Obesity is a growing health concern in Western countries and the link between obesity and mental disorders has been extensively studied, although less attention has been paid to post-traumatic stress spectrum symptoms (PTSS). This observational study aimed at exploring the correlations between lifetime trauma exposure and its related PTSS and maladaptive eating behaviours in obese patients who are candidates for bariatric surgery. A total of 189 obese candidates for bariatric surgery were recruited at the Azienda Ospedaliero-Universitaria Pisana (AOUP) and assessed by the Trauma and Loss Spectrum—Self-Report (TALS-SR Lifetime Version), Emotional Eating Scale (EES), Night Eating Questionnaire—Italian Version (I-NEQ), Grazing Questionnaire (GQ), and Eating Disorder Examination (EDE-Q), Eating Disorder Inventory (EDI). Based on the TALS-SR (Lifetime Version) scores, patients were dichotomised as either with low PTSS scores or high PTSS scores. Results showed high PTSS scores in more than a third of the sample (36.5%), with these individuals showing statistically significant higher total and EES domain scores, total and controllability GQ domain scores, I-NEQ mood/sleep domain scores, and EDE-Q shape concern domain score. A logistic regression showed an association between higher burden of emotional eating and greater probability of lifetime PTSS. PTSS appear to be frequent among bariatric surgery candidates and are related with maladaptive eating behaviours, suggesting accurate evaluation to optimise surgical outcomes.

The Eating Disorder Inventory (EDI) is one of the oldest and most widely used surveys of eating disorder thoughts and behaviors. Its recent and frequent use to study differences in eating pathology across ethnoracial groups underscores importance of establishing its measurement invariance across groups. However, mixed evidence has emerged, and studies have focused on Black, mixed-race Hispanic/Latino, and White women. The present study aimed to establish the measurement invariance of the EDI Drive for Thinness, Bulimia, Perfectionism, Maturity Fears, and Interpersonal Distrust subscales across four ethnoracial groups in a sample of women and men. Participants (N = 2,931) were Hispanic White (7%), non-Hispanic Asian (18%), non-Hispanic Black or African American (7%), and non-Hispanic White (68%) college students (67% female) recruited in a cohort-based epidemiological, longitudinal study of health and eating patterns. First, multigroup confirmatory factor analysis examined whether the EDI performed comparably across ethnoracial groups in the full sample. Next, the same approach was followed in sensitivity analyses within each sex. Evaluation of changes in comparative fit index indicated that full metric invariance, scalar invariance, and uniqueness were supported across ethnoracial groups in the full sample and in women (change in comparative fit index ≤ .01). Only partial measurement invariance was supported in analyses of non-Hispanic Asian and non-Hispanic White men. Analyses support use of the EDI in ethnoracially diverse samples including women and men or only women. Limited score variance in men suggests the need for tests of measurement invariance in larger samples. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Longitudinal associations between adolescent body dissatisfaction, eating disorder and depressive symptoms, and BMI: a UK twin cohort study.

Background: Anorexia nervosa (AN) and obsessive–compulsive disorder (OCD) share core features of cognitive rigidity, anxiety, and altered reward processing. Pharmacological options remain limited, and combined modulation of serotonergic and dopaminergic systems may provide new therapeutic directions. This naturalistic study explored the combined use of lurasidone and fluvoxamine in individuals with restrictive AN (AN-r) and comorbid OCD. Methods: Forty-five female inpatients with AN-r and OCD were followed for six months. Participants received either lurasidone + fluvoxamine (n = 14) or heterogeneous SSRI/antipsychotic regimens (n = 31). Primary outcomes were the Recovery Assessment Scale (RAS) and Body Uneasiness Test Global Severity Index (BUT-GSI). Secondary outcomes included the Eating Disorder Examination-Questionnaire (EDE-Q) and Eating Disorder Inventory-3 (EDI-3). Bayesian repeated-measures ANOVAs were conducted, reporting BF10, BFInclusion, and P(M│data) values, with multiple imputation applied to manage missing data. Results: Analyses indicated time-related changes across primary outcomes (RAS and BUT-GSI), with moderate-to-strong evidence (BF10 = 4.2–18.6) supporting overall improvement during treatment. Secondary and exploratory measures showed weaker or inconsistent trends (BF10 < 3). No evidence emerged for group-by-time interactions exceeding anecdotal strength. Conclusions: Within the constraints of this small, all-female inpatient cohort, the findings illustrate directional, time-related changes compatible with global rehabilitation effects rather than drug-specific efficacy. The study demonstrates the feasibility—and methodological challenges—of applying Bayesian longitudinal modeling to incomplete clinical datasets. Future randomized or adaptive trials incorporating objective endpoints and data-quality pipelines are warranted to test whether serotonergic–dopaminergic–σ-1 synergy provides genuine clinical benefit in the AN–OCD spectrum.

Anorexia nervosa (AN) often persists for years, resulting in high morbidity and mortality. Hypoglycaemia, typically assessed from a single morning blood sample, is a critical severity indicator. Continuous glucose monitoring (CGM) provides more comprehensive information on glycaemic patterns. This study aimed to characterize glycaemia in patients with AN and identify its potential drivers among metabolic severity (current BMI), clinical severity (Eating Disorder Inventory-2 [EDI-2] score), and illness duration, in a real-world outpatient setting. This cross-sectional study included female outpatients with restricting subtype AN. Participants underwent CGM for five days in their usual environment. Collected data comprised age, BMI, illness duration, EDI-2 score, and continuous glycaemic measurements. Glycaemic biomarkers (hypoglycaemic area under the curve [AUC], mean and minimum glycaemia, and coefficient of variation) were computed over 24-hour periods. Three hundred and four female patients were monitored for a mean of 4.8days. No significant correlations were observed between glycaemic biomarkers and BMI. Illness duration was significantly associated with mean and minimum glycaemia (r=0.26 and 0.23, respectively, p<0.001) and with hypoglycaemia AUC (r=-0.25, p<0.001). In female patients with restricting subtype AN, illness duration, rather than BMI, appears to significantly influence glycaemic profiles. This may reflect glycaemic adaptations, a hypothesis that warrants further investigation using CGM, a practical tool for exploring metabolic changes and their potential clinical significance in AN.

Background:Eating disorders are a cluster of challenging psychiatric and medical conditions that constitute a major problem in adolescents and young adults. Animal-assisted interventions are currently a promising complementary therapy with great development in the hospital field.Methods:The study is a non-randomized clinical trial designed with two groups under assessment. The first group consisted of 15 female patients at a Day Hospital diagnosed with eating disorders who received animal-assisted therapy. The second group had a sample of 15 patients from the same hospital with similar diagnoses and matched characteristics to the intervention group. Anxiety, depression, eating symptoms, grip strength, and health-related quality of life were analyzed both previously and after the intervention.Results:ANOVA results showed a significant between-group reduction in the state anxiety levels (p = 0.011, ηp2 = 0.211), with a significant decrease in the intervention group (p = 0.003). Interpersonal distrust (p = 0.042) and fear of maturity (p = 0.012) subscales in the Eating Disorder Inventory (EDI2) questionnaire had larger improvement when comparing pre- and post-measures in the intervention group. A similar trend was observed for the rest of the eating symptoms subscales and grip strength in the group treated with the animal-assisted intervention.Conclusion:This study suggests that dog-assisted therapy may be an effective complementary intervention for reducing state anxiety in adolescents with eating disorders. Given the role of anxiety in the maintenance of anorexia nervosa, targeting this symptom could have therapeutic benefits. Additionally, improvements in interpersonal distrust and maturity fears were observed, highlighting the potential impact of animal-assisted therapy on specific psychological factors associated with eating disorders. These findings support the inclusion of dog-assisted interventions as part of multidisciplinary treatment approaches, although further research with larger samples is needed to confirm these effects.Clinical trial registration:clinicaltrials.gov (NCT04869423).

Background/Objectives: Sociocultural factors, including migration and acculturation, may influence the clinical profile and course of eating disorders (EDs). This study examined differences between immigrant and native-born Spanish patients with EDs in (1) clinical presentation and (2) treatment response. Methods: Consecutive outpatients from the Eating Disorders Unit at Bellvitge University Hospital (Barcelona, Spain) were assessed using the Eating Disorder Inventory-2 (EDI-2), Symptom Checklist-90-R (SCL-90-R), and Temperament and Character Inventory-Revised (TCI-R). Statistical analyses included chi-square tests, ANOVA, Cox regression for dropout, and logistic regression for predictors of poor outcome, adjusted for ED subtype. Results: The sample included 1104 patients (947 native-born; 157 immigrants). Immigrant patients showed a distinct clinical profile, with lower drive for thinness and body dissatisfaction but higher interpersonal distrust, maturity fears, perfectionism, anxiety-related symptoms, and self-transcendence. They also presented a worse treatment response, including higher dropout rates, poorer outcomes, and lower remission rates. Predictive models identified different risk factors for poor treatment response in each group: among native-born patients, younger age of ED onset, higher novelty seeking, and lower self-directedness were associated with worse outcomes, whereas among immigrant patients, greater ED severity, lower harm avoidance, and lower self-transcendence predicted poorer results. Conclusions: Immigrant patients with EDs exhibit a differentiated clinical presentation and less favorable treatment response compared to native-born patients. The differential predictors of poor outcome highlight the need for culturally informed and individually tailored interventions that consider both sociocultural context and personality-related vulnerabilities.

While increasing research is reporting a higher presence of autistic traits (AT) in patients with borderline personality disorder (BPD), both autism spectrum disorder (ASD) and BPD have been associated in literature with a vulnerability to trauma and eating disorders. The present study aimed at evaluating trauma-related symptoms and eating disorder symptoms in BPD patients with or without significant AT. A sample of 73 BPD patients was assessed with the adult autism subthreshold (AdAS) Spectrum, trauma and loss spectrum-self report (TALS-SR), and EDI-2 questionnaires. The findings revealed that BPD patients with autistic traits (BPD-AT) scored significantly higher on the eating disorder inventory (EDI-2) and trauma and loss scale (TALS-SR) compared to those without AT. Moreover, while both AdAS Spectrum and TALS-SR scores predicted higher EDI-2 scores, a significant mediating effect of TALS-SR on the relationship between AdAS Spectrum and EDI-2 scores was reported. These results suggest that AT may imply more severe clinical correlates in the BPD population, including an enhanced vulnerability toward psychopathological traits frequently reported in BPD patients such as eating disorders and trauma-related symptoms, stressing the need to clarify the complex interactions among these disorders and the factors that may shape specific illness trajectories.

IntroductionThis study focuses on disordered eating (DE), a critical mental health issue among university students. Specifically, it examines the relationship between benevolent sexism (BS) and DE, and explores the underlying psychological mechanisms.MethodsA questionnaire-based survey was conducted to investigate the association between BS and DE, as well as the mediating role of appearance comparison on social networking sites (SNSs) and the moderating role of gender. A sample of 2,000 Chinese college students completed the Ambivalent Sexism Inventory, subscales of the Eating Disorder Inventory, and the Social Network Site Appearance Comparison Scale. Using Hayes’ Process Macro, this study tested both a mediation model (Model 4) and a moderated mediation model (Model 59).ResultsThe results showed that BS was positively associated with both appearance comparison on SNSs (a = 0.038, p < 0.001) and DE (c = 0.091, p = 0.001). Appearance comparison on SNSs was positively associated with DE (b = 1.733, p < 0.001) and partially mediated the link between BS and DE (ab = 0.066, 95% CI [0.04, 0.10]). Gender further moderated these associations: BS can directly predict DE among females (cfemale = 0.207, p < 0.001) but not among males (cmale = 0.033, p = 0.319), and the effect of appearance comparison on SNSs on DE was stronger for females (bfemale = 1.966, p < 0.001) than for males (bmale = 1.586, p < 0.001). Conditional indirect effects confirmed that the mediation pathway was significant for males (abmale = 0.070, 95% CI [0.04, 0.11]) but not significant for females (abfemale = 0.051, 95% CI [−0.01, 0.11]).DiscussionThese results integrate Ambivalent Sexism Theory with Social Comparison Theory, illustrating how BS operates within China’s digital and culrural contexts to heighten the risk of disordered eating. The findings emphasize the necessity of culturally grounded and digitally informed interventions that counter benevolent sexist ideologies and reduce appearance-focused social comparison.

Anorexia nervosa (AN) is a severe psychiatric disorder with structural brain alterations; however, the roles of cortical surface area (CSA) and cortical thickness (CTh) during adolescence remain unclear. Building on frequent reports of gray matter reductions in the cingulate cortex and precuneus, this study assesses CSA, CTh, and cortical volume in these regions, alongside exploratory whole-brain analyses and their associations with psychological dimensions. We included 26 adolescent females aged 12-19 years with acute AN and 24 age-matched healthy controls. Participants underwent high-resolution structural MRI and completed psychological assessments: Eating Disorder Inventory-2 (EDI-II), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Perth Alexithymia Questionnaire (PAQ), and Body Perception Questionnaire. MRI data were processed using BIDScoin, fMRIPrep, and FreeSurfer. Analyses included permutation-based non-parametric testing and multiple regression to investigate associations between brain metrics and psychological scores. In primary analyses, individuals with AN exhibited a significant reduction in precuneus CTh only. Precuneus CTh correlated negatively with EDI-II, BAI, and BDI-II scores, and positively with BMI-SDS. Regression analysis identified anxiety (BAI), specific EDI-II subscales, supra-diaphragmatic autonomic reactivity and difficulties describing negative feelings (PAQ) as predictors of precuneus CTh. Exploratory analyses revealed thickness differences in parietal and frontal regions, consistent with prior large-scale studies, with anxiety and depression scores correlating with several of these regions. Reduced precuneus CTh and its association with psychological factors highlight its role in AN's neurobiological mechanisms. Exploratory findings implicate parietal and frontal alterations, suggesting broader disruptions in body perception and behavioral control.

BackgroundGiven the prevalence of disordered eating and the persistence of traditional gender roles in China, this study examined the relationship between ambivalent sexism (including both benevolent and hostile forms) and disordered eating in Chinese women. Hostile sexism refers to overtly negative and antagonistic attitudes toward women, while benevolent sexism involves subjectively positive but patronizing beliefs. The research examined whether women’s endorsement of these sexist beliefs is associated with self-objectification and increased appearance comparisons on social networking sites (SNSs), which link to disordered eating. Furthermore, the research explored the moderating role of partner intimacy in romantic relationships.MethodsA sample of 761 Chinese college women completed the Ambivalent Sexism Inventory, subscales of the Eating Disorder Inventory, the Self-Objectification Questionnaire, and the Social Network Site Appearance Comparison Scale. Among these participants, 253 women in romantic relationships provided additional self-reports on partner intimacy. Data were analyzed using Hayes’ Process Macro Model 6 to test the serial mediation effects (via self-objectification and appearance comparison on SNSs) and Model 85 to test the moderated serial mediation model, where partner intimacy was specified as a moderator.ResultsThe results revealed that both benevolent sexism (b = 0.252, 95% CI [0.14, 0.36]) and hostile sexism (b = 0.162, 95% CI [0.05, 0.27]) were positively associated with disordered eating. These associations were mediated by self-objectification and sequentially through self-objectification and appearance comparison on SNSs. Notably, partner intimacy moderated the path from benevolent sexism to self-objectification (b = 0.095, 95% CI [0.01, 0.18]) and the effects from benevolent sexism to appearance comparison on SNSs (b = − 0.023, 95% CI [-0.04, -0.00]).ConclusionsThese findings suggest that women’s endorsement of ambivalent sexism is associated with disordered eating through self-objectification and appearance-related social comparison, and that romantic relationships are a critical context in which benevolent sexism is linked to women’s psychological processes. By integrating ambivalent sexism with objectification theory, this study advances understanding of how gendered beliefs intersect with relationship contexts in relation to women’s disordered eating in contemporary China.

Disclosure: J. Han: None. M. Yang: None. H. Lee: None. D. Ha: None. H. Kim: None. H. Yoo: None. J. Han: None. J. Kim: None.Background: Psychiatric conditions, such as depression, anxiety disorders, and eating disorders, are prevalent among children and adolescents with type 1 (T1D) and type 2 diabetes mellitus (T2D), which negatively impact diabetes management. Specifically, elevated depressive symptom scores have been linked to poor glycemic control. This study aimed to assess the impact of initial mental health status on clinical outcomes by conducting mental health screenings at diagnosis and comparing clinical outcomes based on screening results. Methods: Childhood-onset (<18 years) patients with T1D and T2D diagnosed between 2019 and 2023 at Seoul National University Bundang Hospital were included. Mental health screening was conducted within one month of diagnosis, and patients were followed for at least one year. Screening tools included the Eating Disorder Inventory-2 (EDI-2; limited to three subscales), the Children’s Depression Inventory (CDI), and the Child Behavior Checklist for ages 6-18 (CBCL 6-18). Patients were categorized into two groups: those with two or more positive findings (top 20% scores of each EDI-2 subscale) and those with all negative findings. Poor glycemic control was defined as glycated hemoglobin (HbA1c) ≥ 6.5% one year after diagnosis. Logistic regression analysis was performed to compare proportions. Results: The study population comprised 32 patients (56.1%) with T1D and 25 (43.9%) with T2D. The mean age at diagnosis was 12.9 ± 3.14 years, with 31 (54.4%) males. Poor glycemic control was observed in 17 patients (29.8%). Females exhibited higher rates of poor glycemic control compared to males (46.2% vs. 16.1%; p = 0.014). Father's educational level was significantly associated with poor glycemic control (p = 0.016), while no associations were found with type of diabetes, age at diagnosis, economic status, baseline HbA1c, BMI, the occurrence of diabetic ketoacidosis or severe hypoglycemia, and mothers' education level. Among the CBCL 6-18 subscales, the somatic problem subscale was significantly associated with poor glycemic control (OR 16.32; p = 0.020), whereas other subscales showed no significant associations. Patients with two or more positive findings (n = 10, 17.5%) exhibited a significantly higher risk of poor glycemic control (OR 9.6; p = 0.040) after adjusting for sex and father’s education level. Conclusion: Psychiatric conditions identified through mental health screening at diagnosis were associated with an increased risk of poor glycemic control in pediatric diabetes patients. These findings underscore the importance of addressing psychiatric comorbidities to optimize diabetes management in pediatric population. Further research is required to elucidate the underlying mechanisms of this association and to develop specialized mental health screening tools tailored for children and adolescents with diabetes.Presentation: Saturday, July 12, 2025

Psychiatric conditions are common in children and adolescents with diabetes and can hinder disease management. In this study, we examined whether mental health status at diagnosis predicts glycemic control at one year. We included 57 patients aged 6&#8211;18 years diagnosed with type 1 diabetes or type 2 diabetes between 2019 and 2023 at Seoul National University Bundang Hospital. Mental health was assessed within three months of diagnosis using the Eating Disorder Inventory-2, Children's Depression Inventory, and Child Behavior Checklist (CBCL) for ages 6-18. Poor glycemic control was defined as glycated hemoglobin > 6.5% at one year. Associations between screening results and glycemic control were analyzed using Fisher's exact test and multivariate logistic regression. Of the 57 patients, 32 (56.1%) had type 1 diabetes, and the mean age at diagnosis was 12.9 ± 3.1 years; 31 (54.4%) were male. Poor glycemic control at one year was observed in 16 (28.1%) patients. While individual subscale positivity was not significantly associated with glycemic control, borderline somatic complaints on the CBCL were significantly associated with poor control (p = 0.022). In multivariate analysis, having two or more positive CBCL subscales showed a trend toward association with poor control (adjusted odds ratio = 21.47, p = 0.054). Early psychological screening, especially for somatic symptoms or multiple psychological problems, may help identify pediatric patients with diabetes at risk for poor glycemic control. These findings underscore the importance of early detection and intervention in optimizing diabetes management.

BackgroundBorderline Personality Disorder (BPD) frequently co-occurs with both eating disorders (EDs) and elevated autistic traits, particularly among women. Social camouflaging—a set of strategies used to mask neurodivergent behaviors—has been extensively studied in autism spectrum conditions but remains underexplored in BPD populations. Given emerging evidence linking camouflaging behaviors to disordered eating, this study aimed to investigate the relationship between social camouflaging and eating disorder symptomatology in women with BPD.MethodsA total of 110 female participants (64 with BPD, 46 healthy controls) were assessed using the Camouflaging Autistic Traits Questionnaire (CAT-Q), the Eating Disorder Inventory-2 (EDI-2), and the Adult Autism Subthreshold Spectrum (AdAS Spectrum).ResultsWomen with BPD scored significantly higher on all domains of the CAT-Q, AdAS Spectrum, and EDI-2. Significant correlations emerged between CAT-Q and EDI-2 scores. CAT-Q total score and CAT-Q compensation domain significantly predicted EDI-2 total score.ConclusionSocial camouflaging is significantly elevated in women with BPD and is closely associated with disordered eating symptoms. Findings highlight camouflaging as a potential transdiagnostic mechanism linking autistic traits and ED symptomatology in BPD populations, with implications for diagnostic clarity and personalized treatment strategies.

ABSTRACT Psychological stress, negative body image, and mental health issues have increased post-pandemic, particularly among young women. However, evidence suggests that female ballet dancers – a high-risk group for eating disorders – may have developed a new, more positive perception of the ‘ballerina body’ during this period. We assembled a 128-item online survey on REDCap that included The Body Uneasiness Test (BUT), Eating Disorder Inventory (EDI), and Cov-19 QoL. We aimed to explore the eating habits, body image, and overall wellness of a sample of 641 female ballet dancers, aged 18–30. Results indicated that post-lockdown, dancers reported reduced preoccupation with dieting, weight, and body image disturbances. However, they also described heightened feelings of hopelessness, insecurity, and difficulty forming interpersonal relationships. Overall, ballerinas report an improvement in body image but a worsening of mental health following the Covid-19 pandemic. These findings underscore the need for dance institutions to prioritize psychological support alongside physical training. Ballet schools and companies may benefit from integrating structured recovery periods, open dialogue around mental health, and targeted support for younger or less experienced dancers. More broadly, this study calls for holistic, trauma-informed strategies when working with high-risk populations, and invites future research into sustainable models of well-being in elite performance settings.

Background/Objectives: Individuals with anorexia nervosa (AN) are known to exhibit both reduced pain sensitivity—when assessed via thresholds and subjective ratings—and diminished facial expressions of emotion. Therefore, investigating the facial response to pain in this population is of particular interest. Method: Seventeen patients with AN and 18 age- and sex-matched healthy controls were assessed using a thermode to induce heat pain. Subjective pain measures included pain threshold, pain tolerance, and pain ratings of supra-threshold stimuli, rated on a numerical rating scale (NRS). Facial responses to the suprathreshold stimuli were analyzed using the Facial Action Coding System (FACS). Eating pathology was assessed using the Eating Attitudes Test (EAT-26), the Eating Disorder Inventory-2 (EDI-2) and the body mass index (BMI), while depression was measured using the Beck Depression Inventory-II (BDI-II). Results: Compared with healthy controls, AN patients showed altogether significantly reduced facial expressions of pain, with particularly pronounced reductions in Action Units AU 6_7 and AU 9_10. In contrast, subjective pain measures showed only marginal differences between groups. Importantly, the reduction in facial expression could not be accounted for by differences in pain thresholds or ratings, nor by levels of eating pathology or depression. Conclusions: Individuals with AN display a markedly reduced facial expression of pain, which was observed for the first time, consistent with similar findings regarding the facial expressions of emotions. As this reduction cannot be explained by subjective pain report, it suggests that the communication of pain is impaired on two levels in AN: both in verbal and in nonverbal signaling. This may hinder the ability of others to recognize and respond to their pain appropriately.

Autism Spectrum symptoms in a population of extremely undernourished patients with Anorexia Nervosa: a pilot study.

IntroductionEating disorders are complex mental health conditions characterised by pathological behaviours related to food intake, often accompanied by a chronic obsession with weight control. Their prevalence is increasing, with an earlier onset and greater severity among young people. Universal prevention, through multicomponent strategies that tackle modifiable risk factors, has emerged as a promising tool. This paper reports the study protocol designed to assess the effectiveness and cost-effectiveness of the PRETA (Prevención de los Trastornos de la Alimentación) programme in reducing the risk of eating disorders and related modifiable risk factors among preadolescents in the school setting.Methods and analysisThe PRETA programme will be assessed by means of an open, community-based, multicentre, controlled trial using 1:1 matched-pairs cluster randomisation at the school level. Schools in Tenerife (Spain) will be assigned to the PRETA programme or a waitlist control group. Participants include 5th- or 6th-grade students (10–13 years old), their parents and teachers. The PRETA programme is a universal, school-based, multicomponent programme designed to reduce eating-disorder risk and modifiable risk factors. Its main component is an interactive online platform called e-PRETA, complemented by training sessions for families and teachers. e-PRETA includes nine 45-minute sessions addressing risk factors, such as dietary habits, beauty standards, media literacy, self-esteem, emotional regulation and social skills. A total of 1068 children from 12 schools will participate. The primary outcome will be the risk of developing eating disorders (Children’s Eating Attitudes Test-26 item version). Secondary outcome measures are body dissatisfaction (Adapted Contour Drawing Rating Scale), eating disorder traits (Eating Disorder Inventory-2), internalisation of appearance ideals (Sociocultural Attitudes Towards Appearance Questionnaire-4) and self-esteem (Rosenberg Self-Esteem Scale). Outcomes will be assessed at baseline and postintervention (3 months). Additional baseline covariates such as electronic device use, parental feeding attitudes, physical activity, sleep duration and screen time will also be collected. Programme effectiveness will be analysed using generalised mixed models. Cost-effectiveness will be assessed by comparing the incremental costs associated with the implementation of the PRETA programme with its estimated effectiveness.Ethics and disseminationEthics approval has been obtained from the Ethics Committee for Research with Medicines at the University Hospital of the Canary Islands (CHUC_2021_78). Written informed consent will be obtained from the parents or legal guardians of all participants. Results will be disseminated through scientific publications and conferences.Trial registration numberNCT06792981.

Background: Obesity remains a major global health challenge, and a significant proportion of bariatric surgery patients continue to experience dysfunctional emotional eating and body image concerns after surgery. Neurofeedback training (NFT) has been investigated as a potential intervention for maladaptive eating behaviours, but evidence in post-bariatric populations is still limited. Methods: Thirty-six patients who underwent sleeve gastrectomy were included, divided into an NFT group (N = 18) and a control group (N = 18). Assessments were performed at baseline and after 10 NFT sessions, using the Eating Disorder Inventory (EDI) and the Body Uneasiness Test (BUT). The intervention aimed to enhance alpha and theta waves with real-time feedback. Results: Compared with the control group, the NFT group showed significant improvements; specifically, reductions were observed in EDI subscales such as Drive for Thinness (p = 0.023, d = 0.51), Bulimia (p = 0.008, d = 0.92), Body Dissatisfaction (p = 0.015, d = 0.52), Ineffectiveness (p = 0.002, d = 0.89), Perfectionism (p = 0.006, d = 0.70), Interpersonal Distrust (p = 0.008, d = 0.82), and Interoceptive Awareness (p = 0.001, d = 0.91). Significant reductions were also found in BUT subscales including Weight Phobia (p = 0.041, d = 0.84), Body Image Concern (p = 0.039, d = 0.90), Avoidance (p = 0.027, d = 0.83), Compulsive Self-Monitoring (p = 0.013, d = 0.83), and Depersonalisation (p = 0.033, d = 0.85). Conclusions: The data indicate that NFT may help reduce emotional eating and related psychological factors in post-bariatric patients in the short term. However, studies with larger samples and longer follow-ups are needed to confirm its effectiveness and assess its clinical applicability.

This study compared overvaluation of weight and shape (OWS), drive for thinness (DT), and their combination (OWS-DT) as alternative severity classifications for anorexia nervosa (AN) to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) severity classification. 312 AN treatment-seeking outpatients (mean age = 26.8, SD = 10.2, mean body mass index = 17.3, SD = 2.4) were classified using BMI-based DSM-5 criteria (mild/moderate/severe/extreme), OWS (no/yes), DT (no/yes), and OWS-DT combination (neither/one or the other/both). These classifications were evaluated based on associations with clinical and functional severity indicators, including psychiatric comorbidities, psychopathology via the Eating Disorder Examination Questionnaire and the Eating Disorder Inventory, functional impairment via the Eating Disorders Quality-of-Life Questionnaire and Work-and-Social Adjustment Scale, and biological markers. OWS and DT separately were strongly and positively associated with psychiatric comorbidities, psychopathology, and functional impairment. Severity increased across OWS-DT groups, distinguishing mild (neither), moderate (mainly OWS), and severe (both OWS and DT). DT rarely appeared without OWS. DSM-5 classification alone had limited clinical relevance, primarily reflecting restriction of energy intake. No significant differences emerged across severity classifications for biological markers. Findings offer limited support for DSM-5 severity criteria alone. OWS and DT showed clearer clinical utility, with the OWS-DT combination more effectively identifying severity. A stepwise model-screening for OWS followed by DT assessment-may best capture severity in clinical settings.