Anorexia nervosa (AN) and autism spectrum disorder (ASD) share symptoms that complicate diagnosis and treatment, including rigidity in thinking and behavior. This inflexibility often manifests as strict food routines in anorexia. Both conditions involve excessive preoccupation with control and perfection, leading to restrictive behaviors and heightened anxiety.

To show the clinical presentation of Anorexia Nervosa and austism spectrum disorder through the presentation of two cases.

Cases presentation and literature review

Case 1

A 15-year-old girl is receiving psychiatric follow-up for restrictive eating habits. She developed normally and has used sophisticated language since childhood. However, during her infancy, she did not engage in symbolic play. Academically, she performs exceptionally well. She describes herself as having a very rigid personality and struggles with understanding irony and certain social behaviors. She has few friends, viewing friendships as a waste of time. Her interests lie deeply in literature and science, and she tends to wear childish clothing.

She expresses feelings of jealousy towards her younger sister and mentioned that she reduced her food intake to prevent growing taller and to achieve “thinner ankles.” As she begins psychotherapy, she shares that she finds it challenging to grasp what the psychologist means due to her tendency for literal thinking.

Case 2

The patient is a 14-year-old male from Peru, who arrived in Spain 8 months ago. Developmental milestones within the normal range. Little symbolic play and difficulty with non-verbal language. Highly ritualised behaviours and tendency to obsessions, requiring psychological intervention due to compulsion to clean in the COVID-19 pandemic. The patient was admitted to the inpatient unit for weight loss of 6 kilograms in one month, with food restriction and excessive increase in physical exercise. Selective mutism is associated with months of selective mutism, as ‘he does not speak to people who do not speak with a Peruvian accent’. Parents speak of a rigid and literal idea of ‘having to be thin in order to make friends and strong in order not to be weak’.

Both cases reflect how the rigidity and literal thinking of autistic disorder can lead to extreme behaviours such as ‘don’t eat so as not to grow up’ in the first case, or ‘don’t eat to make friends’ in the second case, lived with no flexibility

There is a recognized connection between ASD and AN, with studies indicating a prevalence of 20-25%. Inflexible thinking associated with ASD can negatively impact the prognosis of AN, as ASD may contribute to the chronicity of the eating disorder. Additionally, psychotherapy can present challenges, and research suggests that behavioral techniques, particularly Applied Behavior Analysis (ABA), tend to yield better outcomes for individuals with AN.

None Declared

The Atlas study, conducted in 2023, shows that the global prevalence of high body mass index (BMI) is expected to increase significantly by 2035, both in adults (from 42% to over 54%) and in young people aged 5-19 years (from 22% to 39%). Also in 2023, the European Medicines Agency (EMA) published a statement warning about the risk of suicidal thoughts and self-harm with glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including semaglutide, tirzepatide and liraglutide. The psychiatric safety of recently developed anti-obesity drugs has not been adequately studied.

The objective of this study was to collate and evaluate the existing evidence regarding the psychiatric safety of GLP-1 RAs in individuals without major psychopathology.

A narrative literature review was carried out in the PubMed, Cochrane and Embase databases, selecting only the articles published in the last 4 years, using the following keywords: depression suicidal ideation, GLP-1 receptor agonists, semaglutide, tirzepatide, liraglutide.

There is a complex relationship between body weight and depressive and anxiety disorders. Obesity can be understood as chronic low-grade inflammation of adipose tissue, and the activation of inflammatory pathways could lead to the development of depression and anxiety. Also, due to cultural norms, obesity contributes to increased body dissatisfaction and lower self-esteem, both of which are associated with depression and anxiety. All of these factors can contribute to the maintenance and worsening of anxiety and depression. In most trials, there was no evidence of an association between treatment with GLP-1 RAs and an increased risk of developing depression or suicidal thoughts/behaviour. Psychiatric adverse events were rare, occurring in only 1.2-1% of patients. Depression was the most common adverse event reported, followed by anxiety and suicidal ideation. Fatal outcomes occurred mainly in men and in people treated with liraglutide, which is associated with a higher risk of suicide than semaglutide. Tagliapietra et al suggest that the patient population receiving GLP-1RAs compared with other diabetes pharmacotherapies is a group with a higher basal risk of developing depression, rather than a causal effect of the drugs. Recent but limited real-world evidence suggests that the use of semaglutide is associated with reduced suicidal ideation and major depression.

The results of our analysis suggest that GLP-1 RAs did not increase the risk of developing symptoms of depression or suicidal thoughts. However, the severity and fatal outcomes of some of these reports warrant further investigation. People with obesity should be monitored for mental health problems so that they can receive appropriate support and care.

None Declared

Anorexia nervosa is a complex eating disorder often associated with various psychological factors, including maladaptive coping mechanisms and dysfunctional family dynamics. This case report illustrates the impact of parental overcontrol on the development and persistence of anorexia nervosa in a young female patient.

To present the case of a 19-year-old female patient with anorexia nervosa, emphasizing the influence of her childhood experiences, particularly parental overcontrol, on her eating behaviors and psychological state.

Case report.

The patient presented to the emergency room accompanied by family members due to extreme weight loss (29.6 kg; BMI 11.4 kg/m²) and severe purging behaviors, including self-induced vomiting and the consumption of 400 laxative tablets daily for six months. Her history of mental health issues began in 2013, characterized by severe anxiety related to separation from her parents and academic performance, culminating in a suicide attempt. In 2019, she developed purging behaviors and received outpatient treatment for eight months, which she discontinued. Symptoms resumed, and after reaching a target weight of 30 kg, she set a new target weight of 20 kg. The patient’s behavior was influenced by insecure attachment modeled by her father, who exhibited controlling and intrusive parenting styles.

A review study (Gale C.J., et al. A review of the father-child relationship in the development and maintenance of adolescent anorexia and bulimia nervosa. Issues Compr. Pediatr. Nurs. 2013;36:48–69. doi: 10.3109/01460862.2013.779764.) investigated the role of the father–child relationship as a risk or maintenance factor of Eating Disorders in developmental age. Results showed that within the relationship of the father and child, and especially with daughters, there are several themes such as conflict and communication, parental protection and psychological control, emotional regulation and self-esteem, and self-perfectionism that appear to condition the child’s level of self-determining autonomy and can consequently impact maladaptive eating attitudes and psychopathology. (Criscuolo, M., et al (2023). Parental Emotional Availability and Family Functioning in Adolescent Anorexia Nervosa Subtypes. International Journal of Environmental Research and Public Health, 20(1), 68. https://doi.org/10.3390/ijerph20010068)

This case highlights the significant association between parental overcontrol and the development of anorexia nervosa, illustrating the need for targeted interventions that address both psychological and familial factors contributing to the disorder. Further discussion is warranted on the implications of parenting styles in the management and prevention of eating disorders.

None Declared

Depression is a common comorbidity in patients with eating disorders. Epilepsy significantly impacts mood and personality, with up to one-third of epilepsy patients experiencing psychiatric comorbidities. The coexistence of eating disorders, epilepsy, and depression presents a clinical challenge due to complex neurological, psychiatric, and psychosocial interactions. Despite well-established links between these conditions, little literature explores their convergence in a single patient.

We describe a case of anorexia nervosa (AN) in a premorbidly well woman who subsequently developed idiopathic generalized epilepsy. She then developed depression and an intractable urge to end her life solely because she felt “fat”. We discuss the complex relationship between these conditions and propose hypotheses that may explain this interaction.

Informed consent was obtained from Ms. O to access her medical records for this case report. We reviewed her medical history, psychiatric evaluations and treatment interventions.

Miss O is a 24-year old ex-nursing student with no past psychiatric history and was described as a bubbly young girl. She first presented in Nov 2018 with AN (BMI 14.0) achieving weight restoration by Aug 2019 after developing binge-eating episodes. In Jan 2020, she was diagnosed with epilepsy. Shortly thereafter, she developed severe depression, accompanied by personality changes, self-harm behaviours, and intractable suicidal ideations. She attributed her suicidality to her body image disturbances and perceived weight gain. She continues to restrict and purge but her weight has stabilized around BMI 20-22. Since then, she has had 13 admissions for suicide attempts and 7 for managing depression. Her treatments included antidepressants, mood stabilizers, antipsychotics, electroconvulsive therapy, repetitive transcranial magnetic stimulation and intravenous ketamine but her condition remained treatment-resistant.

We propose several hypotheses to explore the interactions between AN, epilepsy, and treatment-resistant depression. These include hypothalamic-pituitary-adrenal axis dysregulation and neuroinflammation, potential common neurological pathways between AN and epilepsy, the possible development of personality disorders, and cognitive distortions where disordered eating and suicidal behaviours serve as maladaptive control mechanisms. We also explored concepts like epileptic personality, interictal dysphoric disorder, and the interplay between antiepileptic drugs and mood.

These hypotheses collectively highlight the complex mechanisms that likely underlie Ms. O’s comorbid AN, epilepsy, and treatment-resistant depression emphasizing the need for integrated, multidimensional treatment approaches. Further research is essential to develop targeted interventions for such challenging comorbidities.

None Declared

Orthorexia Nervosa (ON) is an emerging disordered eating pattern marked by an excessive focus on healthy eating, leading to psychological, social and physical impairments. While ON remains outside formal diagnostic systems, such as the DSM-5, increasing research highlights its prevalence and association with social media use. Social media platforms, particularly image-based platforms, play a dual role, often fostering rigid dietary ideals while simultaneously providing recovery support for users. This study reviews the influence of social media on ON development and its socio-cultural underpinnings.

This literature review aims to examine the interplay between ON and social media, focusing on the extent to which social media exacerbates or alleviates ON symptoms. We explore the influence of platform-specific content on ON behaviors, considering factors such as exposure to “clean eating” ideals, dietary pressures and social validation.

A literature review was conducted, analyzing 17 studies encompassing various methodologies, including cross-sectional, qualitative and mixed-method approaches. Studies were sourced from databases including PubMed and Scopus, focusing on publications from diverse cultural contexts. Data extraction followed the PRISMA guidelines, with attention to PICO criteria, evaluating ON’s psychological, behavioral and social dimensions alongside the impact of social media.

Findings consistently indicate that social media intensifies ON tendencies through heightened exposure to “idealized” eating behaviors. Instagram users frequently encounter diet-focused content that promotes obsessive eating habits under the guise of health, while Twitter discussions reflect societal pressure and the emerging medicalization of ON. Studies reveal that frequent social media users demonstrate higher ON symptom severity, with platforms like Instagram and Grindr contributing uniquely to ON among specific demographics. Moreover, qualitative insights show that social media also fosters community support, with some users seeking recovery guidance.

The relationship between social media and ON is complex, encompassing both risks and recovery potential. While social media can reinforce disordered eating patterns, it also serves as a support mechanism, offering peer connections and recovery tools. Future research should prioritize cross-cultural analyses and interventions targeting social media literacy to mitigate ON risks and enhance positive engagement.

None Declared

Suicidal behavior could be one of the declinations of destructiveness in patients with Eating Disorders (EDs), and represents an important cause of death in these patients. In recent years some theoretical models aimed at a deeper undestanding of suicidal behaviors have been developed and proposed, including the Interpersonal Theory of Suicide (IPTS) by Thomas Joiner, and it has been applied to EDs patients with mixed results.

The objective of this study was to deepen the understanding of the problem of suicide in EDs, with the aid of the IPTS.

Multicenter study coordinated by the Department of Psychology - University of Milano-Bicocca (UniMiB) and the Psychiatry of the Università del Piemonte Orientale (UPO); the recruitment of patients with EDs involves: Novara Mental Health Center and Psychiatry outpatient clinic of the Maggiore della Carità University Hospital in Novara, Regional Expert Center for the Diagnosis and Treatment of Eating Disorders in Turin, outpatient clinic for Nutrition and Eating Disorders, IRCCS San Gerardo dei Tintori Foundation in Monza. Healthy controls were enrolled through UPO and UniMiB. Variables related to suicidal ideation and suicide attempts, IPTS constructs and psychological factors (anxiety, somatic and mental pain, reasons for living, enteroceptive awareness, self-esteem, body image, etc.) were assessed.

Preliminary analyses involving 28 EDs patients (ED group) and 45 healthy controls (HCs). The ED group reported increased lifetime and past-two-weeks suicidal ideation and a greater number of lifetime suicide attempts. With regard to IPTS, a higher Perceived Burdensomeness (INQ-PB) emerged in the ED group compared to HCs; no differences emerged in Thwarted Belongingness and in the Acquired Capability for suicide. In the EDs group, state and trait anxiety, mental pain, Visual Analogue Scale scores for somatic and psychological pain are higher; self-esteem is lower. Correlations emerged between INQ-PB, mental pain and self-esteem in EDs patients: as mental pain increases and self-esteem decreases, INQ-PB increases. The EDs sample has currently almost doubled, and new analyses will be performed to see whether the findings described above are confirmed in a larger sample; analyses comparing different subtypes of EDs will be run as well.

With the limitations of the sample size recruited in the pilot phase, which we aim to overcome by running new analyses in a larger sample as recruitment is ongoing, the preliminary data of this study offer preliminary support to the existing data in the literature on IPTS in EDs. An increase in IPTS construct scores appears to be independent of the severity of body image disorder in these patients.

None Declared

The results of many previous studies report a high prevalence of overweight and obesity in children and adults with Down syndrome (hereinafter DS). According to different authors, the incidence of obesity in them varies between 23 and 70%. The age of onset of overweight formation was 2–3 years.

Glucose transporter (abbreviated GLUT) is a large group of membrane proteins responsible for the transport of glucose across the cell membrane. Since glucose is a vital source of energy, these proteins are present in all types of living organisms. GLUT, or SLC2A, is a separate family of glucose transport proteins found in most mammalian cells. Thus, the human genome encodes twelve proteins of the GLUT family. They are transport uniporter proteins.

We studied PCR of scrapings of the mucous membrane of the inner side of the cheek to search for GLUT1 genes in 31 patients with DS, ьen and women aging from 8 to 39 years. The control group consisted of 67 healthy donors by the same ages and genders.

It was found that the expression of GLUT1 genes was significantly reduced. A decrease in the expression of these genes correlated with an increase in body weight and symptoms of bulimia in patients with Down syndrome.

Eating disorders, namely bulimia, in DS is a serious condition that aggravates the course of the underlying disease. Hereditary factors affect the expression of glucose transporter genes. Taking these circumstances into account would help in developing personalized pharmacotherapy.

None Declared

Eating disorders (ED) can sometimes present with psychotic symptoms, including delusions and cenesthetic or auditory hallucinations. In a minority of patients, these symptoms may stem from an underlying psychotic disorder, such as schizophrenia, which is more common in males (Bou Khalil R, Hachem D, Richa S. (2011). Eating disorders and schizophrenia in male patients: a review. Eat Weight Disord, 16(3), 150-6). Therefore, early detection and intervention are critical in cases where EDs are accompanied by prodromal or attenuated psychotic symptoms.

To present the clinical case of a 14-year-old male with an unspecified eating disorder and high-risk mental state for psychosish

To highlight the importance of early identification and intervention in eating disorders with psychotic features.

A Pubmed database was used to collect information about psycothic symptoms in EDs, using the terms ‘eating disorder’, ‘pyscosis’ and ‘high risk mental state’.

We present the following clinical case:

A 14-year-old spanish male of Bolivian descent. The patient exhibited a two-year history of food restriction, vigorous exercise, social isolation, and absenteeism from school. Detailed clinical evaluations were performed, documenting his physical, psychological, and behavioral symptoms. The patient’s diagnosis was reevaluated based on emerging psychotic symptoms during hospitalization.

The patient reported intense distress about perceived fat accumulation in his face and trunk, which he believed diminished immediately after exercise. He engaged in excessive physical activity, including jumping rope for at least two hours multiple times a day, and swimming against currents. He also experienced episodes of binge eating followed by purging and compensatory exercise. Social withdrawal, emotional blunting, disorganized biological rhythms, and soliloquies were observed during his admission. Based on these findings, his diagnosis was revised to an unspecified ED with a high-risk mental state for psychosis.

Psychotic symptoms, particularly in restrictive anorexia, can arise during the course of an ED, with malnutrition acting as both a cause and sustaining factor by exacerbating serotonin-dopamine dysregulation (Sarró, S (2018). Those courageous boys: 73 years after the Minnesota starvation experiment. A psychiatrist’s view. Neurosciences and History, 6(1), 28-37). While these symptoms may result from malnutrition, they could also signal the onset of a primary psychotic disorder, with males at higher risk (3.6%). Early detection of attenuated or prodromal psychotic symptoms is essential, and regular reevaluation is recommended, especially during the first months of follow-up, to prevent short-, medium-, and long-term complications.

None Declared

Eating disorders (EDs), including binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN), represent serious mental health conditions characterized by disturbances in eating behavior and body image concerns. These disorders significantly impair health, psychosocial functioning, and quality of life. Evidence-based psychotherapies have shown effectiveness in treating EDs.

This study aims to evaluate and compare the effectiveness of various psychotherapies for treating BED, BN, and AN, with a focus on both short-term and long-term outcomes. A secondary objective is to assess the applicability of transdiagnostic psychotherapy approaches across different EDs.

A literature review was conducted using articles from PubMed, focusing on the terms “eating disorders”, “evidence-based psychotherapy”, “cognitive-behavioral therapy”, and “interpersonal psychotherapy”. The selection prioritized the most relevant clinical trials and meta-analyses.

Cognitive-behavioral therapy (CBT) consistently demonstrated significant short-term effects in reducing binge-eating episodes and EDs psychopathology, particularly in BED and BN. It outperformed both inactive controls (e.g., wait-lists) and other psychotherapies. Long-term, CBT continued to show sustained improvements in symptom reduction, particularly for BED, though it was less effective for BN and AN.

For the treatment of AN, most guidelines recommended psychological interventions, particularly family-based therapy (FBT) for younger patients. CBT and structured therapies like Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) were also recommended. Interpersonal psychotherapy (IPT) received limited support due to insufficient evidence.

In BN, CBT was widely endorsed as the first-line treatment. IPT was recommended as an alternative, noted for its slower symptom \reduction but equivalent long-term efficacy. FBT was recommended for younger patients.

For BED, CBT was consistently recommended as the first-line treatment, with growing evidence supporting guided CBT self-help. IPT was recommended by several guidelines as an alternative.

CBT was the most consistently recommended treatment for all EDs, particularly for BN and BED, offering faster symptom reduction, higher remission rates, and better long-term outcomes. While IPT is a viable alternative, particularly for BED, it generally takes longer to achieve comparable results. The findings emphasize the need for more personalized treatment approaches and the exploration of adjunctive therapies to improve outcomes, especially for AN. Further research is required to refine therapy selection and address the distinct challenges posed by different ED subtypes, particularly in achieving long-term treatment success.

None Declared

Eating disorders (EDs) are complex conditions with significant impacts on physical and mental health. This study investigates hospital admissions and resource utilization for EDs among pediatric patients in Spain over a seven-year period, emphasizing the effects of the COVID-19 pandemic.

To analyze the epidemiological trends, prevalence, and hospital resource use for pediatric ED admissions in Spain from 2016 to 2022.

A retrospective analysis was conducted using data from Spain’s Minimum Basic Data Set of acute hospitals (CMBD-H) for patients aged 10–19 years with an ED diagnosis (ICD-10-CM code F50) between January 1, 2016, and December 31, 2022. Trends in hospitalization rates, types of EDs, comorbidities, and resource utilization were assessed.

The study identified 8,275 pediatric ED admissions, comprising 17% of all mental disorder admissions. Table 1 summarizes the characteristics of hospital admissions by age group (10-14 years and 15-19 years). Hospitalization rates increased from 19.4 per 100,000 in 2016 to 32.7 in 2022, with a notable rise in the 10–14-year age group post-pandemic. Anorexia Nervosa (AN) was the predominant diagnosis (71.6%). Psychiatric comorbidities were present in 35.6% of cases. The average length of stay was 24 days, with annual direct medical costs totaling €3 million and a median cost per admission of €11,580. AN patients had longer hospital stays (median 28 days) compared to other disorders, while Bulimia Nervosa (BN) patients had shorter stays (median 14 days) but higher average costs (€12,300). Table 2 details the average hospital length of stay and average cost of hospital admissions for EDs among adolescents in Spain.

Image 1:

Image 2:

There was a 70% increase in pediatric ED admissions in Spain from 2016 to 2022, with a significant post-pandemic rise in younger patients. This underscores the need for improved early detection and intervention strategies, as well as enhanced screening for comorbid mental health conditions to manage the growing hospital demand effectively.

None Declared

Since its inception in 1997, the term orthorexia nervosa (ON), derived from the Greek words for “right” and “appetite” (Donini et al, 2022), has been utilized to describe an obsession with “correct” or “healthy” eating. Despite numerous authors suggesting diagnostic criteria and the publication of several theoretical papers, consensus regarding a definition or even the existence of ON remains elusive (Dunn and Bratman, 2016). Conversely, anorexia nervosa (AN) has been recognized since the first iteration of the DSM (Bhattacharya et al, 2022; Dell’Osso et al 2016). Layperson awareness of these conditions has been increasing, with a notable increase in interest in “orthorexia” over the past several years, potentially influenced by popular culture and increased social media use (Sharma et al, 2023)

The purpose is to understand shifts in public interest as well as the ever-present influence of the online world on patients, especially those with disorder eating patterns.

This study compared United States Google search trends for the terms “orthorexia” and “anorexia”. Using Google Trends data, we reviewed the average monthly search volume from January 2004 to March 2024. We analyzed the data to determine if there was a significant difference in search volume over time.

Google search data revealed a monthly search volume of ˜7000 queries for “orthorexia” in January 2004, and analysis of the volume revealed that there has been a significant and sustained increase in the searches for “orthorexia”. Additionally, searches for the term “anorexia” reached a height of 2.1 million in 2007, but have been steadily declining in the past several years.

While anorexia remains the more prominent search term, over time the queries for anorexia have decreased from their peak in the early 2000’s. The rise in the term orthorexia may be partly due to the proliferation of highly visual social media platforms, particularly YouTube and TikTok, where content creators often focus on healthy eating and lifestyle trends (Sharma et al, 2023).

Additionally, there is a possibility that orthorexia is being used on these platforms to describe a subset of AN. Some individuals with anorexia may present with behaviors resembling orthorexia, such as a fixation on healthy eating or a rigid adherence to specific dietary guidelines.

The findings indicate a shift in the public’s interest in orthorexia and anorexia during the past several years, possibly influenced by increased social media use. Further research is needed to understand the implications of this trend on individuals’ attitudes towards healthy eating and body image.

None Declared

Personality dimensions should be taken into account when diagnosing individuals with disordered eating behaviours in the hope of better understanding their etiology and symptom progression and when planning treatment.

The objective of this study was to attempt to determine the moderating role of self-esteem in the relationships between personality traits included in the Big Five model among Polish women and the occurrence of eating disorders.

The study was conducted among 556 Polish women from Zachodniopomorskie Voivodeship. A diagnostic survey was used as the research method, and the empirical data were collected using the following research tools: The NEO Five-Factor Inventory (NEO-FFI), Rosenberg Self-Esteem Scale (SES), ORTO – 15 Questionnaire, The Three-Factor Eating Questionnaire (TFEQ-13), and the authors’ original questionnaire.

Only the personality trait of neuroticism exhibits a statistically significant effect on the “Cognitive Restraint of Eating”, “Uncontrolled Eating”, and “Emotional Eating” scores (p<0.001). The moderation effect was demonstrated between self-esteem and the personality trait of conscientiousness on the “Cognitive Restraint of Eating” scale score. There is a moderation effect between self-esteem and the personality trait of extraversion on the “Uncontrolled Eating” subscale score. There is a moderation effect between self-esteem and the personality trait of conscientiousness on the “Uncontrolled Eating” scale score.

Table 1. Analysis and the moderation effect between self-esteem and the personality trait of conscientiousness in the effect on the “Cognitive Restraint of Eating” subscale score.

Self-esteem was not a predictor of the occurrence of eating disorders while playing a moderating role in the relationship between certain personality traits and the occurrence of eating disorders. A higher level of neuroticism was identified as an important predictor of higher results for orthorexia, Cognitive Restraint of Eating, Uncontrolled Eating, and Emotional Eating. It was also demonstrated that the orthorexia risk index decreased with increased extraversion and openness to experience.

None Declared

Research has demonstrated the effect of eating disorders on the occurrence of depressiveness as well as the effect of depressiveness on the occurrence of eating disorders.

The objective of the study was to determine the relationship between depressiveness and the occurrence of eating disorders, i.e., emotional eating, uncontrolled eating, cognitive restraint of eating, and the risk of orthorexia.

The study was conducted among 556 women from the West Pomeranian Voivodeship (Poland). The study employed the diagnostic survey method using a questionnaire technique: The Beck Depression Inventory, the ORTO—15 Questionnaire, the Three-Factor Eating Questionnaire, and a sociodemographic questionnaire.

Higher depressiveness severity is associated with a higher score on the “Cognitive Restraint of Eating” scale. The authors’ original study demonstrated a statistically significant relationship only between depressiveness and the “Uncontrolled Eating” subscale (p = 0.001).

Table 1. A multivariate model without moderation—analysis of the effect of sociodemographic variables and the severity of depressiveness according to the BDI on cognitive restraint of eating according to TFEQ-13

ref.—reference level, ß—standardized regression coefficient, CI—confidence interval, and BDI—Beck Depression Inventory

Table 2. A multivariate model with moderation—analysis of the effect of sociodemographic variables and the severity of depressiveness according to the BDI on cognitive restraint of eating according to TFEQ-13

ref.—reference level, ß—standardized regression coefficient, CI—confidence interval, BDI—Beck Depression Inventory, and ٭ moderation effect

The results of this study suggest that depressiveness is an important factor that contributes to a better understanding of eating behaviors. In addition, the results of this study suggest that eating behaviors and psychological factors should be taken into account in psychological interventions in the treatment of eating disorders. The clinical goal can be considered to be an improvement in non-normative eating behaviors, such as a reduction in overeating episodes or eating less frequently in the absence of a feeling of hunger.

None Declared

Guilt and shame are common emotional experiences that may influence the prognosis and treatment of many psychiatric disorders.

The aim of this study was to examine the role of guilt and shame in individuals with eating disorders (ED).

Forty-three adults diagnosed with anorexia nervosa, bulimia nervosa, and binge eating disorder were included in the study. They completed the following questionnaires: the Moral Orientation Guilt Scale (MOGS), which measures different components of guilt, and the Eating Disorder Inventory 2 (EDI-2), which measures ED psychopathology. To assess the relationships between MOGS and EDI-2 subscales, Spearman’s correlations and a stepwise multiple regression have been conducted including all patients in a unique ED group.

Positive correlations were found between the EDI-2 bulimia subscale and the MNV (moral normal violation) subscale of the MOGS (0.26, p.=0.05), between the EDI-2 interpersonal distrust subscale and the MNV subscale of the MOGS (Rho=0.28, p=0.03), and between the EDI-2 interpersonal distrust subscale and both altruistic guilt components of the MOGS (Rho=0.33, p=0.01 for harm; Rho=0.29, p=0.03 for empathy). The multiple linear regression model was significant (R²=0.29, F=8.38, p.<0.01) and showed age (t=-2.9, p<0.01) and the HARM subscale (t=3.4, p<0.01) as predictors of interpersonal distrust.

The results provide preliminary evidence for a possible role of guilt in the aetiopathogenesis of ED. Sensitivity to altruistic guilt, and especially to the harm caused, seems to influence the ability to trust others. Avoidance, distancing, or closure may be strategies to overcome high sensitivity to guilt. Further studies with larger samples, including both ED patients and healthy individuals, are needed to determine the role of guilt in EDs.

None Declared

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines pica as the ingestion of non-nutritive and non-food substances. For a diagnosis to be made, the behavior must persist for at least one month, not be consistent with the child’s developmental stage, and not be a socially normative or culturally accepted practice. The etiology of pica is not well understood. Additionally, knowledge about its overall prevalence is limited.

We present the case of a 61-year-old female patient diagnosed with histrionic personality disorder and generalized anxiety disorder, who began to frequently visit the hospital emergency department due to the ingestion of various objects, such as screws, paper clips… (Image 1). It was decided to admit her to the psychiatric ward with two main objectives:To halt the progression of disruptive behaviors and to determine the underlying cause of the pica behaviors.

During hospitalization, no clear affective disturbances toward any polarity were observed. Additionally, the patient was unable to coherently justify her behaviors, merely describing them as “spontaneous and irresistible impulses.” However, significant cognitive impairment was evident during the admission. Furthermore, the presence of balance disturbances with lower limb incoordination and urinary incontinence was confirmed. The described triad—gait disturbances, urinary incontinence, and cognitive deterioration—is characteristic of adult chronic hydrocephalus (ACH). Given this suspicion, a cranial computed tomography (CT) scan, was requested.

The Evans’ index (EI) was calculated. An EI greater than 0.30 is indicative of ventricular dilation, and the patient’s EI was 0.39 (Image 2). The high clinical suspicion, insidious onset, and the ventricular dilation observed made the diagnosis of ACH highly probable. Consequently, the patient was referred to the neurosurgery department to evaluate the potential placement of a cerebrospinal fluid shunt.

Image 1:

Image 2:

Although pica behaviors can be associated with various psychiatric disorders, there is often an underlying organic substrate. In this patient, the initial diagnosis of personality disorders and generalized anxiety, coupled with the repetitive pica behaviors, might have initially pointed exclusively toward a psychiatric approach. The identification of a broader symptomatic pattern, led to the suspicion of adult chronic hydrocephalus (ACH). The triad of symptoms in ACH, though classic, may not always be evident, and neuropsychiatric manifestations such as pica could be indirect signs of brain involvement.

This case underscores the need to consider organic differential diagnoses in patients presenting with atypical or unexplained behaviors from a purely psychiatric standpoint.

None Declared

Gelatinous bone marrow transformation (GBMT) is a degenerative change in hematopoietic bone marrow, initially linked to anorexia nervosa (AN) and recently to bariatric surgery (BS) (Böhm et al. Am J Surg Pathol 2000; 24(1) 56-65). BS is associated to malabsorption, nutrient deficits, diets, and medical complications resembling eating disorders (ED) (Conceição et al. Int J Eat Disord 2023; 56(4) 831-834), complicating diagnosis and management. Treating the underlying cause is key for GBMT recovery.

Review BS complications: malnutrition, GBMT and AN with normal Body Mass Index (BMI).

This case study highlight the emergence of GBMT and atypical AN following BS.

A 55-year-old woman first sought treatment from the Community Mental Health Team (CMHT) over 30 years ago for marital issues and was given medication. In 2006, she underwent bariatric surgery (BS) due to morbid obesity (BMI 52.6 kg/m²). Since 2007, she had 3 hospitalizations for cosmetic surgeries and 5 for medical complications, including oedema, hypoproteinaemia, pancytopenia, zinc deficiency, and sepsis requiring ICU admission. She also showed symptoms of depressive disorder (DD), AN, and purgative symptoms. In 2017, she was re-referred to CMHT and diagnosed with DD, anorexia was considered a symptom of DD.

In 04/2024 she was readmitted under Internal Medicine care with subacute multifactorial diarrhoea, severe malnutrition, pancytopenia, coagulopathy, vitamins A, E, D and Zn deficiency and lower limb oedema (likely contributing to a normal BMI).

Diarrhoea was managed by switching sertraline to citalopram and budesonide added to treat lymphocytic colitis. Moreover, ciprofloxacin and metronidazole were used for small intestinal bacterial overgrowth.

Psychiatric involvement confirmed DD, anxiety disorder (AD), and atypical AN. Topiramate, mirtazapine and olanzapine were stopped to possible myelotoxic effects. A bone marrow aspirate confirmed GBMT. Benzodiazepines and gabapentin were used to manage AD. Her malnutrition was managed with Total Parenteral Nutrition and she was transferred to a psychiatric ward where she received specific treatment for ED. Pancreatic enzymes were added to reduce malabsorptive impact of BS. The option of reversing the bypass was considered.

Once the vital risk decreased and she was consuming normalized intakes, she was discharged with a BMI=20.9.

One month later, she was euthymic, reduced anxiety and coagulopathy and nutritional parameters normalized with haematological improvement.

Given the high prevalence of malnutrition and ED post-BS, ED should be systematically assessed even in patients with normal BMI. Early diagnosis prevents worsening of symptoms, which only improve after nutritional recovery (Steinhausen et al. Am J Psychiatry 2002; 159(8) 1284-93). Multidisciplinary management is crucial to achieve optimal nutritional outcomes.

None Declared

Refeeding syndrome is a severe metabolic condition seen in psychiatric patients, particularly those with anorexia nervosa or other eating disorders, after rapid nutrient reintroduction. It involves disturbances such as hypophosphatemia, hypokalemia, and hypomagnesemia, creating challenges in psychiatric and medical settings. Early identification and management are critical to prevent complications like cardiac and respiratory failure (1,2,3).

This study analyzes the pathophysiological mechanisms of refeeding syndrome, focusing on key metabolic, psychiatric and electrolyte disturbances during the refeeding process in malnourished patients. It also discusses prevention strategies and clinical management, emphasizing the role of multidisciplinary teams in early diagnosis and treatment (1,2,3).

A literature review was conducted using Scielo, PubMed, Cochrane, and BMJ, focusing on studies about the pathophysiology, risks, and interventions related to refeeding syndrome. From 40 articles analyzed, 12 published between 2000 and 2023 were selected, focusing on clinical management and treatment guidelines for malnourished patients.

The review highlights that refeeding syndrome (RS) is a serious metabolic condition in malnourished patients, especially those with psychiatric disorders like anorexia nervosa. Rapid nutrient intake can cause metabolic issues, such as hypophosphatemia and hypokalemia, alongside significant psychiatric stress. Anxiety and treatment resistance may increase, especially in patients fearing weight gain, raising the risk of relapse.

Physical discomfort from refeeding, such as fluid retention, can worsen anxiety and complicate treatment. This may lead to extended hospitalization and poor treatment adherence. In psychiatric settings, inadequate management of RS can lead to agitation or self-harm. Preventive measures like controlled carbohydrate intake, thiamine supplementation, and electrolyte monitoring are crucial.

Multidisciplinary teams, including psychiatrists, psychologists, and nutritionists, are key to managing RS. Guidelines like those from NICE recommend gradual refeeding to reduce both metabolic and psychiatric stress.

Refeeding syndrome is a preventable yet potentially fatal condition. Early identification of at-risk patients and careful nutritional strategies are essential to reduce morbidity and mortality. Multidisciplinary teams play a crucial role in managing and educating patients, while further research is needed to inform clinical practices (6-7).

None Declared

Orthorexia Nervosa (ON) is an eating disorder, characterized by rigid and irrational rules about nutrition and food preparation. Although it is not officially recognized by the DSM-5 as a mental disorder, individuals with ON exhibit compulsive and obsessive behaviors related to their diets, with an interest that starts moderate but gradually becomes excessive and potentially pathological.

To assess individuals facing eating disorders, with an emphasis on Orthorexia Nervosa (ON) and Obsessive-Compulsive Disorder (OCD).

This is an integrative literature review, with analyses conducted on the National Library of Medicine (PUBMED) using the descriptors and boolean operators: (Orthorexia Nervosa) AND (Eating Disorders) AND (Obsessive-Compulsive Disorder) AND (obsessive compulsive). Filters applied included: articles published in the last 10 years and available in full text. All articles were analyzed a priori based on the information in the title, followed by reading the abstract, and subsequently, reading the full article.

Seventeen studies were found. According to the data, the age range between 23 and 26 years is at the highest risk for ON, while the risk is lower in individuals between 16 and 19 years. Orthorexic tendencies are more prevalent among Hispanics/Latinos and individuals with overweight or obesity. ON is frequently associated with patients who have body distortions, dissatisfaction with body image, excessive desire for thinness, and eating disorders such as anorexia and bulimia nervosa. Additionally, ON is linked to compulsive behaviors, obesity, strict diets, perfectionism. In individuals on diets, behaviors and problems similar to those seen in eating disorders are often observed, including orthorexic tendencies and obsession with adhering to strict dietary rules. Perfectionism is a common trait among these patients, who often begin with the desire to improve their diet and adopt a healthier lifestyle. However, this pursuit can become excessive, leading to behaviors such as social isolation, high spending on food, and nutritional deficiencies. Various tests conducted in the analyzed studies showed effects in identifying patients with ON, indicating the need for further research to better understand risk factors in different populations and to develop effective strategies for diagnosis, prevention, and treatment.

While a careful diet is not pathological in itself, severe dietary restrictions and social problems should raise the possibility of ON. Improving the identification of risk factors and behaviors may contribute to a better understanding, prevention, and management of ON.

None Declared

Eating disorders (EDs) can significantly worsen one’s physical and psychological well-being. In the professional environment, EDs may have serious consequences on the psychological and physical health of workers.

Our study aims to screen EDs and psychological health among workers.

We conducted a descriptive, analytical, cross-sectional survey among workers from an electricity company. We collected sociodemographic and professional characteristics. We screened EDs using the SCOFF questionnaire (Sick, Control, One stone, Fat, Food). Psychological health of our participants was assessed using the Hospital anxiety and depression scale (HADS).

Our study included 497 workers with an average age of 42.2 ± 11.1 years. Among them, 381 were male (76.7%) and 72.2% were married. Two hundred twenty-two participants engaged in physical activity, and 44.1% were smokers. The average job tenure was 15.2 ± 10.8 years. According to the SCOFF questionnaire, 35.6% of participants showed signs of possible eating disorders (EDs). Additionally, 12.5% of participants were found to be anxious, and 13.9% were depressed. The likelihood of EDs was higher among those with depression. Factors associated with an increased probability of EDs included feeling slowed down, experiencing anxiety symptoms like ‘butterflies’ in the stomach, and losing interest in personal appearance.

Eating disorders are common among workers, with notable rates of anxiety and depression also observed. It is essential to raise awareness about the importance of a healthy, balanced diet to support mental well-being and, in turn, improve workplace productivity.

None Declared

Eating disorders have some of the highest mortality rates among mental health conditions, particularly when co-occurring with diabetes. In such cases, the risk of complications like recurrent diabetic ketoacidosis and premature mortality significantly increases. Diabulimia, characterized by intentional insulin restriction in individuals with type 1 diabetes to lose weight, remains unrecognized as a distinct diagnosis in psychiatric classification systems, limiting effective treatment options.

To examine the unique clinical challenges of managing diabulimia and address the diagnostic limitations in current psychiatric frameworks

A comprehensive case report was conducted, which included a review of the patient’s clinical history, treatment responses, and psychosocial interventions. Additionally, a literature review was performed using multiple databases, including PubMed, PsycINFO, and Scopus, to evaluate current research on the co-occurrence of eating disorders and diabetes, with particular emphasis on diabulimia. This review helped contextualize the case findings within the broader clinical understanding of diabulimia and its management.

The patient, a 22-year-old woman, has a long history of type 1 diabetes and struggles with diabulimia. She is aware of the severe risks associated with insulin omission, but her desire for weight control leads her to intentionally restrict insulin, particularly during periods of emotional distress. She has a concurrent psychiatric history of depression and anxiety, which exacerbate her difficulties with diabetes management. The patient’s adherence to insulin therapy has been inconsistent, with cycles of brief compliance followed by relapse, particularly during times of heightened stress and body image dissatisfaction. Despite treatment with fluoxetine and ongoing cognitive-behavioral therapy (CBT), she continues to face significant challenges in managing both her diabetes and eating disorder. Recent interventions, including a structured fitness program and targeted psychotherapy, have yielded partial improvements, helping her develop healthier coping mechanisms and improve self-management. However, sustaining these gains remains difficult, and she continues to experience frequent hospitalizations due to metabolic decompensation.

Diabulimia presents unique diagnostic and therapeutic challenges, primarily due to its lack of recognition as a distinct disorder within current psychiatric classification systems. This case highlights the complex interplay between eating disorders, mental health, and diabetes management, highlighting the need for an integrated, multidisciplinary approach to treatment. There is a critical need for increased awareness, the development of specific diagnostic criteria, and tailored therapeutic interventions to improve outcomes for individuals affected by this often-overlooked condition.

None Declared