Alexithymia, Resilience, and Depression in Functional Impairment Among Adolescents With Eating Disorders: A Case-Control Study

Background:
Eating disorders (EDs) in adolescence are associated with marked emotional difficulties and broad functional impairment. The objective of this study was to examine the relationships among alexithymia, resilience, internalizing symptoms (anxiety and depression), and functional impairment in adolescents with EDs.
Method:
A cross-sectional, case-control study included 51 adolescents diagnosed with EDs according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria (primarily anorexia nervosa, bulimia nervosa, and binge eating disorder) and 57 matched controls. Adolescents completed self-report measures assessing alexithymia, resilience, and internalizing symptoms, and parents reported on functional impairment.
Results:
Adolescents with EDs showed significantly greater functional impairment at both global and subdomain levels, along with higher levels of depressive and anxiety symptoms, higher alexithymia scores, and lower resilience than did controls. Difficulty describing feelings (DDF) was the only variable significantly associated with ED group membership. Within the ED group, functional impairment was positively correlated with depressive symptoms, anxiety symptoms, DDF, and difficulty identifying feelings (DIF), and was negatively correlated with resilience. Depressive symptoms were significantly associated with functional impairment, and mediation analyses indicated that the association between DIF and global functional impairment was statistically mediated by depressive symptoms.
Conclusion:
These findings suggested that adolescents with EDs experience widespread functional difficulties, with depressive mood, exacerbated by challenges in emotion identification, potentially contributing to these impairments.