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Objective: Recent research has suggested that problematic smartphone use is associated with several psychological factors and that mobile apps and smartphone-related behavior (i.e. selfi e behavior) may encourage the development of problematic smartphone use. However, little is known about how the interplay between dysfunctional personality characteristics and selfi e-related behavior can infl uence problematic smartphone use. The aim of this study was to examine the relationship between narcissism and problematic smartphone use, as well as the mediating role of selfi e-related behavior in this relationship among young men and women. Method: In the current study, a total of 627 undergraduate students (283 males and 344 females) completed a cross-sectional survey. A structural equation model was tested separately for males and females in order to evaluate the associations between narcissism, selfi e-related behavior and problematic smartphone use. Results: The results showed that greater narcissism was related to increased selfi e-related behavior, which in turn were positively associated with problematic smartphone use both for males and females. However, selfi e-related behavior mediated the relationship between narcissism and problematic smartphone use only for females. Conclusions: The study provides fresh insight into our understanding of the psychological mechanisms underlying problematic smartphone use, which may inform prevention and treatment interventions.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD. (c) 2018 The Author(s). Published by Elsevier Masson SAS.

Purposes: Congenital uterine anomalies (CUA) are benign conditions associated with relatively serious complications affecting the reproductive life. Due to their infrequency CUA are often misdiagnosed, exposing the patient to possible future complications. Case description: We report the cases of three women affected by an unknown CUA, which underwent three different diagnostic and surgical approaches. Conclusions: A correct and early diagnosis of CUA is mandatory to allow a correct clinical and therapeutic management. In our opinion we might avoid the use of MRI considered as the second line technique after 2D-US, keeping in mind that in CUA the diagnostic value of 3D-US has the same accuracy as MRI.

Background. A growing body of research has highlighted the negative effects of the COVID-19 pandemic on women’s mental health. Previous studies showed that women have higher levels of depression, anxiety and PTSD, and worse psychological adjustment than men, which also persisted after the earlier phase of the pandemic. This study aimed to evaluate changes in women’s psychological distress during the pandemic and to evaluate the factors that have a more significant impact in predicting women’s psychological distress. Methods. This two-wave longitudinal study (T1 = Italian first lockdown, and T2 = second phase, when the restrictive measures were eased) involved 893 women (Mage = 36.45, SD = 14.48). Participants provided demographic and health data as well as measures of psychological distress, emotion regulation processes, and ability to tolerate uncertainty. Results. No significant changes were found in women’s psychological distress between T1 and T2, i.e., during and after the first lockdown. Lower social stability status and higher maladaptive emotional coping predicted high psychological distress. Conclusions. Results showed that modifiable psychological variables play a central role in predicting distress and indicated that emotion regulation interventions might be helpful in increasing psychological resilience and mitigating the adverse impacts of the COVID-19 pandemic within the female population.

Il conferimento d’azienda, quale strumento finalizzato ad attuare il passaggio generazionale dell’impresa dal titolare ai propri familiari, è largamente adoperato nella pratica poiché permette all’imprenditore – da un lato – di anticipare gli effetti che deriverebbero dalla successione ereditaria, scegliendo liberamente i familiari che ritiene più idonei a proseguire l’attività d’impresa con l’azienda conferita e – dall’altro – di assicurare una maggiore stabilità degli effetti rispetto all’alternativa della donazione di azienda, evitando (o almeno limitando) successivi dissidi e conflitti tra gli eredi, e beneficiando nel contempo di un trattamento fiscale più favorevole. Si tratta, inoltre, di uno strumento particolarmente “duttile”, che si presta ad essere impiegato sia dall’imprenditore individuale (compreso il caso dell’impresa familiare), sia nell’ambito di realtà imprenditoriali a struttura associativa e societaria. Nel contributo vengono analizzati anzitutto i tratti distintivi della fattispecie, evidenziando le differenze rispetto a tecniche alternative (donazione dell’azienda, patto di famiglia, operazioni societarie straordinarie). Quindi si passa ad esaminare la disciplina applicabile sul piano civilistico, risultante dalla combinazione delle norme sul trasferimento di azienda e di quelle sui conferimenti in società (e diverse a seconda del tipo prescelto per la società conferitaria): dalla delimitazione dei beni aziendali che possono formare oggetto di conferimento, alla valutazione dell’azienda conferita; dalla forma e pubblicità del conferimento al divieto di concorrenza; dal subingresso nei contratti e nei rapporti di lavoro al regime dei crediti e dei debiti aziendali.

Abstract. The Smartphone Addiction Inventory (SPAI) is widely used to measure problematic smartphone use (PSU). Although the SPAI has been translated and validated in different countries, its measurement invariance across gender has received little research attention. This study aimed to examine whether men and women interpreted the Italian version of the SPAI (SPAI-I) similarly and, consequently, whether the observed gender differences in SPAI scores, which have been shown in previous studies, could be due to true differences, rather than to differences in measurement. Six hundred nineteen Italian young adults ( Mage = 22.02 ± 2.63; 55.7% women) took part in the study and completed the SPAI-I. Multigroup CFA was applied to test the measurement invariance across gender, and the item parameter invariance was investigated with the item-response theory (IRT) differential item functioning (DIF) method for multidimensional models. Evidence of measurement invariance across gender was found. Only one item (i.e., item 14, “The idea of using smartphone comes as the first thought on mind when waking up each morning”) out of 24 items of the SPAI-I showed DIF with a large effect size. Gender-related differences found with the SPAI-I reflect true differences in smartphone overuse rather than specific characteristics of the measure.

The stress and anxiety caused by the coronavirus pandemic (COVID-19) have exacerbated body image concerns. A society that perpetuates the attempt for a perfect and thin appearance represents a fertile ground for the development of exercise addiction (EA). This cross-sectional study aims to explore EA during the second wave of the pandemic (October–December 2020) and to examine the independent influence of both time spent on moderate and vigorous physical activities and body image variables (i.e., drive for leanness and sociocultural attitudes toward appearance) on EA. A sample of Italian sporty people (N = 194; 48.5% females; Mage = 25.91 ± 6.32) was surveyed using the Exercise Addiction Inventory, the Drive for Leanness Scale, the Sociocultural Attitudes Towards Appearance Questionnaire, and the Global Physical Activity Questionnaire. A total of 82% of the sample were symptomatic of and 11.3% were at risk of EA. Hierarchical regressions revealed an association between the time spent on vigorous physical activities and levels of EA (p < 0.05). Moreover, body image variables were positively related to EA, explaining an additional 11% of variance (p < 0.05). Results showed the importance of considering and addressing body image factors to investigate and dampen the risk of EA among sporty people.

Contemporary adolescents increasingly engage with social media via their smartphones, and problematic smartphone use has been identified as a growing concern. The aim of the current study was to examine the association between problematic smartphone use and body esteem among adolescent boys and girls. A sample of 647 adolescents (mean age: 14.15years; 56.7% females) completed measures of problematic smartphone use, emotional regulation, and body esteem. Findings from hierarchical regression models revealed that problematic smartphone use was weakly associated with body esteem among both adolescent girls and boys. Furthermore, difficulties with emotional regulation were moderately associated with problematic smartphone use and, among girls, moderated the relationship between problematic smartphone use and the evaluation attributed to others about one’s own body, such that problematic smartphone use was more tightly associated with appearance attributions among girls with greater emotion regulation difficulties. This study provides initial support for the relationships between problematic smartphone use and emotional regulation difficulties on the one hand, and body esteem on the other, among both adolescent boys and girls.

The social isolation and the subsequent, increased use of Social Networking Sites due to the COVID-19 pandemic have had an impact on subjective well-being around the world. The present longitudinal study examined whether changes in psychological distress and well-being during the Italian second wave of the pandemic differ among people with different levels of Problematic Facebook Use (PFU). A total of 493 participants (Mage = 24.55 ± 7.25; 80.3% females) completed measures of passive use of Facebook, social comparison orientation on Facebook, fear of missing out, psychological distress (depressive symptoms and fear of COVID-19 pandemic) and well-being across three waves. Latent class analysis (LCA) categorized participants into three groups with different PFU levels: healthy users, moderate PFU users, and high PFU users. Hierarchical linear modeling (HLM) showed that the between-person level (class membership) accounted for most of the variability in psychological distress and well-being. No significant changes were found in psychological distress and well-being over time, but the High PFU users showed greater levels of psychological distress and lower levels of well-being at each time point. The findings of this study suggest that the relationship between PFU, psychological distress and well-being may reflect trait-like time-invariant differences between individuals rather than state-like changes.

Background: It still remains unclear whether problematic social media use (PSMU) is a cause or a consequence of psychological distress. The present study aimed to investigate the temporal relationships between PSMU and psychological distress through a three-wave panel study (between April and July 2020, with an interval of 1 month between each period of time). Methods: 3,912 adult Italian participants were surveyed during the COVID-19 pandemic for psychological distress (Depression, Anxiety and Stress Scale) and PSMU (Bergen Social Media Addiction Scale). Random-Intercept Cross-Lagged Panel Models were applied to disaggregate between-person from within-person associations as regards PSMU and an individual’s distress. Results: On a between-person level we found that adults with higher PSMU also reported heightened levels of psychological distress across the three waves. However, on a within-person level, no cross-lagged associations were found between changes in distress and subsequent changes in PSMU and vice versa. The results were largely unchanged with the inclusion of participants’ gender and age or COVID-19-related fears as covariates, and when the three subscales of depression, anxiety and stress were examined in separate models. Conclusions: The current study suggests that the link between PSMU and psychological distress is mainly driven by trait-like differences and not by state-like individual changes over time.

miRNAs modulate cardiomyocyte specification by targeting mRNAs of cell cycle regulators and acting in cardiac muscle lineage gene regulatory loops. It is unknown if or to-what-extent these miRNA/mRNA networks are operative during cardiomyocyte differentiation of adult cardiac stem/progenitor cells (CSCs). Clonally-derived mouse CSCs differentiated into contracting cardiomyocytes in vitro (iCMs). Comparison of “CSCs vs. iCMs” mRNome and microRNome showed a balanced up-regulation of CM-related mRNAs together with a down-regulation of cell cycle and DNA replication mRNAs. The down-regulation of cell cycle genes and the up-regulation of the mature myofilament genes in iCMs reached intermediate levels between those of fetal and neonatal cardiomyocytes. Cardiomyo-miRs were up-regulated in iCMs. The specific networks of miRNA/mRNAs operative in iCMs closely resembled those of adult CMs (aCMs). miR-1 and miR-499 enhanced myogenic commitment toward terminal differentiation of iCMs. In conclusions, CSC specification/differentiation into contracting iCMs follows known cardiomyo-MiR-dependent developmental cardiomyocyte differentiation trajectories and iCMs transcriptome/miRNome resembles that of CMs., Scalise et al. examine the mRNAome and miRNAome of cardiomyocytes differentiated from murine adult cardiac stem cells (CSCs). Their results show that the differentiation process follows a trajectory of miRNA/mRNA expression that resembles that of adult cardiomyocytes.

The coronavirus disease 2019 (COVID-19) spread several months ago from China and it is now a global pandemic. The experience of lockdown has been an undesirable condition for people with mental health problems, including eating disorders. The present study has the aim of understanding the impact of the first wave of the COVID-19 pandemic on people with selfreported disordered eating behaviours. A linguistic analysis was carried out with regard to the online posts and comments published by 1971 individuals (86% women) in a Facebook online community focusing on EDs during the lockdown. A total of 244 posts and 3603 comments were collected during the 56 days of lockdown (from the 10th of March until the 4th of May 2020) in Italy and were analysed by Linguistic Inquiry and Word Count (LIWC) software. The results showed that words related to peer support decreased in posts over time, and that anxiety and anger increased in the published comments. Moreover, greater feelings of negativity and anxiety were found in posts and comments throughout the COVID-19 pandemic, as well as lesser use of words related to positive emotions. Thematic qualitative analysis revealed eight themes that described the main subjective components of ED symptomatology and distress during the first COVID-19 lockdown. The current findings can help in delivering tailored treatments to people with eating disorders during the COVID-19 pandemic.

Recent studies have suggested that health constructs embraced by the Terror Management Theory (TMT) and the Basic Psychological Needs Theory (BPNT) may drive individuals’ COVID-19 health-related decisions. This study examines the relationships between existential concerns (ECs; within the TMT), basic psychological needs (BPNs; within the BPNT) and COVID-19 vaccine hesitancy (VH), as well as the mediating role of negative attitudes toward COVID-19 vaccines. A cross-sectional survey was carried out from April to May 2021 on a sample of two hundred and eighty-seven adults (Mage = 36.04 ± 12.07; 59.9% females). Participants provided information regarding existential concerns, basic psychological needs, attitudes toward COVID-19 vaccines and vaccine hesitancy for Pfizer-BioNTech and AstraZeneca vaccines separately. Higher vaccine hesitancy (32.1%) and vaccine resistance (32.8%) rates were found for AstraZeneca than for Pfizer-BioNTech COVID-19 vaccine (22.3% and 10.1%, respectively). Structural equation modeling showed that existential concerns were related to Pfizer-BioNTech and AstraZeneca vaccine hesitancy both directly and indirectly through negative attitudes toward potential side effects of COVID-19 vaccines. The findings of the study confirm that the TMT is efficient in explaining COVID-19 vaccine hesitancy. Targeted efforts are needed to increase the acceptance of COVID-19 vaccines.

Background In recent years, the Fear of Missing Out (FoMO) construct has been the object of growing attention in digital technology research with previous studies finding support for the relationship between FoMO and problematic smartphone use (PSU) among adolescents and young adults. However, no previous studies clarified the causal link between FoMO and PSU using a longitudinal design. Methods An auto-regressive, cross-lagged panel design was tested by using a longitudinal dataset with two waves of data collection (T0 and T1, one year apart). Participants included two hundred and forty-two adolescents (109 males and 133 females), with a mean age of 14.16 years, who filled out the Fear of Missing Out scale (FoMOs) and the Smartphone Addiction Scale (SAS). Moreover, participants filled out the Difficulties in Emotion Regulation Scale (DERS), at the first time-point of data collection. Results The findings of the study show that FoMO (both FoMO-Fear and FoMO-Control subscales) and PSU are positively related at both time-points (i.e. at a cross-sectional level). However no cross-lagged associations between them were longitudinally supported. Females and older adolescents show higher FoMO-Fear at T1. Conclusions The findings of the present study suggest caution when causal links between FoMO and PSU are inferred.

The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841.

Aims Cardiac myxomas usually develop in the atria and consist of an acid-mucopolysaccharide-rich myxoid matrix with polygonal stromal cells scattered throughout. These human benign tumours are a valuable research model because of the rarity of cardiac tumours, their clinical presentation and uncertain origin. Here, we assessed whether multipotent cardiac stem/progenitor cells (CSCs) give rise to atrial myxoma tissue. Methods and results Twenty-three myxomas were collected and analysed for the presence of multipotent CSCs. We detected myxoma cells positive for c-kit (c-kitpos) but very rare Isl-1 positive cells. Most of the c-kitpos cells were blood lineage-committed CD45pos/CD31pos cells. However, c-kitpos/CD45neg/CD31neg cardiac myxoma cells expressed stemness and cardiac progenitor cell transcription factors. Approximately ≤10% of the c-kitpos/CD45neg/CD31neg myxoma cells also expressed calretinin, a characteristic of myxoma stromal cells. In vitro, the c-kitpos/CD45neg/CD31neg myxoma cells secrete chondroitin-6-sulfate and hyaluronic acid, which are the main components of gelatinous myxoma matrix in vivo. In vitro, c-kitpos/CD45neg/CD31neg myxoma cells have stem cell properties being clonogenic, self-renewing, and sphere forming while exhibiting an abortive cardiac differentiation potential. Myxoma-derived CSCs possess a mRNA and microRNA transcriptome overall similar to normal myocardium-derived c-kitpos/CD45neg/CD31negCSCs , yet showing a relatively small and relevant fraction of dysregulated mRNA/miRNAs (miR-126-3p and miR-335-5p, in particular). Importantly, myxoma-derived CSCs but not normal myocardium-derived CSCs, seed human myxoma tumours in xenograft’s in immunodeficient NOD/SCID mice. Conclusion Myxoma-derived c-kitpos/CD45neg/CD31neg CSCs fulfill the criteria expected of atrial myxoma-initiating stem cells. The transcriptome of these cells indicates that they belong to or are derived from the same lineage as the atrial multipotent c-kitpos/CD45neg/CD31neg CSCs. Taken together the data presented here suggest that human myxomas could be the first-described CSC-related human heart disease.

Background: This study investigated the relationship among negative affect, body image disturbances (BID), and interpersonal problems, and the mediat- ing effect of self-esteem in a group of treatment-seeking obese individuals. Methods: Four hundred twenty-two obese patients (85 males and 337 females) completed standardised measures that assessed negative affect, BID, self-esteem, and interpersonal problems. Results: Structural equation modelling showed that obese individuals with greater negative affect and BID reported higher interpersonal problems and that self-esteem mediated the relationships among negative affect, BID, and interpersonal problems. Conclusions: The mediating role of self-esteem in the relationship between interpersonal functioning and psychological distress needs to be considered when selecting psychologically based interventions that aim to improve the well-being of treatment-seeking obese patients.

Although several studies have investigated the factor structure of the Rosenberg Self-Esteem Scale (RSES), there are still disagreements about it. The present study assessed: a) the goodness of fit of nine competing factor models for the RSES using data from a clinical sample of 855 women with eating/weight disorders; and b) its measurement invariance across clinical and non-clinical (n = 943) samples. A bifactor model, with a general self-esteem factor, plus positive and negative method factors, provided a better fit with the data than alternative models. However, the results showed the high reliability of the general self-esteem factor, and a low reliability of the two method factors. Furthermore, the full metric invariance of the RSES, as well as a partial scalar invariance and partial strict invariance across clinical and non-clinical groups, was supported by our findings. The factor variances and means differed significantly across groups. Overall, the findings of this study showed that the factor structure of the RSES is contaminated by method effects due to item wording, also with clinical samples, and that respondents from clinical and non-clinical groups interpret the self-esteem construct of the RSES items in a substantially similar way.

Previous research has evidenced the link between body image dissatisfaction, social anxiety, low self-esteem, negative affect and eating disorders in adolescence. The present study aimed to explore the gender differences on body image perception, self-esteem, and relational styles in a group of adolescents and to investigate whether body image and self-esteem predict the development of interpersonal problems in a different way for males and females. Method: Data were obtained from a group (n = 1311) of adolescents (805 males and 506 females), recruited in a high school in Palermo. Participants filled in the BIAI, the IIP-32 and the RSES. Results: Our results confirm the difference between males and females in the areas investigated and the link between perception of body image dissatisfaction, self esteem and interpersonal problems. Furthermore, only in males participants self-esteem partially mediated the relationship between body image and interpersonal problems. Conclusions: Results imply that levels of self-esteem and body dissatisfaction must be considered to prevent the development of relational problems in adolescents.

Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient-carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer (n = 149; mostly mothers) were randomised to receive a carer skills intervention (ECHO) in addition to treatment as usual (TAU), or TAU alone, as part of a larger clinical trial. Carers and patients completed a standardised measure of psychological distress (The Depression, Anxiety, and Stress Scale) at baseline and 12 months post-treatment. The Actor Partner Interdependence Model was used to examine longitudinal changes in interdependence by treatment group. As expected, post-treatment levels of distress were related to baseline levels in both groups (actor effects). Moreover, carer distress at 12 months was related to patient distress at baseline for the TAU (partner effects), but not for the ECHO group. Finally, carers' distress change was not a significant predictor of patients' body mass index (BMI) change in the two treatment conditions. These findings are limited to predominantly mother-offspring dyads and may not generalise to other relationships. The ECHO intervention which is designed to teach carers skills in illness management and emotion regulation may be an effective addition to TAU for ameliorating interdependence of distress in patients and their primary carers over time.

Study question Is the Fertility Quality of Life Questionnaire (FertiQoL)-Relational Scale a valid measure to assess the relational domain regarding quality of life in women and men undergoing infertility treatment? Summary answer The FertiQoL-Relational scale (FertiQoL-REL) showed good psychometric properties and captured core aspects of couple relationships. What is known already FertiQoL has become a gold standard for the assessment of infertility-related quality of life in patients undergoing assisted reproduction treatment (ART). Despite its growing importance, no previous studies have examined the convergent validity of the FertiQoL-REL and its discriminant validity across gender. Study design, size, duration Baseline cross-sectional data as part of a longitudinal study of infertile couples undergoing an ART between February 2013 and January 2015. Participants/materials, setting, methods Five hundred and eighty-nine patients (301 females and 288 males), prior to starting an ART in a private clinic, filled in the Fertility Quality of Life Questionnaire (FertiQoL) and several measures of the marital relationship (Dyadic Adjustment Scale, Marital Commitment Inventory and ENRICH Marital Satisfaction Scale) and infertility-related distress (Fertility Problem Inventory). Main results and the role of chance Confirmatory factor analysis showed that the FertiQoL four-factor solution provided a good fit for the observed data. Reliability of the FertiQoL-REL was higher for women than men. Significant correlations between the FertiQoL-REL scores and all the other measures of marital relationship were found for both women and men. FertiQoL-REL scores did not differ significantly in women and men. The FertiQoL-REL was able to differentiate subjects as regards the Dyadic Adjustment Scale and ENRICH Marital Satisfaction Scale threshold. Limitations, reasons for caution Findings are limited because the data were obtained from only one Italian private clinic. Wider implications of the findings FertiQoL-REL threshold scores are useful for identifying those patients undergoing ART who are more likely to report poor or good relationship quality. Clinicians should tailor their counselling strategies to the positive qualities in a couple's relationship, so as to reinforce the overall quality of life, especially among women, and to support patients in tackling the psychological burden, so that they can either continue treatment or choose discontinuation. Study funding/competing interests This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study. Trial registration number Not necessary.

The interpersonal model has been validated for binge eating disorder (BED), but it is not yet known if the model applies to individuals who are obese but who do not binge eat. The goal of this study was to compare the validity of the interpersonal model in those with BED versus those with obesity, and normal weight samples. Data from a sample of 93 treatment-seeking women diagnosed with BED, 186 women who were obese without BED, and 100 controls who were normal weight were examined for indirect effects of interpersonal problems on binge eating psychopathology mediated through negative affect. Findings demonstrated the mediating role of negative affect for those with BED and those who were obese without BED. Testing a reverse model suggested that the interpersonal model is specific for BED but that this model may not be specific for those without BED. This is the first study to find support for the interpersonal model in a sample of women with obesity but who do not binge. However, negative affect likely plays a more complex role in determining overeating in those with obesity but who do not binge. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Objective: The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa. Method: A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents (n = 196) of adolescents (n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report. Results: Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour was significantly lower in fathers than in mothers. Accommodating behaviours mediated the relationship between objective burden and subjective burden in mothers, whereas EE and carers' skills did not mediate this relationship for either parent. Discussion: The objective burden for most mothers is high. In order to reduce subjective burden, it may be helpful to target accommodating behaviours. Trial Registration: ISRCTN83003225 - Expert Carers Helping Others (ECHO). Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Background The cognitive interpersonal model predicts that parental caregiving style will impact on the rate of improvement of anorexia nervosa symptoms. The study aims to examine whether the absolute levels and the relative congruence between mothers' and fathers' care giving styles influenced the rate of change of their children's symptoms of anorexia nervosa over 12 months. Methods Triads ( n =54) consisting of patients with anorexia nervosa and both of their parents were included in the study. Caregivers completed the Caregiver Skills scale and the Accommodation and Enabling Scale at intake. Patients completed the Short Evaluation of Eating Disorders at intake and at monthly intervals for one year. Polynomial Hierarchical Linear Modeling was used for the analysis. Results There is a person/dose dependant relationship between accommodation and patients' outcome, i.e. when both mother and father are highly accommodating outcome is poor, if either is highly accommodating outcome is intermediate and if both parents are low on accommodation outcome is good. Outcome is also good if both parents or mother alone have high levels of carer skills and poor if both have low levels of skills. Limitations Including only a sub-sample of an adolescent clinical population; not considering time spent care giving, and reporting patient's self-reported outcome data limits the generalisability of the current findings. Conclusion Accommodating and enabling behaviours by family members can serve to maintain eating disorder behaviours. However, skilful behaviours particularly by mothers, can aid recovery. Clinical interventions to optimise care giving skills and to reduce accommodation by both parents may be an important addition to treatment for anorexia nervosa.