{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:19:52Z","timestamp":1760059192095,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health-Ricerca Corrente"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Emotional dysregulation has been strongly linked to maladaptive eating behaviors in obesity. Worry and rumination are frequently implicated in emotional dysregulation and may serve as pathways linking emotional regulation difficulties to emotional eating. The current study examines the mediating role of worry and rumination in the relationship between emotional dysregulation and emotional eating among individuals with obesity. Methods: Ninety hospitalized Italian adults were involved in the study with 53 obese males, 37 obese females, mean age \u00b1 SD: 50.1 + 10.9 years; mean body mass index: 46.4 \u00b1 9.4 kg\/m2. To assess worry, rumination, emotion dysregulation, and emotional eating, the participants were asked to fill in, respectively, the following questionnaires: The Penn State Worry Questionnaire; The Ruminative Response Scale; The Anger Rumination Scale; The Difficulties in Emotion Regulation Scale; Emotional Eating subscale of the Dutch Eating Behavior Questionnaire. Three mediation models were tested to examine the relationships between difficulties in emotional regulation as a predictor, worry and rumination as mediators separately, and emotional eating as the dependent variable. Results: The mediation analyses revealed significant indirect effects across all models, suggesting the presence of mediation effects of worry and rumination in the relationships between emotional dysregulation and emotional eating. Conclusions: These findings highlight the critical mediating role of worry and rumination that drive the observed relationships between emotional dysregulation and emotional eating. This study contributes to a deeper understanding of the cognitive-emotional mechanisms involved in emotional eating in individuals with obesity. Such results can contribute to developing targeted interventions aimed at improving emotional regulation and reducing maladaptive eating behaviors.<\/jats:p>","DOI":"10.3390\/jcm14113871","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T10:21:49Z","timestamp":1748859709000},"page":"3871","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Emotional Dysregulation and Emotional Eating in Hospitalized Adults with Obesity: The Mediating Role of Worry and Rumination"],"prefix":"10.3390","volume":"14","author":[{"given":"Anna","family":"Guerrini Usubini","sequence":"first","affiliation":[{"name":"Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Ducale","sequence":"additional","affiliation":[{"name":"Psychology Research Laboratory, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9145-5400","authenticated-orcid":false,"given":"Adele","family":"Bondesan","sequence":"additional","affiliation":[{"name":"Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1227-1747","authenticated-orcid":false,"given":"Francesca","family":"Frigerio","sequence":"additional","affiliation":[{"name":"Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriella","family":"Tringali","sequence":"additional","affiliation":[{"name":"Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Cornacchia","sequence":"additional","affiliation":[{"name":"Division of Pneumology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferruccio","family":"Nibbio","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2633-9822","authenticated-orcid":false,"given":"Gianluca","family":"Castelnuovo","sequence":"additional","affiliation":[{"name":"Psychology Research Laboratory, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"},{"name":"Department of Psychology, Catholic University of Milan, 20123 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9620-4133","authenticated-orcid":false,"given":"Alessandro","family":"Sartorio","sequence":"additional","affiliation":[{"name":"Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 28824 Piancavallo-Verbania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2025, April 14). Obesity and Overweight. Available online: https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Palmieri, L., Marcozzi, B., Lo Noce, C., Vannucchi, S., Lonardo ADi Damiano, C., Galeone, D., Bellisario, P., Palmieri, L., and Donfrancesco, C. (2025, April 14). Measured Obesity and Overweight in Adults: The Italian Health Examination Survey 2023-CUORE Project. Available online: https:\/\/academic.oup.com\/eurpub\/article\/34\/Supplement_3\/ckae144.1441\/7844349.","DOI":"10.1093\/eurpub\/ckae144.1441"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Dakanalis, A., Mentzelou, M., Papadopoulou, S.K., Papandreou, D., Spanoudaki, M., Vasios, G.K., Pavlidou, E., Mantzorou, M., and Giaginis, C. (2023). The association of emotional eating with overweight\/obesity, depression, anxiety\/stress, and dietary patterns: A review of the current clinical evidence. Nutrients, 15.","DOI":"10.3390\/nu15051173"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/ajcn\/79.1.6","article-title":"Poverty and obesity: The role of energy density and energy costs","volume":"79","author":"Drewnowski","year":"2004","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"240128","DOI":"10.1155\/2013\/240128","article-title":"The clinical obesity maintenance model: An integration of psychological constructs including mood, emotional regulation, disordered overeating, habitual cluster behaviours, health literacy and cognitive function","volume":"2013","author":"Raman","year":"2013","journal-title":"J. Obes."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1002\/eat.23206","article-title":"A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders","volume":"53","author":"Atwood","year":"2020","journal-title":"Int. J. Eat. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1023\/B:JOBA.0000007455.08539.94","article-title":"Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale","volume":"26","author":"Gratz","year":"2004","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1002\/cpp.2152","article-title":"Anger and depressive ruminations as predictors of dysregulated behaviours in borderline personality disorder","volume":"25","author":"Martino","year":"2018","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1017\/S0954579419000282","article-title":"Emotion dysregulation: A theme in search of definition","volume":"31","author":"Thompson","year":"2019","journal-title":"Dev. Psychopathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1002\/cpp.628","article-title":"Emotion recognition and regulation in anorexia nervosa","volume":"16","author":"Harrison","year":"2009","journal-title":"Clin. Psychol. Psychother. Int. J. Theory Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"104438","DOI":"10.1016\/j.appet.2019.104438","article-title":"Emotion regulation across eating pathology: A meta-analysis","volume":"143","author":"Prefit","year":"2019","journal-title":"Appetite"},{"key":"ref_12","first-page":"57","article-title":"A review of binge eating disorder and obesity","volume":"35","year":"2021","journal-title":"Neuropsychiatr. Klin. Diagn. Ther. Rehabil. Organ. Ges. Osterreichischer Nervenarzte Psychiater"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1002\/1098-108X(198602)5:2<295::AID-EAT2260050209>3.0.CO;2-T","article-title":"The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior","volume":"5","author":"Frijters","year":"1986","journal-title":"Int. J. Eat. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11892-018-1000-x","article-title":"Causes of emotional eating and matched treatment of obesity","volume":"18","year":"2018","journal-title":"Curr. Diabetes Rep."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, American Psychiatric Publishing.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s40337-025-01197-y","article-title":"Emotion regulation difficulties and disordered eating in adolescents and young adults: A meta-analysis","volume":"13","author":"Zhou","year":"2025","journal-title":"J. Eat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Barbuti, M., D\u2019Alessandro, G., Weiss, F., Calderone, A., Santini, F., Perugi, G., and Maremmani, I. (2024). The Impact of Negative Emotional Dysregulation on the Outcome of Bariatric Surgery in Patients with Severe Obesity: An Observational One-Year Follow-Up Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13175158"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1111\/jhn.13176","article-title":"Emotional eating among adults with healthy weight, overweight and obesity: A systematic review and meta-analysis","volume":"36","author":"Vasileiou","year":"2023","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S1471-0153(02)00100-9","article-title":"Emotional eating in overweight, normal weight, and underweight individuals","volume":"3","author":"Geliebter","year":"2003","journal-title":"Eat. Behav."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/bjop.12768","article-title":"The global prevalence of emotional eating in overweight and obese populations: A systematic review and meta-analysis","volume":"116","author":"Chew","year":"2025","journal-title":"Br. J. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/j.1745-6924.2008.00088.x","article-title":"Rethinking Rumination","volume":"3","author":"Wisco","year":"2008","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ijpsycho.2008.12.014","article-title":"The autonomic phenotype of rumination","volume":"72","author":"Ottaviani","year":"2009","journal-title":"Int. J. Psychophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s10862-009-9136-2","article-title":"Ruminating on rumination: Are rumination on anger and sadness differentially related to aggression and depressed mood?","volume":"32","author":"Peled","year":"2010","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1037\/0033-2909.134.2.163","article-title":"Constructive and unconstructive repetitive thought","volume":"134","author":"Watkins","year":"2008","journal-title":"Psychol. Bull."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/1088868312467086","article-title":"The multiple systems model of angry rumination","volume":"17","author":"Denson","year":"2013","journal-title":"Personal. Soc. Psychol. Rev."},{"key":"ref_26","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_27","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s40519-020-00857-z","article-title":"Rumination, mood, and maladaptive eating behaviors in overweight and healthy populations","volume":"26","author":"Kornacka","year":"2021","journal-title":"Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Palmieri, S., Mansueto, G., Scaini, S., Caselli, G., Sapuppo, W., Spada, M.M., Sassaroli, S., and Ruggiero, G.M. (2021). Repetitive negative thinking and eating disorders: A meta-analysis of the role of worry and rumination. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112448"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/0005-7967(90)90135-6","article-title":"Development and validation of the penn state worry questionnaire","volume":"28","author":"Meyer","year":"1990","journal-title":"Behav. Res. Ther."},{"key":"ref_30","first-page":"13","article-title":"Penn State Worry Questionnaire e Worry Domains Questionnaire. Presentazione delle versioni italiane ed analisi della fedelt\u00e0","volume":"5","author":"Morani","year":"1999","journal-title":"Cogn. E Comport."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1037\/0022-3514.61.1.115","article-title":"A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta Earthquake","volume":"61","author":"Morrow","year":"1991","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_32","first-page":"229","article-title":"Misurare la ruminazione: Propriet\u00e0 psicometriche della Ruminative Response Scale nella versione italiana","volume":"34","author":"Palmieri","year":"2007","journal-title":"G. Ital. Psicol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S0191-8869(00)00171-9","article-title":"Development and validation of the anger rumination scale","volume":"31","author":"Sukhodolsky","year":"2001","journal-title":"Personal. Individ. Differ."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Balsamo, M., Carlucci, L., Sergi, M.R., Klein Murdock, K., and Saggino, A. (2015). The mediating role of early maladaptive schemas in the relation between co-rumination and depression in young adults. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0140177"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1002\/jclp.21876","article-title":"Cultural Adaptation of the Difficulties in Emotion Regulation Scale: Reliability and Validity of an Italian Version","volume":"68","author":"Giromini","year":"2012","journal-title":"J. Clin. Psychol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.appet.2013.08.010","article-title":"Italian version of the Dutch Eating Behavior Questionnaire. Psychometric proprieties and measurement invariance across sex, BMI-status and age","volume":"71","author":"Dakanalis","year":"2013","journal-title":"Appetite"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"879","DOI":"10.3758\/BRM.40.3.879","article-title":"Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models","volume":"40","author":"Preacher","year":"2008","journal-title":"Behav. Res. Methods"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.jad.2022.04.086","article-title":"Difficulties in emotion regulation: The role of repetitive negative thinking and metacognitive beliefs","volume":"308","author":"Mansueto","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s41811-022-00133-1","article-title":"Repetitive Negative Thinking Processes Account for Gender Differences in Depression and Anxiety During Adolescence","volume":"15","author":"Espinosa","year":"2022","journal-title":"Int. J. Cogn. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.paid.2013.03.019","article-title":"Gender differences in rumination: A meta-analysis","volume":"55","author":"Johnson","year":"2013","journal-title":"Pers Individ. Dif"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.appet.2016.12.020","article-title":"Gender differences in eating behavior and eating pathology: The mediating role of rumination","volume":"110","author":"Opwis","year":"2017","journal-title":"Appetite"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1016\/j.brat.2006.09.018","article-title":"Rumination-focused cognitive behaviour therapy for residual depression: A case series","volume":"45","author":"Watkins","year":"2007","journal-title":"Behav. Res. Ther."},{"key":"ref_43","unstructured":"Cooper, Z., Fairburn, C., and Hawker, D. (2003). Cognitive-Behavioral Treatment of Obesity: A Clinician\u2019s Guide, The Guilford Press."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"496","DOI":"10.23736\/S1973-9087.20.06232-2","article-title":"ISPRM\/ESPRM guidelines on physical and rehabilitation Medicine professional practice for adults with obesity and related comorbidities","volume":"56","author":"Giusti","year":"2020","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.addbeh.2014.08.002","article-title":"Metacognition in addictive behaviors","volume":"44","author":"Spada","year":"2015","journal-title":"Addict. Behav."},{"key":"ref_46","unstructured":"Wells, A. (2009). SM Metacognitive therapy. Treatment Resistant Anxiety Disorders: Resolving Impasses to Symptom Remission, Routledge."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3871\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:44:15Z","timestamp":1760031855000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3871"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113871"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113871","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,5,30]]}}}