European Eating Disorders Review最新文献

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.

Objective: Recent studies underscore the relevance of life meaning to the maintenance of eating disorders. A previously conducted randomized controlled trial tested a meaning-centered intervention for female university students with high weight and shape concerns. After a 6-week online intervention led by a trainer, participants in the intervention condition scored higher on life meaning and lower on eating disorder symptoms and general distress compared to a waitlist group.

Method: Given that the original study took place during COVID-19, this study replicated the design to test the findings' robustness.

Results: Compared to the waitlist condition (n = 68), participants in the intervention condition (n = 63) again scored higher on the presence of life meaning at post-assessment and follow-up. Participants in the intervention condition also showed moderately lower internalizing symptoms at both timepoints, whereas eating disorder symptoms were only reduced in those with relatively high baseline symptom severity.

Conclusions: Thus, also without social distancing measures, the intervention increased life meaning and reduced eating disorder symptoms and comorbid internalizing symptoms in women with weight and shape concerns.

Objective: This systematic review explores the associations between qualitative/quantitative changes in gut microbiota and psychopathological symptoms or other clinical features in patients with eating disorders (EDs). Secondary outcomes include exploring gut microbiota changes in EDs and potential relationships with psychotropic drug use.

Method: A systematic search was conducted across biomedical databases from inception to June 2024 according to PRISMA guidelines. The risk of bias was assessed, and a narrative synthesis was performed due to the heterogeneity of the outcomes.

Results: Only findings related to anorexia nervosa (AN) were identified. Ten studies, of which seven were longitudinal, two cross-sectional, and one interventional (N = 350 patients with AN, and 304 HCs), were included. Despite no clear links between diversity metrics and clinical symptoms being observed, specific taxa belonging to phylum Firmicutes, such as Clostridium, Roseburia, Lactobacillus, Faecalibacterium, and Bifidobacterium belonging to Actinobacteriota correlated with ED psychopathology, including anxiety and depressive symptoms.

Conclusions: Changes in microbiota were related to anxiety and depressive symptoms, as well as altered eating behaviours by modulating inflammation and insulin pathways through short-chain fatty acids (SCFAs), that also lead to neurotransmitter imbalances. Further studies are required to replicate these finding and to explore whether similar patterns are observed in other EDs.

Objective: Eating disorders (ED) typically emerge in adolescence, a critical period for brain development and peer bonding. Interpersonal difficulties-particularly social anxiety-frequently co-occur with ED. Oxytocin is a neuropeptide that modulates social cognition and linked to prosocial effects. To date, no study has investigated oxytocin's effects on negative interpretation bias toward ambiguous information in adolescents with ED.

Methods: Forty-eight female adolescents aged 16 to 17 years with and without EDs took part in a placebo-controlled, double-blinded, randomised, crossover trial investigating the effects of 24 IU intranasal oxytocin on negative interpretations of ambiguous scenarios. Participants and controls were tested twice, approximately one week apart.

Results: Contrary to hypothesis, oxytocin increased negative interpretations overall (p = 0.019, large effect). Adolescent females with AN or BN made more negative interpretations than controls when presented with ambiguous information. There was no group effect for those who reached or did not reach threshold on an autism screen.

Conclusions: This study suggests adolescents with EDs interpret ambiguous information more negatively than controls and that oxytocin administration amplifies negative responses to ambiguity in adolescent females, including in controls. Research tools that effectively identify these biases would help to widen the scope of ED treatments for adolescents.