s Spectrographic Dysphonia Classifications, and “GIRBAS” perceptual qualitative voice rating were assessed. Questionnaires for Vocal Fatigue Index (VFI), and the Reflux Symptoms Index (RSI) were administered. Puberty-related changes in voice spectra were considered. Bonferroni-corrected and BMI-adjusted analyses of covariance (ANCOVAs) were conducted.

Results: Fifteen girls with AN and 30 age- and sex-matched HC (1:2) were enrolled. The VFI revealed a greater impairment for AN patients in the tiredness of voice/voice avoidance (VFI-1, p < 0.001), physical discomfort associated with voicing (VIF-2, p = 0.002) and on the role of rest on vocal symptoms (VFI-3, p = 0.011). Reflux-related scores were greater in AN as well (p < 0.001). AVQI (p < 0.001) showed differences between the two groups, the GIRBAS scale showed alterations in different parameters (G, I, R, B). Yanagihara’s Spectrographic Classification was pathologic in 53% of AN patients (p = 0.017). Fundamental frequency did not show a significant difference. The ANCOVA showed alterations of vocal parameters were only associated to the AN/HC groups status, with no significant impact for weight measures.

Discussion and conclusions: This is the first research to relate voice alterations and AN using standardized tools and non-invasive tools, and controlling for the potentially confounding impact of weight measures. In this study, young patients with AN showed significant alteration in the quality of voice, both on objective and subjective scores, also the self-reported symptoms were worse in the group with AN. Psychological (functional vocal impairments) and organic factors may be involved to explain these findings. Further studies should expand these results, with prospective designs and invasive investigations.

References

• 1. Maciejewska, B., et al., 2016. The assessment of the impact of anorexia nervosa on the vocal apparatus in adolescent girls – A preliminary report. International Journal of Pediatric Otorhinolaryngology, 85, 141–147.

• 2. Bhargava, A., et al., 2017. Role of Reflux Symptom Index and Reflux Finding Score in Evaluation of Treatment Outcome in Patients with Laryngopharyngeal Reflux. Int J Phonosurgery & Laryngology, 7(2), 39–43.

There’s not any conflict of interest for any of the authors.

A55 The weight of prejudice: an educational and experiential weight-related teasing prevention program in high school students

A. Zegretti^1,*, M. Vacca^1,*, S. Cerolini^1,*, A. Zagaria¹, C. Lombardo¹

¹Department of Psychology, Sapienza Università di Roma

*Equally contributed to the study.

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A55

Keywords: Body shaming; Adolescents; Weight bias; Weight stigma; High school

Introduction: Weight stigma is a negative weight-related attitudes toward people with overweight (OW) or obesity (OB) and expressed in the form of negative stereotyping and body shaming (BD). Evidence from the Italian context indicates alarming percentages of OW/OB in youth, reaching one of the highest prevalence in Europe. The present research aims at assessing the feasibility of a prevention program targeting the reduction of weight stigma, BS and associated negative outcomes in a sample of high-school students and teachers.

Transversally, this study extended our knowledge on the prevalence of weigh stigma and BS in Italian school contexts and on the identification of their risk and protective factors. Methods. A total of 1027 high-school students (56,6% M; Mage = 15.97) completed a series of questionnaires on weight stigma, BD and psychopathological outcomes before (T1) and after (T2) six sessions of an educational and experiential weight-related teasing prevention program. 46 teachers (28,3% M, M age: 51,14) completed a series of questionnaires on and after they participated in one session of an educational program.

Results: Preliminary results showed that 24% of teachers report that bullying has occurred in their classrooms in the last three months. Moreover, preliminary results showed a significant trend of reduction in psychological indicators associated with BD in the experimental group of students following the intervention.

Discussions and conclusions: These findings suggest that including psycho-educational and experiential strategies to address weight stigma and weight-related teasing could potentially reduce societal weight bias and stigmatizing experiences as well as negative outcomes associated, especially in adolescents.

References

• 1. Schlüter, C., Kraag, G. & Schmidt, J. Body Shaming: an Exploratory Study on its Definition and Classification. Int Journal of Bullying Prevention (2021). https://doi.org/https://doi.org/10.1007/s42380-021-00109-3 Bertocchi, F. (2019). La violenza fra minori: il bullismo avanza. Rivista di Criminologia, Vittimologia e Sicurezza, 13(1), 34–56.

• 2. Forbes, Y., & Donovan, C. (2019). The role of internalised weight stigma and self‐compassion in the psychological well‐being of overweight and obese women. Australian Psychologist, 54(6), 471–482.

• 3. Guardabassi, V., & Tomasetto, C. (2020). Weight status or weight stigma? Obesity stereotypes—Not excess weight—Reduce working memory in school-aged children. Journal of experimental child psychology, 189, 104706.

• 4. Bacchini, D., Licenziati, M. R., Garrasi, A., Corciulo, N., Driul, D., Tanas, R., … & Valerio, G. (2015). Bullying and victimization in overweight and obese outpatient children and adolescents: an Italian multicentric study. PLoS One, 10(11), e0142715.

• 5. Miyairi, M., Reel, J. J., Próspero, M., & Okang, E. N. (2015). Addressing Size Stereotypes: A Weight Bias and Weight-Related Teasing Intervention among Adolescents. Journal of Health Education Teaching, 6(1), 33–42.

• 6. Pearl, R. L., & Puhl, R. M. (2014). Measuring internalized weight attitudes across body weight categories: validation of the modified weight bias internalization scale. Body image, 11(1), 89–92.

• 7. Lombardo, C., Russo, P. M., Lucidi, F., Iani, L., & Violani, C. (2004). Internal consistency, convergent validity and reliability of a brief Questionnaire on Disordered Eating (DEQ). Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 9(2), 91–98.

Declaration of competing interest: The authors have no conflict to declare.

A56 Theoretical rationale and clinical experience about use of vortioxetine in the treatment of depressive symptoms associated with eating disorders

F. Salvaro¹

¹Psychiatrist Doctor, AUSL of Romagna, DSM-DP of Forlì-Cesena, Mental Health Center of Forlì

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A56

Keywords: ED, Pharmacotherapy, Antidepressants

Introduction: No pharmacological therapy is approved for treatment of anorexia nervosa and bulimia nervosa, except for fluoxetine for BN.

In clinical practice, mood symptoms are often present and frequently such symptoms receive off-label drug treatment; SSRIs are first-line choice antidepressants due to their high tolerability¹. However, side effects such as emotional blunting, libido deficit and reduced concentration, can invalidate significant areas of patients in a very active age.

The different tolerability profile of vortioxetine can provide a further therapeutic choice.

Vortioxetine is a multimodal antidepressant; it does not generate sexual dysfunctions or alterations in cognitive performance. The most frequent side effect is nausea². There are no clinical studies evaluating the effect of vortioxetine on depressive symptoms associated with AN or BN; is detectable in the blood even in patients with low BMI³.

Materials and methods: We collected clinical records of patients under treatment in the last 18 months (from January 2022 to June 2023) at the Center for Eating Disorders of Forlimpopoli (diagnosis: anorexia nervosa, bulimia nervosa, eating disorder NOS); we identified patients who received drug treatment with antidepressants. We analyzed medical records of patients who received vortioxetine treatment, to identify efficacy reports or reasons for discontinuation.

Results: In the period examined, 48 patients received one or more prescription for a pharmacological treatment with an antidepressant (Table 1); 8 patients received a prescription for vortioxetine.

From the analysis of the medical records, it emerged that 4 patients have a total (3) or partial (1) improvement of the depressive symptoms. One patient discontinued the drug due to nausea and vomiting; no drug efficacy reports were available for 3 patients.

Discussion and conclusions: The reported theoretical bases and clinical practice provide a first step to hypothesize that vortioxetine is a drug that can be useful for the treatment of depressive symptoms associated with eating disorders, without the typical side effects of other antidepressants. Further studies are needed.

Table 1 (abstract A56)

Antidepressant	Number of prescriptions
Sertraline	19
Fluoxetine	13
Paroxetine	9
Vortioxetine	8
Trazodone	6
Bupropione	4
Citalopram	3
Escitalopram	3
Mirtazapine	2

References

• 1. Muratore AF, Attia E. Psychopharmacologic Management of Eating Disorders. Curr Psychiatry Rep. 2022 Jul;24(7):345-351. https://doi.org/10.1007/s11920-022-01340-5. Epub 2022 May 16. PMID: 35576089; PMCID: PMC9233107.

• 2. FDA, Vortioxetine label at www.accessdata.fda.gov

• 3. Fabio Panariello, Tomas Mastellari, Angela di Gianni, Francesco Fornasari, Gianluca Borgiani, Michele Protti, Laura Mercolini, Diana De Ronchi, Anna Rita Atti. Therapeutic Drug Monitoring of Antidepressant by Minimally-Invasive Techniques in Eating Disorders Patients: A Clinical Research Report with A Focus on Vortioxetine. Archives of Clinical and Medical Case Reports 5 (2021): 404–421

A57 Understanding the impact of Covid-19 on eating disorder patients: a perspective from “Mariconda” Regional Residential Structure in Salerno

S. Palermo¹, A. Vignapiano¹, E. Ferrara¹, A. Caputo¹, R. Bonifacio¹, M. Di Pierro¹, A. Boccia¹, I. Forte¹, A. Longobardi¹, A. Mainardi¹, S. Landi¹, F. Monaco¹, G. Corrivetti¹

¹Department of Mental Health, ASL Salerno, Salerno, Italy

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A57

Keywords: Eating disorder, Department of Mental Health Salerno, Covid-19

Introduction: The COVID-19 pandemic restrictions have contributed to an increase in eating disorder (ED) cases. Literature data suggest that the pandemic might worsen symptoms and increase relapse rates among individuals with ED.

Aim of the study: Our study evaluates changes in ED presentation before and after the Covid-19 pandemic.

Materials and methods: The sample includes 149 subjects admitted to residential care from December 2018 to June 2023. Pandemic restrictions began around mid-2020 due to access suspension in the Campania Region. Admissions adhere to DSM-5 eating disorder criteria, with demographic and anthropometric data collected for each patient.

Results: Among 149 subjects, 102 were admitted at treatment program post Covid (PC) restrictions. The PC group consisted of 89 AN, 11 BN and 2 EDNOS. The groups reported a significant difference regarding age, education and past hospitalization. The PC group was younger, less educated and with prior hospitalizations. The two groups reported no significant difference in regards to admission diagnosis, their average body mass index (BMI), presence of amenorrhea and length of stay.

Discussion and conclusions: The COVID-19 pandemic has exacerbated ED psychopathology in the general population with an increase of the requests for specific treatments.

Our results confirm a reduction in the age of ED presentation, in line with the literature with an early access to an integrated treatment. Further studies will be necessary to investigate the potential contribution of treatment-related factors to the COVID-19 related psychopathology changes in ED.

References

• 1. Zipfel, et al., (2022). The hidden burden of eating disorders during the COVID-19 pandemic. The Lancet Psychiatry, Volume 9, Issue 1, 9–11

• 2. J. Devoe, et al., (2023). The impact of the COVID-19 pandemic on eating disorders: A systematic review. International Journal of Eating Disorders, 56(1), 5–25. https://doi.org/https://doi.org/10.1002/eat.23704

Declaration of conflict of interest: None.

Table 1 Mean age of patients attending residential care between December 2018 and June 2020 (abstract A57)

Table 2 Mean age of patients attending residential care between July 2020 and June 2023 (abstract A57)

A58 Visceral adipose tissue is reduced in patients with anorexia nervosa and hypothalamic amenorrhea

V. Pellegatta^1,*, F. Camardella^1,*, M. V. Ievolella^1,*, F. Frigerio¹, G. Pistilli¹, L. Tanase², A. Cotugno², D. Accorrà², I. Marini³, M. Pasquini³, L. M. Donini¹, E. Poggiogalle¹

¹Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; ²Hospital of Santa Maria della Pietà, ASL Rome 1, Rome, Italy; ³Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

*These authors contributed equally.

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A58

Keywords: Anorexia nervosa; VAT; Amenorrhea

Introduction: Anorexia nervosa (AN) is a psychiatric disorder characterized by severe weight loss and related malnutrition issues, often emerging during adolescence. Hypothalamic amenorrhea (HA) in AN is determined by a reduced function of the hypothalamic–pituitary axis that inhibits GnRH production. Pituitary FSH and LH release is altered, impairing folliculogenesis and ovulation. Visceral adipose tissue (VAT) is primarily situated within the mesentery and omentum. Different from subcutaneous adipose tissue (SAT), VAT possesses a greater number of glucocorticoid and androgen receptors than SAT. To which extent VAT amount can affect the onset of HA has not been investigated yet.

Aim of the study: The aim of our study is to evaluate the amount of VAT in AN patients with and without HA.

Materials and methods: 60 female AN patients with and without HA aged 13–33 were enrolled. Patients underwent dual-energy X-ray absorptiometry (DXA) for body composition analysis and VAT mass calculation. Independent-samples t-test was performed comparing patients with and without HA using VAT mass and BMI (both log- transformed) as the dependent variables.

Results: In this preliminary study, 60 patients (age mean ± SD, 18.8 ± 5.3, amenorrhea duration months 8.0 ± 19.1) were included; HA prevalence was 68%. Patients with HA exhibited a significantly lower VAT mass (p = 0.030) than eumenorrheic counterparts; the magnitude of the difference was medium (Cohen’s d = 0.68, 95% C.I. 0.12–1.24). Likewise, BMI was significantly decreased (p = 0.007) in the HA group, with a large effect size (Cohen’s d = 0.85, 95% C.I. 0.31–1.38).

Discussion and conclusions: VAT mass reduction is associated with HA in AN patients; future studies should further clarify the role of VAT in this clinical population.

References

• 1. Keji Jada, S. K. (2021). The Pathophysiology of Anorexia Nervosa in Hypothalamic Endocrine Function and Bone Metabolism. Cureus, 13(12).

• 2. Marwan El Ghoch, S. C. (2014). Anorexia Nervosa and Body Fat Distribution: a Systematic Review. Nutrients, 3895-3912.

• 3. Treasure J, Z. S. (2015). Anorexia nervosa. Nat Rev Dis Primers, 1:15074.

• 4. Zamboni M., A. F. (1997). Body fat distribution before and after weight gain in anorexia nervosa. Int J Obes Relat Metab Disord, (1):33-6.

Disclosure of interest: None declared.

A59 Where and how to treat patients with extremely severe restricting type eating disorders, with serious organ failure: a clinical case

A. A. N. Zappalà², I. Giunti1, L. Lazzeretti¹, B. Paladini², F. Faldi², S. Lucarelli¹

¹U.F.C. Disturbi Alimentari, Azienda USI. Toscana Centro; ²S.0.S. Attività tecniche assistenziali Dietetica Professionale Aziendale, U.F.C. Disturbi Alimentari

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 2024, 29(1): A59

Keywords: Eating disorders, Extremely severe and chronic condition of anorexia nervosa, Multidisciplinary team, High Refeeding Syndrome risk, Specific hospital setting with trained staff

Introduction: Eating disorders affect approximately 4% of the population. They are based on multifactorial causes (psychological and biological) and they produce adverse effects on physical and psychosocial health with reduced quality of life and high suicide risk.

A specific treatment with a multidisciplinary team is recommended for eating disorders. Despite eating disorders' gravity and prevalence, there are no standards for clinical practice and for the training of experts who provide the treatment. With a stepped-care approach, patients affected by a restricting type eating disorder with severe medical implications and with a high Refeeding Syndrome risk are entrusted to non-specialised wards, resulting in poor prognosis related to structural, relational and professional competence aspects.

Aim of the study: This example wants to focus on the way in which an extremely severe and chronic condition of anorexia nervosa (BMI 8.00) with organ failure responded positively to the transfer to the eating disorders specialised psychiatric unit (SPDC), in which the condition was treated by a specialised multidisciplinary team with an adequate training.

Materials and methods: A clinical study of a female non-European patient with a significant language barrier has been proposed.

The therapeutic pathway has been described in terms of nutritional increase calibrated on hematic and clinical and laboratorial parameters and in terms of the implemented psychopharmacological intervention.

Results: This example confirmed the efficacy of good medical practices and the need for the hospitalisation in a specific hospital setting with trained staff.

Discussion and conclusions: Even if this is a single case, it stimulates a reflection on “how” and especially on “where” it is appropriate to treat patients with eating disorders with high-risk quoad vitam. Unfortunately, to this day, the present organisation of the National Health System does not explicitly clarify the guidelines in this direction, therefore it happens very often to proceed out of necessity in an extemporaneous way.

References

• 1. National Institute for Health Care and Excellence. Clinical Guideline 69. Eating Disorders: recognition and treatment. Published: 23 May 2017. Last updated: 16 December 2020. Last accessed: 30 June 2023 at: https://www.nice.org.uk/guidance/ng69

• 2. Joshua S. V. da Silva. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract. 2020;35(2):178-195

• 3. McHugh CM, Harron M, Kilcullen A, O’Connor P, Burns N, Toolan A, O’Mahony E. The Experience of the Management of Eating Disorders in a Pop-up Eating Disorder Unit. Ir Med J. 2018;111(8):806.

Disclosure of interests: The authors have no conflicts of interest to declare that are relevant to the content of this article.