Journal of Eating Disorders最新文献

Background: The ANZAED (Australia and New Zealand Academy for Eating Disorders) Eating Disorder Credential is the first national, cross-disciplinary program to recognise minimum standards qualifications, knowledge, training, and ongoing professional development for health professionals to provide safe and effective treatment. While timely access to safe and effective treatment is known to improve quality of life and increase the likelihood of optimal treatment outcomes, there is currently no empirical evidence on the Credential's impact for people with an eating disorder (ED). To address this gap, this study explored the perceptions and treatment experiences of individuals with an ED who received care from a Credentialed Eating Disorder Clinician.

Methods: Participants were 16 people with lived experience of an ED, who had received treatment from a credentialed clinician. Participants engaged in a semi-structured interview and an online self-report survey, both exploring their ED treatment experiences. Analysis included descriptive statistics from survey data and an inductive reflexive thematic analysis of interview transcripts.

Results: The first theme generated by the thematic analysis was treatment experiences with credentialed vs. non-credentialed clinicians, with (1) trust and safety, (2) seeing the whole person, and (3) teamwork identified as subthemes. The second theme was attitudes towards the Credential, with (1) the perception of the Credential as a source of hope and (2) the potential for improved access to appropriate treatment as subthemes.

Conclusions: Participants consistently perceived treatment with credentialed clinicians positively and felt that additional training and supervision facilitated trust in credentialed clinicians. Some participants reported their treatment team consisted of credentialed clinicians working together to coordinate treatment, which was also perceived to facilitate trust. However, some participants felt uncertain about whether the Credential met their needs and instead emphasised the importance of treatment access in regional locations and an understanding of individual presentations including comorbid conditions.

Improving eating disorder (ED) care in a meaningful and equitable way requires clinicians and researchers to learn from people with lived experiences (PWLE) of EDs. Thus, epistemic injustice faced by individuals who are denied the right to share their experiential knowledge with professionals is a barrier to improving ED care. The present commentary builds on a two-part article series published last year in the Journal of Eating Disorders, where recommendations for improving ED care are offered from my lived experience and quality improvement (QI) perspective. In this complementary piece, I present examples of lessons that I have learnt since the 2025 article series was written, thereby highlighting the wider importance of learning from PWLE. Specifically, I discuss lessons that I have learnt from ED sufferers diagnosed with borderline personality disorder (BPD), male ED sufferers, and longstanding ED sufferers. The complexity and diversity of their lived experiences lead to the conclusion that all-inclusive ED care models must be built using the precious building blocks of knowledge that PWLE offer us.

Background: Eating disorders (EDs) are rising, yet research predominantly focuses on younger women, leaving midlife women understudied. This study examined how emotion dysregulation and body image concerns relate to disordered eating symptoms across emerging adulthood (EA, 18-30 years) and middle adulthood (MA, 45-65 years) and across levels of ED symptom severity.

Methods: Participants were 1055 women (317 EA lower-symptom-severity, 298 MA lower-symptom-severity, 211 EA higher-symptom-severity, 229 MA higher-symptom-severity). Emotion dysregulation was measured with the Difficulties in Emotion Regulation Scale-18 (DERS-18), body image concerns with the Body Image Concerns Inventory (BICI), and disordered eating symptoms with the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Attitudes Test-26 (EAT-26). Psychometric analyses, including confirmatory factor analyses and measurement invariance testing are detailed in the Supplemental Materials. Multiple-group structural equation modeling (MGSEM) was conducted to examine whether associations between predictors and outcomes differed by age and symptom severity.

Results: Associations varied across age and symptom severity. Difficulties with emotional clarity, impulse control, and appearance dissatisfaction were consistently associated with higher ED symptoms, whereas greater emotional awareness was linked to lower symptoms in some groups. Difficulties with goal-directed behaviors, nonacceptance, limited access to emotion regulation strategies, and social avoidance showed both positive and negative associations depending on age and symptom severity.

Conclusions: Findings underscore the need for developmentally informed, transdiagnostic approaches to ED prevention beyond early adulthood. Subscale-level analyses revealed that commonly defined "risk factors" may also be associated with adaptive or protective patterns, highlighting the complexity of these associations across the female lifespan. These insights support more nuanced, strength-based approaches to inform early detection, prevention, and intervention across the ED spectrum.

Background: Orthorexia Nervosa (OrNe) and Exercise Addiction (EA) are potentially dysfunctional variants of health-oriented behaviours, but their status as distinct mental disorders remains debated. OrNe is the obsessive preoccupation with 'healthy' eating, whereas EA is characterized by loss of control over exercise and prioritization over other life domains. Both commonly coincide with disordered eating, raising the question whether the clinical indicators are inherent to OrNe and EA or primarily reflect overlapping eating pathologies. This study examined whether OrNe and EA are distinct from restrictive and muscularity-oriented disordered eating by assessing their overlap and their unique links to psychological distress and psychosocial impairment.

Methods: Within a cross-sectional web-based study, 384 participants (age = 31.5±11.5; 76.3% women) completed the Teruel Orthorexia Scale (TOS), Exercise Dependence Scale Revised (EDS-R), Eating Disorder Examination-Questionnaire (EDE-Q), Muscularity-Oriented Eating Test (MOET), Brief Symptom Inventory-18 (BSI-18), and Clinical Impairment Assessment Questionnaire (CIA).

Results: Bivariate correlation analyses revealed strong overlaps of TOS-OrNe with both forms of disordered eating (EDE-Q: r = .635, MOET: r = .730), which were significantly more pronounced in women (EDE-Q: r = .676, MOET: r = .810) than men. EA was strongly correlated with MOET (r = .536), and weakly with EDE-Q (r = .242). Multiple regression and path analyses showed OrNe predicted psychosocial impairment and psychological distress both directly and mediated by EDE-Q, whereas EA was not uniquely linked to clinical indicators. Exploratory factor analysis further suggested strongly related latent constructs.

Conclusion: Although OrNe was uniquely associated with psychological distress and impairment, its substantial overlap with restrictive and muscularity-oriented disordered eating challenges its validity as a distinct disorder. EA's association with impairment appears largely explained by muscularity concerns, questioning its conceptualization as a behavioural addiction. These findings underscore the importance of considering muscularity-related motives and behaviours in both research and clinical assessment. Overall, OrNe and EA may reflect socioculturally shaped expressions of disordered eating rather than independent mental disorders.

Background: Interoception is the capacity to perceive, interpret, and respond to internal bodily signals and is increasingly recognised as an important factor in the development and maintenance of eating disorders (EDs). Altered interoception contributes to disrupted hunger and satiety, body image disturbances, and difficulties with emotional awareness and responsiveness, all of which are central to ED psychopathology. Despite this growing theoretical and clinical interest, empirical research examining associations between interoception and diverse ED symptoms remains limited, particularly with respect to the potential moderating role of sociodemographic factors.

Objective: This study used self-report instruments to investigate interoceptive sensibility across ED symptoms.

Methods: A community sample of 221 Australian adults aged 18 or above completed validated self-report measures of interoceptive sensibility (Interoception Sensory Questionnaire, ISQ) and ED symptoms (e.g., Eating Disorder Questionnaire, EDE-Q and Nine Item ARFID Screener, NIAS). Correlation analyses were conducted to assess associations between ISQ scores and ED measures. In addition, we undertook moderation analyses to assess whether sociodemographic factors (i.e., racial background, gender identity, age, employment status, living situation, and sex assigned at birth) influenced ISQ scores and their associations with ED measures.

Results: Statistically significant correlations between ISQ scores and all ED measures were found, with the strongest associations observed with the NIAS and the EDE-Q. Some sociodemographic factors (i.e., sexual orientation, racial background, and sex assigned at birth) also influenced ISQ scores and their association with ED measures.

Conclusions: Difficulties with interoceptive sensibility are evident across a wide range of self-reported ED symptoms, suggesting that altered interoceptive sensibility may be a transdiagnostic feature of EDs, though the statistical strength of associations between ISQ scores and ED measures varied. Integrating interoceptive sensibility into ED assessment and treatment may enhance the individualisation of care.

Background: Food addiction is the concept that individuals can feel "addicted" to highly processed foods. Few interventions exist to treat it; however, recent studies targeting food addiction have drawn upon evidence-based treatments for addictions and eating disorders, including adapted motivational interviewing (AMI) and cognitive behavioural therapy (CBT).

Methods: The current study investigated the efficacy of a novel 4-session intervention for food addiction that combines AMI + CBT (MotivATE) compared to a waitlist control (WLC). Of 131 screened individuals from the general community, 92 participants (mean age = 34.9 years, SD = 12.0; 77% women; 51% People of Colour; 29% sexual minorities) were randomized into AMI + CBT (MotivATE) therapy (n = 55) or WLC (n = 37). Participants needed to meet criteria for at least "mild" food addiction on the modified Yale Food Addiction Scale (YFAS) 2.0 to be eligible. Baseline average YFAS 2.0 scores were 8.7-8.9 symptoms ("severe" food addiction) out of a possible 11 for both groups. Therapists were clinical psychology doctoral students supervised by a registered clinical psychologist. Participants were assessed at Baseline, Month 1 (postintervention), Month 2, and Month 4. Follow-up periods were similar to previous MI interventions for binge eating. Sample size was determined by power analyses using effect sizes from such interventions.

Results: Of 60 participants who started therapy, 40% met diagnostic criteria for Binge Eating Disorder, 25% for Bulimia Nervosa, 7% for Other Specified Feeding or Eating Disorder (OSFED), and 28% did not meet criteria for a current eating disorder. The therapy group reported significantly greater reductions in food addiction, addiction-like eating, binge eating symptoms, and loss-of-control eating compared to the WLC group at all follow-up timepoints. However, the therapy group did not report greater reductions in self-reported binge eating episodes or food cravings compared to WLC.

Conclusion: This trial provides initial evidence for the feasibility and efficacy of a brief AMI + CBT intervention for food addiction among a diverse community sample. Future trials of this intervention may benefit from greater dosages of treatment and longer follow-up periods. Trial registration ClinicalTrials.gov identifier NCT04666831; registered December 14, 2020.

Background: Parenting a child with an eating disorder (ED) while also navigating the healthcare system can be complex and overwhelming. Preliminary research indicates that parent-led peer support could be a promising avenue to ease this burden. This study examined the expanding implementation of virtual parent-led peer-support groups (vPLPSGs) for parents of children with EDs.

Methods: A convergent mixed methods design was used to evaluate the effectiveness of the vPLPSG intervention and success of its implementation. Parents of children who had recovered from an ED, or parent peer support providers (PPSPs), were trained to lead vPLPSGs for parents of children currently ill with an ED. Groups occurred biweekly across two study waves, totalling 12 months. Parents completed measures of caregiver burden, caregiver needs, and caregiver confidence before and after attending vPLPSGs over a three-month period. PPSPs completed weekly ratings of fidelity and pre- and post-implementation measures of readiness for change, attitudes towards evidence-based practice, and perceptions of the effectiveness of the principles guiding this intervention. Using qualitative methods, PPSPs and parents participated in a focus group and individual semi-structured interviews, respectively.

Results: At post-intervention, parents (n = 35) reported decreased caregiver burden (MD=-4.69; p = 0.050), an increase in met information and support needs (MD = 5.60; p < 0.001), and increased confidence to support their child with an ED (MD = 8.09; p < 0.01). Qualitative data indicated that parents reported vPLPSGs as a positive, supportive experience. PPSPs (n = 8) experienced a decrease in PPSPs' attitudes towards evidence-based practices (MD=-0.54; p < 0.01). Around half (50.5%) of the fidelity ratings met the pre-determined criterion (80%). PPSPs gave overall positive qualitative reports of their experiences facilitating vPLPSGs.

Conclusions: In this expanded vPLPSG intervention implemented across Canada, the program demonstrated effectiveness in improving parent outcomes and supporting PPSPs' readiness, attitudes, and perceived fit for the intervention. Both parents and PPSPs found the intervention acceptable and meaningful, and PPSPs demonstrated fidelity to the model. Parent-led peer support may be a useful adjunct to traditional pediatric ED care. Further research is needed to explore the implementation of vPLPSGs across diverse healthcare settings and demographic groups.

Background: Adult picky eating (PE) is quite common, and when extreme, is associated with emotional, social, and physical distress and damage. In this correlational study we examined retrospectively childhood PE, parental accommodation of childhood PE, sensory over-responsiveness, and current symptoms of anxiety and depression, to test their combined contribution to adult picky eating.

Methods: Participants were 352 adult community volunteers, predominantly female (79.5%), aged 18-71 years, with some college education (mean 14.4 years). They self-reported online on current picky eating, retrospective childhood picky eating, parental accommodation of childhood PE, sensory regulation disorder, and current symptoms of anxiety and depression.

Results: Adult picky eating was positively associated with retrospectively reported childhood picky eating, parental accommodation of childhood picky eating, sensory over-responsiveness, and current symptoms of anxiety and depression. In hierarchical regression analyses, parental accommodation explained unique variance in adult picky eating above and beyond childhood picky eating, sensory over-responsiveness, and emotional symptoms. Structural equation modeling supported a developmental model in which childhood picky eating and sensory over-responsiveness contributed to adult picky eating both directly and indirectly, via parental accommodation and symptoms of anxiety and depression.

Conclusion: While the initiation of childhood PE is related to sensory hyper-responsivity, progression from childhood PE to adult PE is more likely to be maintained by parental accommodation. Counseling parents of children with PE to minimize accommodation may have beneficial effects on their children's development, even if selective eating is fueled by sensory over-responsiveness.

Background: Affect regulation models suggest high negative and low positive affect may drive binge eating and purging in bulimia nervosa (BN). While ecological momentary assessment (EMA) studies often support these theories, inconsistent outcomes in affect-targeted interventions suggest causal relations vary across individuals. This study applied causal discovery analysis (CDA) to EMA data to characterize such heterogeneity in person-specific causal models for BN.

Methods: EMA data from 118 adult women with BN, collected over 14 days, assessed momentary negative affect, positive affect, binge eating, and self-induced vomiting. Using the Greedy Fast Causal Inference algorithm, we derived individual causal models and estimated effect sizes via structural equation modeling. Heterogeneity was evaluated by the proportion of participants with affect as a causal factor for BN behaviors.

Results: Causal patterns were highly heterogeneous. Elevated negative affect was causal for binge eating in 16.9% of participants, vomiting in 18.6%, and either behavior in 27.1%. Low positive affect was causal for binge eating in 8.5%, vomiting in 11.0%, and either behavior in 15.3%. Behavior-behavior causality was also common: vomiting caused binge eating in 26.3% of participants, and binge eating caused vomiting in 22.0%.

Conclusions: CDA revealed marked heterogeneity in causal factors underlying BN behaviors, with some models showing affect-driven behaviors and others indicating behavior-driven patterns. Ultimately, this work indicates that the link between momentary affect and BN behaviors is highly individualized, underscoring the need for precision-targeted interventions rather than one-size-fits-all treatments.