Background/Objectives: Eating disorders (EDs) are complex psychopathological conditions involving dysfunctional eating behaviors, excessive body image concerns, and impaired emotional regulation. Among moral emotions, guilt plays a significant role in ED dynamics, influencing both symptomatology and interpersonal relationships. This study examines specific guilt subtypes (normative and altruistic guilt) using a specific psychometric tool. Methods: Forty-three adults with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were recruited from the Eating Disorder Center of the University of Campania “Luigi Vanvitelli” or referred by psychotherapists. Diagnoses followed DSM-5 criteria. Participants completed the Moral Orientation Guilt Scale (MOGS), assessing guilt subtypes, and the Eating Disorder Inventory-2 (EDI-2), measuring ED symptomatology. Spearman’s rank correlation and stepwise multiple regression analyses were used to identify relationships between guilt dimensions and ED-related symptoms. Results: MOGS subscales were positively correlated with ED symptomatology. Normative guilt was significantly associated with binging and purging (ρ = 0.26, p < 0.05), while altruistic guilt predicted higher interpersonal distrust (t = 3.4, p < 0.01). Regression analysis revealed that age negatively influenced interpersonal distrust (t = −2.9, p < 0.01). Conclusions: In the population examined, guilt significantly influences ED symptomatology and interpersonal functioning, with specific dimensions linked to distinct behaviors and traits. Therapeutic interventions targeting guilt may enhance treatment outcomes by addressing ED emotional underpinnings. However, the results should be interpreted with caution due to the small sample size and lack of longitudinal data to establish causality. Further research with larger samples and longitudinal designs is necessary to validate these findings.

Alexithymia is a personality trait that has been defined as a difficulty in identifying, describing, and expressing one's emotions. Individuals with eating disorders (EDs) exhibit higher prevalence of alexithymia than general population. A prolonged exposure to stress related to alexithymia could affect the functioning of the hypothalamus-pituitary-adrenal (HPA) axis. The aim of this study was to assess the reactivity of HPA axis to the Trier Social Stress Test (TSST) by measuring the cortisol response in women with EDs according to their levels of alexithymia. Eighty-nine women with EDs and 40 healthy women participated into an experimental study. Alexithymia was evaluated by the Toronto Alexithymia Scale-20. Salivary cortisol levels were measured to assess the HPA axis reactivity to TSST. Women with EDs and high levels of alexithymia showed higher salivary cortisol compared to women with EDs and low alexithymia levels and healthy controls, but reduced change in cortisol over time, evaluated by AUCi, compared to healthy controls. In conclusion, our study results show that women with EDs and high levels of alexithymia exhibited higher basal activity and an impaired sensitivity of the HPA axis in response to TSST compared to women with EDs and low levels of alexithymia and healthy women.

Objective: Although childhood maltreatment, especially emotional abuse, is strongly linked to the psychopathology of anorexia nervosa (AN), the impact of such a traumatic experience on treatment outcome is not clear. This study aimed to explore how emotional abuse affects change in psychopathology during treatment.Method: Adolescents with AN (n = 331) completed the Childhood Trauma Questionnaire at admission to inpatient treatment and the Eating Disorder Inventory‐2, Patient Health Questionnaire‐9, Patient Health Questionnaire‐15, and Generalized Anxiety Disorder‐7 both at admission and at discharge. Relationships of emotional abuse with body mass index (BMI) and questionnaire scores at admission and at discharge were examined with percentage bend correlation coefficients. Changes in BMI and questionnaire scores from admission to discharge and whether these changes were moderated by emotional abuse were tested with robust mixed models.Results: Higher emotional abuse scores related to higher eating disorder, depressive, anxiety, and somatic symptoms but not to BMI at admission and at discharge. BMI increased and eating disorder, depressive, anxiety, and somatic symptoms decreased from admission to discharge but these changes were not moderated by emotional abuse scores.Discussion: Emotional abuse did not affect treatment response during hospitalization for AN, but it was associated with heightened eating and general psychological symptom severity at both hospital admission and discharge. Clinicians are advised to investigate a history of emotional abuse in adolescents with AN and to consider emotional abuse not as a predictor of treatment resistance, but as a psychological scar that persists regardless of symptom severity.