European Eating Disorders Review最新文献

Objective

Post-traumatic stress disorder (PTSD) symptoms in caregivers of children and young people (CYP) with eating disorder (ED) symptoms remain understudied, despite their potential impact. This study examines these symptoms and their relationship to demographic and ED-related factors, and caregiver skills. This aims to inform efforts to improve caregivers' wellbeing and ability to support CYP with EDs.

Method

UK-based parental caregivers of CYP with ED symptoms were recruited via social media and mental health organizations. A total of 123 participants provided demographic and ED-related information and completed measures of caregiver skills and PTSD symptoms via an online survey. Descriptive statistics, correlations and regressions were conducted.

Results

The majority of participants (62.6%) exhibited scores indicative of probable PTSD. Demographic and ED-related factors explained 21% of the variance in caregiver PTSD symptoms, with ED relapse contributing the largest independent effect. PTSD symptoms explained 34% of the variance in self-reported caregiver skills.

Conclusions

Caregivers to a wider ED population than previously studied may be at high risk of PTSD, and symptoms may hinder caregivers' ability to support their child. The link between ED relapse and caregiver PTSD warrants further investigation. Trauma-informed approaches to caregiver support in child and adult ED services are recommended.

Objective

Eating disorders (EDs) are associated with neuropsychological inefficiencies across diagnoses. A transdiagnostic approach may help clarify how neuropsychological factors contribute to ED psychopathology. This study aimed to investigate the neuropsychological profiles in patients with restrictive or binge/purge subtype of EDs.

Methods

Sixty-nine patients with restrictive or binge/purge subtype of EDs participated. Neuropsychological functioning was assessed using a comprehensive battery of tests. Neuropsychological outcomes were compared between the two groups, and with normative scores. Multiple linear regression was used to investigate potential predictors of neuropsychological inefficiencies.

Results

The subgroups displayed similar performance on most cognitive measures. Compared to normative scores inefficiencies related to central coherence, impulsivity, and self-reported executive functioning difficulties were observed in both groups. In addition, the restrictive subgroup demonstrated better set-shifting abilities, while the binge/purge subgroup excelled on a planning task. A significant association was found between depressive symptoms and self-reported executive function difficulties, but not with performance-based measures.

Conclusion

The findings suggest similar cognitive inefficiencies across ED subtypes. However, each group demonstrated some distinct cognitive strengths compared to normative scores. Findings underscore discrepancies between performance-based and self-reported executive functioning assessment, raising questions about ecological validity, and the distinctiveness of cognitive measures in this population.

Trail Registration: The current study utilises baseline data from a randomised controlled trail (ClinicalTrials.gov Id: NCT03808467)

Background

One study recently suggested that phosphate supplementation might contribute to the occurrence of refeeding edema in patients with restrictive eating disorders (EDs) with severe malnutrition complications.

Objective

This commentary aims to provide insight into the study while suggesting a more detailed approach to defining malnutrition, refeeding syndrome, and edema.

Main Discussion

There are several diagnostic criteria for diagnosing malnutrition, some of which might overlap with the criteria of refeeding syndrome risks. A precise nutritional and hydration status assessment is needed before starting nutritional therapy for patients with restrictive EDs. With the potential occurrence of refeeding edema during the refeeding practice in these individuals, this commentary discusses the available assessment methods to differentiate edema and other conditions that are related to acute body weight gain. Furthermore, this commentary also outlines the potential pathomechanism involved and provides future recommendations for studies and clinical practice.

Conclusions and Implications

Understanding the pathomechanism of the development of refeeding edema is important to ensure patient safety during refeeding practices in patients with restrictive EDs. Further studies are needed to understand this complex mechanism, which includes analyzing the involvement of hyperinsulinemia and capillary leakage as a potential etiology of refeeding edema.

Objective

GDF15 induces anorexia and visceral discomfort, regulating appetite, food intake and potentially metabolic responses. However, its role in eating disorders remains unexplored.

Method

A total of 145 participants were recruited (60 patients with anorexia nervosa, 20 with bulimia nervosa, 13 with binge eating disorder, 52 participants from the general population). Ghrelin and GDF15 serum levels were measured with immunosorbent assay kits.

Results

Ghrelin was elevated in patients with an eating disorder compared to healthy controls (age and BMI-adjusted ANCOVA, F-value 4.084, p-value 0.008). GDF15 was significantly correlated with ghrelin (Spearman rho 0.430, p-value < 0.001) and BMI (rho = −0.176, p-value = 0.025). GDF15 predicted the BMI of patients with anorexia nervosa and individuals from the general population, again being elevated at lower BMI (linear regression beta −0.254, p-value 0.005). The effect of GDF15 on BMI was observed as under the mediation of ghrelin (direct effect −0.056, p-value 0.577; indirect effect −0.199, p-value < 0.001).

Conclusions

Present results provide novel insights into the role of GDF15 in eating disorders, describing its serum level in this clinical population for the first time. In addition, a positive correlation between GDF15 and ghrelin serum levels is also reported for the first time.

Introduction

ECHOMANTRA supports both patients and carers as an adjunct to treatment in Eating Disorders (Eds).

Objective

This study evaluates the efficacy, acceptability, and feasibility of ECHOMANTRA as an add-on to treatment-as-usual (TAU) for adolescent ED patients and their carers, using an individualised online format.

Method

A multicenter, randomized controlled trial compared two parallel groups (TAU + ECHOMANTRA vs. TAU alone) with 108 patient-carer dyads.

Results

Patients in both groups showed improvements in BMI, ED symptoms, emotional state, quality of life, confidence in change, obsessiveness, and perfectionism, with larger effects in the ECHOMANTRA + TAU group. Carers in both groups improved in expressed emotion, accommodation, perceived ED impact, and emotional well-being, with greater effects in the ECHOMANTRA + TAU group. Only carers in this group improved in caregiver skills. Completion rates were high (patients: 87.04%, carers: 81.84%), with strong satisfaction.

Conclusions

ECHOMANTRA is an effective, feasible online intervention that enhances outcomes for adolescent ED patients and carers when added to standard care.

Objective

Psychiatric comorbid conditions are common among individuals with Eating Disorders (EDs), and these symptoms may exacerbate and/or interact with ED symptoms and impact treatment effectiveness. Whilst comorbid symptomology in Anorexia Nervosa (AN) has been well described, less is known about how the ‘newer’ ED diagnoses of Atypical Anorexia Nervosa (AAN) and Avoidant/Restrictive Food Intake Disorder (ARFID) differ relative to AN. The current study aimed to extend the literature by examining similarities and differences in comorbid symptomology AN, AAN, and ARFID groups.

Method

In this cross-sectional study, young people (n = 311, female = 87.8%, mean age = 14.32: SD = 2.05, range 5–17) with AN, AAN, and ARFID completed self-report measures capturing comorbid symptomology prior to engaging in treatment at a specialist ED outpatient clinic.

Results

There was no difference between AN and AAN on any measure of comorbid symptoms. Both showed severe levels of comorbidity with over half exceeding the cut-point for four or more comorbid diagnoses, with Obsessive Compulsive Disorder, depression and Social Anxiety particularly common. ARFID, on the other hand, had comparatively less severe comorbid symptoms compared to AN and AAN.

Conclusions

Findings provide a better understanding of the nature of comorbid symptomology among these disorders and encourages future research to investigate the role that they play in the treatment outcome.

Objective

Research on avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) has emphasised differences between these disorders, but similarities maintaining dietary restriction may be overlooked. ARFID-related eating disturbances may also occur and facilitate egosyntonic restriction in AN.

Method

Using the Nine Item ARFID Screen (NIAS; N = 141) and ecological momentary assessment (N = 76), we examined endorsement of ARFID-related and traditional eating disorder (ED) reasons for restrictive eating in women with ARFID, AN-restrictive subtype (AN-R), AN binge eating/purging subtype (AN-BP), and controls.

Results

Clinical groups scored higher on NIAS subscales than controls. ARFID participants scored higher on NIAS-Picky than AN groups, and higher on NIAS-Fears and NIAS-Appetite than AN-BP, while AN-R did not differ from either. For skipped meals, ARFID and AN-R did not differ on ratings of avoidant/restrictive motivations, while AN-BP did not differ from either on fears of aversive consequences. For restriction at meal/snack, ARFID did not differ from AN-R on endorsement of picky eating nor AN-BP on lack of interest but endorsed stronger fears of aversive consequences.

Conclusions

While sensory sensitivity/picky eating appears unique to primarily-restrictive EDs, lack of interest was common across clinical groups. Results highlight differences and potential transdiagnostic treatment targets.

Objective

Negative emotional states have been found to predict food cravings and consumption in the general population. People with a persistent tendency to restrict food intake, however, might be eating less when sad, angry, or stressed. In this study, the impact of inducing a negative emotional state through social exclusion on wanting and liking of food pictures was explored in patients with anorexia nervosa.

Method

43 patients with anorexia nervosa and 22 healthy controls completed a computerised social rejection and food appraisal task. Participants viewed short videos in which a stranger made either a negative comment directed toward them or a neutral comment. After each video, participants rated their affective state, as well as their wanting and liking for pictures of high-calorie foods.

Results

Participants in both groups experienced greater negative affect after viewing the negative videos compared to the neutral ones. They also reported lower wanting for high-calorie foods following negative videos, while no significant effects were observed for liking scores. Interestingly, patients with higher body mass index exhibited a greater reduction in both food wanting and liking following negative videos.

Conclusions

These results suggest that negative social interactions can exacerbate restrictive behaviours, especially in patients who are recovering weight during treatment.

Background and Aims

Food addiction has been linked to psychopathology and reduced psychological well-being. Here, we investigated whether these associations are mainly driven by food addiction itself or mediated via an increase in BMI.

Methods

Data stem from a nationwide survey from Denmark (n = 1474 participants). The survey questionnaire included the Yale Food Addiction Scale 2.0 (YFAS 2.0) measuring food addiction, questions on height and weight (to compute BMI), and a range of self-reported measures of psychopathology and psychological well-being. The association between food addiction and psychopathology/psychological well-being, stratified by weight category (normal weight (BMI 18.5-24.9), overweight (BMI 25–29.9) and obesity (BMI ≥ 30)), was assessed via multivariable regression analyses, adjusted for sex, age, socioeconomic status and BMI.

Results

Across all BMI categories, having food addiction was strongly positively associated with psychopathology (depression, anxiety, and interpersonal sensitivity) and strongly negatively associated with psychological well-being (all p-values < 0.001), despite adjustment for BMI. These associations remained following exclusion of participants either having received a diagnosis of mental disorder or having redeemed a prescription for psychopharmacological treatment.

Conclusion

The findings from this study are compatible with food addiction itself, and not increased BMI likely arising from it, being associated with psychopathology and reduced psychological well-being.

Objectives

Impulsivity has been linked to overeating and loss of control eating (LOCE), yet most adolescent research has focused on between-subjects (i.e., trait) impulsivity; thus, less is known about how within-subjects (i.e., state) impulsivity predicts overeating and LOCE. Given this gap, this study used ecological momentary assessment (EMA) to examine the construct validity of the four-item Momentary Impulsiveness Scale (MIS) in adolescents and the relationship between within- and between-subjects impulsivity and overeating and LOCE.

Methods

Seventy-four adolescents (M_age = 15.68) completed a 10-day EMA protocol, reporting impulsivity (measured with the MIS) and eating behaviours multiple times daily. Generalised linear mixed models were run examining associations between baseline impulsivity measures and EMA impulsivity and impulsivity, disaggregated into within- and between-subjects effects, as a prospective predictor of overeating and LOCE.

Results

Generally, baseline impulsivity measures predicted elevated EMA impulsivity. Also, higher within-subject impulsivity significantly predicted greater LOCE and higher between-subject impulsivity was significantly associated with greater overeating and LOCE.

Discussion

Analyses demonstrated concordance between baseline and EMA impulsivity measures in adolescents and suggested that state impulsivity impacts the perceived control over eating. Adolescent preventions/interventions that provide strategies to reduce or mitigate state impulsivity warrant further investigation (e.g., providing in-the-moment self-regulatory strategies when feeling impulsive).