Guilt Facets and Eating Disorder Psychopathology: An Exploratory Cross-Sectional Study Using the Moral Orientation...

Background and Objectives: Moral emotions are increasingly implicated in the maintenance of eating disorders (EDs), yet guilt is less differentiated than shame in the ED literature. Contemporary cognitive accounts distinguish deontological guilt linked to violating internalised moral norms from altruistic guilt linked to empathic concern or perceived harm to others. This study examined associations between guilt facets, ED diagnosis, and ED psychopathology in a clinical sample. Materials and Methods: One hundred and eleven adult outpatients (≥18 years) with DSM-5 ED diagnoses (anorexia nervosa, n = 32; bulimia nervosa, n = 24; binge-eating disorder, n = 55; 92 women) were consecutively recruited at first assessment at the Eating Disorders Centre of the University of Campania "Luigi Vanvitelli" (Naples, Italy) between January 2024 and December 2025 and completed the Italian versions of the Moral Orientation Guilt Scale (MOGS) and the Eating Disorder Inventory 2 (EDI-2). Between-diagnosis differences in guilt facets were tested using Kruskal-Wallis analyses. Spearman correlations examined relationships between MOGS facets and EDI-2 subscales. An exploratory regression tested whether MOGS Empathy was associated with EDI-2 Asceticism beyond sex. Results: Significant between-diagnosis differences emerged for Moral Norm Violation (p < 0.001), Moral Dirtiness (p = 0.020), Harm (p = 0.021), and both deontological (p = 0.001) and altruistic guilt composites (p = 0.041), with binge-eating disorder showing the highest mean levels. No between-diagnosis difference emerged for Empathy (p = 0.114). The prespecified MNV-Bulimia correlation was not confirmed (ρ = 0.12, unadjusted p = 0.199; Holm-adjusted p = 0.199). Empathy was associated with Asceticism (ρ = 0.28, unadjusted p = 0.003; Holm-adjusted p = 0.008), and altruistic guilt was associated with Interpersonal Distrust (ρ = 0.24, unadjusted p = 0.010; Holm-adjusted p = 0.020). Broader exploratory correlations did not survive false discovery rate correction. In a regression model including sex, Empathy was associated with Asceticism (B = 0.263, 95% CI 0.078-0.447; standardised β = 0.26; p = 0.006), explaining approximately 7% of the variance (R² = 0.07). Conclusions: Distinct guilt facets show selective, small-to-moderate associations with ED-related psychological traits in an adult outpatient sample. These findings are hypothesis-generating and require replication in larger and longitudinal samples that include shame, trauma, self-criticism, weight stigma, illness duration, and gender identity measures.