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

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 and December 2024 and completed the Italian versions of the Moral Orientation Guilt Scale (MOGS) and the Eating Disorder Inventory–2 (EDI-2) at first assessment. Between-diagnosis differences in guilt facets were tested with Kruskal–Wallis analyses. Spearman correlations (two-tailed) examined relationships between MOGS facets and EDI-2 subscales. An exploratory regression tested whether MOGS Empathy predicted 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). Bulimia symptoms were not significantly correlated with MOGS indices. Asceticism correlated with moral dirtiness (ρ = 0.20, p = 0.038), empathy (ρ = 0.28, p = 0.003), and both deontological (ρ = 0.20, p = 0.038) and altruistic guilt composites (ρ = 0.25, p = 0.010), and interpersonal distrust correlated with empathy (ρ = 0.26, p = 0.007) and altruistic guilt (ρ = 0.24, p = 0.010). In a regression model including sex, empathy predicted asceticism (standardised β = 0.26; p = 0.006), explaining ~7% of variance (R² = 0.07).Conclusions: Distinct guilt facets—particularly empathy-related (altruistic) guilt—show selective associations with ED psychopathology and may represent a clinically relevant treatment target. Replication in larger and longitudinal samples and inclusion of shame and self-criticism measures are needed.