{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:40:23Z","timestamp":1791999623099,"version":"4.4.0"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>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 \u201cLuigi Vanvitelli\u201d 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\u2019s 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 (\u03c1 = 0.26, p &lt; 0.05), while altruistic guilt predicted higher interpersonal distrust (t = 3.4, p &lt; 0.01). Regression analysis revealed that age negatively influenced interpersonal distrust (t = \u22122.9, p &lt; 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.<\/jats:p>","DOI":"10.3390\/clinpract15030056","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T09:36:24Z","timestamp":1741599384000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Exploring the Role of Guilt in Eating Disorders: A Pilot Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1818-4237","authenticated-orcid":false,"given":"Fabiola","family":"Raffone","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"},{"name":"Department of Mental Health, Asl Napoli 1 Centro, 80145 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3889-3265","authenticated-orcid":false,"given":"Danilo","family":"Atripaldi","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"Barone","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Marone","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1357-1035","authenticated-orcid":false,"given":"Marco","family":"Carfagno","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8765-4047","authenticated-orcid":false,"given":"Francesco","family":"Mancini","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, University \u201cGuglielmo Marconi\u201d, 00193 Rome, Italy"},{"name":"School of Cognitive Psychotherapy (APC-SPC), 00187 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1013-6361","authenticated-orcid":false,"given":"Angelo Maria","family":"Saliani","sequence":"additional","affiliation":[{"name":"School of Cognitive Psychotherapy (APC-SPC), 00187 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3344-1000","authenticated-orcid":false,"given":"Vassilis","family":"Martiadis","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Asl Napoli 1 Centro, 80145 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S0140-6736(03)12378-1","article-title":"Eating disorders","volume":"361","author":"Fairburn","year":"2003","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1002\/cpp.627","article-title":"Shame, pride, and eating disorders","volume":"16","author":"Goss","year":"2009","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"104470","DOI":"10.1016\/j.appet.2019.104470","article-title":"The role of self-compassion and self-criticism in binge eating behaviour","volume":"144","author":"Serpell","year":"2020","journal-title":"Appetite"},{"key":"ref_4","first-page":"335","article-title":"The relationship between self-attacking\/self-reassurance and eating disorder symptoms: A comparison of non-clinical women and women with eating disorders","volume":"87","author":"Gilbert","year":"2014","journal-title":"Psychol. Psychother. Theory Res. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/papt.12198","article-title":"Experiences of shame and guilt in anorexia and bulimia nervosa: A systematic review","volume":"93","author":"Blythin","year":"2020","journal-title":"Psychol. Psychother. Theory Res. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1002\/eat.23583","article-title":"Shame and eating disorders symptoms: A meta-analysis","volume":"54","author":"Nechita","year":"2021","journal-title":"Int. J. Eat. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"104381","DOI":"10.1016\/j.brat.2023.104381","article-title":"Shame facets as predictors of problematic eating behaviors: An ecological momentary assessment study","volume":"168","author":"Nechita","year":"2023","journal-title":"Behav. Res. Ther."},{"key":"ref_8","first-page":"366","article-title":"The relation of anger to disgust: The role of self-disgust in eating disorders","volume":"16","author":"Fox","year":"2008","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_9","first-page":"656","article-title":"Self-criticism, perfectionism, and eating disorders: The effect of shame, self-compassion, and eating disorders symptomatology","volume":"27","author":"Ferreira","year":"2020","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Mancini, F., and Gangemi, A. (2021). Deontological and altruistic guilt feelings: A dualistic thesis. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.651937"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1146\/annurev.psych.56.091103.070145","article-title":"Moral emotions and moral behavior","volume":"58","author":"Tangney","year":"2007","journal-title":"Annu. Rev. Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mancini, A., Granziol, U., Gragnani, A., Femia, G., Migliorati, D., Cosentino, T., Luppino, O.I., Perdighe, C., Saliani, A.M., and Tenore, K. (2022). Guilt feelings in obsessive compulsive disorder: An investigation between diagnostic groups. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164673"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S0005-7967(02)00088-8","article-title":"Cognitive behaviour therapy for eating disorders: A \u201ctransdiagnostic\u201d theory and treatment","volume":"41","author":"Fairburn","year":"2003","journal-title":"Behav. Res. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/S0165-0327(01)00408-6","article-title":"Guilt, fear, submission, and empathy in depression","volume":"71","author":"Berry","year":"2002","journal-title":"J. Affect. Disord."},{"key":"ref_15","unstructured":"Garner, D.M. (1991). Eating Disorder Inventory 2: Professional Manual, Psychological Assessment Resources."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Oakley, B., Knafo, A., Madhavan, G., and Wilson, D.S. (2012). Empathy, guilt, and depression: When caring for others becomes costly to children. Pathological Altruism, Oxford University Press.","DOI":"10.1093\/acprof:oso\/9780199738571.001.0001"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1159\/000527555","article-title":"Personality disorder in adolescent patients with anorexia nervosa","volume":"56","author":"Laczkovics","year":"2023","journal-title":"Psychopathology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0005-7967(01)00059-6","article-title":"Clinical perfectionism: A cognitive-behavioural analysis","volume":"40","author":"Shafran","year":"2002","journal-title":"Behav. Res. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.comppsych.2008.09.004","article-title":"Self-criticism versus neuroticism in predicting depression and psychosocial impairment over four years in a clinical sample","volume":"50","author":"Dunkley","year":"2009","journal-title":"Compr. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.cpr.2009.11.004","article-title":"Emotion-regulation strategies across psychopathology: A meta-analytic review","volume":"30","author":"Aldao","year":"2010","journal-title":"Clin. Psychol. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/eat.20352","article-title":"What\u2019s driving the binge in binge eating disorder? A prospective examination of precursors and consequences","volume":"40","author":"Stein","year":"2007","journal-title":"Int. J. Eat. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.eatbeh.2014.08.025","article-title":"Escaping from body image shame and harsh self-criticism: Exploration of underlying mechanisms of binge eating","volume":"15","author":"Duarte","year":"2014","journal-title":"Eat. Behav."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.bodyim.2022.05.008","article-title":"\u201cFeeling fat,\u201d disgust, guilt, and shame: Preliminary evaluation of a mediation model of binge-eating in adults with higher-weight bodies","volume":"42","author":"Anderson","year":"2022","journal-title":"Body Image"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.neubiorev.2015.08.011","article-title":"Negative mood and eating behavior: A meta-analysis of experimental studies","volume":"57","author":"Cardi","year":"2015","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s11031-006-9006-0","article-title":"The approach and avoidance function of guilt and shame emotions: Comparing reactions to self-caused and other-caused wrongdoing","volume":"30","author":"Schmader","year":"2006","journal-title":"Motiv. Emot."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gilbert, P. (2010). Compassion-Focused Therapy, Routledge.","DOI":"10.4324\/9780203851197"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1002\/jclp.21923","article-title":"A pilot study and randomized controlled trial of the mindful self-compassion program","volume":"69","author":"Neff","year":"2013","journal-title":"J. Clin. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1348\/014466503322528919","article-title":"The relationship between shame, eating disorders and disclosure in treatment: A study of women with bulimia nervosa","volume":"42","author":"Swan","year":"2003","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"111495","DOI":"10.1016\/j.paid.2021.111495","article-title":"Moral Orientation Guilt Scale (MOGS): Development and validation of a novel guilt measurement","volume":"189","author":"Mancini","year":"2022","journal-title":"Personal. Individ. Differ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/hbm.21009","article-title":"Deontological and altruistic guilt: Evidence for distinct neurobiological substrates","volume":"32","author":"Basile","year":"2011","journal-title":"Hum. Brain Mapp."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"131","DOI":"10.5964\/ejop.2115","article-title":"Shame and self-esteem: A meta-analysis","volume":"17","author":"Budiarto","year":"2021","journal-title":"Eur. J. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1037\/a0027930","article-title":"Gender differences in self-conscious emotional experience: A meta-analysis","volume":"138","author":"Higgins","year":"2012","journal-title":"Psychol. Bull."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.neubiorev.2017.05.008","article-title":"Core, social and moral disgust are bounded: A review on behavioral and neural bases of repugnance in clinical disorders","volume":"80","author":"Vicario","year":"2017","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1007\/s11920-020-01217-5","article-title":"The role of disgust in eating disorders","volume":"23","author":"Anderson","year":"2021","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3533","DOI":"10.1007\/s40519-022-01490-8","article-title":"Exploring the contributions of affective constructs and interoceptive awareness to feeling fat","volume":"27","author":"Morales","year":"2022","journal-title":"Eat. Weight. Disord. Stud. Anorex. Bulim. Obes."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s40519-016-0345-x","article-title":"The comorbidity of personality disorders in eating disorders: A meta-analysis","volume":"22","author":"Martinussen","year":"2017","journal-title":"Eat. Weight Disord."},{"key":"ref_37","first-page":"411","article-title":"What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models","volume":"66","author":"Babyak","year":"2004","journal-title":"Psychosom. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1002\/eat.20382","article-title":"Health service utilization for eating disorders: Findings from a community-based study","volume":"40","author":"Mond","year":"2007","journal-title":"Int. J. Eat. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/eat.20380","article-title":"Functional impairment associated with bulimic behaviors in a community sample of men and women","volume":"40","author":"Mond","year":"2007","journal-title":"Int. J. Eat. Disord."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s10339-013-0570-4","article-title":"Intrapsychic and interpersonal guilt: A critical review of the recent literature","volume":"14","author":"Petrocchi","year":"2013","journal-title":"Cogn. Process."},{"key":"ref_41","unstructured":"Robins, R.W., Fraley, R.C., and Krueger, R.F. (2007). The self-report method. Handbook of Research Methods in Personality Psychology, The Guilford Press."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/15\/3\/56\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:50:08Z","timestamp":1760028608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/15\/3\/56"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,10]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["clinpract15030056"],"URL":"https:\/\/doi.org\/10.3390\/clinpract15030056","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,10]]}}}