Affect, Body, and Eating Habits in Children: A Systematic Review.

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

The Fear of Facing Drives and Desires: Is It Still Appropriate to Reduce Anorexia and Bulimia to Eating Disorders?

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

The Refugee Experience of Asylum Seekers in Italy: A Qualitative Study on the Intertwining of Protective and Risk Factors.

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

Risk factors for binge eating severity among adolescent girls and boys. A structural equation modeling approach.

OBJECTIVE: Parental bonding, low self-esteem, emotion dysregulation, and eating style are correlated with each other and are associated with binge eating among adolescents. However, no studies have yet examined all these variables simultaneously. In the current study, the independent and combined influences of such constructs on binge eating were tested with structural equation modeling. METHOD: A sample of 973 students aged between 12 and 16 (M = 14.17, SD = 1.25) years was screened by means of self-report measures assessing parental bonding, self-esteem, emotion dysregulation, eating styles and binge eating severity. RESULTS: Self-esteem (ß = -0.205) and eating styles (emotional ß = 0.313, external ß = 0.133, and restrained ß = 0.178) had a direct effect on binge eating severity. The model (χ2(22) = 57.679; RMSEA = 0.041; CFI = 0.987; TLI = 0.949; SRMR = 0.024) revealed that the paths from both maternal and paternal care and maternal overprotection to binge eating were mediated through low self-esteem, emotion dysregulation and each eating style, explaining 35% of the variance. DISCUSSION: Findings provide support for a comprehensive theoretical-based model of risk factors for binge eating and suggest the possible mechanisms through which the quality of early parental relationships contribute to developing dysfunctional eating patterns. Treatment and prevention efforts should improve self-esteem and emphasize emotion regulation capabilities.

Self-Esteem and Binge Eating among Adolescent Boys and Girls: The Role of Body Disinvestment.

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

Paternal rejection, psychological maladjustment, and child emotional eating: Path analysis in 8- to 11-year-old boys and girls.

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

Non-Suicidal Self-Injury: A School-Based Peer Education Program for Adolescents During COVID-19 Pandemic.

Introduction: Non-suicidal self-injury (NSSI) constitutes a major health concern among youth. However, less is known about the useful ways to prevent NSSI. As such, the NSSI- Peer Education Program (NSSI-PEP) aims to intervene on the vulnerability factors that predispose to NSSI by applying a peer education approach. The NSSI-PEP is grounded on the psychoanalytic tradition's tenets, implementing modules targeting four crucial risk factors for NSSI: pubertal transformation, body image, self-esteem, and emotion regulation. Methods: Selected 8th grade students were trained to serve as peer educators and held a peer-education intervention for 6th and 7th grade students. Pre- and post-intervention assessments were conducted in order to evaluate the program's effectiveness. Results: Results revealed preliminary support for the program's feasibility, as students reported greater emotion regulation abilities (p = 0.038) and significant changes in self-esteem (p<0.001), personal alienation (p = 0.005), body image (p < 0.001), and maturity fear (p < 0.001). Also, NSSI-PEP was positively evaluated by participants. Discussion: Our pilot study provides preliminary empirical support for the NSSI-PEP, representing a promising way to address areas of vulnerability for NSSI onset. Findings may also help current policies to promote targeted preventive activities and produce sizable benefits to society.

Non-Suicidal Self-Injury Among Italian Adolescents: The Role of Parental Rejection, Self-Concept, Anger Expression, and Body Investment.

OBJECTIVE: Parental rejection, poor self-concept, anger expression, and negative body investment have often been associated with non-suicidal self-injury (NSSI). However, research has investigated each factor separately. To address this shortcoming, the main aim of the study was to integrate these factors and test a hierarchical regression to examine the impact of each factor above and beyond the others. METHOD: A cross-sectional sample of 481 Italian high school students aged 13-19 (Mage=15.48; SD=1.46) were screened by self-report measures that assess parental rejection, self-concept, anger expression, body emotional investment, and NSSI. A semi-structured interview was administered in order to assess the characteristics of self-injurious behaviors. RESULTS: After the interview, twenty-three (4.8%) students reported having engaged in NSSI (Mage =12.63; SD=1.58). Neither gender nor age differences were found. The hierarchical regression revealed the NSSI was associated with the inward expression of anger (ORs=1.1-1.7) and the negative body investment (ORs=.037-.281). CONCLUSIONS: These findings point out that the expression of anger inwardly and the emotional investment in the body may be salient factors to consider in understanding the occurrence of NSSI among adolescents. The clinical relevance of these findings was discussed.

Does body shame mediate the relationship between parental bonding, self-esteem, maladaptive perfectionism, body mass index and eating disorders? A structural equation model.

PURPOSE: Body shame has been strongly associated with eating pathology. However, less is known about the predisposing factors linked to these feelings and how they interact with other variables in eating disorder development. Thus, the aim of the present study was to provide a preliminary understanding of the relationship between body shame and some of the major risk factors for eating disorder onset, identifying the possible mechanisms of action. Specifically, we tested a structural equation model in which perceived parental bonding, self-esteem, perfectionism, and body mass index are associated with eating disorder risk via body shame. METHODS: 1156 high school students aged 13-20 were screened by means of self-report measures of parental behavior, self-esteem, perfectionism, body shame and eating disorder risk. The height and weight of each individual were measured. RESULTS: In predicting eating disorder risk, parental protectiveness (ß = 0.09), body mass index (ß = 0.18), self-esteem (ß = - 0.14) and body shame (ß = 0.58) had a direct effect on this variable and overall our model accounted for 58% of its variance. The experience of shame related to one's body appeared to have a considerably significant influence on eating disturbances vulnerability and it also serves as a mediator between other risk factors and eating disturbance risk. A series of multi-group analyses indicated no significant difference between males and females. CONCLUSION: The emotion of shame may enhance our understanding of eating disorders, as well as being a salient factor for the development of preventive programs and treatment approaches. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Binge Eating Disorder and Related Features in Bariatric Surgery Candidates.

OBJECTIVE: The present study sought to: 1) assess the prevalence of Binge Eating Disorder (BED) and abnormal eating behaviors in bariatric surgery candidates; 2) compare patients with and without BED as regards to eating disturbances, psychological characteristics, and health status; 3) individuate which factors were significantly related to binge eating severity. METHODS: Sixty-three preoperative patients (17 males and 46 females) were screened by means of an ad hoc socio-demographic schedule, the Rosenberg Self-Esteem Scale, the Eating Disorders Inventory-3, the Binge Eating Scale, and the General Health Questionnaire-28. BED diagnosis was performed through a clinical interview. RESULTS: BED and disordered eating, such as episodes of binge eating, sense of lack of control over eating and inappropriate compensatory behaviors, appear common in patients undergoing weight loss surgery. Significant differences between BED and non-BED subjects in relation to eating disturbances and psychological characteristics emerged. Multiple regression analysis revealed that only emotional dys-regulation significantly predicted binge eating vulnerability. CONCLUSION: The recognition of factors involved in the development and maintenance of disordered eating in bariatric patients may support the choice of particular therapeutic strategies and improve bariatric surgery outcome. Further studies on this issue would be useful.

Relationships Between Self-Esteem, Interoceptive Awareness, Impulse Regulation, and Binge Eating. Path Analysis in Bariatric Surgery Candidates.

OBJECTIVE: The current study investigates the hypothesis that the effect of low self-esteem on binge eating in bariatric candidates was mediated by both difficulties in the perception of bodily signals and impulse regulation after accounting for gender, age, and body mass index. METHOD: 59 preoperative patients (both male and female) were screened by means of self-report measures of self-esteem, interoceptive deficits, impulse dysregulation, and severity of binge eating. Results: Results indicated that all direct effects were significant, except for the self-esteem on impulse dysregulation and the interoceptive deficits on binge eating. Self-esteem had a significant indirect effect on impulse dysregulation mediated by interoceptive deficits. Impulse dysregulation, in turn, mediates the effect of interoceptive deficits on binge eating. Moreover, the path starting from self-esteem, going first to interoceptive deficits, then going via impulse regulation difficulties to binge eating was significant. RESULTS AND CONCLUSIONS: A potential underlying mechanism through which self-esteem is linked to binge eating has been suggested. Obese individuals who perceived themselves as inadequate may carry a stronger burden by the confusion and mistrust related to bodily functioning and, consequently, may act more impulsively, through binge eating.

Nonsuicidal Self-injury: A Systematic Review.

Objective: Nonsuicidal self-injury (NSSI) refers to the intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned. Our paper presents an up-to-date overview on nonsuicidal, self-injurious behaviors. Method: In accordance with PRISMA guidelines, a systematic literature search was conducted across two databases, PubMed and PsycARTICLES, regarding the main features of NSSI with a focus on epidemiological and etiologic data, diagnostic criteria, and functions. All English articles, published between 1998 and 2016, were considered, and screened against a priori inclusion/exclusion criteria. The search terms include: self-harm, self-injury, NSSI, epidemiology, comorbidity, gender, functions and DSM. We also examined the references of the retrieved articles. Results: NSSI is most common among adolescents and young adults, and the age of onset is reported to occur between 12 and 14 years. Comorbidity with borderline personality disorder (BPD) and eating disorders is often reported. DSM-5 includes NSSI as a condition requiring further study. This review gives an overview of the prevalence rates (7.5-46.5% adolescents, 38.9% university students, 4-23% adults) and main causes that appear to stem from childhood trauma, comorbidity with many other disorders and several functions of NSSI, and the potential independence of a NSSI disorder. Conclusion: Over the years, interest in NSSI grew to such an extent that an ongoing debate was instigated on whether NSSI should be considered as a diagnosis in its own right and given its own category. This paper provides an up-to-date overview on self-injury, what is known about it and what remains to be done. Clearly, our understanding of the main issues of NSSI has increased in last two decades. However, future researches is needed to examine the developmental trajectories, cultural backgrounds and shed light on the risk factors and functions as well as clarify its role as an independent diagnostic entity.

Identifying Predictors Associated with the Severity of Eating Concerns in Females with Eating Disorders.

Considering how to improve efficacy of therapeutic strategies, the overall objective of the present study was to investigate the extent of eating concerns and to identify predictors associated with the severity of disordered eating symptomatology among people with eating pathologies. We screened 80 female eating disordered patients, ranging from 13 to 40 years, by means of self-report measures of parental behavior as perceived by the offspring, self-esteem, perfectionism, body shame and eating disorder severity. Self-reported weight and height were obtained. The diagnosis of bulimia nervosa resulted to be associated with a greater severity of the eating symptomatology. Maladaptive perfectionism, body shame and self-esteem, significantly predicted the level of eating concerns. The recognition of potential maintaining factors may support the choice of particular therapeutic strategies to improve the treatment of eating pathologies and their outcomes.

Self-esteem, body shame and eating disorder risk in obese and normal weight adolescents: A mediation model.

OBJECTIVE: To investigate dysfunctional eating behaviors and psychological variables typically associated to eating disturbances such as low self-esteem, perfectionism, shame, perceived parental care and protectiveness in obese and normal weight adolescents and to examine how the main powerful eating disorder risk factors interact with each other which explains eating psychopathology vulnerability. METHOD: 111 high school students (68 males; age range 13-19years) classified as obese and 111 age-, sex- and social status-homogeneous normal weight controls were included in the current study. All participants were asked to fill out self-report measures of parental behavior as perceived by the offspring, eating disturbance attitudes and behaviors, self-esteem, perfectionism and shame. RESULTS: Significant differences between the two groups in relation to dysfunctional eating behaviors emerged. Body shame had the strongest relationship to eating problems vulnerability and acted as a mediator in the relationship between low self-esteem and eating disorder risk among both obese and non-obese youngsters. CONCLUSIONS: These findings further our understanding of a potential underlying mechanism for eating pathology development in youngsters in general and in obese adolescents in particular, which is of great importance in terms of prevention and treatment.

How perceived parental bonding affects self-concept and drive for thinness: a community-based study.

The main aims of the present study were to investigate the relationship between perceived parental bonding and self-concept and to investigate whether these variables have an effect on eating disturbances vulnerability by testing a mediation model. We screened 3158 Italian high school students (1132 males and 2026 females), ranging in age from 14 to 18 years old by means of self-report measures of parental behavior as perceived by the offspring, eating disturbance propensity and self-concept. Weight and height were also measured. The link between a parental bonding behavior characterized by low paternal care and by maternal overprotection and a dysfunctional eating attitude (expressed by the drive for thinness) was significant and was found to be perfectly mediated by adolescents' self-concept. Moreover, our results showed that the impact of self-concept for the drive for thinness (and hence on eating psychopathologies) is moderated by the participants' body mass index and gender, but not by age. We consider this evidence of study to be useful for the prevention and treatment of eating related problems in adolescence.

Influence of gender role orientation (masculinity versus femininity) on body satisfaction and eating attitudes in homosexuals, heterosexuals and transsexuals.

OBJECTIVE: The primary aim of this study was to investigate the relationship between gender role orientation and eating disorder attitudes and behaviors and body dissatisfaction in a sample of homosexuals, heterosexuals, and transsexuals. METHOD: We screened 132 homosexuals, 178 heterosexuals (both male and female), and 15 MtF transsexuals by means of an ad hoc socio-demographic schedule; the Eating Disorders Inventory-2 and Symptom Checklist; the Body Uneasiness Test and the Bem Sex Role Inventory. RESULTS: Differences between homosexual, heterosexual, and transsexual participants emerged, but those data seem to be best explained by the constructs of femininity and masculinity than by the biological gender. DISCUSSION: The empirical evidence of a positive correlation between femininity and eating problems, and the negative correlation between masculinity and eating problems, is full of implications. Eating disorders appear to be diseases of femininity; masculinity seems to be a protective factor, independently by the biological gender.

My body and me: self-injurious behaviors and body modifications in eating disorders--preliminary results.

We investigated self-injurious behaviors and body modification practices in eating disorder patients, considering different ED diagnoses and illness severities. Of the total sample, 50.9% showed at least one form of self-injury and 50.9% reported at least one tattoo, piercing, or both. Patients reporting only body modifications showed more positive feelings toward their bodies, higher levels of self-esteem, less impulsivity, depression, and anxiety, and lower levels of social dysfunction than those reporting only self-injury or both self-injury and body modifications. Self-injury was influenced by both diagnosis and severity of disorders.

Brief report: psychological characteristics of less severe forms of eating disorders: an epidemiological study among 259 female adolescents.

We screened a sample of 259 female students, aged 17-20 years old, by means of the Eating Disorder Inventory 2 (EDI 2) and the General Health Questionnaire (GHQ-28). Those students identified to be at risk for an eating disorder underwent a semi-structured interview to provide a diagnosis according to DSM-IV criteria. We also considered the prevalence of "not full-blown diagnosis". We found two cases of full-syndrome (0.77%), both bulimics, 9 partial-syndrome bulimia nervosa (3.47%) and 1 of partial-syndrome binge eating disorder (0.38%). Moreover, 18 (6.94%) girls met the criteria for subclinical-syndrome, of which the majority was subclinical anorexia (5.79%). We did not find statistically relevant differences between the anorexic and the bulimic samples on the psychological characteristics measured by the EDI 2 subscales. These findings suggest the hypothesis that anorexia and bulimia could have the same psychopathological core and bulimia could be considered as a "failed" anorexia.