Cognitive training via mobile app for addressing eating disorders' cognitions in adolescents: a randomized control trial protocol.

During adolescence, individuals are particularly vulnerable to developing eating disorders (EDs). To address the dysfunctional beliefs linked to these disorders, a new mobile app has been developed. This app, called GG eating disorders-Adolescents (GGED-AD), was created based on CBT to help adolescents work on their self-dialogue related to the core beliefs of eating disorders. The objective is to present the protocol for a randomized controlled trial to explore the efficacy of GGED-AD.Methods The study will be carried out in adolescents aged 13 to 16 from an educational center in the Valencian Community. The participants will be randomized into two groups: the experimental group will use the GGED-AD app during 14 consecutive days for approximately 5 min each day; and the control group will use a neutral app (GGNEUTRAL) during the same time. Both groups will complete instruments that assess dysfunctional beliefs related to eating disorders, eating symptoms, symptoms of depression and anxiety, body satisfaction and self-esteem before and after the intervention. A follow-up will be conducted one month later.Results A decrease in the degree of ascription to dysfunctional beliefs associated with eating disorders and eating symptomatology is expected, as well as an increase in body satisfaction and the self-esteem of the participants of the experimental group.Discussion The app in this study could help tackle and prevent ED-related symptoms in adolescents.Trial registration NCT06039514.

A mobile app to challenge obsessional beliefs in adolescents: a protocol of a two-armed, parallel randomized controlled trial.

BACKGROUND: Adolescence is a crucial stage for the development of OCD symptoms that, in most cases, persist into adulthood. This requires designing preventive strategies tailored to this population. Therefore, we aim to describe the study protocol that will be used to examine the effectiveness of a mobile health application to challenge obsessional beliefs in adolescents. METHODS: A two-armed randomized controlled trial will be conducted on an adolescent sample from the general population. The experimental group will use the intervention module (GGOC-AD) of a mobile app on the GGtude platform for 14 days whereas the control group will use a non-active module (GGN-AD) of said app. Primary outcome measures will be obsessional beliefs and obsessive-compulsive symptoms, and secondary measures will be self-esteem and emotional symptoms. Three assessment points will be conducted at baseline, post-intervention, and one-month follow-up. A linear multiple regression model with an intention to treat approach will be used. The expected total sample size will be 55 participants. DISCUSSION: We expect that the intervention group will show a reduction in obsessional beliefs and OCD-symptoms at post and follow-up in comparison with the control group. Additionally, we expect that the app will improve participants' self-esteem. This study could provide an accessible mobile health tool to prevent OCD-related symptoms in adolescents. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06033391 . Registered September 4, 2023.

Can an app increase health literacy and reduce the stigma associated with obsessive-compulsive disorder? A crossover randomized controlled trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a disabling condition with a high delay in seeking treatment. esTOCma is an app developed to increase mental health literacy (MHL) about OCD, reduce stigma, and increase the intention to seek professional treatment. It is a serious game and participants are asked to fight against the "OCD stigma monster" by accomplishing 10 missions. The aim of this study is to evaluate the effectiveness of this app in a community sample. METHODS: A randomized controlled trial with a crossover design was carried out. Participants were randomized to two groups: immediate use (iApp, n = 102) and delayed use (dApp, n = 106) of esTOCma. The iApp group started using the app at baseline until the game was over. The dApp group initiated at 10-days until the game finished. Participants were requested to complete a set of questionnaires at baseline and 10-day, 20-day and 3-month follow-ups. RESULTS: The Time×Group interaction effect was significant for the primary outcome measures: there was an increase in MHL and intention to seek help, and a decrease in stigma and OC symptoms, with large effect sizes, only after using the app. Changes were maintained (or increased) at follow-up. LIMITATIONS: The study did not include an active control group and some of the scales showed low internal consistency or a ceiling effect. CONCLUSIONS: This study provides first evidence for the effectiveness of esTOCma as a promising intervention to fight stigma and reduce the treatment gap in OCD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04777292. Registered February 23, 2021, https://clinicaltrials.gov/ct2/show/NCT04777292.

Outcomes after intensive chemotherapy for secondary and myeloid-related changes acute myeloid leukemia patients aged 60 to 75 years old: a retrospective analysis from the PETHEMA registry.

Treatment options for patients with secondary acute myeloid leukemia (sAML) and AML with myeloid-related changes (AMLMRC) aged 60 to 75 years are scarce and unsuitable. A pivotal trial showed that CPX-351 improved complete remission with/without incomplete recovery (CR/CRi) and overall survival (OS) as compared with standard "3+7" regimens. We retrospectively analyze outcomes of 765 patients with sAML and AML-MRC aged 60 to 75 years treated with intensive chemotherapy, reported to the PETHEMA registry before CPX-351 became available. The CR/CRi rate was 48%, median OS was 7.6 months (95% confidence interval [CI]: 6.7-8.5) and event-free survival (EFS) 2.7 months (95% CI: 2-3.3), without differences between intensive chemotherapy regimens and AML type. Multivariate analyses identified age ≥70 years, Eastern Cooperative Oncology Group performance status ≥1 as independent adverse prognostic factors for CR/CRi and OS, while favorable/intermediate cytogenetic risk and NPM1 were favorable prognostic factors. Patients receiving allogeneic stem cell transplant (HSCT), autologous HSCT, and those who completed more consolidation cycles showed improved OS. This large study suggests that classical intensive chemotherapy could lead to similar CR/CRi rates with slightly shorter median OS than CPX-351.

Healthy orthorexia vs. orthorexia nervosa: Italian validation of the Teruel Orthorexia Scale (TOS).

PURPOSE: Orthorexia nervosa (OrNe) is a potentially pathological condition characterized by a fixation on healthy diet. An increasing number of studies have been conducted on this mental preoccupation, but the validity and reliability of some of the psychometric instruments employed in its assessment are still under debate. Among these measures, the Teruel Orthorexia Scale (TOS) seems to be promising, given that it allows to differentiate between OrNe and other non-problematic forms of interest with healthy eating, named as healthy orthorexia (HeOr). The aim of this study was to examine the psychometric properties of an Italian version of the TOS, by testing its factorial structure, internal consistency, test-retest reliability, and validity. METHOD: Through an online survey, we recruited 782 participants from different regions of Italy, asking them to complete the following self-report instruments: TOS, EHQ, EDI-3, OCI-R, and BSI-18. From the initial sample, 144 participants agreed to complete a second TOS administration 2 weeks later. RESULTS: Data confirmed the validity of the 2-correlated factors structure of the TOS. The questionnaire also showed good reliability, both in terms of internal consistency and temporal stability. With regard to the TOS validity, results showed that OrNe was significantly and positively associated with measures of psychopathology and psychological distress, while HeOr showed no correlations or negative associations with the above-mentioned measures. CONCLUSION: Based on these results, the TOS can be considered a promising measure for the assessment of both pathological and non-problematic forms of orthorexic eating behavior also in Italian population. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Efectividad de la aplicación del programa Echomantra en una adolescente con anorexia nerviosa y su familiar: Un estudio de caso / Effectiveness of the application of the Echomantra in an adolescent girl with anorexia nervosa and her caregiver: A case study

El programa ECHOMANTRA tiene como finalidad facilitar la transición de las pacientes con un trastorno de la conducta alimentaria desde el ingreso hospitalario a su vida cotidiana. Consta de una intervención para los/las familiares (ECHO; Treasure et al., 2015) y otra para las pacientes (MANTRA, Schmidt, et al, 2014). El objetivo de este estudio fue evaluar la efectividad del programa ECHOMANTRA, aplicado junto al tratamiento usual, en una adolescente de 15 años con anorexia nerviosa (AN) y su madre. Se utilizó un diseño de caso único y medidas pre-post, con seguimiento a los 3 y 6 meses. En la paciente se evaluó: patología alimentaria (EDE-Q), estado emocional (DASS-21), ajuste psicosocial (EQ-5D-5L y el CIA 3.0) y motivación al cambio; y en la madre: emoción expresada (FQ), impacto de los síntomas (EDSIS), acomodación a la enfermedad (EAISA), estado emocional (DASS-21) y habilidades de cuidadora (CSS). Ambos programas constaban de 8 sesiones online individuales y semanales. Los resultados mostraron una reducción en la sintomatología de AN, aumento del IMC, mejora del estado emocional, motivación al cambio y ajuste psicosocial; y en la madre, mejoró el estado emocional y las habilidades de cuidado, y disminuyó la acomodación a la enfermedad, la emoción expresada y el impacto de los síntomas. Estos cambios se mantuvieron en el seguimiento. Ambas valoraron el programa como satisfactorio. La aceptabilidad y la eficiencia del tratamiento de la AN puede mejorarse utilizando el ECHOMANTRA para preparar la transición de la atención hospitalaria, apoyando a las pacientes y familiares. (AU)

The aim of the ECHOMANTRA program is to facilitate the transition from hospital back into the community. ECHOMANTRA is based on interventions for carers (Experienced Carers Helping Others, ECHO; Treasure et al. 2016) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA; Schmidt, et al., 2014). The aim of this study was to evaluate the effectiveness of the ECHOMANTRA program, applied together with the usual treatment, in a 15-yearold adolescent girl with anorexia nervosa (AN) and her mother. A single case design and pre-post measures were used, as well as follow-up at 3 and 6 months. The patient was assessed for: eating pathology (EDE-Q), emotional state (DASS-21), psychosocial adjustment (EQ-5D-5L and CIA 3.0) and motivation to change. In the mother: expressed emotion (FQ), symptom impact (EDSIS), accommodation to illness (EAISA), emotional state (DASS-21) and her caregiver skills (CSS) were assessed. Both programs consisted of 8 on-line sessions, which were conducted individually and on a weekly basis. The results showed a reduction in AN symptomatology, increased BMI, improved emotional state, motivation to change and psychosocial adjustment; and in the mother, improved emotional state and caregiving skills, and reduced accommodation to illness, expressed emotion and the impact of symptoms. These changes were maintained at follow-up. Both patient and family valued the program as satisfactory. Both the acceptability and efficiency of treatment for AN may be improved by using ECHOMANATRA to prepare for transition from inpatient care, by giving support to both patients and their carers. (AU)

Orthorexic eating behaviors are not all pathological: a French validation of the Teruel Orthorexia Scale (TOS).

As no French validated measurement tool distinguishing healthy orthorexia (HeOr) from orthorexia nervosa (OrNe) currently exists, this study aimed at examining psychometric properties of the French version of the Teruel Orthorexia Scale (TOS). A sample of 799 participants (Mean [SD] age: 28.5 [12.1] years-old) completed the French versions of the TOS, the Düsseldorfer Orthorexia Skala, the Eating Disorder Examination-Questionnaire, and the Obsessive-Compulsive Inventory-Revised. Confirmatory factor analysis and exploratory structural equation modeling (ESEM) were used. Although the bidimensional model, with OrNe and HeOr, of the original 17-item version showed an adequate fit, we suggest excluding items 9 and 15. The bidimensional model for the shortened version provided a satisfactory fit (ESEM model: CFI = .963, TLI = .949, RMSEA = .068). The mean loading was .65 for HeOr and .70 for OrNe. The internal consistency of both dimensions was adequate (αHeOr = .83 and αOrNe = .81). Partial correlations showed that eating disorders and obsessive-compulsive symptomatology measures were positively related to OrNe and unrelated or negatively related to HeOr. The scores from the 15-item French version of the TOS in the current sample appears to present an adequate internal consistency, pattern of associations in line with what was theoretically expected, and promising for differentiating both types of orthorexia in a French population. We discuss why both dimensions of orthorexia should be considered in this area of research.

Orthorexia ('right appetite', from the Greek) covers two dimensions: (1) orthorexia nervosa (OrNe), a strong preoccupation with healthy diet with negative emotional, cognitive, and/or social consequences while trying to approach this goal and when the eating behavior deviates from it, and (2) healthy orthorexia (HeOr), which can be defined as a healthy interest in diet, (self-assessed) healthy behavior with regard to diet and eating healthily as part of one's identity. OrNe is not yet indexed into mental disorder classifications. Some prominent measurement tools in the area of orthorexia present important limitations: it is unclear if they validly assess OrNe and they do not tap HeOr by design. To overcome these limitations, a promising self-reported instrument was developed: the Teruel Orthorexia Scale (TOS), a bidimensional questionnaire whose structure has been replicated in different samples. Our research based on 799 participants aimed to adapt this instrument in a French speaking population. The results revealed that the French version of the TOS is an empirically supported tool allowing to differentiate both forms of orthorexia (healthy and nervosa). It also suggests that OrNe is associated with psychopathological symptoms while opposite patterns were found with HeOr. We discuss the importance of measuring both orthorexia dimensions.

A consensus document on definition and diagnostic criteria for orthorexia nervosa.

PURPOSE: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. METHODS: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. RESULTS: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. CONCLUSIONS: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. LEVEL OF EVIDENCE: Level V: opinions of expert committees.

Enhancing mental health literacy in obsessive-compulsive disorder and reducing stigma via smartphone: A randomized controlled trial protocol.

Background: Obsessive-compulsive disorder (OCD) is a disabling disorder that can be successfully treated. However, individuals with OCD do not seek or delay seeking treatment. This delay may be explained by poor mental health literacy and stigmatizing attitudes toward OCD in community. In order to work on these variables, a gamified mental health mobile application (app) called esTOCma has been developed. The purpose of this study is to describe the protocol for a study to test the efficacy of esTOCma, increasing mental health literacy and help-seeking intention, reducing the stigmatizing attitudes and social distance suffered by people with OCD, as well as the distress associated with obsessive-compulsive symptoms. Methods: A randomized controlled trial with a crossover design with two conditions (immediate-use App group versus delayed-use App group) will be conducted on a non-clinical adult sample of the community of a minimum size of 200 participants. Participants in the immediate-use App group will start using the app at baseline until completion (10 days); whereas participants in the delayed-use App group will wait 10 days, and then start using the app until completion (10 days). The outcomes will be measured at four assessment points (baseline; 10 days from baseline; and 20 days from baseline; and after 3 months). The following instruments will be administered: Attribution Questionnaire, General Help-Seeking Questionnaire, Social Distance Scale, Mental Health Literacy, Psychoeducation Questionnaire, Social Desirability Scale, Single-Item Self-esteem Scale, and Obsessive-Compulsive Inventory-Revised. Discussion: This protocol presents the first study to describe a randomized control trial of a mental health app focused on changing mental health literacy, stigmatizing attitudes, social distance and help-seeking intention associated with OCD. An app intervention of these characteristics is especially relevant nowadays as the COVID-19 pandemic has increased obsessive-compulsive symptoms and severity. An improvement in general knowledge about OCD and a reduction in stigma could be associated with earlier OCD detection and an increase in help-seeking intention, which could result in greater wellbeing. Moreover, normalizing intrusions and knowledge about the cognitive OCD model could serve as a protective variable in vulnerable individuals. Trial registration: ClinicalTrials.gov identifier: NCT04777292. Registered February 23, 2021, https://clinicaltrials.gov/ct2/show/NCT04777292.

Treatment patterns and outcomes of 2310 patients with secondary acute myeloid leukemia: a PETHEMA registry study.

Secondary acute myeloid leukemia (sAML) comprises a heterogeneous group of patients and is associated with poor overall survival (OS). We analyze the characteristics, treatment patterns, and outcomes of adult patients with sAML in the Programa Español de Tratamientos en Hematología (PETHEMA) registry. Overall, 6211 (72.9%) were de novo and 2310 (27.1%) had sAML, divided into myelodysplastic syndrome AML (MDS-AML, 44%), MDS/myeloproliferative AML (MDS/MPN-AML, 10%), MPN-AML (11%), therapy-related AML (t-AML, 25%), and antecedent neoplasia without prior chemotherapy/radiotherapy (neo-AML, 9%). Compared with de novo, patients with sAML were older (median age, 69 years), had more Eastern Cooperative Oncology Group ≥2 (35%) or high-risk cytogenetics (40%), less FMS-like tyrosine kinase 3 internal tandem duplication (11%), and nucleophosmin 1 (NPM1) mutations (21%) and received less intensive chemotherapy regimens (38%) (all P < .001). Median OS was higher for de novo than sAML (10.9 vs 5.6 months; P < .001) and shorter in sAML after hematologic disorder (MDS, MDS/MPN, or MPN) compared with t-AML and neo-AML (5.3 vs 6.1 vs 5.7 months, respectively; P = .04). After intensive chemotherapy, median OS was better among patients with de novo and neo-AML (17.2 and 14.6 months, respectively). No OS differences were observed after hypomethylating agents according to type of AML. sAML was an independent adverse prognostic factor for OS. We confirmed high prevalence and adverse features of sAML and established its independent adverse prognostic value. This trial was registered at www.clinicaltrials.gov as #NCT02607059.

Adaptation and Implementation of an Intervention Programme on Spanish Carers and Adolescent Patients With an Eating Disorder: Study Protocol of a Randomized Controlled Trial.

Introduction: One of the major problems with inpatient treatment of adolescent girls with an eating disorder (ED) is that the strategies learned during their hospital stay are not easily applied or maintained in their daily lives, and this has been related to high rates of relapse and readmission. The ECHOMANTRA programme was developed to optimize outcomes during and following inpatient or day-patient treatment. ECHOMANTRA is based on interventions for carers (Experienced Carers Helping Others, ECHO) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) and is developed from the cognitive interpersonal model of anorexia (Schmidt and Treasure, 2006; Treasure and Schmidt, 2013). This study aims to describe the study protocol of a randomized controlled trial (RCT) for evaluating the efficacy of an adaptation of a novel intervention for patients and carers (ECHOMANTRA) to be implemented as an add-on to treatment-as-usual (TAU). Method: In a multi-center pilot RCT, 80 female adolescent patients with a DSM-5 diagnosis of an ED and their carers will be invited to participate in the study. They will then be randomized to receive either the ECHOMANTRA intervention as an add-on to TAU or TAU alone. A repeated measures design will be conducted across four time points. Primary outcomes will be patient psychological well-being and eating disorder symptoms, and secondary outcomes will include body mass index, obsessive-compulsive symptoms, perfectionism, motivation to change and psychosocial adjustment. For carers, outcome variables will include psychological well-being, expressed emotion, accommodation and enabling behaviors, burden, and care skills. Discussion: The results from this trial will establish the effectiveness of ECHOMANTRA and may reveal whether and to what extent this novel intervention can optimize outcomes during and following inpatient treatment. This study will also provide the adaptation of the ECHOMANTRA in the Spanish context for inpatient/day-care treatment.

Personality Profile in Orthorexia Nervosa and Healthy Orthorexia.

Little is known about orthorexia in both its pathological (orthorexia nervosa, OrNe) and adaptive (healthy orthorexia, HeOr) forms. To date, few studies have been carried out to analyze the personality profile associated with orthorexia, and the results have been contradictory. The aim of the present study was to explore the characteristic pathological personality traits associated with OrNe and HeOr. A total of 297 participants (M age = 30.8 years; 94.6% women) from the general population completed the Teruel Orthorexia Scale (TOS) and Personality Inventory for DSM-5-Short Form (PID-5-SF) questionnaires. Results showed significant low-medium correlations between OrNe and the four personality factors (Negative Affectivity, Detachment, Disinhibition, and Psychoticism) (rs range [0.08, 0.36]). In the regression analysis, the predictors of OrNe were Neuroticism and, to a lesser extent, Psychoticism. For HeOr, the associations were lower (rs range [-0.13, 0.05]) and negative, except Psychoticism. Only the relationship with Disinhibition was statistically significant, although after controlling for OrNe, Negative Affectivity and Antagonism also became significant. In the regression analysis, the predictors of HeOr were Disinhibition (negative direction) and Psychoticism (positive direction). The findings show that OrNe is associated with a pathological personality pattern characterized by difficulty in regulating emotions and negative affect (Negative Affectivity), as well as eccentricity, feeling special, and holding beliefs outside the norm (Psychoticism). However, HeOr seems to be related to the tendency toward high responsibility, self-control, the ability to maintain the focus of attention (low Disinhibition), and Psychoticism. Future studies should confirm whether this combination is a key component underlying the development and maintenance of orthorexia.

The Role of Negative Affect in Emotional Processing of Food-Related Images in Eating Disorders and Obesity.

The aim of the present study was to analyze differences in the emotional processing (valence, arousal, and dominance) of food-related information in patients with eating disorders (ED), patients with obesity, and healthy women. Moreover, the mediator role of negative affect and the moderating role of the diagnostic group (ED vs. non-ED) were analyzed. METHOD: The sample consisted of 94 women (39 with eating disorders, 19 with obesity, and 36 healthy participants). MEASURES: International Affective Picture System (IAPS) food picture exposure task; Self-Assessment Manikin Analog-Visual Scale (SAM) appraising Arousal, Valence, and Dominance; Eating Attitudes Test (EAT-26); Positive and Negative Affect Schedule (PANAS). RESULTS: Patients with purging symptomatology rated food images as more unpleasant than healthy women. Patients with purging and restrictive eating symptomatology showed higher levels of arousal and less dominance over the emotions experienced, compared to patients with obesity and healthy women. The mediation analysis showed that negative affect mediated the relationship between eating symptomatology (EAT-26) and the Valence of food images, as well as the control over the emotions experienced when viewing food images (Dominance). For the moderation analysis participants were regrouped into two groups (ED patients vs. non-ED patients). The direct relationship between eating symptomatology and food image valence was moderated by the diagnostic group. However, the group did not moderate the direct relationship between the EAT-26 and dominance over experienced emotions, or the indirect effect on eating symptomatology through negative affect. These results show the relevance of negative affect in the emotional processing of food-related information, and they support an eating disorder-disordered eating dimensional perspective.

The relation of orthorexia with lifestyle habits: Arabic versions of the Eating Habits Questionnaire and the Dusseldorf Orthorexia Scale.

BACKGROUND: Some of the commonly used tools to assess orthorexia nervosa (OrNe) do not allow a meaningful interpretation of the scores or yield mixed results about the dimensions needed to represent orthorexia. Since no advancement in the theoretical knowledge can be made without a thorough examination of the measurement aspects, this study aimed to evaluate the correlation between orthorexia nervosa (OrNe) and lifestyle habits, notably alcohol drinking, cigarette and waterpipe smoking, and physical exercise, and to validate and assess the psychometric properties of the Arabic versions of the Eating Habits Questionnaire (EHQ) and Düsseldorf Orthorexia Scale (DOS). METHODS: A total of 456 adult participants completed a self-administered questionnaire. Exploratory structural equation models were used to test the internal structure of the instruments. Shorter and more explicit versions were proposed for instruments. Pearson and partial correlations were computed between orthorexia scores and healthy behaviors scores. RESULTS: Regarding the internal structure of both EHQ and DOS, evidence favored the bi-dimensional construct of orthorexia. Both tools presented two theoretically clearly interpretable factors (OrNe and Healthy Orthorexia-HeOr-). The two questionnaires presented a high convergent validity, as dimensions with the same interpretation were correlated around 0.80. While OrNe was positively correlated with the use of unhealthy substances (higher alcohol use disorder, cigarette, and waterpipe dependence), HeOr was negatively associated with these behaviors. CONCLUSION: Our results emphasize the idea that further attention should be paid to the multidimensional structure of orthorexia, as OrNe and HeOr present an opposite pattern of associations with healthy behaviors. An OrNe etiopathogenesis common to eating disorders can explain these differences.

The term "orthorexia nervosa" (OrNe) denotes a possible pathological fixation on a health-conscious diet. Some of the commonly used tools to assess orthorexia nervosa (OrNe) do not allow a meaningful interpretation of the scores or yield mixed results about the dimensions needed to represent orthorexia. In this study, some items were simultaneously tapping both dimensions of orthorexic tendencies, and shorter versions of the DOS and EHQ scales were proposed to offer instruments with a more explicit structure. The final versions still presented high reliabilities. While HeOr was negatively associated with the consumption of unhealthy substances (higher alcohol use disorder, cigarette, and waterpipe dependence), OrNe was positively correlated with these behaviors. After controlling for OrNe or HeOr (partial correlations), the associations were even higher; the pattern of associations was more explicit, showing the importance of considering the multidimensional structure of orthorexia.

Teachers' Knowledge and Stigmatizing Attitudes Associated With Obsessive-Compulsive Disorder: Effectiveness of a Brief Educational Intervention.

Because children and adolescents are vulnerable to developing obsessive-compulsive disorder (OCD), classroom teachers play an important role in the early identification and intervention in students with OCD. The present study aims to explore the recognition of OCD, general knowledge about this disorder, implications in the classroom, and stigmatizing attitudes among teachers, as well as the effectiveness of a brief educational intervention about OCD. Participants (n = 95; mean age = 43. 29 years old; 64.3% female) were primary and secondary school teachers who were randomly assigned to an experimental group or a control group. All of them completed a set of self-report questionnaires, read an educational fact sheet (either about OCD in the experimental group or about a healthy diet in the control group), and again completed the questionnaires. Results show that prior to the intervention, most of the teachers identified the contamination and order OCD symptoms described in a vignette as specific to OCD (82.1%) and would recommend talking about the problem (98.9%) and seeking help (94.7%). However, only a few (36.8%) knew about the most effective OCD treatments or identified compulsions as a main OCD symptom (33%). Moreover, only about half of the teachers correctly identified OCD's possible interference in classroom routines, such as delays to achieve perfection or concentration problems, and strategies for dealing with OCD, such as continuing with the class rhythm. Stigma levels were from low to moderate. After the brief educational intervention, participants in the experimental group increased their knowledge about OCD, improved their strategies for managing a student with OCD symptoms, and had fewer stigmatizing attitudes associated with pity (p < 0.05). These changes were not observed in the control group. We can conclude that this brief and easy-to-administer intervention is an effective educational intervention to significantly improve teachers' knowledge and attitudes, at least in the short-term. These results are especially relevant because OCD is associated with high interference and long delays in seeking treatment, and teachers have a unique opportunity to help with prevention, early identification, and recommending an adequate intervention for OCD.

Contribution of executive functions to eating behaviours in obesity and eating disorders.

BACKGROUND: Patients with eating disorders (ED) or obesity show difficulties in tasks assessing decision-making, set-shifting abilities and central coherence. AIMS: The aim of this study was to explore executive functions in eating and weight-related problems, ranging from restricting types of ED to obesity. METHOD: Two hundred and eighty-eight female participants (75 with obesity; 149 with ED: 76 with restrictive eating, 73 with bingeing-purging symptoms; and 64 healthy controls) were administered the Wisconsin Card Sorting Test, the Iowa Gambling Task, and the Group Embedded Figures Test to assess set-shifting, decision-making and central coherence, respectively. RESULTS: Participants with either obesity or ED performed poorly on tests measuring executive functioning compared with healthy controls, even after controlling for age and intelligence. Both participants with obesity and participants with ED showed a preference for global information processing. CONCLUSIONS: The findings suggest that treatments for obesity and ED would benefit from addressing difficulties in cognitive functioning, in addition to the more evident clinical symptoms related to eating, body weight and shape.

Spanish version of the Inferential Confusion Questionnaire-Expanded Version: Further support for the role of inferential confusion in obsessive-compulsive symptoms.

The purposes of this research were (1) to analyse the psychometric properties of the Inferential Confusion Questionnaire-Expanded Version (ICQ-EV) in a Spanish population; (2) to explore the role of inferential confusion in obsessive-compulsive disorder (OCD); and (3) to compare the inferential confusion construct in nonclinical and clinical samples. A sample of 342 nonclinical participants and 66 patients with OCD completed the ICQ-EV Spanish adaptation as well as a set of questionnaires. Results confirmed a good fit of the ICQ-EV Spanish version to the original unifactorial structure and excellent internal consistency and test-retest reliability. Moreover, results confirmed that the ICQ-EV predicts Obsessing, Checking, Washing, and Hoarding symptoms, independently of the contribution of dysfunctional beliefs. In addition, OCD patients scored significantly higher on the ICQ-EV than nonclinical participants. The Spanish version of the ICQ-EV is a reliable instrument to assess inferential confusion, and further support is provided for the relevance of the inferential confusion construct in OCD.