{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:13:38Z","timestamp":1788776018657,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Moral emotions are increasingly implicated in the maintenance of eating disorders (EDs), yet guilt is less differentiated than shame in the ED literature. Contemporary cognitive accounts distinguish deontological guilt linked to violating internalised moral norms from altruistic guilt linked to empathic concern or perceived harm to others. This study examined associations between guilt facets, ED diagnosis, and ED psychopathology in a clinical sample. Materials and Methods: One hundred and eleven adult outpatients (\u226518 years) with DSM-5 ED diagnoses (anorexia nervosa, n = 32; bulimia nervosa, n = 24; binge-eating disorder, n = 55; 92 women) were consecutively recruited at first assessment at the Eating Disorders Centre of the University of Campania \u201cLuigi Vanvitelli\u201d (Naples, Italy) between January 2024 and December 2025 and completed the Italian versions of the Moral Orientation Guilt Scale (MOGS) and the Eating Disorder Inventory 2 (EDI-2). Between-diagnosis differences in guilt facets were tested using Kruskal\u2013Wallis analyses. Spearman correlations examined relationships between MOGS facets and EDI-2 subscales. An exploratory regression tested whether MOGS Empathy was associated with EDI-2 Asceticism beyond sex. Results: Significant between-diagnosis differences emerged for Moral Norm Violation (p &lt; 0.001), Moral Dirtiness (p = 0.020), Harm (p = 0.021), and both deontological (p = 0.001) and altruistic guilt composites (p = 0.041), with binge-eating disorder showing the highest mean levels. No between-diagnosis difference emerged for Empathy (p = 0.114). The prespecified MNV\u2013Bulimia correlation was not confirmed (\u03c1 = 0.12, unadjusted p = 0.199; Holm-adjusted p = 0.199). Empathy was associated with Asceticism (\u03c1 = 0.28, unadjusted p = 0.003; Holm-adjusted p = 0.008), and altruistic guilt was associated with Interpersonal Distrust (\u03c1 = 0.24, unadjusted p = 0.010; Holm-adjusted p = 0.020). Broader exploratory correlations did not survive false discovery rate correction. In a regression model including sex, Empathy was associated with Asceticism (B = 0.263, 95% CI 0.078\u20130.447; standardised \u03b2 = 0.26; p = 0.006), explaining approximately 7% of the variance (R2 = 0.07). Conclusions: Distinct guilt facets show selective, small-to-moderate associations with ED-related psychological traits in an adult outpatient sample. These findings are hypothesis-generating and require replication in larger and longitudinal samples that include shame, trauma, self-criticism, weight stigma, illness duration, and gender identity measures.<\/jats:p>","DOI":"10.3390\/medicina62091719","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:23:37Z","timestamp":1788773017000},"page":"1719","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Guilt Facets and Eating Disorder Psychopathology: An Exploratory Cross-Sectional Study Using the Moral Orientation Guilt Scale"],"prefix":"10.3390","volume":"62","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"}]},{"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":"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":"Eleonora","family":"Arsenio","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Cruccu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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\/0000-0002-3344-1000","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"}]},{"given":"Alessio Maria","family":"Monteleone","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1177\/0004867419849487","article-title":"A biopsychosocial proposal to progress the field of anorexia nervosa","volume":"53","author":"Phillipou","year":"2019","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"102547","DOI":"10.1016\/j.cpr.2025.102547","article-title":"A meta-analysis of mortality rates in eating disorders: An update of the literature from 2010 to 2024","volume":"116","author":"Krug","year":"2025","journal-title":"Clin. Psychol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1002\/wps.70014","article-title":"All-cause and cause-specific mortality risk in individuals with eating disorders: Systematic review and meta-analysis of relative risk and aggravating or attenuating factors","volume":"25","author":"Semchishen","year":"2026","journal-title":"World Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1111\/eat.70002","article-title":"Systematic review and meta-analysis of mortality in patients with anorexia nervosa","volume":"59","author":"Lai","year":"2026","journal-title":"Int. J. Eat. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S0005-7967(02)00088-8","article-title":"Cognitive behavior therapy for eating disorders: A transdiagnostic theory and treatment","volume":"41","author":"Fairburn","year":"2003","journal-title":"Behav. Res. Ther."},{"key":"ref_7","unstructured":"Fairburn, C.G. (2008). Cognitive Behavior Therapy and Eating Disorders, Guilford Press."},{"key":"ref_8","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_9","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1037\/0033-2909.128.5.825","article-title":"Risk and maintenance factors for eating pathology: A meta-analytic review","volume":"128","author":"Stice","year":"2002","journal-title":"Psychol. Bull."},{"key":"ref_10","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_11","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1037\/a0021466","article-title":"Shame, guilt, and depressive symptoms: A meta-analytic review","volume":"137","author":"Kim","year":"2011","journal-title":"Psychol. Bull."},{"key":"ref_12","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_13","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."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1002\/cpp.2615","article-title":"Shame and binge eating pathology: A systematic review","volume":"29","author":"Grant","year":"2022","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Raffone, F., Atripaldi, D., Barone, E., Marone, L., Carfagno, M., Mancini, F., Saliani, A.M., and Martiadis, V. (2025). Exploring the role of guilt in eating disorders: A pilot study. Clin. Pract., 15.","DOI":"10.3390\/clinpract15030056"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1037\/a0029703","article-title":"Facets of negative affect prior to and following binge-only, purge-only, and binge\/purge events in women with bulimia nervosa","volume":"122","author":"Berg","year":"2013","journal-title":"J. Abnorm. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jpsychires.2012.11.012","article-title":"Moderators of post-binge eating negative emotion in eating disorders","volume":"47","author":"Lavender","year":"2013","journal-title":"J. Psychiatr. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1002\/eat.22401","article-title":"Negative affect prior to and following overeating-only, loss of control eating-only, and binge eating episodes in obese adults","volume":"48","author":"Berg","year":"2015","journal-title":"Int. J. Eat. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1037\/abn0000517","article-title":"The role of affect in the maintenance of binge-eating disorder: Evidence from an ecological momentary assessment study","volume":"129","author":"Schaefer","year":"2020","journal-title":"J. Abnorm. Psychol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1002\/eat.22770","article-title":"Negative affect and binge eating: Reconciling differences between two analytic approaches in ecological momentary assessment research","volume":"50","author":"Berg","year":"2017","journal-title":"Int. J. Eat. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1037\/abn0000202","article-title":"Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa","volume":"126","author":"Haynos","year":"2017","journal-title":"J. Abnorm. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.eatbeh.2019.03.002","article-title":"Weight-related shame and guilt and their associations with intuitive eating and binge eating symptomatology","volume":"33","author":"Craven","year":"2019","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","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_25","doi-asserted-by":"crossref","first-page":"111495","DOI":"10.1016\/j.paid.2021.111495","article-title":"The Moral Orientation Guilt Scale (MOGS): Development and validation of a novel guilt measurement","volume":"189","author":"Mancini","year":"2022","journal-title":"Pers. Individ. Differ."},{"key":"ref_26","unstructured":"Garner, D.M. (1991). Eating Disorder Inventory-2: Professional Manual, Psychological Assessment Resources."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1080\/08039480500504537","article-title":"Validating the EDI-2 in three Swedish female samples: Eating disorders patients, psychiatric outpatients and normal controls","volume":"60","author":"Nevonen","year":"2006","journal-title":"Nord. J. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1177\/1073191103255001","article-title":"Psychometric properties of the Eating Disorders Inventory-2 among women seeking treatment for binge eating disorder","volume":"10","author":"Tasca","year":"2003","journal-title":"Assessment"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., G\u00f8tzsche, P.C., and Vandenbroucke, J.P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040296"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: A practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B"},{"key":"ref_31","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_32","unstructured":"JASP Team (2026, February 17). JASP (Version 0.18.3) [Computer Software]. Available online: https:\/\/jasp-stats.org."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1111\/obr.12701","article-title":"Weight bias internalization and health: A systematic review","volume":"19","author":"Pearl","year":"2018","journal-title":"Obes. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/eat.22598","article-title":"Perceived barriers and facilitators towards help-seeking for eating disorders: A systematic review","volume":"50","author":"Ali","year":"2017","journal-title":"Int. J. Eat. Disord."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1002\/eat.24166","article-title":"Self-criticism and self-compassion in disordered eating: A systematic review and meta-analysis","volume":"57","author":"Paranjothy","year":"2024","journal-title":"Int. J. Eat. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1186\/s40337-025-01418-4","article-title":"The efficacy of compassion focused therapy in eating disorders: A systematic review of the literature","volume":"13","author":"Stock","year":"2025","journal-title":"J. Eat. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1002\/eat.23260","article-title":"A framework to conceptualize personal recovery from eating disorders: A systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience","volume":"53","author":"Wetzler","year":"2020","journal-title":"Int. J. Eat. Disord."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1111\/ap.12171","article-title":"Eating disorder patient experiences of volitional stigma within the healthcare system and views on biogenetic framing: A qualitative perspective","volume":"53","author":"Bannatyne","year":"2018","journal-title":"Aust. Psychol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s40337-021-00435-3","article-title":"Initial self-blame predicts eating disorder remission after 9 years","volume":"9","author":"Petersson","year":"2021","journal-title":"J. Eat. Disord."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1002\/(SICI)1098-108X(200005)27:4<428::AID-EAT7>3.0.CO;2-Y","article-title":"Duration of illness predicts outcome for bulimia nervosa: A long-term follow-up study","volume":"27","author":"Reas","year":"2000","journal-title":"Int. J. Eat. Disord."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s40337-023-00806-y","article-title":"Eating disorder symptomatology among transgender individuals: A systematic review and meta-analysis","volume":"11","author":"Rasmussen","year":"2023","journal-title":"J. Eat. Disord."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1719\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:07:14Z","timestamp":1788775634000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medicina62091719"],"URL":"https:\/\/doi.org\/10.3390\/medicina62091719","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}