Risk and Maintenance Factors for Eating Disorders: An Exploration of Multivariate Models on Clinical and Non-Clinical Populations

The recognition of factors involved in the development and maintenance of eating disorders (EDs) may support the choice of therapeutic strategies and improve the prevention/treatment of eating pathologies and their outcomes. Based on this consideration, the overall purpose of the chapter is to investigate how some psychological characteristics link to EDs. It is organized as follows. First, the epidemiological aspects, risk, and maintaining factors for ED are outlined. Next, we present the findings from our two studies. The purpose of the first study was to identify predictors associated with the severity of eating symptomatology. Then, the objective of the second study was to provide an understanding of the relationship among perceived parental bonding, self-esteem, perfectionism, body shame, body mass index, and ED risk and mainly to test a predictive ED risk model in a non-clinical sample. In conclusion, the major findings and practical implications are discussed

Does Anger Expression Mediate the Relationship Between Parental Rejection and Direct and Indirect Forms of Non-suicidal Self-injury?

Non-suicidal self-injury (NSSI) is defined as the intentional destruction of one’s own body without an intent to die (e.g., self-cutting). On the other hand, indirect forms of self-injury refer to behaviors in which people harm themselves in an indirect way (e.g., substance use). Existing literature suggests that a negative parent–child relationship may increase vulnerability to NSSI and indirect forms of self-injury. However, little is known about the potential mediators that intervene in the aforementioned relationship. Therefore, the present work tests a path model to investigate whether the manner of anger expression—anger-in (redirect anger inwardly) or anger-out (express anger outwardly)—mediates the association between parental rejection and direct (specifically self-cutting) and indirect (specifically substance use) forms of self-injury in a cross-sectional sample of Italian adolescents. We assessed self-injury, parental acceptance/rejection, and the expression of anger using self-report questionnaires in 2464 high school students, aged 13–20 years (Mage = 15.93, SD = 1.49). Additionally, characteristics of NSSI were also assessed using semi-structured interviews. We found that parental rejection was significantly positively associated with both self-cutting and substance use. The aforementioned relationship was mediated through anger-in for self-cutting, and through anger-out for substance use. The current work demonstrated that anger expression might work as a bridge between invalidating caregiving environment (i.e., rejecting), in which an individual feels unloved and uncared for, and the occurrence of self-cutting and substance use. The salient role of anger management in the development of prevention and intervention programs for NSSI and indirect self-injury among adolescents is discussed

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 8(th) grade students were trained to serve as peer educators and held a peer-education intervention for 6(th) and 7(th) 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

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

Unique and shared correlates of disordered eating and non-suicidal self-injury among school-based adolescents

Background: Disordered eating (DE) and non-suicidal self-injury (NSSI) commonly co-occur, resulting in increasingly adverse outcomes. Parental bonding, self-esteem, emotion dysregulation, and body-related concerns have been implicated in DE and NSSI, separately and in combination. Little is known about how they contribute to their interrelationship. Thus, the present study investigates the degree to which those constructs represent shared or unique risk factors for NSSI, DE and their overlapping. Methods: Participants were 309 Italian school students (Mage=15.64, SD=1.98) screened by mixed methods. Based on a semi-structured interview and a clinical cut-off, they were divided into four groups: NSSI (n=58), DE (n=118), DE+NSSI (n=34), and a control group (CG; n=99). MANCOVAs were used to examine differences in the dependent measures. A series of stepwise logistic regressions were also used to investigate which of the dependent variables best predicted group membership. Results: NSSI, DE, and DE+NSSI scored significantly different on almost all measures compared to CG, while the combined group showed greater impairment than other groups. Body-related constructs significantly differentiated the DE group from the NSSI group. The co-occurrence of DE and NSSI was influenced by emotion dysregulation and body dissatisfaction. Limitations: Sample of typically functioning adolescents completing self-report measures. Conclusions: Difficulties in regulating emotions and body dissatisfaction appear to increase the likelihood of co-occurrence, while body-related concerns have more salience to DE. Enhancing emotion regulation skills may be an effective intervention measure, also targeting body-related constructs according to the predominant condition. Further investigation of risk factors would result in more comprehensive etiological models

The permanence of the setting modifications adopted during the COVID-19 pandemic in the clinical practice of Italian psychoanalysts

The research aims to verify if the remote modality, introduced widely by Italian psychoanalysts at the lockdown, remains in clinical practice today, with specific reasons and characteristics. The authors hypothesize that the use of such modality, beyond health limitations, is a point of no return compared to the classical setting. Based on this hypothesis, an ad hoc online questionnaire was proposed; the subjects were also called upon to express an opinion on taleanalysis. Two hundred sixty-seven subjects responded. The results confirm a wide use of remote analysis even in the current situation. They seem to indicate recognition by psychoanalysts of the emergence of new psychic phenomena in this type of setting, for example, childhood traumas that in the face-to-face analysis were unknown or inelaborate, usable in the treatment process.La ricerca intende verificare se l’uso della modalità da remoto, introdotto in maniera diffusa dagli psicoanalisti italiani al tempo del lockdown, permanga ancora oggi nella pratica clinica, con quali motivazioni e caratteristiche specifiche. Gli autori ipotizzano che il ricorso a tale modalità, aldilà delle limitazioni sanitarie, sia un punto di non ritorno rispetto al setting classico. Sulla base di questa ipotesi, è stato proposto un questionario online, costruito ad hoc; i soggetti erano chiamati anche a esprimere una opinione sulla teleanalisi. Hanno risposto 267 soggetti. I risultati confermano un ampio utilizzo dell’analisi da remoto anche nella situazione attuale e sembrano indicare il riconoscimento da parte degli psicoanalisti dell’emergere di nuovi fenomeni psichici in questo tipo di setting, ad esempio traumi infantili che nell’analisi in presenza risultavano sconosciuti o inelaborabili, utilizzabili nel processo di cura

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

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 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