European Eating Disorders Review最新文献

Objective: Despite an increase in eating disorder (ED) cases during the COVID-19 pandemic, there are limited longitudinal studies exploring treatment outcomes. The aims of the present study were: (1) to compare the clinical features of patients with EDs whose onset was during the COVID-19 lockdown (pandemic cohort) against patients with EDs whose onset was prior to the pandemic (pre-pandemic cohort) and, (2) to compare therapy responses between the cohorts.

Method: The sample consisted of 115 adult women with an ED. N = 37 new ED cases (pandemic cohort) were diagnosed and included in the study during the pandemic (May 2020-May 2021); these patients did not have any previous history of an ED. We also included N = 78 ED cases (pre-pandemic cohort) diagnosed prior to the COVID-19 pandemic breakout (prior to March 2020). All ED subtypes were considered in both groups and several clinical variables were assessed.

Results: At baseline, pandemic cohort reported lower levels of impulsivity and higher emotional regulation capacities than the pre-pandemic cohort; however, no differences were found in aspects of general psychopathology and ED related severity. Following treatment, the pandemic cohort showed higher rates of good outcome and lower rates of dropouts than the pre-pandemic cohort.

Conclusions: Although both cohorts showed similar ED-related symptoms and general psychopathology scores, treatment outcomes were more favourable in the pandemic cohort.

Introduction: Sleep is crucial for physical and psychological health, and disturbances are closely linked to psychiatric disorders, making their management essential for improving treatment outcomes and preventing relapse. Although sleep disturbances are implicated in psychopathology of eating disorders, its role in anorexia nervosa (AN) remains unclear. This review aimed to characterise sleep in AN.

Methods: A systematic search was conducted in four scientific databases, including papers from inception to 25 May 2024. A machine learning algorithm (ASReview) was utilised to screen titles and abstracts for eligibility. Sleep quantity, architecture, and quality were investigated. Meta-analyses were conducted to investigate the difference between patients with AN and healthy controls (HC) in total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), sleep efficiency, Sleep Stage 1, 2, slow wave sleep, rapid eye movement (REM) sleep and REM latency. Certainty of evidence was assessed using the GRADE approach.

Results: Out of 67 potentially eligible papers, 31 were included in this review, with 15 in the meta-analyses. Statistically significant average mean differences were found for TST (-32.1 min [95% CI: -50.9, -13.4]), WASO (19.0 min [95% CI: -2.4, 40.3]), and sleep efficiency (-4.4% [95% CI: -7.9, -0.9]). Additionally, Sleep stage 1 was significantly increased (2.4% [95%-CI: 0.05, 4.7]), while REM sleep was reduced (-2.1% [95%-CI: -4.2, -0.02]). Subgroup analysis showed that TST and WASO did not improve significantly after weight restoration.

Conclusion: Sleep in patients with AN is impaired, with lower TST and sleep efficiency, higher WASO, more time in stage 1 sleep, and less in REM. Weight restoration alone may not improve sleep. While more research is needed, substantial accompanying sleep disturbances in AN justifies addressing these in current treatment practice, also because of the chronic character of AN and importance of sleep for long term (mental) health.

Objective: The COVID-19 pandemic initiated public health measures, impacting mental health and exacerbating disordered eating behaviours (DEB). This study aims to fill gaps in understanding DEB in the general population during the pandemic, emphasising gender dynamics and the experiences of gender and/or sexual minority (SGM) individuals.

Method: A systematic literature review followed PRISMA guidelines to investigate DEB during the pandemic, focusing on gender-sensitive analyses and SGM populations. Outcomes from the included studies were synthesised to identify patterns and associations related to DEB, particularly considering gender dynamics and SGM experiences.

Results: Significant gender associations with DEB were observed, with women consistently exhibiting higher scores. SGM populations also showed elevated DEB symptoms. Longitudinal studies indicated changes in DEB over time, with some decreases observed among men.

Conclusions: The review underscores significant gender differences in DEB during the pandemic, with women exhibiting higher symptom levels. Lockdown measures had nuanced impacts on DEB, varying across studies. Various factors including pandemic-related stressors influenced DEB. Consideration of these factors can inform tailored interventions for DEB in the general population. Overall, the review enhances our understanding of how gender intersects with the pandemic's impact on DEB, emphasising the need for diverse approaches to address these behaviours.

Objective: Despite its potential for informing tailored treatments, the severity of eating disorders (EDs) lacks clear conceptualisation. The present retrospective cohort study examined the clinical validity and utility of severity specifiers for anorexia nervosa (AN) and atypical AN in a Korean population.

Method: Data from 696 Korean outpatients with AN or atypical AN were analysed. Severity criteria for AN from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Medical Emergencies in Eating Disorders (MEED) guidance were used. Severity criteria applied for atypical AN were the frequency of intermittent fasting (ED Diagnostic Scale item 17), Eating Disorder Examination Questionnaire global scores, and the degree of weight suppression.

Results: Prevalence of extreme cases of AN in our cohort was higher than in Western populations in previous studies. MEED guidance further subclassified extreme AN, revealing distinct psychopathological profiles across severity levels. The proposed severity classification for atypical AN based on the weight loss behaviour of intermittent fasting showed merit.

Conclusions: These findings suggest a potential need for a more nuanced AN severity classification that better represents severe medical aspects and encompasses cultural and ethnic diversities. In atypical AN, there is a need to examine severity indices measuring pathological behaviours.

Objective: This national study aimed to estimate the prevalence of the transgender and gender-diverse identity and to assess the level of gender congruence, body dissatisfaction and quality of life among patients with eating disorders in Denmark.

Method: Patients with eating disorders were compared to a matched non-clinical comparison group. The survey included the Eating Disorder Examination Questionnaire and assessment of body dissatisfaction, gender congruence and quality of life.

Results: In total 568 patients with eating disorders and 538 individuals from the non-clinical comparison group were included. The prevalence of individuals identifying as transgender or gender-diverse was 4.50% (n = 20) among patients with eating disorders, and 6.23% (n = 23) in the non-clinical comparison group (p-value = 0.276). The transgender and gender-diverse individuals with eating disorders showed no statistically significant differences in eating disorder symptomatology compared to the cisgender individuals with eating disorders; however, they reported significantly more body dissatisfaction, less gender congruence and lower quality of life.

Conclusion: The prevalence of transgender and gender-diverse individuals did not differ between patients with eating disorders and the non-clinical comparison group; however, transgender and gender-diverse individuals with eating disorders may be characterised by pronounced body dissatisfaction and low quality of life.

Objective: To summarise existing evidence on bonding and parent-child quality of interaction in parents with eating disorder (ED).

Methods: A scoping review was conducted. Seven databases (PsycInfo, Embase, Medline, Pubmed, OpenGrey, ProQuest and Google Scholar) were examined and studies exploring research into bonding and quality of interaction in parents with ED were included.

Results: Seventeen quantitative studies were included in the review. Reviewed literature suggests that parents with ED tend to be more intrusive, may exhibit more negative expressed emotions and may be involved in higher levels of mealtime conflicts during mealtimes. Additionally, they may be less sensitive and may offer less structured in non-feeding interactions. Children of parents with ED may have a more difficult temperament, may display greater internalisation and externalisation problems, may be less responsive to their parents and exhibit more behavioural difficulties.

Conclusion: Overall, we found that parents with ED are more likely to have difficulties during interactions with children, compared with controls, both in feeding and non-feeding contexts which might impact children's mental health. Proposals for future research are suggested to enhance our understanding of the intergenerational transmission of ED, holding the potential to pinpoint therapeutic and preventative targets for both parents with ED and their children.

Objective: We developed ECHOMANTRA, a digital guided intervention for patients with anorexia nervosa and their carers to provide support during transition from inpatient care to community settings. This study reports on participants' engagement with, and feedback of, ECHOMANTRA.

Method: Patients and carers (N = 184 dyads) were given access to ECHOMANTRA for 12 months. The intervention included online groups, a workbook and recovery-oriented videoclips. Satisfactory engagement was defined as attendance of a minimum of four online groups by each dyad. Participants received an Intervention Feedback Form to measure frequency of use and provide feedback of the intervention. Those who did not meet the engagement criterion were asked to complete an Obstacles to Engagement Form.

Results: 19% of the sample reached the engagement criterion. Seventy-six patients and 60 carers completed the Intervention Feedback Form. Of those, approximately 60% reported using at least a quarter of the workbook and videoclips. Overall, participants found the materials useful and easy to access (median = 3 on a scale 1-5). Obstacles to engagement (35 patients and 14 carers) included lack of time due to caring responsibilities, treatment, work/school commitments.

Conclusion: A more personalised form of support may be needed to enhance motivation and ability to change following inpatient care.

Objective: To analyse and compare the original four published anorexia nervosa (AN) case histories of William Gull with modern-day approaches.

Method: Case histories of the patients described by Gull were reviewed and placed in a tabulated format (which included demographics, clinical presentation, treatment, and prognosis) along with his general comments on AN, for easier comparison.

Results: Many of the presenting features of AN are similar to cases seen in more modern times but lack weight or body image disturbances. The cases described by Gull can be categorised as AN under the Diagnostic and Statistical Manual-Fifth Edition (DSM-5) and the Text Revision (DSM-5-TR) however, they were excluded by the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV) and the International Classification of Diseases-10th Revision (ICD-10) criteria. Reference to Gull's work might have avoided the necessary change in diagnostic criteria.

Conclusions: 150 years on, Gull's cases resemble presentations of AN without weight or body image issues and emphasise the heterogeneity of the diagnostic conceptualisation of AN in the modern era. Nutritional rehabilitation remains core to the treatment with other interventions supporting this goal while aetiology remains elusive.