European Eating Disorders Review最新文献

Objective: Our aim was to evaluate the diagnostic accuracy of the Eating Disorder Examination Questionnaire (EDE-Q) scores and establish general and context-specific cut-off points for anorexia nervosa (AN) in Australian women.

Methods: The sample included 67 women with AN, 41 women with a history of AN and restored weight, 100 women with self-reported AN, 27 sisters of individuals with AN, 73 healthy controls, and 597 community controls. ROC analysis assessed the EDE-Q's accuracy and determined cut-off scores in different contexts.

Results: The EDE-Q showed varying discriminative ability, with cut-off scores differing by context. In the most realistic scenario-diagnosed AN versus community controls drawn from the general population, reflecting typical screening contexts-, the Area Under the Curve (AUC) was 0.88, and a cut-off score of 2.775 yielded sensitivity of 0.91 and specificity of 0.71, recommended as the general cut-off for AN in Australian women.

Conclusion: These findings indicate the EDE-Q is useful for identifying individuals at risk of AN but has limited diagnostic capacity due to moderate specificity. While the EDE-Q can guide initial screening using a 2.775 cut-off on the Global score, it is primarily a screening tool and should be complemented by further assessment to confirm diagnosis. Overall, our study provides evidence-based guidance for establishing a general EDE-Q cut-off for AN and informs the definition of context-specific thresholds.

Introduction: Adolescents with anorexia nervosa (AN) often present cognitive rigidity, impaired decision-making, and difficulties processing emotions, all of which can impede engagement in treatment. The marked rise in paediatric hospitalisations for AN during the COVID-19 pandemic highlights the urgent need for brief, targeted interventions in inpatient settings.

Methods: This case series explored the feasibility and preliminary effects of combining Cognitive Remediation Therapy (CRT) and Cognitive Remediation and Emotion Skills Training (CREST) for eight female adolescents (12-16 years) admitted to a paediatric ward with AN or atypical AN. Over the course of their hospitalisation, participants received 20 individual CRT + CREST sessions in addition to standard multidisciplinary care.

Results: Neuropsychological and self-report measures administered at admission (T0), post-intervention (T1), and 6-month follow-up (T2) revealed significant improvements in central coherence, cognitive flexibility, decision-making, theory of mind, and interoceptive awareness between T0 and T1 (all p < 0.05). These gains were maintained at T2, with no further significant changes. All participants completed the intervention without dropout.

Conclusion: Findings suggest that CRT combined with CREST is a feasible, developmentally sensitive approach that may enhance cognitive and emotional readiness for subsequent therapy in adolescents with AN during inpatient care. Larger controlled studies are needed to confirm these promising results.

Objective: Individuals with binge-spectrum eating disorders (EDs) engage in varying degrees of maladaptive and adaptive exercise. Elevated shape/weight concern is associated with engagement in maladaptive and adaptive exercise. No research has examined whether specific facets of shape/weight concern (e.g., fear of weight gain) are associated with degree of maladaptive versus adaptive exercise engagement.

Method: Participants were 124 adults with binge-spectrum EDs enroled in outpatient trials of Enhanced Cognitive Behaviour Therapy. Linear regression models examined associations between each facet of shape and weight concern concurrently at pre-treatment and degree of maladaptive versus adaptive exercise at pre-treatment (i.e., percentage maladaptive exercise episodes of total exercise episodes). We explored these relationships across treatment and diagnostic groups.

Results: Greater pre-treatment fear of weight gain was associated with a greater degree of pre-treatment maladaptive exercise (p = 0.027). This pattern was marginally significant in the longitudinal model (p = 0.057) and was upheld within the BN-spectrum (p's < 0.041) but not the BED-spectrum group.

Discussion: Accounting for all other facets, fear of weight gain may function as a risk factor for engagement in a greater degree of maladaptive exercise pre- and post-treatment. Future research should examine the mechanisms underlying associations between fear of weight gain and maladaptive exercise engagement.

Background: Intensive Outreach Programmes (IOP) for eating disorders (ED) were established to reduce the need for inpatient admissions by providing intensive support to families of young people at high risk of hospitalisation, thereby facilitating ongoing community treatment and decreasing the use of inpatient services. This study investigates patient and carer experiences of treatment in IOP with the aim of identifying perceived benefits, challenges, and changes during treatment and generating recommendations for enhancing outreach services.

Methods: Nine adolescent patients and 13 caregivers participated in individual semi-structured interviews at 1-month post-discharge from the IOP. Open-ended questions guided the discussions, which were recorded and transcribed verbatim. Data were analysed using the 6-stages of reflexive thematic analysis.

Results: The analysis generated three key themes: (1) From Despair to Direction (2) Rock Bottom (3) No Quick Fix. Various shared insights were reported, such as beginning during an acute crisis and viewing IOP as a catalyst to change. Parents reflected on feeling supported by professionals to take a more assertive role during treatment and young people reflecting on the firm but necessary boundaries that shaped and supported their engagement with the treatment.

Discussion: Families recognised prompt structured support, collaboration, individualised approaches as key facilitators for change. Recommendations include enhancing communication between ED services and families, ensuring flexibility in appointments, and maintaining a structured, patient-centred approach to optimise the efficacy of intensive outreach interventions for young people with ED.

Objective: Bulimia nervosa and related syndromes (BN-S) are clinically heterogeneous and complex disorders. Frequent comorbidity with anxiety disorders (ADs) and substance use disorders (SUDs) implicates inherent fear- and approach-based tendencies in BN-S. This study aimed to clarify how comorbid ADs and SUDs, along with fear- and approach-based traits, influence the presentation and severity of BN-S.

Method: Women (N = 399) with BN-S (n = 321) or no history of eating disorders (n = 78) completed the Eating Disorder Examination, Structured Clinical Interview for DSM-5 Disorders, Behavioural Inhibition System/Behavioural Activation System scales, and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire.

Results: Diagnostic features, symptom frequencies, and eating pathology scores were not significantly affected by comorbidity with ADs or SUDs. Controlling for ADs, participants with BN-S scored significantly higher than controls on fear-based traits. Similarly, controlling for SUDs, individuals with BN-S showed elevated sensitivity to reward. Finally, elevated fear- and approach-based traits both contributed to elevated severity across a range of bulimic symptoms.

Conclusion: Fear- and approach-based traits coexist in individuals with BN-S and were associated with the same symptoms. Although BN-S are currently placed within the Hierarchical Taxonomy of Psychopathology's internalising spectrum, findings indicate overlap with the externalising spectrum.

Objective: Recovery rates for adolescent anorexia nervosa (AN) remain poor, requiring creativity within the field to explore alternative treatment options. One novel, evidence-informed approach integrates both family/parent and individual adolescent-focussed treatment components, through an individualised developmental lens. This study aimed to offer preliminary insights on early response to Adolescent and Parent Treatment (APT) in terms of 8-week weight trajectory.

Method: A naturalistic, repeated measures design was employed. Twenty-four adolescents with AN or atypical AN receiving APT as standard care were identified from a specialist private outpatient clinic. Anthropometrics and psychometrics were collected at baseline, with repeat anthropometrics 8-week later.

Results: A significant increase in weight was found from baseline to 8-week follow-up (2.57 kg; p < 0.001), with a large effect size (d = 1.22). No associations were found between baseline clinical features and degree of weight recovery.

Conclusions: This small, exploratory study provides preliminary support for meaningful early weight recovery in APT, at a similar trajectory to that found in current first line treatment. This suggests little consequence to early weight recovery goals when integrating individual psychological support with the adolescent alongside parent-lead re-feeding, from the start of treatment. Further empirical investigation of the treatment package is indicated.

Objective: Anorexia nervosa (AN) is a severe psychiatric disorder displaying an altered gut microbiome. Faecal microbiome transplantation (FMT) has emerged as a powerful research tool and potential treatment option in AN due to the microbiome-gut-brain axis. Current studies are limited and reveal variable FMT protocols. This leads to heterogeneous outcomes and complicates drawing definitive conclusions from existing literature. This review aims to compile and assess the different protocols and develop recommendations on ideal donors, handling of faeces, recipients, duration/frequency of FMT, and measuring transfer success for future FMT studies regarding AN.

Methods: We systematically screened three databases (Pubmed, Embase, Web of Science), identifying 13 studies, including two human case reports, one human study protocol, and 10 animal studies.

Results: While all studies demonstrated microbial alterations in the recipients, not all animal studies successfully induced an AN/underweight phenotype, suggesting that precise coordination of study protocol components to allow further refinement is essential.

Conclusion: Researchers should prioritise clear, comprehensive, and transparent documentation to ensure the interpretability and reproducibility of FMT procedures. Detailed reporting will enable more meaningful comparisons across studies, deepen our understanding of the microbiome's role in AN, and help identify methodological factors that influence outcomes. Ultimately, completeness of documentation in FMT studies in AN has substantial potential to support future clinical applications and improve patient care.

Introduction: This paper aims to examine family intervention programs based on the Cognitive-Interpersonal Maintenance Model of anorexia nervosa (AN) and their impact on patients and carers.

Method: A systematic search was undertaken across several databases through 20 December 2024 in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses.

Results: 15 studies were identified. Meta-analyses of patient outcomes revealed no significant differences in BMI, eating disorder symptomatology, or emotional well-being between intervention and control groups at post-treatment or 12-month follow-up. In contrast, carers showed significant improvements in emotional well-being and expressed emotion at post-treatment, with benefits maintained at follow-up, and enhanced caregiving skills. These family intervention programs yielded better results in the evaluated variables among carers compared to the other programs with which they were compared. Moderator analyses suggested that these interventions are more effective in improving caregiving skills if they are delivered in a face-to-face format and improve caregivers' emotional well-being and accommodation to a greater extent when patients are younger.

Conclusions: The present findings highlight the positive impact of family intervention programs based on this model on carers, particularly in enhancing their emotional well-being, expressed emotion and care skills. Future studies should continue to refine these programs to optimise benefits for all stakeholders involved.

Objective: Outpatient treatment for bulimia nervosa (BN) often fails to reduce core symptoms like binge eating and purging, while inpatient care is costly and separates patients from their everyday environment. Day-patient treatment offers a middle ground by providing intensive daytime therapy with the opportunity to apply skills at home. This meta-analysis evaluated the effectiveness of day-patient treatment for BN and explored potential outcome moderators.

Methods: A systematic search yielded 1664 records, and 20 studies were included in the analysis. Outcome variables were changes in questionnaire scores on eating disorder psychopathology, binge eating frequency, purging frequency, and body mass index (BMI) from admission to discharge and, if available, from discharge to follow up.

Results: Eating disorder psychopathology decreased from admission to discharge with a large effect size and remained stable from discharge to follow up. Pooled effect sizes showed large reductions in binge eating and purging frequency from admission to discharge, whereas BMI did not change significantly.

Conclusion: Day-patient treatment effectively reduces eating disorder psychopathology, binge eating, and purging. As BMI seems to remain stable, this may be used to ease patients' weight gain concerns.

Objectives: Interventions for eating disorder (ED) carers can improve carers' wellbeing and outcomes for their loved one with an ED. However, the effectiveness of peer support groups for Avoidant/Restrictive Food Intake Disorder (ARFID) carers, facilitated by individuals with lived experience, has not been established. This qualitative study examined carers' experiences of caring for a loved one with ARFID and participating in the ARFID carer support group run by Eating Disorders Families Australia (EDFA).

Method: 20 ARFID carers completed an online survey and semi-structured interview. Interviews were analysed using reflective thematic analysis.

Results: Five themes and 15 subthemes were identified. Carers reported substantial burden and psychological distress (Theme 1), alongside limited knowledge about ARFID among family members and health professionals (Theme 2). The group reduced loneliness and validated caregiving approaches, although challenges arose from dominant members and exposure to distressing stories (Theme 3). Information sharing and facilitation by individuals with lived experience were highly valued (Theme 4). Finally, participation was perceived to positively influence the loved one with ARFID and broader family functioning (Theme 5).

Discussion: These findings underscore the unique challenges faced by ARFID carers and the importance of peer-led support groups in meeting psychological and educational needs. Future research should examine their long-term impact and broader family support needs.