J Psychiatr Res. 2026 Jul 21;201:641-650. doi: 10.1016/j.jpsychires.2026.07.020. Online ahead of print.
ABSTRACT
BACKGROUND: Anorexia nervosa (AN) is a severe psychiatric disorder frequently associated with affective disturbances, particularly depression, and marked deficits in emotional awareness. Alexithymia has been identified as a core vulnerability factor in AN, however, its relationship with eating disorder symptomatology appears complex and may be influenced by depressive mood. Despite growing interest in transdiagnostic emotional processes, the mediating role of depression in the association between alexithymia and eating symptoms remains insufficiently explored, especially in young women and using comprehensive psychopathological assessment tools.
OBJECTIVES: The present study aimed to examine differences in alexithymia, emotion regulation, mood, personality-related psychopathology, and eating disorder symptoms between young women with and without restrictive AN; to investigate associations among these dimensions within each group; and to test the mediating role of depression in the relationship between alexithymia and eating disorder symptomatology.
METHODS: The sample consisted of 47 young women with restrictive AN and 48 non-clinical controls aged 16-30 years. Participants completed the Toronto Alexithymia Scale (TAS-20), Profile of Mood States (POMS), Emotion Regulation Questionnaire (ERQ), Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Eating Disorder Inventory-3 (EDI-3). Group comparisons were performed between the clinical and control groups. Correlational analyses and mediation models were conducted separately within each group.
RESULTS: Compared to controls, patients with AN showed significantly higher levels of psychopathology, depressive mood, alexithymia, and expressive suppression. Correlational analyses revealed partially different patterns across groups. Mediation analyses indicated that, in the clinical group, the association between alexithymia and eating disorder symptoms was fully accounted for by depressive symptoms, whereas in the control group both direct and indirect associations remained statistically significant.
CONCLUSIONS: These findings suggest that depressive symptoms may partially account for the observed association between alexithymia and eating disorder symptoms in AN. However, the cross-sectional design precludes causal inferences. Nevertheless, the results highlight the clinical relevance of assessing emotional awareness and depressive symptoms in young women with AN.
PMID:42503289 | DOI:10.1016/j.jpsychires.2026.07.020
