Congenital anomalies identified during early childhood in NICU infants with bilateral hearing loss: a multi-centre longitudinal cohort study.

Eating disorders (EDs) are among the most severe psychiatric conditions, due to their high morbidity and mortality and their detrimental impact on both physical and mental health (). Although EDs encompass a range of diagnostic presentations, Anorexia Nervosa (AN) is widely considered the most severe and clinically complex subtype. It is associated with marked psychological distress, serious medical complications, and one of the highest mortality rates of all psychiatric illnesses (). Epidemiological evidence highlighted that AN typically emerge during adolescence and that its prevalence and clinical burden have increased in recent years. A recent comprehensive review () estimated the lifetime prevalence of AN to range from 0.8% to 6.3%. Specifically, prevalence estimates ranged from 0% to 3.2% in young women, while current prevalence rates in young men ranged from 0% to 1.6%. A growing body of literature has emphasized the role of maladaptive cognitive processes in EDs (, ). Repetitive negative thinking (RNT) is a transdiagnostic construct encompassing persistent, recurrent, and difficult-to-control patterns of thinking, such as worry and rumination (–). Worry is defined as an uncontrollable chain of thoughts and images accompanied by negative emotions (). It reflects an effort to solve problems whose outcomes are uncertain but could be mentally adverse. Rumination refers to repetitive patterns of thinking that focus on negative emotions and symptoms, as well as their causes, meanings, and consequences (). While worry is generally oriented toward problem-solving and future possibilities, rumination more often is focused on past experiences (). Worry and rumination have been conceptualized as transdiagnostic maintenance mechanisms that contribute to the persistence and severity of EDs psychopathology (). Specifically, it has been suggested that worry and rumination may interfere with adaptive emotional processing by promoting prolonged cognitive engagement with distressing thoughts while limiting emotional awareness and regulation (). Within this framework, in AN, higher levels of worry and rumination may intensify preoccupations with body weight, shape, and control, thereby reinforcing psychological distress and maladaptive eating behaviors.