Federico Giovannoni

Background: This study aimed to investigate the relationship between orthorexic tendencies, autistic traits (ATs), and eating disorder (ED) psychopathology in patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), compared to healthy controls (HCs). Methods: A total of 125 participants were assessed using the Adult Autism Subthreshold Spectrum (AdAS Spectrum), ORTO-15, and Eating Disorder Inventory-2 (EDI-2). Results: ED patients exhibited significantly greater orthorexic tendencies and higher AdAS Spectrum and EDI-2 scores than HCs. ORTO-15 scores were significantly associated with both AdAS Spectrum and EDI-2 total scores and with most of their respective domains. In the multivariable regression model, AdAS Spectrum total score was significantly associated with orthorexic tendencies, whereas EDI-2 total score did not reach statistical significance. However, within the EDI-2 domains, Drive for Thinness and Maturity Fears were significantly associated with greater orthorexic tendencies. Among the AdAS Spectrum domains, Non-Verbal Communication was significantly associated with greater orthorexic tendencies. Conclusions: Orthorexic tendencies were elevated among ED patients and were associated with ATs and ED symptomatology itself. Our findings highlight the potential relevance of AT in understanding orthorexic tendencies in patients with ED and warrant confirmation in larger studies using psychometrically refined measures of orthorexia.

Background/Objectives: Orthorexia Nervosa (ON), a condition marked by an obsessive focus on eating healthily, has drawn increasing clinical attention due to its rigid dietary patterns and social impairment. Borderline Personality Disorder (BPD), characterized by emotional dysregulation, impulsivity, and unstable interpersonal relationships, frequently co-occurs with eating disorders. Recent research suggests that autistic traits—such as cognitive rigidity and restricted interests—may underlie both ON and BPD, especially in female populations. This study aimed to assess the prevalence of orthorexic tendencies in patients with BPD compared to healthy controls (HCs) and to explore their associations with autistic traits and disordered eating behaviors. Methods: This study involved 73 BPD patients and 52 HCs. Participants completed the Adult Autism Subthreshold (AdAS) Spectrum, Eating Disorder Inventory-2 (EDI-2), and the ORTO-15 questionnaire. Results: BPD patients scored significantly higher than HCs on AdAS Spectrum and EDI-2, and significantly lower on ORTO-15, indicating more pronounced autistic traits, disordered eating behavior, and orthorexic tendencies. A greater proportion of BPD individuals reported clinically relevant ON symptoms according to the ORTO-15 threshold. Orthorexic symptoms were significantly correlated with most EDI-2 and all AdAS Spectrum domains. Regression analysis revealed that autistic traits, but not feeding and eating disorder symptoms, significantly predicted orthorexic tendencies. Conclusions: Orthorexic tendencies are more prevalent in individuals with BPD and are significantly associated with autistic traits. These findings suggest that ON may represent a manifestation of the autism spectrum, particularly in individuals with BPD, and support a reconceptualization of ON within a neurodevelopmental framework. Recommendation: Future research is needed in order to clarify the temporal and causal relationships among autistic traits, BPD symptomatology, and the emergence of orthorexic behaviors.

Objectives: Hikikomori is a condition characterized by extreme social withdrawal, functional impairment, and mental distress, which has gained increasing recognition worldwide. While it can be associated with comorbid psychiatric disorders, hikikomori shares similarities with autism spectrum, prompting investigations into their relationship. Given that hikikomori commonly manifests in early adulthood, this study aimed to explore the relationship between autistic features and hikikomori tendencies among university students. Methods: A total of 2037 university students were recruited via an online survey and assessed with the Adult Autism Subthreshold (AdAS) Spectrum and the Hikikomori Questionnaire (HQ-25). Participants were categorized into four groups: healthy controls (HCs), subjects with hikikomori tendencies (HKs), subjects with significant autistic traits (ATs), and subjects with both significant ATs and hikikomori tendencies (AT-HKs). Results: Results showed significant effects of both hikikomori presence and significant ATs on AdAS Spectrum and HQ-25 scores, while a significant effect of their interaction was detected on AdAS Spectrum scores. The AT-HK group consistently scored higher on both AdAS Spectrum and HQ-25 compared to other groups, with the AT and HK groups outperforming HCs in specific domains. HQ-25 Socialization and Isolation domains predicted higher AdAS Spectrum scores in hikikomori subjects, while various AdAS Spectrum domains served as predictors of HQ-25 scores in AT subjects. Conclusions: This study highlights a significant relationship between ATs and hikikomori tendencies in university students, suggesting that their comorbidity may represent a more severe phenotype, where each condition may exacerbate the other.

Background: Borderline personality disorder (BPD) is a pervasive mental health condition characterized by a heightened risk of suicidal behavior. Emerging research has suggested a potential overlap between BPD and subthreshold autistic traits (ATs), raising the possibility that these traits may influence the development, course, and severity of BPD, particularly in relation to suicidal ideation and behaviors. This study aims to evaluate the relationship between suicidal ideation, suicidal behaviors, and ATs in individuals with BPD. Methods: We assessed 106 subjects with BPD using the mood spectrum self-report version (MOODS-SR) of the Adult Autism Subthreshold Spectrum (AdAS Spectrum) questionnaire. The sample was divided into three groups based on suicidal ideation and behaviors. Non-parametric tests compared AdAS Spectrum scores, while Spearman’s correlation assessed the relationships between AdAS Spectrum scores and suicidality. Logistic regression analyses were conducted to identify predictive AdAS Spectrum domains for suicidal ideation and behaviors. Results: Subjects with suicidal behaviors and suicidal ideation showed significantly more autistic features than non-suicidal subjects. Correlation analysis revealed that all AdAS Spectrum domains, except empathy, were significantly correlated with both suicidal ideation and behaviors, with stronger correlations for suicidal behaviors. Moreover, restricted interests, rumination, and sensory sensitivity emerged as significant predictors of suicidal ideation, while the lack of empathy was a significant predictor of suicidal behavior. Conclusions: Our results confirm a strong correlation between the presence of ATs and suicidality in subjects with BPD, in particular highlighting rumination, altered sensitivity, and empathic deficits as specific predictors of suicidal thoughts and behaviors.

Autism spectrum disorder (ASD) is a condition that is gaining increasing interest in research and clinical fields. Due to the improvement of screening programs and diagnostic procedures, an increasing number of cases are reaching clinical attention. Despite this, the available pharmacological options for treating ASD-related symptoms are still very limited, and while a wide number of studies are focused on children or adolescents, there is a need to increase research about the treatment of ASD in adult subjects. Given this framework, this work aims to review the available literature about pharmacological treatments for ASD, from older strategies to possible new therapeutic targets for this condition, which are often poorly responsive to available resources. The literature, besides confirming the efficacy of the approved drugs for ASD, shows a lack of adequate research for several psychopharmacological treatments despite possible promising results that need to be further investigated.

Background/Objectives: Recent research has explored the presence of subthreshold autistic traits (ATs) in individuals with borderline personality disorder (BPD), suggesting that these traits may contribute to the severity of BPD symptoms and increase the risk of other mental health issues, including suicidal behaviors. This study aims to investigate the relationship between ATs and affective symptoms, such as mood instability and suicidality, in people diagnosed with BPD. Methods: A total of 48 subjects with BPD were assessed with self-report questionnaires including the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the mood spectrum self-report version (MOODS-SR) and the ruminative response scale (RRS). Results: Subjects with significant ATs scored higher than BPD subjects in all domains and in the total score of AdAS Spectrum, RRS, and MOODS-SR, as well as in the items investigating suicidality. RRS total score, its depression domain, and the MOODS-SR rhythmicity domain, as well as suicidality, were predictors of the presence of ATs. Conclusions: Our data confirm the relationship between the presence of clinically significant ATs and affective symptoms, ruminative thinking, and suicidality in patients with BPD.

In the previous literature, specific attention has been paid to investigate autism spectrum symptoms and traits in university students. In this framework, we aimed to evaluate the presence and correlates of autistic traits, hikikomori tendencies, altered eating behaviors, and pathological videogaming in a sample of Italian university students enrolled in bachelor’s degree courses. A total of 1192 students were recruited via an online survey and assessed with the Hikikomori Questionnaire-25, the Adult Autism Subthreshold Spectrum Questionnaire, the Eating Attitude test-26, and the Assessment of Internet and Computer Game Addiction. Our results highlighted significant differences in the prevalence of autistic traits, social withdrawal tendencies, altered eating habits, and pathological videogame use in university students based on gender, age, parents’ level of instruction, and field of study. A significant effect of the presence of autistic traits and gender on the scores obtained with the other questionnaires was reported. Our results not only support the role of autistic traits as a vulnerability factor for the development of a set of psychopathological conditions but also suggest that gender could modulate this vulnerability, supporting the hypothesis of gender-specific phenotypes in the autism spectrum.

The current literature globally highlights the efficacy of Clozapine in several psychiatric disorders all over the world, with an FDA indication for reducing the risk of repeated suicidal behavior in patients with schizophrenia or schizoaffective disorder. A growing field of research is also stressing a possible broader beneficial effect of Clozapine in promoting neuroprotection and neurotrophism. However, this drug is linked to several life-threatening side effects, such as agranulocytosis, myocarditis and seizures, that limit its use in daily clinical practice. For this work, a search was performed on PubMed using the terms “Clozapine indications”, “Clozapine adverse effects”, “Clozapine regenerative effects”, and “Clozapine neuroplasticity” with the aim of reviewing the scientific literature on Clozapine’s treatment indications, adverse effects and potential regenerative role. The results confirmed the efficacy of clozapine in clinical practice, although limited by its adverse effects. It appears crucial to raise awareness among clinicians about the potential benefits of using Clozapine, as well educating medical personnel about its risks and the early identification of possible adverse effects and their management.

Introduction: The prevalence of Autism Spectrum Disorder (ASD) is four times higher in males than females; however, females are significantly more likely to go undiagnosed due to the existence of a “female autistic phenotype”, a manifestation unique to females that conflicts with conventional, masculine conceptualizations of ASD. Furthermore, subthreshold autistic traits, which exert a significantly negative impact on quality of life and represent a vulnerability factor for the development of other psychopathological conditions, may remain even more under-recognized. Subsequently, many women with ASD may never receive a diagnosis or any resulting care, with serious consequences for their health. Aims: We aimed to describe two brief cases in order to confirm the diagnostic difficulties that ASD female undergo during their clinical evaluation and the possible alternative phenotype that they can manifest. Methods: We reported the cases of two young women on the autism spectrum that came to clinical attention only after the development of severe symptomatology attributed to other mental disorders, overlooking the presence of underlying autism spectrum features and a brief résumé of the literature on this topic. Results: These cases confirm the need for a timely and proper identification of females on the autism spectrum in order to prevent complications and improve the outcome. Conclusions: Research on gender differences could lead to a reexamination of the sex ratio in the prevalence of ASD and provide a better understanding of several psychiatric conditions that are frequently diagnosed in women, supporting the neurodevelopmental approach to psychopathology.