Margherita Boltri

Alongside excessive physical activity, individuals with eating disorders (EDs) frequently report a heightened urge to move and physical restlessness, which may contribute to both somatic and psychological burden. The State Urge to be Physically Active Questionnaire (SUPA-Q) specifically measures this acute, state-like dimension in ED patients, but a validated Italian version is not yet available. Two hundred thirty-three inpatients (93.6% female; M_age = 31.7 ± 14.3) formally diagnosed with EDs completed the SUPAQ-I alongside measures of compulsive exercise, exercise addiction, impulsivity, and ED psychopathology. Psychometric evaluation covered item performance, internal consistency, confirmatory factor analysis, convergent/divergent validity, sensitivity to change, and exploratory clinical cutoffs. Paired-samples t tests assessed score changes. SUPAQ-I scores demonstrated excellent reliability (α = .958, ω = 0.959) and good factorial validity. Scores significantly positively correlated with ED severity (drive for thinness, body dissatisfaction, overcontrol) and negatively with body mass index. Post hoc analyses revealed higher scores occurring in anorexia nervosa compared to binge-eating disorder, which decreased significantly over hospitalization, findings that are consistent with sensitivity to clinical change. High scores predominated in restrictive anorexia nervosa subtypes. Overall, findings support the psychometric adequacy of SUPAQ-I score interpretations for measuring acute movement urges in EDs. It appeared to capture an affect-driven and state-related dimension of movement urges related to, but not fully explained by, existing trait-based exercise measures and showed sensitive to clinical change. Further research is needed to refine cutoffs and examine the generalizability of these findings across populations and settings. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Food addiction (FA) is an emerging construct describing a compulsive and dysregulated pattern of food consumption that parallels mechanisms observed in substance-related addictions. This study aimed to investigate the prevalence and clinical correlates of FA in a sample of 141 Italian adult inpatients diagnosed with eating disorders (ED). Participants completed standardized self-report instruments assessing FA (YFAS 2.0), binge-eating behaviours (BES), ED-related psychopathology (EDI-3), body image distress (BUT), and general psychological symptoms (SCL-90) at admission (T0) and discharge (T1) from a multidisciplinary ED rehabilitation program. FA showed a high prevalence (85.6%), with more than half of the participants (51.1%) classified as severe. YFAS 2.0 scores were significantly higher among patients with binge eating disorder (BED) and bulimia nervosa (BN). FA severity was strongly associated with bulimic and binge-eating symptoms and interoceptive deficits, but not with body dissatisfaction. Regression analyses indicated that FA at admission was significantly associated with the severity of bulimic and binge-eating symptoms, independently of age, BMI, and illness duration. Overall, findings suggest that FA may reflect a dimensional feature associated with symptom severity across eating disorders, particularly in binge-spectrum presentations. Routine assessment of FA could therefore serve as a potentially useful clinical indicator and guide personalized interventions aimed at reducing compulsive eating behaviours and preventing relapse.

Objective: Anorexia nervosa (AN) is a severe eating disorder, leading to life-threatening complications and psychosocial impairment. Among its complex clinical features, a prominent but poorly understood feature is the intense State Urge to be Physically Active (SUPA), which may not always manifest as observable physical activity. This systematic review follows PRISMA guidelines to examine the characteristics, biological underpinnings, and clinical implications of SUPA in AN across varying illness severity levels. Methods: A systematic search of PubMed, Scopus, and EBSCOhost databases identified 1165 records, of which 17 studies met the inclusion criteria and were included in the final review. These studies employed both objective and subjective assessments of the SUPA. Results: Findings suggest that the SUPA may persist regardless of BMI changes, including during recovery, and may function as a maladaptive emotion regulation strategy, rather than reflect a dispositional feature. Higher SUPA levels during weight restoration seem to predict poorer post treatment weight maintenance. Discussion: In clinical settings, SUPA may signal illness severity and resistance to weight restoration, warranting its proactive inclusion in diagnostic and treatment frameworks. To advance understanding and management of SUPA in AN, future research should address confounding factors such as illness duration, validate standardised assessment tools and procedures, and explore targeted interventions to improve outcomes in AN.

Introduction: Anorexia nervosa (AN) is a severe and complex eating disorder (ED), whose incidence has increased following the COVID-19 pandemic, straining specialized healthcare systems worldwide. Although patients often resort to compulsive exercise as a means of weight control, prolonged fasting intensifies the urge to move, leading to increased motor restlessness. Despite progress in understanding AN, interventions often overlook the crucial role that the urge to be physically active plays in reinforcing the ED itself. This case series tested the feasibility of a Virtual Reality-based Running Exposure (VR-RE) protocol to target the acute urge to be physically active in inpatients with severe AN undergoing rehabilitation. Methods: Three female inpatients with severe AN (body mass index ≤15 kg/m2), aged 21, 23, and 26, participated in a 4-week VR-RE protocol, involving four sessions of simulated jogging in a VR environment. Pre- and post-intervention assessments evaluated ED symptoms and traits characteristics, such as compulsive exercise and physical activity addiction. Results: Although treatment outcomes were only partially achieved and there was little change observed in clinical parameters such as weight and body mass index, reductions in the acute urge to move were observed for all after each VR session. Additionally, reliable and clinically relevant changes were observed in drive for thinness, body image dissatisfaction, interoceptive deficits, and emotional regulation. Two patients also reported a decrease in both trait and addictive physical activity at the end of the protocol and rehabilitation program. Qualitative feedback revealed perceived synchronization with the avatar and endorsed the protocol’s potential for outpatient settings. No cybersickness was reported. Conclusion: This study presents a structured VR-based protocol targeting the acute urge to be physically active in severe AN, integrated into a rehabilitation setting. Future research with longer, personalized, and controlled trials is needed to validate its clinical utility.

Background and Aims: Avolition is a symptom responsible for a high burden in patients suffering from psychiatric diseases. It refers to a motivation loss for initiating and maintaining goal-directed activities, often called fatigue by patients. Fatigue is a widespread complaint of patients suffering from inflammatory bowel disease (IBD), significantly impacting patients’ well-being, even during the quiescent stage of the disease. We here address the hypothesis that fatigue experienced by IBD patients is associated with motivational impairment. Methods: Patients presenting IBD (n = 110) in a quiescent stage of Crohn’s disease (CD) (n = 60) and ulcerative colitis (UC) (n = 50) were enrolled and classified following their declared experience of fatigue (n = 58) or not (n = 52). Patients were phenotyped using self-administered scales for fatigue experience, bowel disease disability, quality of life and mental health symptoms. Results: The self-administered negative symptoms scale scores identified avolition as a specific feature of fatigue experience: fatigued vs. no-fatigue in the CD group (3.806 vs. 2.103; p = 0.003) and in the UC group (2.815 vs. 1.174; p = 0.003). This difference is independent of current depressive disorder and previous history of depressive disorder. Avolition associates and correlates with the experience of fatigue (r = 0.49) in multivariate analysis. Conclusions: To tackle the question of fatigue in IBD, research should consider investigating the biological mechanisms implicating intestinal physiopathology of IBD in the impairment of brain structure involved in motivation. This may open new fields for treatment in targeting structures of the brain reward system.