Arturo Rodríguez-Rey

Background: Body image disturbance (BID) involves a distorted perception of one’s body, whereas body dissatisfaction (BDS) reflects negative affective evaluation of body appearance. Both are central features of eating disorders such as anorexia nervosa (AN), but their expression in siblings of affected individuals remains underexplored, particularly in younger populations. Methods: This cross-sectional preliminary study included 53 full sisters of adolescent patients with severe AN treated in a tertiary hospital. Participants underwent anthropometric assessment and completed standardized measures of BID, BDS, physical activity, eating-related attitudes, perfectionism, anxiety, and depressive symptoms. Results: Participants exhibited marked body size overestimation (mean relative BID = +45.2%), with 64.2% classified as high overestimators and 3.8% as underestimators. Overestimation was most pronounced in the waist, chest, and calves. BID was not significantly associated with BDS or with anthropometric measures, including body mass index. BDS showed significant positive correlations with depressive symptoms and self-oriented perfectionism, whereas BID was positively associated with physical activity. No significant associations were found between BID or BDS and age, socioeconomic status, or birth order. Conclusions: Sisters of adolescents with severe AN show substantial perceptual distortion of body size without corresponding levels of body dissatisfaction, suggesting partial independence between perceptual and affective components of body image. These findings identify a potentially vulnerable group and highlight the need for longitudinal studies to clarify mechanisms and inform preventive strategies.

Background/Objectives: Anorexia nervosa (AN) is a severe psychiatric-metabolic disorder with high morbidity and mortality, profoundly impacting family systems. Siblings of patients with AN constitute a vulnerable group, yet there is a lack of specific, quantitative evidence on their mental health status, particularly when examined from a sex/gender perspective. This review aimed to synthesize existing evidence on the prevalence of psychiatric symptoms, diagnoses, and other mental health challenges in siblings of individuals with AN and critically analyze it from a sex/gender perspective. Methods: Following PRISMAguidelines, a systematic search was conducted across five databases (April–May 2025). The protocol was registered in PROSPERO (CRD420251025535). Sixteen studies published between 1983 and 2022 met eligibility criteria. Results: Included studies were rated as high or moderate quality, and overall risk of bias was estimated as low–moderate. Only half of the studies included brothers, and overall quality assessment from a sex/gender perspective was modest. Dimensional psychopathology assessments found increased prevalence of both internalizing and externalizing symptoms in siblings compared to controls, although siblings were generally more like controls than affected probands in psychometric evaluations. The few studies based on clinically diagnosed psychopathology state that siblings are at increased risk of several mental health disorders. Conclusions: Specific quantitative evidence on psychiatric diagnoses, psychopathology and other mental health challenges in siblings of individuals with AN is relatively scarce and biased, particularly by systematic exclusion of externalizing symptoms and male siblings. Future translational research should be designed and interpreted using a sex/gender perspective and prioritize systematic assessment by clinicians.

Background: It is common for patients with eating disorders (ED) to report traumatic experiences early in their lifetime. The objective of this study was to explore the presence and types of traumatic events and the comorbidity with Post-Traumatic Stress Disorder (PTSD) in a sample of adolescents with severe ED. Method: A total of 118 adolescents treated at our Eating Disorders Day Care Hospital (EDDCH) were systematically evaluated for depressive symptoms, disordered eating, early traumatic experiences, and presence of PTSD. Likewise, various clinical variables were collected including comorbidities, age upon ED diagnosis, number of hospital admissions, presence of non-suicidal self-injury, and suicide attempts. Results: Seventy-seven (65.3%) of adolescents of the total sample reported exposure to four or more traumatic events (bullying, psychological abuse, and sexual abuse being the most common). Fifty-seven of them (48.3% of the total sample) scored significantly high in PTSD assessment. Patients with ED and comorbid PTSD (PTSD+) presented higher disordered eating (p < 0.001) and depressive symptoms (p < 0.001) and also a higher prevalence of both non-suicidal self-injury (p = 0.031) and suicide attempts (p = 0.004). The depressive symptoms, measured with the CDI, emerged as an independent predictor of belonging to the PTSD+ group, explaining 22.9% of the variance. Conclusions: It is imperative to systematically screen adolescents with severe ED for traumatic events and PTSD, especially in patients presenting with more depressive symptoms and suicidal or non-suicidal self-injury behaviours, since this subset of patients could be at a higher risk of PTSD. Offering specific psychotherapeutic care targeting PTSD and/or posttraumatic symptoms in addition to the ED standard of care could arguably improve the prognosis of the ED in comorbid patients.

Background: Many people attending primary care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem, and digital tools have been proposed as a solution. Objective: We aimed to present the development, feasibility, and potential effectiveness of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout, and detecting suicide risk in patients from PC and health care workers. Methods: Healthy controls (HCs) tested Vickybot for reliability. For the simulation study, HCs used Vickybot for 2 weeks to simulate different clinical situations. For feasibility and effectiveness study, people consulting PC or health care workers with mental health problems used Vickybot for 1 month. Self-assessments for anxiety (Generalized Anxiety Disorder 7-item) and depression (Patient Health Questionnaire-9) symptoms and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every 2 weeks. Feasibility was determined from both subjective and objective user-engagement indicators (UEIs). Potential effectiveness was measured using paired 2-tailed t tests or Wilcoxon signed-rank test for changes in self-assessment scores. Results: Overall, 40 HCs tested Vickybot simultaneously, and the data were reliably transmitted and registered. For simulation, 17 HCs (n=13, 76% female; mean age 36.5, SD 9.7 years) received 98.8% of the expected modules. Suicidal alerts were received correctly. For the feasibility and potential effectiveness study, 34 patients (15 from PC and 19 health care workers; 76% [26/34] female; mean age 35.3, SD 10.1 years) completed the first self-assessments, with 100% (34/34) presenting anxiety symptoms, 94% (32/34) depressive symptoms, and 65% (22/34) work-related burnout. In addition, 27% (9/34) of patients completed the second self-assessment after 2 weeks of use. No significant differences were found between the first and second self-assessments for anxiety (t8=1.000; P=.34) or depressive (t8=0.40; P=.70) symptoms. However, work-related burnout scores were moderately reduced (z=−2.07, P=.04, r=0.32). There was a nonsignificant trend toward a greater reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Furthermore, 9% (3/34) of patients activated the suicide alert, and the research team promptly intervened with successful outcomes. Vickybot showed high subjective UEI (acceptability, usability, and satisfaction), but low objective UEI (completion, adherence, compliance, and engagement). Vickybot was moderately feasible. Conclusions: The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and for detecting suicidal risk. Potential effectiveness was shown to reduce work-related burnout but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution to improve engagement. A consensus on how to report UEIs and validate digital solutions, particularly for chatbots, is required.