Journal of Eating Disorders最新文献

Background: A significant portion of youth with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) have history of 'overweight/obesity' (i.e., body mass index ≥ 85th percentile for age-and-sex) prior to the onset of the eating disorder (ED) diagnosis, but research on this population remains limited. The present study used semi-structured interviews to explore themes related to triggers of weight loss, treatment, and recovery among youth with AN/AAN and history of 'overweight/obesity,' and their parents.

Method: The sample included eleven youth and parent dyads (Median [IQR] age of youth = 16.0 (1.5) years, 90.9% female, 90.9% White, 27.3% Hispanic) who were evaluated for an ED in a multidisciplinary ED program at a pediatric hospital between November 2020 and April 2021. Nine youth and separately, nine parents of these 11 dyads completed semi-structured interviews with the research team. Seven matched pairs of patients and parents completed demographic surveys and study interviews. Interviews were recorded, transcribed, and coded by four research team members using a reflexive thematic approach.

Results: Weight stigma was the most frequently reported theme for a trigger for weight loss that led to the onset for developing AN/AAN by both youth and parents. Regarding barriers to recovery, themes from more than a half of youth included uncertainty of weight goals in treatment and feeling they are "not sick enough." Notable themes for attitudes towards treatment from most parents included general agreement with clinician recommendations, but also an uncertainty of weight restoration goals and a belief that their child need to have a "normal" weight.

Conclusion: These results highlighted how the majority of interviewed youth with history of 'overweight/obesity' reported weight stigma as both a trigger for the development of AN/AAN as well as a barrier to recovering. Internalized weight stigma among parents may influence their attitudes towards weight restoration as a treatment goal where these youth and parents may experience uncertainty of weight goals in treatment. This study demonstrated triggers and barriers to treatment that may be unique to youth with ED and history of 'overweight/obesity' and more research is needed to address weight stigma in multidisciplinary ED treatment for this understudied population.

Background: Unlike evidence-based guidelines that exist for families of youth with eating disorders, little is known about the optimal role for families of adult patients. Given issues of patient autonomy and confidentiality, it is common for family members to report high levels of distress, confusion about how to offer support, and feelings of exclusion. Nevertheless, interactions with parents play a critical role in the recovery process. The purpose of this research was to increase understanding of support experiences of parents of adult children while identifying what they believe to be the most beneficial forms of support.

Methods: Sixteen parents of adults who were either recovered or actively engaged in intensive eating disorders treatment participated in semi-structured interviews. Participants were asked to describe the nature of their relationship, beliefs about their child's support needs, and factors that challenged or facilitated their capacity to offer what they deemed as optimal support.

Results: In the context of receiving support and practicing self-care, parents' aspiration shifted from fixing the eating disorder to prioritizing a relational goal of unrelenting connection with their child. Achieving this involved three key skills: managing reactions and expectations, learning boundaries, and practicing validation.

Conclusions: This research highlights the ongoing challenges faced by parents, indicating that interventions aimed at supporting their own well-being and fostering connection with their child may be of benefit.

A lean muscular body of low weight is often associated with performance for cyclists and can be difficult to achieve. Disordered eating for some cyclists may develop in the pursuit of lean muscularity which is perceived to be beneficial to performance. Further, emotion dysregulation may exacerbate negative feelings about body image, increasing the risk of developing disordered eating as a means of controlling weight and shape. While research in athlete populations has been substantial, disordered eating in cyclists is relatively under-explored. The current study examined whether shape and weight concern and drive for leanness were associated with muscularity-oriented disordered eating and whether these relationships were moderated by emotion dysregulation. Interactions between these factors were also investigated. Participants were 139 Australian competitive cyclists (112 males, 27 females, aged 18-68 years) who completed a self-report questionnaire comprised of measures of shape and weight concern, drive for leanness, muscularity-oriented eating and emotion dysregulation variables. Both shape and weight concern and drive for leanness had a unique association with muscularity-oriented disordered eating. Emotion dysregulation was found to have a unique association with muscularity-oriented disordered eating when controlling for drive for leanness, but not when shape and weight concern was controlled. Additionally, emotion dysregulation moderated the association between shape and weight concern and muscularity-oriented disordered eating, whereby the relationship was intensified at higher levels of emotion dysregulation. Our study has extended the literature by indicating that cyclists' desire to attain a lean body is associated with muscularity-oriented disordered eating. Further, emotion dysregulation moderated this link, suggesting it could be a maintaining factor worth addressing.

Autistic people and those with attention deficit hyperactivity disorder are at a high risk of developing an eating disorder. While there is limited evidence on the relationship between other forms of neurodivergence and eating disorders, research suggests associations between giftedness, intellectual disability, obsessive-compulsive disorder, psychosis, Tourette's syndrome, and disordered eating. Factors underlying disordered eating and/or eating disorder risk for neurodivergent people are multifaceted and complex, encompassing a wide range of intertwined psychosocial, environmental, and biological processes. Moreover, research shows that neurodivergent individuals experience poorer treatment outcomes compared to neurotypical individuals. However, there is a paucity of research in this area overall. More specifically, lived experience-led research remains rare, despite its critical role for improving individualised eating disorder care, as well as mental healthcare more broadly. Indeed, the importance of eating disorder care individuation is increasingly being recognised, particularly within the context of neurodivergence, given the heterogeneous experiences and support needs of neurodivergent people affected by disordered eating and/or eating disorders. Furthermore, despite documented overlaps between various forms of neurodivergence (e.g., co-occurring autism and attention deficit hyperactivity disorder), research looking at eating disorders in the context of neurodivergence through a transdiagnostic perspective is scarce. This lived experience-led narrative review aims to shed light on the intersectional factors underlying elevated disordered eating and/or eating disorder risk for neurodivergent individuals. First, an overview of prevalence data is provided, followed by a thematic framework identifying factors underlying disordered eating and/or eating disorder risk in relation to neurodivergence. A critical appraisal of current eating disorder research and care is then offered before suggestions for neurodiversity-affirming eating disorder care are made. In this view, this paper offers a foundation for future empirical work in this nascent field of inquiry by providing a lived experience-led, transdiagnostic, and intersectional account of eating disorders in the context of neurodivergence.

Background: Patient narratives can best be defined as personal stories of persons previously or currently affected by a physical or mental health disorder. The collaborative development and implementation of such narratives reflects a participatory approach between researchers, patients, and members of the public towards the development of new interventions. Patient narratives can foster feelings of support and belonging, as well as increase hope and motivation towards recovery. Aims of this pilot study were (a) the collaborative development of a series of evidence-based patient narrative videos about eating disorders, (b) their initial evaluation with a group of participants without (current) eating disorders, and (c) to provide a reproducible documentation of this methodological approach.

Method: A multi-stage participatory process was used including a) a systematic review, b) focus groups with affected persons, c) the participatory narrative development, and d) an initial pilot study with participants without (current) eating disorders. A former and currently recovered patient was recruited as a lived experience representative, while a psychotherapist provided the same information from a professional perspective. Control group videos featured the lived experience representative discussing a somatic condition unrelated to eating disorders (i.e., torn knee ligament). Two videos were created for each perspective with varying degrees of emotionality of the content.

Results: Nineteen female participants without (current) eating disorders were recruited for the pilot study. All videos received positive ratings, however, participants rated videos in which the lived experience representative discussed her eating disorder as significantly more authentic than the control group videos, as well as significantly more empathic, useful, and better overall than the psychotherapist and control group videos. Participants further indicated a clear preference for videos with higher emotionality, regardless of which perspective or disorder was being presented.

Discussion: The use of patient narratives for eating disorders is a relatively new methodological approach. This paper provides one example of how evidence-based patient narratives can be constructed. The patient narratives created in this study received positive feedback from participants without (current) eating disorders and are currently being tested in a 4-arm randomised controlled pilot study with patients affected by eating disorders.

Background: Despite the increasing use of dialectical behaviour therapy (DBT) as a treatment for eating disorders (EDs), there is little published evidence of its effectiveness for treating restrictive eating disorders. DBT for EDs may be particularly helpful for those who live with severe and enduring eating disorders (SE-EDs) given that it targets those for whom first-line treatments have not been effective, its focus on factors thought to maintain symptoms and its focus on improving quality of life. This study sought to evaluate the experiences of participants in a comprehensive DBT programme for people with SE-EDs.

Methods: Semistructured interviews were conducted with seven participants who were treated in the 'DBT for Multidiagnostic Eating Disorders (MED-DBT)' programme at a regional eating disorders service in New Zealand. The interviews were transcribed verbatim and analysed via thematic analysis.

Results: The findings indicate that the MED-DBT programme was perceived as effective by participants. The skills learned provided participants with valuable tools that could be used to better manage emotions, crises, and tasks of daily life, which improved their quality of life and improved their management of their eating disorder symptoms. Several participants reported that the programme saved their lives. A key component of the MED-DBT programme was having access to phone coaching that supported participants with the acquisition and consolidation of skills to reduce crises and generalise learning of the skills. These skills have continued to be used by participants more than five years posttreatment.

Conclusions: The qualitative findings of the present study suggest that the MED-DBT programme is an effective and valuable treatment for participants. All participants endorsed the MED-DBT programme for ED treatment. The treatment programme was seen as a highly beneficial and feasible treatment that could provide greater options for treating complex clients with severe and enduring eating symptomology with confidence.

Background: The factorial structure of the Eating Attitudes Test (EAT-26) has been found to be inconsistent across studies and samples. This study aimed to resolve inconsistencies in the factorial structure of the Arabic version of the EAT-26 by identifying the best-fitting model and test its measurement invariance across sexes and BMI categories in a large non-clinical Saudi sample.

Methods: 1,734 Saudi adults (M_age 26.88 and SD 9.13), predominantly female, completed an online survey. Several existing models were tested (e.g., original 26-item three-factor model, second order 26-item three-factor model, 20-item four-factor model, and 16-item four-factor model) using confirmatory factor analysis (CFA). Fit indices including the CFI, SRMR, and RMSEA were used to identify the best-fitting model for Arabic version of the EAT-26. Multi-group confirmatory factor analysis (MGCFA) was used to test measurement invariance.

Results: The original three-factor model and two other common models demonstrated poor fit (e.g., CFI = 0.727; SRMR = 0.0911; RMSEA = 0.085 [90% CI 0.082-0.087] for the original three-factor model). Instead, a 16-item, four-factor structure [(Self-Perceptions of Body Weight), (Dieting), (Awareness of Food Contents), and (Food Preoccupation)] showed acceptable fit ([CFI = 0.904; SRMR = 0.0554; RMSEA = 0.073 [90% CI 0.068- 0.077]). Internal consistency was good (α and ω = 0.88), and measurement invariance was supported across sex (male and female) and BMI categories (underweight, normal weight, overweight, and obese).

Conclusions: These findings underscore the need for culturally relevant validation of the EAT-26 among Arabic-speaking populations, as the revised factorial structure diverged from previously established models. Future research should further examine this revised 16-item, four-factor structure in clinical settings.

Background: Unlike eating disorders (ED) that are officially recognized and focusing on the quantity of food, Orthorexia Nervosa (ON) revolves around an unhealthy fixation on the quality of food eaten. Existing ON scales differ in how these conceptualize and define ON, ensuing inconsistency in assessments that not only affects the validity and reliability of ON related research, but also impacts the ability of healthcare professionals to identify and provide support for individuals struggling with ON.

Objective: Create the first Eastern locally validated tool that considers the cultural nuances and specificity of the Lebanese general population's eating attitudes and their social context, addresses the limitations of existing scales and thereby provides a valid instrument that can be used in Lebanon and culturally-similar countries.

Methods: Data were collected between September 2023 and February 2024, enrolling 320 participants for the exploratory factor analysis and 658 for the confirmatory analysis.

Results: Starting from an initial pool of 25 items, the exploratory-confirmatory (EFA-CFA) factor analyses retained 13 items. The LONI showed a unidimensional factor structure, and satisfactory convergent and concurrent validity with a composite reliability (ω and α) of 0.90 providing clear evidence of its high reliability, supporting the stability and consistency of LONI scores across different subsamples. The structural characteristics, factor loadings, and item intercepts of the LONI remained consistent regardless of gender, affirming the tool's stability and reliability in measuring ON traits across diverse populations.

Conclusion: The LONI is a valid tool for assessing ON, particularly in accounting for Lebanese and culturally similar populations. The scale's unidimensional structure allows for straightforward calculation of the score, making it practical for both clinical and research applications, while offering a unique advantage in considering regional dietary patterns compared with existing ON screening tools due to its cultural specificity and psychometric strengths. The ON prevalence was high in the present sample, underscoring the significance of sociocultural and behavioral factors in its manifestation.

Background: Higher level of care (HLOC) treatment for eating disorders (EDs) is sometimes necessary, but research is lacking on whether HLOCs are actually more effective than less structured, lower levels of care. The purpose of the current study was to compare outcomes for patients with EDs at low weights who entered 24/7 care (inpatient and residential) to those entering non-24/7 care (partial hospitalization programming and intensive outpatient programming).

Methods: Participants were 1104 adults with body mass indices (BMI) between 14 and 17 receiving treatment for an ED at a large multisite treatment facility offering HLOCs between August 2019 and February 2024. The Eating Disorder Examination-Questionnaire (EDE-Q), assessing ED psychopathology, was completed at admission and discharge. Weight was taken throughout treatment.

Results: In unadjusted analyses, there was a significant difference between those receiving 24/7 care (3.79) versus non-24/7 care (2.17) in BMI increase during treatment. In adjusted analyses controlling for ED diagnosis, length of stay, and admission BMI, results remained the same. Weight gain per week was significantly greater for patients in 24/7 care. Changes in ED psychopathology, as measured by the EDE-Q, were not significantly associated with 24/7 care.

Conclusions: The current study suggests that patients with EDs at low BMIs gain more weight at a faster rate when participating in 24/7 care compared to non-24/7 care. Entering treatment at an appropriate level may result in shorter overall lengths of stay and may increase the chances of a positive long-term outcome.