{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:47:06Z","timestamp":1791463626627,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Anorexia nervosa (AN) is a complex psychiatric disorder that requires a multidisciplinary approach. The World Health Organization recognizes the therapeutic value of expressive arts, including drama, in enhancing emotional, cognitive, and relational domains in severe mental illnesses such as AN. Expressive arts interventions may improve emotional intelligence, empathy, and self-awareness while reducing anxiety and alexithymia. This study evaluated the impact of an adjunctive expressive arts program on alexithymia in pediatric inpatients with AN. Methods: We enrolled patients aged 11\u201318 years hospitalized for AN, according to the American Psychiatric Association\u2019s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, at the Pediatric Unit of Bambino Ges\u00f9 Children\u2019s Hospital, Rome. The study period ran from December 2024 to April 2025. Participants attended drama therapy sessions and expressive arts workshops in a dedicated recreational space integrated into a multidisciplinary treatment plan. Alexithymia was assessed at admission and discharge using the Toronto Alexithymia Scale (TAS-20), with scores \u2265 61 indicating alexithymia. At the end of the program, participants completed a semi-structured satisfaction questionnaire to evaluate subjective experiences and mood. Results: Thirty patients met inclusion criteria. The TAS-20 scores were statistically different between pre-\/post-theater activity (p &lt; 0.001). The proportion of alexithymic participants declined from 73.3% at baseline to 26.7% at discharge. Most participants reported mood improvements: 66.6% \u201csomewhat\u201d and 26.7% \u201cgreatly.\u201d Additionally, 90% reported improved peer relationships. Conclusions: Expressive arts, particularly drama-based interventions, may represent an effective adjunctive therapy for adolescents with AN, supporting emotional awareness, self-regulation, and social connectedness. Arts-based interventions are associated with nonverbal avenues for emotional processing and may promote neuroplasticity, representing valuable complementary strategies for AN treatment.<\/jats:p>","DOI":"10.3390\/children12101394","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T07:29:38Z","timestamp":1760599778000},"page":"1394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Impact of Expressive Arts Therapy on Alexithymia Levels in Adolescent Inpatients with Severe Anorexia Nervosa"],"prefix":"10.3390","volume":"12","author":[{"given":"Flavia","family":"Cirillo","sequence":"first","affiliation":[{"name":"Pediatric Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5685-5468","authenticated-orcid":false,"given":"Giulia","family":"Spina","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3274-9756","authenticated-orcid":false,"given":"Mariangela","family":"Irrera","sequence":"additional","affiliation":[{"name":"Academy of Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5947-2414","authenticated-orcid":false,"given":"Elena","family":"Bozzola","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Mascolo","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0316-6359","authenticated-orcid":false,"given":"Livia","family":"Gargiullo","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Burla","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Roversi","sequence":"additional","affiliation":[{"name":"Trials Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Maria","family":"Carlevaris","sequence":"additional","affiliation":[{"name":"Health Directorate, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Dusi","sequence":"additional","affiliation":[{"name":"Health Directorate, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Italo","family":"Pretelli","sequence":"additional","affiliation":[{"name":"Child and Adolescent Neuropsychiatry Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6787-8198","authenticated-orcid":false,"given":"Maria Rosaria","family":"Marchili","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). 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