4. Discussion
Maudsley, eating disorder
The current study examined changes in emotions, stress, and eating disorder attitudes after a simulated social overinclusion or exclusion scenario via a ball-tossing game. This is the first study that examined the effect of social exclusion and overinclusion across the ED spectrum and aimed to extend the previous findings in patients with AN, looking for similarities or differences between the entire spectrum of patients with ED.Evaluation of the perception of ball passes showed that all the subgroups could discriminate between exclusion and overinclusion in the ball-toss game; our results confirmed preliminary evidence about the ability of AN patients to determine the nature of a social scenario [Some peculiarities concerning the specific ED diagnosis also emerged. Patients with AN demonstrated psychological difficulty in being excluded by peers with lower scores at the evaluation after the Cyberball task [Indeed, patients with BN reported that interpersonal exposure induced by the over including condition results in lower scores for self-esteem and sense of belonging than other participants. Both of these elements agree with the interpersonal model for ED [In line with our previous study, the data indicate difficulties in emotional reactivity in AN patients after being ostracized [Interestingly, patients with BED reduced their negative emotional state after being excluded, which was linked to the high level of belonging reported on the NTS scale. The same results have been found in post-bariatric patients [In the overincluding paradigm, patients with BN showed a significant decrease in negative emotions, with a possible positive effect of social interactions on negative emotions but not on positive emotions that may be linked to an impaired reward from social interactions [Several studies in the literature have pointed out the role of the age of menarche in emotional regulation and social cognition [No relationships emerged between psychological need, psychopathology, and eating thoughts in the control group, which differed from previous literature and may be linked to the different tasks applied [Although the relevance of interpersonal relationships has been noted in several treatment approaches, from interpersonal therapy to family-based therapy and the Maudsley Model (MANTRA), more studies are needed [This is the first study to apply the Cyberball task to the whole spectrum of EDs, and the main strength is the experimental psychopathological approach applied, but upon examining our results, several limitations should be considered. First, the self-reporting nature of the data could affect the self-report results, and future studies should include different ways to record participants’ responses (e.g., skin conductance, heartbeat). Second, in seeking increasing homogeneity, we included only female participants, but this choice could limit the generalizability of the results. Third, this is a laboratory-based experiment. Even if none of the participants were familiar with the Cyberball task before the session or reported doubts about the real presence of the other participants, more studies are needed to confirm our results and to compare a laboratory task to real-world situations. Fourth, our results need to be replicated and confirmed with larger populations and from different experimental studies. Finally, in evaluating the psychological effects of the Cyberball task, we included participants of different ages, but we may have lost some specific differences between adolescents and adults that could be investigated in future studies.