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Numerous studies addressed the topic of behavioral and symptomatic changes in eating disorders. Rates of transition vary widely across studies, ranging from 0 to 70.8%, depending on the diagnoses taken into account and the study design. Evidence shows that the specific transition from restrictive-type anorexia nervosa (AN-R) to disorders involving binging and purging behaviors (BPB) is related to a worsening of the clinical picture and worse long-term outcomes. The aim of this systematic review and meta-analysis is to focus on this specific transition, review existing literature, and summarize related risk factors. Medline and PsycINFO databases were searched, including prospective and retrospective studies on individuals with AN-R. The primary outcome considered was the rate of onset of BPB. Twelve studies (N = 725 patients) were included in the qualitative and quantitative analysis. A total of 41.84% (95% CI 33.58-50.11) of patients with AN-R manifested BPB at some point during follow-up. Risk factors for the onset of BPB included potentially treatable and untreatable factors such as the family environment, unipolar depression and higher premorbid BMI. These findings highlight that patients with AN-R frequently transition to BPB over time, with a worsening of the clinical picture. Existing studies in this field are still insufficient and heterogeneous, and further research is needed. Mental health professionals should be aware of the frequent onset of BPB in AN-R and its risk factors and take this information into account in the treatment of AN-R. LEVEL OF EVIDENCE: Evidence obtained from a systematic review and meta-analysis, Level I., (© 2021. The Author(s).)

Background: Binge eating disorder (BED) is commonly associated with a history of trauma. Yet, there is little insight into the potential effect that trauma, dissociation, and depressive symptoms may have on the outcome of treatment interventions., Methods: A total of 142 treatment-seeking patients admitted with a diagnosis of DSM-5 BED (88% female; mean age = 38.7; SD = 10.8) took part in a 6-month, protocolized, group cognitive behavioural therapy (CBT). Self-report questionnaires were administered to assess lifetime traumatic experiences, dissociation, and depression. Body mass index and the number of binges per week (BPW) were measured throughout treatment. The main outcomes were the percentage reduction in BPW and remission (i.e., less than one BPW; cf. DSM-5)., Results: Most BED patients (91.5%) reported a history of trauma, with two in three patients reporting three or more traumatic experiences. Whereas the number of traumatic experiences was not significantly associated with a reduction in BPW or remission, a higher traumatic impact score significantly decreased the likelihood of obtaining remission at the end of treatment (OR = 0.96; 95% CI [0.92, 0.99]). Higher levels of dissociative symptoms partially mediated this prospective association., Conclusions: The impact of traumatic experiences, as opposed to the number of traumatic experiences experienced, negatively predicts remission after 6 months of CBT. These findings highlight the importance of addressing trauma and dissociative features in the CBT treatment of BED., (© 2020 John Wiley & Sons, Ltd and Eating Disorders Association.)

We combined virtual reality and multisensory bodily illusion with the aim to characterize and reduce the perceptual (body overestimation) and the cognitive-emotional (body dissatisfaction) components of body image distortion (BID) in anorexia nervosa (AN). For each participant (20 anorexics, 20 healthy controls) we built personalized avatars that reproduced their own body size, shape, and verisimilar increases and losses of their original weight. Body overestimation and dissatisfaction were measured by asking participants to choose the avatar that best resembled their real and ideal body. Results show higher body dissatisfaction in AN, caused by the desire of a thinner body, and no body-size overestimation. Interpersonal multisensory stimulation (IMS) was then applied on the avatar reproducing participant's perceived body, and on the two avatars which reproduced increases and losses of 15% of it, all presented with a first-person perspective (1PP). Embodiment was stronger after synchronous IMS in both groups, but did not reduce BID in participants with AN. Interestingly, anorexics reported more negative emotions after embodying the fattest avatar, which scaled with symptoms severity. Overall, our findings suggest that the cognitive-emotional, more than the perceptual component of BID is severely altered in AN and that perspective (1PP vs. 3PP) from which a body is evaluated may play a crucial role. Future research and clinical trials might take advantage of virtual reality to reduce the emotional distress related to body dissatisfaction.

Individuals with eating disorders (EDs) often report a history of early traumatization. Although great attention has been paid to certain types of trauma, such as sexual and emotional abuse, less is known about the occurrence of childhood neglect in individuals with EDs. The aim of the present meta-analysis was to provide an estimate of the prevalence of childhood emotional neglect (EN) and physical neglect (PN) in individuals with EDs. A systematic literature search, a critical appraisal of the collected studies, and a meta-analysis were conducted. An electronic search of EMBASE, PsycINFO, PubMed, and the Cochrane Library from the inception of these databases up to July 2015 was performed. The final meta-analyzed data set included 7 studies focusing on EN in EDs (N = 963) and 6 on PN in EDs (N = 665). Our meta-analytic data showed that among individuals with EDs, the prevalence of childhood EN is 53.3%, whereas 45.4% reported experience of childhood PN. These preliminary findings confirm the high prevalence of childhood EN and PN in ED samples compared to the general population and underline the importance of systematically screening for the presence of neglect as a possible traumatic experience in individuals with EDs, as its presence may have important consequences for the therapeutic approach.

Objective: The purpose of this study was to assess olfactory-gustatory function impairment in patients with eating disorders., Methods: Nineteen patients with a diagnosis of bulimia nervosa, 18 patients with a diagnosis of anorexia nervosa and a control sample of 19 healthy subjects were recruited from the day hospital service of the Complex Operative Unit for Alimentary Conduct Disorders of the Policlinico Umberto I in Rome. Evaluation of olfactory and gustatory functions was performed on patients through the 'Sniffin' Sticks' method in order to assess the olfactory threshold, the capacity for discriminating and identifying olfactory stimuli, and the overall olfactory function, and through the 'taste strip' kit method in order to assess the gustatory function. The results were processed statistically to assess differences between patients with anorexia nervosa, patients with bulimia nervosa and healthy controls., Results: The two groups of patients with bulimia nervosa and anorexia nervosa showed a poorer olfactory and gustatory function compared with the healthy controls; discrimination of olfactory stimuli and overall olfactory function were reduced in both samples, as well as the overall gustatory function and the perception of bitter stimuli, whereas olfactory threshold was altered only in patients with bulimia nervosa. In both samples, scores for olfactory function fell within the range of hyposmia., Discussion: Our data suggest that patients with eating disorders have an altered perception of olfactory and gustatory stimuli. The alterations observed are worth further investigation., (Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.)

Aim: This study investigate presence, the psychopathological and treatment implications of weight phobia and maturity fears in patient with eating disorders., Methods: The study group comprised 43 patients, with diagnosis DSM-IV-TR for anorexia, bulimia and eating disorders not otherwise specified. Subjects completed the following self-administered questionnaires: Eating Disorder Inventory 2 (EDI -2), Body Uneasiness Test (BUT), MMPI-2., Results: Associations emerged between MF and: K-correction, Antisocial behaviour, Cynicism, Negative Treatment Indicators (MMPI-II) and with Ineffectiveness (EDI-II). No association emerged between maturity fears and BUT subscales, neither with the biological variables., Discussion: Maturity fears is a dimension without differences both in the AN that in BN, associated with personality traits, which denotes insecurity, relationship incompetence, ineffectiveness, incapability in to ask and to get help from the others with distrust. It doesn't associate with weight phobia.

Historically, depression has been considered almost exclusively from an intrapersonal viewpoint, focusing almost entirely on the depressed individual in treatment. In this article, the focus is shifted to an interpersonal view of depression, emphasizing the role of family and cultural influences on the evolution of depression and its successful treatment. Patterns of hypnosis that can be applied in a systemic treatment framework are described and illustrated with case examples.

Many authors agree on the idea that the affective and behavioural characteristic of a certain type of family encourages the use of the body as a primary means of communication with others. This way of communicating has usually been acquired during childhood and later, in the adult life, it appears again in the different social contests. Some authors like Alby, Levy, Baker, Parker, Lipscombe, Marcelli, Bianchi and others focus on this type of family interaction and the single characteristic of the personalities of each family member. These authors describe some relationship patterns used by hypochondriac patient such as: avoiding unpleasant situations, blaming others, adopt a sick-role as a way of controlling the relationship between existential events and somatic symptoms; relationship with physicians and the need to confirm her/himself.

Our research is based on the cases of 40 patients diagnosed as schizophrenics and the patterns of their family interaction at the moment of the hospitalization, in order to formulate an initial analysis of the reason of admission as the first phase in a therapeutic process. With this intent the authors have conducted a catamnestic research on the charts of patients who have been divided in three groups according to the presence or absence of the parents. The following variables have been therefore taken into consideration: the referrals, her/his behavior at the moment of hospitalization, expectations and difficulties in widening the field of observation within the family.

The psychologic adaptation of children with malignancies is influenced by the strategies that both the relatives and the other members of the family employ as a reaction towards the disease and the therapeutic progress. Our experience in the Department of Hematology of the University "La Sapienza": by carefully observing the communication styles, the distribution of roles, and the modification of the family organization up to the eventual adaptation to the disease, we have been able to identify various reaction typologies of the family, and also to evaluate their frequency and their varying functionality with time. A thorough analysis of these modalities of reaction may allow prompt recognition of problems related with psychologic and social adaptation of both the pediatric patient and his family, and may allow the adoption of pertinent strategies of intervention, in order to guarantee a better compliance throughout the whole therapy.

"Folie à deux" is characterized by the communication of delusional ideas from one subject to other ones who have been living closely with him for a long time, usually his relatives. Before illness shows, there is a leader-follower relationship between partners, who are lacking of external sources of pleasure and are socially or culturally isolated. The dominating partner usually is a paranoic subject who strongly needs his ideas to be accepted by other people, while the dominated partner is a dependent subject who shares the other one's ideas in order to get pleasure from him and who is not able to criticize these ideas because of the lack for external influences. The two partners project hostility into the external world because, if the dominated partner does not share the other one's ideas, hostility will be projected into him and he will become very anxious. Interpersonal mechanisms in "folie à deux" are similar to those which take place in brainwashing, hypnosis and psychotherapy.

Despite the increasing diffusion of the illness there is poor systemic investigation in the area of depression. This study examines the typology of interactive models of the depressed patient in the couple relationship, with the family of origin, the children, the outside world and the therapist. The couple relationship usually becomes an helping relationship with the depressive patients that assumes the "care eliciting" while the partner develops the "care giving" attitude. Sequential disqualification and negative self fulfilling prophecy are as well typical of the depressive couple. An intrusive bind with families of origin is very often activated by depressive behavior, and a transgenerational competition for taking care of one relative's chronic inability may rise. Some guidelines for a specific therapeutic strategy for depressive families together with some case examples are given. The role of the therapist's own depressive feelings when working with this type of families is considered.