European Eating Disorders Review最新文献

Objective: The purpose of this paper is to comprehensively review the medical complications associated with purging behaviours and their recommended treatments.

Methods: A thorough review of the literature through May 2024 was completed.

Results: The medical complications associated with purging behaviours affect every body system. Some of these complications are related to the method and frequency of purging while others are independent of the method of purging.

Conclusion: Purging behaviours associated with eating disorders confer serious medical complications that are generally reversible with cessation of purging behaviours, weight restoration, and treatment of the underlying eating disorder.

The human brain possesses a unique ability to switch between patterns of functional connectivity, known as brain states, which are crucial for regulating biological, cognitive, and emotional processes. These states are linked to numerous neurological and neuropsychiatric conditions, however, their relationship to clinical symptoms of anorexia nervosa (AN) is not well understood. In this exploratory study, we aimed to identify whole-brain dynamic functional alterations in AN and their association with AN symptoms. To this end, we recruited 19 women diagnosed with AN and 22 healthy controls (HCs) who underwent resting-state functional magnetic resonance imaging. By implementing a sliding-window approach, we found that AN patients had limited flexibility to transit between different brain configurations compared to HCs. Moreover, AN patients spent a significant amount of time in a functional configuration characterised by strong coupling between the ventral attentional network and the somatomotor network. Changes in these networks play a crucial role in body image disturbances, interoceptive awareness, and body image-body schema interaction. Interestingly, the time spent in this specific brain state showed a negative relationship with body mass index, along with a positive correlation with eating disorder indices. Our study highlights the potential of dynamic functional connectivity as a prognostic and therapeutic means to spotlight maladaptive functional brain configurations in AN.

Objective: Autism and eating disorders (ED) frequently co-occur, particularly in women. Autistic individuals are often undiagnosed when they present to mental health services and many receive their autism diagnosis during or after ED treatment. This study sought to understand the experiences of autistic women with co-occurring anorexia nervosa (AN) receiving an autism diagnosis.

Method: Secondary data analysis was conducted on 17 semi-structured interviews with autistic women with AN using reflexive thematic analysis. Participants had a diagnosis of autism, had current or past experience of AN, were female-identifying and aged 18 or above.

Results: Participants experienced missed opportunities for autism diagnosis along with misdiagnoses and misunderstandings from healthcare professionals. Participants tended to receive their diagnosis at the point of crisis and experienced being passed between autism and ED services. Receiving a diagnosis helped participants make sense of their experiences and take control of their lives but also brought feelings of shock and distress.

Conclusions: While autism diagnosis is often a positive experience for autistic women with AN, a range of emotions can be experienced. The findings highlight a need for better and earlier identification of autism among women with EDs, alongside appropriate post-diagnosis support and ED treatment that is adapted to autistic individuals' needs.

Objective: To synthesise qualitative findings on the autistic experience of restrictive eating disorders in order to identify common themes and use this to inform future research on the development of more effective care.

Method: This systematic review was pre-registered on PROSPERO (CRD42023434116) and followed PRISMA guidelines. CINAHL, PsycINFO, Medline, Embase, Web of Science and Global Health databases were searched. Studies were included if they contained qualitative data detailing the autistic experience of restrictive eating disorders from autistic people, carers or healthcare professionals. The Critical Appraisal Skills Programme was used to assess quality of studies. Recurring themes were identified via thematic synthesis.

Results: Nine studies met the inclusion criteria, all focused on anorexia nervosa. Four themes arose from the analysis: (1) the relationship between autism and restrictive eating; (2) the journey to self-understanding; (3) experience of eating disorder services; (4) suggested treatment adaptations.

Conclusion: Findings suggest a broad range of mechanisms underlying the development and perpetuation of anorexia nervosa that are related to autism and are not consistently acknowledged and addressed in current care provision. This emphasises the need for more research into developing adapted or novel interventions for autistic people with eating disorders, as well as training programmes for clinicians.

Objective: Reality TV model contests like Germany's Next Topmodel (GNTM) remain popular worldwide, but face media criticism for potentially impacting women's body image. This experience sampling study is the first to examine GNTM's impact on body dissatisfaction, affect, and self-esteem among women with and without eating disorders (EDs).

Method: Women with (n = 36) and without self-reported EDs (n = 143) watched the 18^th season of GNTM in their private environment to enhance ecological validity. Questionnaires on body dissatisfaction, body-related self-ideal discrepancy, affect, and self-esteem were completed before, during, and after each episode. Statistical analysis was conducted using Bayesian multilevel modelling.

Results: After watching an episode, women with self-reported EDs showed a significantly stronger increase in body dissatisfaction, self-ideal discrepancy, and negative affect compared to women without EDs (p < 0.001). Moreover, in women with EDs, the self-ideal discrepancy became significantly greater over the course of the entire season (p < 0.01).

Conclusions: This study demonstrates that TV model contests may have negative psychological effects on women, particularly women with EDs. Accordingly, these shows may play a role in the aetiology and maintenance of EDs. Interventions increasing the critical distance to such content might be developed for at-risk groups.

Objective: Disordered eating (DE) increased during the COVID-19 pandemic, and a recent systematic review identified marginalised identity, psychological wellbeing, loneliness, stress, higher body mass index (BMI), and internalised weight bias (IWB) contributing to pandemic-era DE. The present study aimed to extend these findings by evaluating hypothesised contributors to pandemic-era DE while evaluating pandemic era stressors among a single, more diverse sample of university students.

Method: A diverse cohort of first-year university students (N = 1289, 43.4% White, 24.2% LGBTQ+) were surveyed in Autumn 2021 about the pandemic's impact on health, socialisation, and academic readiness and performance as part of a larger research project. BMI, IWB, loneliness, self-esteem, depression, DE, screen time, and perceived stress measures were collected. General linear and PROCESS mediation models evaluated group differences and mediators of pandemic-era stressors and DE.

Results: Depression, self-esteem, stress, and loneliness partially mediated the relationship between pandemic-era stressors and DE. IWB partially mediated associations between Pandemic-era stressors and DE, with higher IWB strengthening this relationship; however, greater media exposure and higher BMI strengthened these findings [Figure] the extent to which IWB mediated the relationship between Pandemic-era stressors and DE. Black students had lower DE than other racial groups, while sexual minority students had higher DE, though this differed across genders.

Conclusions: IWB, loneliness, and psychological distress may exacerbate pandemic-era DE. Further, marginalisation of bodies, genders, and sexual orientations may play a role in pandemic-era DE. These factors may help identify students most at-risk for DE and help target preventive care to kerb rising eating disorders rates.

Objective: Impairment in personality functioning (PF) has been linked to a number of mental disorders, including eating disorders (EDs). However, the precise relationship between PF and symptom severity, as well as the potential impact on outcome, remains unclear. The study aimed to analyse the association of PF and its change with severity of ED symptomatology as well as outcome of hospital treatment.

Method: The sample consisted of 397 patients with EDs, treated in 19 university hospitals for Psychosomatic Medicine and Psychotherapy in Germany between 1/2019 and 12/2020. PF was measured with the Structure Questionnaire of the Operationalised Psychodynamic Diagnosis (OPD-SQ, short version), eating psychopathology with the ED examination questionnaire (EDE-Q). Outcome was defined as a change in the EDE-Q total score. We used Latent Change Score Modelling to analyse changes in ED pathology during treatment and a 1-year follow-up period.

Results: A higher level of impairment in PF at admission correlated with more eating psychopathology and a less favourable outcome. Additionally, greater improvement in PF correlated with greater improvements in ED symptomatology at discharge.

Conclusion: Impairment in PF needs to be part of diagnostic assessments and should be considered an important treatment target for psychotherapeutic interventions.

Trial registration: The MEPP study was registered in the German Clinical Trials Register (DRKS, www.drks.de; ID: DRKS00016412).

Objective: Motivation to change significantly impacts treatment outcomes in eating disorders (EDs). This study investigated patient-related factors associated with motivation to change in adolescents with first-onset anorexia nervosa (AN). Understanding these factors will help tailor interventions to individual needs, enhancing treatment outcomes.

Method: Seventy-six female adolescents with first-onset AN completed the Readiness and Motivation Questionnaire (RMQ)-Dutch translation. ED symptoms, body mass index, and comorbidity (depressive, anxiety, obsessive-compulsive, autism spectrum disorder, and attention deficit and hyperactivity disorder symptoms) were analysed using linear regression analyses. As a secondary aim, the association between specific ED behaviours and motivation to change was analysed. This project was preregistered: https://osf.io/vx9ud/.

Results: Adolescents with more severe ED symptoms, depressive symptoms, and obsessive-compulsive symptoms, experienced lower motivation to change. The severity of ED symptoms emerged as the most important factor associated with motivation to change, specifically ED symptoms concerning weight and body shape. Additionally, laxative misuse was associated with greater motivation to change.

Conclusions: The link between motivation to change and ED symptoms suggests that early treatment can improve outcomes by reducing ED symptoms and facilitating change. Furthermore, addressing depression during treatment might enhance motivation to change.

Background: Poor rates of retention associated with digital interventions necessitate understanding of factors influencing engagement. This study presents a secondary analysis of a three-arm, randomised controlled trial of an online self-help treatment for bulimia nervosa (clinician-supported, self-help and waitlist control).

Aims: The study aimed to understand the effect of added clinician-support, or lack of support, upon user experience and therapeutic alliance.

Method: At post-treatment, 61 participants completed a battery of self-report questionnaires assessing user experience and therapeutic alliance. Data were analysed using mixed methods (regression and thematic analyses).

Results: Quantitative analyses indicated clinician-supported participants reported higher levels of treatment satisfaction and therapeutic alliance, however differences were not significant after controlling for covariates. Intervention effectiveness ratings were positively associated with post-treatment reductions in binge episodes and eating disorder psychopathology. Qualitative data were organised into four themes: (1) human support, (2) content, structure and digital set up, (3) process of therapeutic change and (4) positive feedback.

Conclusions: Overall, the intervention was found to have positive ratings of user experience and therapeutic alliance in both supported and unsupported versions. The qualitative analyses revealed a strong preference for human support. The findings shed light on the complex interactions between digital and human elements of blended treatment delivery.

Trial registration: The trial was pre-registered with the Australia New Zealand Clinical Trials Registry (ACTRN12619000123145p).

Introduction: Avoidant/restrictive food intake disorder (ARFID) only recently emerged in the DSM-5 and ICD-11. Relatedly, emerging conceptualisations of ARFID are equivocal. A functional conceptualisation of ARFID (i.e., cohesive conceptualisation that can guide research and clinical work) is needed. The present systematic scoping review aimed to synthesise ARFID literature to develop a functional conceptualisation model with recommendations for ongoing research and clinical work.

Method: Utilising PRISMA guidelines, 25 references were found eligible for inclusion and categorised using a bottom-up approach into 6 (not mutually exclusive) conceptualisations of ARFID: clinical presentation subtypes (n = 16), symptom presentation (n = 4), biological (n = 3), behavioural (n = 4), learning (n = 3), and biopsychosocial (n = 4) models.

Results: Conceptually, both clinical presentation subtype and biopsychosocial models posed important avenues for further exploration of the aetiology, maintenance, and treatment of ARFID. Clinical presentation subtype models were most common, echoing and extending previous research support for the DSM's subtype categorisation. Biopsychosocial models were agnostic to ARFID subtypes, but encompassed elements of the biological, behavioural, and learning models, and suggested factors related to the aetiology and maintenance of ARFID subtypes.

Discussion: Together, these conceptualisations allow for streamlined, nuanced research and clinical work aimed at understanding and treating ARFID.