Journal of Eating Disorders最新文献

Background: Early treatment is critical to improve eating disorder prognosis. Single session interventions have been proposed as a strategy to provide short term support to people on waitlists for eating disorder treatment, however, it is not always possible to access this early intervention. Conversational artificial intelligence agents or "chatbots" reflect a unique opportunity to attempt to fill this gap in service provision. The aim of this research was to co-design a novel chatbot capable of delivering a single session intervention for adults on the waitlist for eating disorder treatment across the diagnostic spectrum and ascertain its preliminary acceptability and feasibility.

Methods: A Double Diamond co-design approach was employed which included four phases: discover, define, develop, and deliver. There were 17 participants in total in Australia; ten adults with a lived experience of an eating disorder and seven registered psychologists working in the field of eating disorders, who participated in online interviews and workshops. Thematic and content analyses were undertaken with interview/workshop transcriptions with findings from the previous phase informing the ideas and development of the next phase. A final prototype of a single session intervention chatbot was presented to the participants in the deliver phase.

Results: Thematic and content analyses identified four main themes that were present across the four phases of interviews/workshops: conversational tone, safety and risk management, user journey and session structure, and content.

Conclusions: Overall, the feedback on the single session intervention chatbot was positive throughout the Double Diamond process from both people with a lived experience of an eating disorder and psychologists. Incorporating the feedback across the four themes and four co-design phases allowed for refinement of the chatbot. Further research is required to evaluate the chatbot's efficacy in early treatment settings.

Background: Residential facilities for eating disorders are becoming increasingly common, providing recovery-oriented care in less restrictive environments compared to traditional hospital treatments. Despite their popularity, there is a lack of research regarding parent and carer experiences of residential programs. Furthermore, while the impact of eating disorders on parents and caregivers is well-documented, understandings of their lived experiences remain limited. The aim of this study was to explore parent and carer lived experiences of Australia's first residential facility for the treatment of eating disorders.

Methods: As part of a clinical evaluation (June 2021 - August 2023), 15 parents participated in a semi-structured interview about their experience of residential treatment. Transcripts were analysed using inductive reflexive thematic analysis.

Results: Analysis generated six main themes from the data: (1) When everything is still not enough; (2) They were giving us hope; (3) I just felt relief; (4) I can resume the role of loving parent; (5) We almost need our own therapist; and, (6) Treatment access: There needs to be a hundred more. These themes collectively highlight both the burden of caring for a loved one with an ED and parents' experiences of residential treatment. Overall, participants described residential treatment as providing respite and hope, enabling them to reclaim aspects of their lives that had been overshadowed by the eating disorder. Although not a "magic cure", residential care was viewed as an essential component of a broader continuum of care.

Conclusions: This research highlights the unique benefits of the residential model and the importance of a compassionate care environment, while underscoring the importance of supporting caregivers throughout the treatment process. Given the critical role of carers in treatment outcomes, further research is essential to deepen our understandings of the carer experience and develop interventions that support both the experiencing person and their primary support people.

Trial registration: This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR12621001651875p).

Background: Stigma significantly hinders treatment seeking, adherence to treatment, referrals, and can prolong recovery, while increasing the risk of relapse due to social exclusion and stress. Stigmatizing attitudes towards anorexia nervosa are widespread, and not only held by the general public, but also by professionals.

Objective: As stigmatizing attitudes towards mental disorders often develop early during education and training, the study's objective was to investigate stigmatizing attitudes towards anorexia nervosa among Dutch psychiatry residents, as well as their mental health literacy.

Methods: In this pilot study, Dutch psychiatry residents (N = 61) were surveyed, with a 49% response rate, using a comprehensive questionnaire that included nine parts, covering multiple stigma domains, disease prestige, knowledge, and professional training.

Results: Anorexia nervosa was ranked 18th in disease prestige with a mean score of 6.23. Although most stigmatizing attitudes were not widely endorsed by psychiatry residents, there were a few notable exceptions, especially attitudes related to blame, fragility and social distance. They characterized patients as insecure, controlling, sad, and defensive, and reported feeling worried, incompetent, pessimistic and anxious when dealing with patients with anorexia nervosa. Only 37% felt confident in diagnosing anorexia nervosa.

Conclusion: There is a critical need for further research on the social value ranking of psychiatric disorders and the development of a comprehensive stigma scale, as well as targeted educational interventions. Addressing stigma through focused training programs could lead to better patient outcomes, improved treatment satisfaction, and reduced barriers to care for individuals with anorexia nervosa.

Background: While some children are open to trying new foods, many exhibit dislike or refusal when encountering them for the first time. These behaviors can be broadly characterized as food neophobia and pickiness, which are believed to be the primary forms of food rejection among children. Because there are differences between countries in early feeding practices and culinary traditions, culturally adapted scales are needed to measure these behaviors. This study aimed to (1) test the reliability and validity of the Turkish adaptation of the Child Food Rejection Scale (CFRS), and (2) examine patterns of food rejection and the correlations between scale scores and sociodemographic characteristics among Turkish children.

Methods: The validity of the CFRS translated into Turkish and cross-culturally adapted was assessed by content validity, construct validity, and convergent validity. Internal consistency was measured with Cronbach's alpha coefficient for the scale and its subdimensions. The scale reliability was also evaluated using test-retest reliability and several tests.

Results: Three hundred seventy-five primary caregivers (mainly mothers) of children aged 2 to 7 years were recruited through an online questionnaire. The results confirmed the psychometric soundness of the Turkish CFRS. Construct validity was supported by factor analysis (KMO coefficient = 0.852; Bartlett's sphericity test χ²=1301.580, p < 0.01), with two factors explaining 53.47% of the variance. Internal consistency was high (Cronbach's α = 0.838 for the total scale; α = 0.845 for neophobia, α = 0.600 for pickiness). Test-retest reliability (ICC = 0.770) indicated stability over time. Reliability was further supported by split-half reliability (Spearman-Brown coefficient = 0.749; Guttman split-half coefficient = 0.746), and the scale demonstrated additivity (Tukey's test F = 35.543, p ≤ 0.001) and absence of response bias (Hotelling T-square test F = 63.041, p ≤ 0.001). Confirmatory factor analysis showed good model fit for the two-factor structure, supporting construct validity. Moreover, the rate of food rejection was 21.1%, and CFRS scores did not vary by gender, age, or other sociodemographic characteristics among Turkish children.

Conclusions: Overall, these findings affirm that the adapted CFRS is a reliable and valid tool for assessing food rejection behaviors in Turkish children.

Background: Avoidant/Restrictive Food Intake Disorder (ARFID) is a recently recognized eating disorder category in the DSM-5 and ICD-11classifications. Recent functional neuroimaging studies have suggested alterations in the cerebellar intrinsic connectivity networks in patients suffering from eating disorders. Associations between eating disorders and central nervous system tumors have been documented, but to date no studies have linked eating disorders to cerebellar lesions. This case report presents a 13-year-old boy with ARFID symptoms and a cerebellar tumor, exploring the potential connection between the two.

Case presentation: A 13-year-old adolescent with a history of dental agenesis, escalating food restriction, severe abdominal pain, impaired weight gain and statural growth was initially diagnosed with ARFID. A brain magnetic resonance imaging revealed a large and threatening cerebellar tumor, leading to urgent neurosurgery. After tumor removal, the patient's eating behaviors, weight, and growth but also puberty improved dramatically. One year later, a tumor remnant was found, necessitating targeted therapy.

Conclusions: This case underscores the possibility that cerebellar tumors can mimic ARFID-like syndrome, suggesting a neurological origin for the observed disordered eating behaviors. The marked improvement in eating patterns and growth after tumor removal strongly suggests a direct link between the cerebellar tumor and the patient's symptoms. Given the rarity and complexity of such cases, neurological evaluations, including brain magnetic resonance imaging, should be considered in any children and adolescents with eating disorder or severe disordered eating especially when growth is affected, or unusual symptoms are present.

Level of evidence: level V, case report.

Background: Body image has predominantly been examined among young White women. As a result, the guiding theories in this area of study are based on implicit assumptions that this population's experience is normative. These assumptions include thinness as the ideal body type and the lack of consideration of body shape, skin tone, and hair texture in body image. As a result, research examining body image among Black women has been limited by using theoretical constructs that do not fully capture the lived experiences of this population. The purpose of the study was to investigate the role of the racialized beauty aesthetic in Black women's body image.

Methods: Eight focus groups were conducted with 30 Black women aged 18-29 with a Body Mass Index (BMI) ≥ 25-kg/m². Focus groups used a semi-structured interview guide to assess race, beauty ideals, pressures to meet the beauty ideals, and the social costs and benefits of obtaining the ideals. We used a constructivist grounded theory approach to develop a conceptual model. This method's steps include initial, focused, and theoretical coding.

Results: Results indicated that the standardization of Eurocentric beauty standards resulted in the stigmatization and devaluation of Black women based on appearance. Participants described being stigmatized on the basis of their appearance and feeling devalued due to the prevalence of negative stereotypes about Black women's appearance and behavior. Experiences of gendered racism resulted in racialized body dissatisfaction. Participants coped with these experiences by engaging in shifting behaviors to reduce the appearance of stigmatizing marks or by rejecting normative Whiteness. Both coping methods came with costs and benefits; participants expressed that they felt they were in a no-win situation, which had adverse health consequences. These findings resulted in the development of the Black Feminist Model of Body Image.

Conclusions: Consideration of Black women's body image in the context of their intersectional marginalized identities highlights how Eurocentric beauty standards are used to perpetuate the stigmatization of Black women. This work implies that efforts to improve the health of Black women must seriously consider the role of body image and racialized body dissatisfaction on their mental and physical health.

Background: A deficiency in autobiographical memory functioning could be of relevance to the maintenance of an eating disorder (ED). Past research has found that people with EDs have difficulties in recalling specific details of autobiographical memories (AM) and in imagining future events. Our aim was to investigate AM and episodic future thinking (EFT) in individuals with anorexia nervosa (AN), binge-type eating disorders (Bulimia Nervosa or Binge Eating Disorders; BN/BED), and healthy controls (HCs) using negative cue words relevant to the experience of being disgusted and morally violated.

Methods: Remotely administered computerised versions of the autobiographical memory task (AMT) and the EFT task were used to measure the specificity and vividness of AMs and EFTs. Neutral or negative/moral disgust-relevant cues were used to elicit AMs and EFTs. The relationship between AM specificity and EFT specificity was explored. The predictor role of individual differences in childhood teasing and betrayal sensitivity on the specificity and vividness of AMT and EFTs induced by moral disgust-relevant cues was examined.

Results: Individuals with AN and BN/BED did not have difficulties retrieving specific and vivid details of AMs and imagining future events in both cue conditions. AM specificity predicted EFT specificity in AN and HC groups. Future events primed by neutral cues were rated as more vivid by the control group compared to those induced by negative cues. Participants with EDs who had greater levels of childhood teasing and betrayal sensitivity generated more vivid AMs and EFTs in response to moral disgust-related cues, which was not observed in HCs.

Conclusions: This study did not detect alterations in AMT and EFT characteristics in people with AN or binge-type EDs compared with HCs. The findings were discussed regarding sample characteristics (e.g., illness severity, ethnicity) and methodology (e.g., cue words) in the present study. Individual differences in childhood teasing and betrayal sensitivity may be related to more vivid negative memories and future events, which might increase the salience of past and future victimisation-related events.

Background: Eating disorders (EDs) in the athlete population are often discussed in terms of comparing with non-athlete samples, however little is known regarding their gender clinical differences. Therefore, this study aimed to compare clinical and psychopathological features among athletes with an eating disorder (ED+A), non-athletes with an eating disorder (ED-A) and healthy controls (HCs), in addition to observing gender differences.

Methods: The sample consisted of 192 participants, all were age and gender matched, ED+A n = 64, ED-A n = 64 and HCs n = 64, with each group consisting of 50 females and 14 males. And each participant completed a face-to-face interview and various self-report questionnaires regarding personality traits (Temperament and Character Inventory-Revised), eating (Eating Disorder Inventory - 2) and general psychopathology (Symptom Checklist 90 - Revised), as well as relevant clinical indexes (lifetime suicidal attempts/ideation and sport activities conducted).

Results: In the ED+A group females had significantly higher eating and general psychopathology compared to males, especially body dissatisfaction (BD) and drive for thinness (DT) (p <.001). Overall, ED+A males had the lowest BD across the 3 groups. In terms of personality traits, ED+A females had significantly higher harm avoidance and lower self-directedness compared to their male counterparts. Lastly, suicidal ideation was significantly higher in ED+A females compared to males.

Conclusions: These results suggest that it may be imperative to better understand the risk factors in the athletic realm which may lead to the development of EDs, and which factors may be protective as well. It may also be helpful to encourage trainers to include preventive and screening strategies for athletes.

This Correspondence article provides a lived experience perspective on McColl et al.'s study, which examines the use of Dialectical Behaviour Therapy for individuals with eating disorders. Drawing on experiences of DBT treatment for longstanding and severe anorexia, the author critically engages with the study's findings, highlighting both the strengths and limitations of the treatment approach McColl et al. describe. While DBT has shown promise in addressing the emotional dysregulation and distress tolerance that underlie many eating disorder behaviours, the author emphasises the need for further adaptation to cater to the complexities of co-occurring physical, psychological, and neurodivergent conditions. The benefits of DBT for eating disorders are explored through personal reflections which emphasise the value and importance of skill-development, therapeutic validation, and motivation to build a "life worth living". Additional, co-produced research is required to further develop the evidence for DBT-based approaches, with particular attention needed in addressing language, stigma, cultural biases, and exclusionary research and clinical practices. Writing from a UK context, the author ends by advocating for the reinstatement of DBT within national guidelines for eating disorder treatment, highlighting its transdiagnostic relevance and potential to provide comprehensive, holistic support for those with more complex presentations.