Feeling identification most strongly linked with eating disorder symptoms in Italian youth

Difficulty identifying feelings was the strongest statistical predictor of eating disorder symptoms in a study of 293 Italian late adolescents and emerging adults, while problems describing feelings were also associated with higher symptom scores. The research used a non-clinical community sample of late adolescents and emerging adults. Participants were 63.8% female, with a mean age of 20.58 years and a standard deviation of 4.23.

They completed the Toronto Alexithymia Scale, the Mentalization Scale, the 26-item Eating Attitudes Test and the DSM-5 Cross-Cutting Symptom Measure. The authors described the study as the first to evaluate, across their specific dimensions, the relative contributions of alexithymia and self-related mentalization to eating disorder symptoms while controlling for sex, age and cross-cutting symptoms. The questionnaire results showed notable symptom and trait scores within the community sample.

Twenty percent of participants screened positive on the EAT-26, and 47.8% fell within the borderline or alexithymic range on the Toronto Alexithymia Scale. In analyses conducted for both sexes, self-related mentalization correlated strongly and negatively with difficulty identifying feelings and difficulty describing feelings. EAT-26 scores correlated positively with those two difficulties and moderately with self-related mentalization.

In a hierarchical regression, the best-fitting model included sex, age, cross-cutting symptoms, difficulty identifying feelings and difficulty describing feelings. Together, those variables explained 26.7% of the variance in EAT-26 scores, with difficulty identifying feelings emerging as the strongest predictor. Self-related mentalization became non-significant once cross-cutting symptoms or alexithymia dimensions were controlled.

Partial correlations pointed in the same direction: difficulty identifying feelings remained associated with EAT-26 scores, whereas self-related mentalization did not. Additional analyses supported the robustness of the main result. Difficulty identifying feelings remained significant when externally oriented thinking and all measured mentalization dimensions were added to the model.

It also remained significant after influential cases were excluded. The pattern did not establish that difficulty identifying feelings causes eating disorder symptoms, nor did it show that targeting emotional identification would prevent or treat eating disorders. The study relied on self-report measures and statistical associations in a non-clinical sample, so its screening results cannot be interpreted as clinical diagnoses or as proof of a causal relationship.

The authors instead presented the findings as consistent with conceptualizing alexithymia as a specific aspect of mentalized affectivity.

Subject of Research: Associations among alexithymia, self-related mentalization and eating disorder symptoms in an Italian community sample.

Article Title: The relationship between alexithymia and mentalization, and their unique contributions to eating disorder symptoms among Italian adolescents and emerging adults

Article References: Germani, A., Pizzini, B., Dragone, M., & De Luca Picione, R. (2026). The relationship between alexithymia and mentalization, and their unique contributions to eating disorder symptoms among Italian adolescents and emerging adults. Current Psychology, 45(21), Article 1640. https://doi.org/10.1007/s12144-026-10209-2

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10209-2

Keywords: eating disorder symptoms, alexithymia, emotional identification, self-related mentalization, Italian youth, community sample, self-report measures, hierarchical regression, cross-cutting symptoms, relationship, between, mentalization