Journal of Eating Disorders最新文献

Background: Anxiety and eating disorder (ED) symptoms often emerge during adolescence and frequently co-occur, considerably impairing the physical health and psychosocial functioning. Previous research has largely focused on assessing only one direction of the association between anxiety and ED symptoms. Limited understanding exists regarding the potential bidirectional associations and the role of childhood household dysfunction (CHD) in this association. This study aims to examine the bidirectional association between anxiety and ED symptoms in adolescents and further explore whether CHD moderates this association.

Methods: This longitudinal study was conducted among students from nine high schools in China. A total of 8,703 participants (mean [SD] age at baseline, 15.89 [0.60] years; 47.4% female) completed the self-reported questionnaires at baseline (June-August 2023) and at a 4-month follow-up (October-December 2023). Anxiety symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale, and ED symptoms using the Sick, Control, One, Fat, Food questionnaire. Information on eight indicators of CHD was collected at baseline. Cross-lagged panel models (CLPM) were applied to examine the bidirectional association between anxiety and ED symptoms, and moderation analyses were performed to assess the moderating role of CHD. Bonferroni corrections were applied with significance thresholds adjusted for multiple testing.

Results: The CLPM results showed that anxiety and ED symptoms exhibit a bidirectional association, with anxiety at baseline predicted subsequent increased ED symptoms (β = 0.13, 95% CI = 0.11-0.15) and ED symptoms at baseline also predicted subsequent increased anxiety symptoms (β = 0.06, 95% CI = 0.04-0.08). The cumulative CHD score was positively associated with both anxiety (β = 0.07, 95% CI = 0.04-0.11) and ED symptoms (β = 0.06, 95% CI = 0.02-0.09) at follow-up, but did not significantly moderate their relationship. Individual CHD indicators demonstrated distinct moderating effects for boys and girls; none of these effects remained significant after Bonferroni correction.

Conclusions: These findings indicate that anxiety and ED symptoms reinforce each other over time, highlighting the potential value of integrated strategies to address both conditions simultaneously. Future research is warranted to clarify the mechanisms underlying this bidirectional association, explore additional moderating factors, and develop targeted prevention strategies.

Background: Evidence-based practice (EBP) for pediatric eating disorders (EDs), including the strongly recommended family-based treatment (FBT), is not always available to children, adolescents or emerging adults and their families. Our aim was to investigate clinician knowledge and perspectives of EBP, including FBT, and explore barriers and facilitators to its implementation.

Methods: Clinicians working in Western Canada who were engaged in care for pediatric EDs were invited to participate. A multimethod design was employed using an online survey and subsequent phone interview for data collection. Descriptive data was summarized using means and frequencies. Qualitative data was analysed using a mixed approach encompassing inductive and deductive techniques.

Results: Eighty-four clinicians completed the survey and 24 completed the interview. A total of 64% of clinicians providing therapy were offering FBT in their practice. Of these, 12.5% had no formal training in the modality. Clinicians identified a range of barriers and facilitators to EBP, including FBT, such as service-centered reasons (inadequate training, staff beliefs around which professionals should be involved, program mandates, and private practice therapists struggling to get other professionals on the 'same page' in FBT), clinician-centered reasons (desire to offer more holistic care, lack of inclusion of dietetics, belief that FBT was better suited to hospital settings), and patient/family-centered reasons (co-occurring conditions in parents or children, lack of financial privilege).

Conclusions: The barriers to delivering EBP, and low rates of formal FBT training indicate a need to improve capacity building efforts for pediatric ED clinicians, including improved access to training and consultation.

Eating disorders (EDs), including anorexia nervosa, bulimia nervosa, and binge eating disorder, are severe psychiatric illnesses marked by disordered eating patterns and psychological disturbances. Post-traumatic stress disorder (PTSD), a common response to trauma, is characterized by re-experiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. The prevalence of PTSD is significantly higher among individuals with EDs than in the general population. This comorbidity is associated with more severe clinical presentations, greater functional impairment, higher treatment dropout rates, and poorer prognoses. Despite increasing recognition of this co-occurrence, the underlying biological and psychological mechanisms remain inadequately understood. This review explores potential shared pathways from a biopsychological perspective, including dysregulation of the hypothalamic-pituitary-adrenal axis, immune system alterations, gut microbiota imbalances, emotional dysregulation, and dissociation. Current treatment strategies are reviewed, highlighting the lack of specific clinical guidelines for this population. There is an urgent need for integrated, trauma-informed interventions to enhance outcomes for individuals affected by the dual burden of EDs and PTSD.

Objective: Familial factors play crucial roles in the development of eating disorders and related psychopathology. However, the generalizability of findings from Western studies on familial influences to Chinese populations remains questionable. This review systematically examines the relationship between family functioning, conceptualized within the family process model, and the development of eating disorders in Chinese patients.

Methods: Empirical studies were systematically reviewed on the basis of family process theory. The quantitative data were integrated and synthesized with qualitative data using a convergent integrated approach. A thematic analysis was conducted using NVivo 12. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 Checklist and was registered with PROSPERO.

Results: Fifty studies (13 quantitative and 37 qualitative or case studies) highlighted six themes: (1) family values; (2) family tasks: individuality; (3) family communication: conflict avoidance and affective involvement; (4) parental roles; (5) parental control; and (6) specific behaviours (e.g., unhealthy feeding practices and negative family body talk). These factors may play a role in the development of eating disorders and provide insight into the dynamics within Chinese families.

Conclusion: Filial piety and gender preferences characterize cultural contexts in patients', families', and professionals' narratives. While individuality and eating-related behaviours appear in both Chinese and Western contexts, notable differences exist. Avoidant family communication, emotional disengagement, parental control, and strong academic focus were identified, but parental roles and divisions showed no consistent patterns. Quantitative findings only partially support the qualitative descriptions.

Background: While many multi-item measures are available to evaluate an individual's body image, study demands occasionally require the use of very brief measures, including single-items. However, little is known about how single-items perform relative to multi-item counterparts.

Methods: The present study aimed to evaluate the utility of two single-item assessments of appearance satisfaction, i.e. an individual's evaluation of their appearance, using a four-step and seven-step Likert scale and drawing on secondary data from three studies: (1) the Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 5,952, aged 14), (2) a cross-sectional study of older adolescents primarily with probable eating disorder diagnoses (the STORY study) (N = 242, aged 16-25), (3) and a longitudinal study of emergent adults (the COVID study) (N = 201 participants aged 18-30). Thus, the present study aimed to examine the concurrent validity (Body Dissatisfaction Scale, children's mother-reported body dissatisfaction, Body Esteem Scale for Adolescents and Adults - Appearance Subscale), convergent validity (Eating Disorder Examination Questionnaire, Eating Disorder-15, the Patient Health Questionnaire version 4 and 8), and test-retest reliability of single items measuring appearance satisfaction.

Results: In study 1, the single-item measure showed good concurrent validity with the Body Dissatisfaction Scale for both boys and girls, and moderate concurrent validity with mother-reported body dissatisfaction for girls only. In study 2, acceptable - yet lower - convergent validity was established in a female population with probable eating disorders, and strong convergent and concurrent validity in a small healthy control population. In study 3, strong significant convergent and concurrent validity were established for the implemented single-item assessment in emerging adults with and without a self-reported eating disorder diagnosis, as well as acceptable test-retest reliability.

Conclusion: These results provide insights into the utility of two highly similar single-item assessments of appearance satisfaction and give preliminary support for the use of similar measures in research (specifically for female non-eating disorder populations) when necessary.

Objective: Eating disorders have been associated with neurobehavioral differences in social processing and interactions. Clinically, social support is a positive prognostic factor that protects against relapse. For these reasons, interventions that modify features in the social domain may be promising therapeutic targets to improve outcomes in eating disorders. Because groups require multiple social interactions, group therapy may be an ideal format to facilitate change. However, there is currently no standard adjunctive therapy for eating disorders that targets social domain concepts in a group setting.

Method: The Social Domain Intervention (SDI) is an eight-session intervention that focuses on building insight about social processing within a group. Each session includes a collaborative experiential art task followed by a psychoeducational presentation and related activity. Engagement in the SDI was measured in terms of sessions attended and assignments completed. Written participant feedback was analyzed using Braun and Clark's method for thematic analysis. Written responses were coded and then grouped into themes.

Results: Eighteen female participants between the ages of 18-30 were enrolled in the group across three cohorts. Two participants withdrew after attending three sessions. On average, the remaining 16 participants attended 7 out of 8 group sessions and completed 5 out of 7 homework assignments. Qualitative analysis of feedback revealed that participants valued both the artistic component and the psychoeducation. The most highly rated sessions discussed identity, values, and connection. The main themes identified were that self-disclosure facilitates closeness, perfectionism impedes connection, shared accomplishments enhance satisfaction, and that art is a valuable grounding tool for emotional regulation. The primary challenges described by participants were related to perfectionism, social anxiety, and feelings of vulnerability.

Discussion: Collaborative art therapy may be an effective modality for patients struggling with distress tolerance or avoidant behaviors, as the tasks necessitate engagement in the present moment. The concurrent psychoeducation allows participants to openly discuss the challenges, goals, and expectations present in their social interactions. Time-limited groups may be successful adjunctive treatments for outpatients with eating disorders. More work is needed to determine if these groups can facilitate long-term changes in interpersonal relationships.

Trial registration: NCT06198023.

Background: The COVID-19 pandemic has significantly influenced adolescent mental health, particularly contributing to increased presentations of eating disorders (EDs). This study investigates how referral patterns, diagnostic profiles, and comorbidities changed among adolescents in Türkiye before and during the pandemic.

Methods: A retrospective chart review was conducted at Ankara City Hospital, including adolescents aged 10-18 years who were referred for ED-related concerns between September 2019 and August 2021. The data were grouped into pre-pandemic (6 months) and pandemic (18 months) periods. Demographics, diagnostic categories, psychiatric comorbidities, and referral trends were examined.

Results: Of the 176 total cases, 87.5% were referred during the pandemic. The average monthly referral rate rose by 133%, from 3.67 to 8.56 cases. Most patients were female (93.2%), and the average age was 15.1 years. The majority of diagnoses fell under OSFED (69.6%), followed by anorexia nervosa (24.4%) and bulimia nervosa (5.7%). While comorbid depression and anxiety were commonly observed before the pandemic, their rates were lower during the pandemic period, which may reflect pandemic-specific stressors and referral patterns.

Conclusions: During the pandemic period, the number of ED referrals was more than twice as high as before the pandemic, accompanied by differences in the complexity and comorbidity profiles of referred cases. These findings underscore the urgency of enhancing early detection, educator awareness, and service accessibility-including telehealth interventions-to meet the growing demand and support adolescent mental health, both during crises and in long-term service planning.

Background: Disordered eating behaviors (DEBs) and eating disorders (EDs) are increasingly recognized as significant public health concerns among university students worldwide. Although research from the Middle East and North Africa (MENA) region has expanded in recent years, comprehensive population-based studies using standardized assessment tools remain limited. This study aimed to examine the prevalence and predictors of disordered eating attitudes and behaviors among students enrolled at the Saudi Electronic University (SEU), encompassing 15 campuses across Saudi Arabia.

Methods: A cross-sectional, survey-based study was conducted between February and March 2025. The study utilized Arabic-adapted versions of the Eating Attitudes Test-26 (EAT-26) and Behavioral Questions (BQ), prepared through forward-backward translation and pilot testing for cultural and linguistic appropriateness. These instruments were used to assess attitudinal and behavioral aspects of eating risk. Multivariable logistic regression identified independent predictors of disordered eating risk.

Results: Among 771 participants (mean age: 25.1 ± 6.3 years; 69.7% female), 27.1% exceeded the EAT-26 clinical threshold (> 20), indicating risk for eating disorders, and 44.2% reported at least one disordered eating behavior. Prior ED diagnosis (OR = 3.33; 95% CI: 1.90-5.85), recent weight loss ≥ 10 kg (OR = 2.75; 95% CI: 1.83-4.13), higher BMI (OR = 1.05; 95% CI: 1.03-1.08), and younger age (OR = 0.94; 95% CI: 0.91-0.98) were significant predictors of elevated EAT-26 scores. For behavioral risk, recent weight loss (OR = 2.22; 95% CI: 1.51-3.27) and higher BMI (OR = 1.02; 95% CI: 1.00-1.05) remained significant.

Conclusions: Disordered eating behaviors are prevalent among university students in Saudi Arabia, with notable proportions meeting clinical risk thresholds. These findings underscore the need for early identification, targeted screening, and culturally sensitive interventions within university health services, while recognizing the predominance of female respondents as a study limitation. Addressing this overlooked public health concern aligns with Saudi Arabia's Vision 2030 goals to promote youth mental health and strengthen preventive care initiatives.

Introduction: Posttraumatic stress disorder (PTSD) and dissociation are associated with eating disorders (EDs) and serve as markers of higher severity and comorbidity. However, the role of complex PTSD (CPTSD) and the dissociative subtype of PTSD (DPTSD) in EDs remains relatively unexplored.

Methods: Participants were 635 patients (60% female) admitted to a higher level of care (residential, partial hospital or intensive outpatient) for treatment of a DSM-5 defined ED, substance use disorder (SUD), PTSD and/or mood disorder. In addition to a semi-structured interview, patients completed self-report assessments within 72 h of admission, including the Eating Disorder Examination Questionnaire; Life Events Checklist for DSM-5; PTSD Checklist for DSM-5; International Trauma Questionnaire; Dissociative Subtype of PTSD Scale; Alcohol Use Disorder Identification Test; Drug Abuse Screening Test-10; Patient Health Questionnaire-9; Spielberger State Trait Anxiety Scale short form, and the World Health Organization Quality of Life Abbreviated Scale. Patients with (n = 231) and without EDs (n = 404) were compared using multivariant analyses of variance and age, admission BMI, gender, race, sexual orientation and level of care as covariates.

Results: In this highly comorbid group, patients with EDs had significantly higher rates of self-reported types of traumatic events (8 v. 7), provisional PTSD (68% v. 48%), DPTSD (50% v. 27%), and CPTSD (33% v. 19%) compared to those without EDs (p ≤ .01). Patients with DPTSD and/or CPTSD had significantly higher symptom scores for EDs, major depression, substance use, state and trait anxiety, and worse quality of life. In addition, there was significant overlap between the diagnoses of CPTSD and DPTSD with 25% of those with EDs meeting criteria for both disorders.

Conclusions: DPTSD and CPTSD are common in patients with EDs and indicate more complex psychiatric comorbidity associated with high doses of trauma. These results emphasize the importance of thorough assessment procedures and the need for integrated treatment approaches that directly address the full spectrum of trauma-related symptoms.

Background: This lived experience-led scoping review explores the evidence base related to eating disorders/disordered eating behaviours in Autistic trans and gender diverse (TGD) people. This review highlights the currently available data on eating disorder prevalence rates, comparisons with allistic and cisgender groups, drivers and maintenance factors, the relationship between eating disorders and gender-affirming medical care, and treatment outcomes in this population.

Methods: We conducted a search of the databases ProQuest, Medline, CINAHL, Cochrane Library, Web of Science, Scopus, and PsycINFO for articles relating to eating disorders/disordered eating behaviours in Autistic TGD people. Five articles published between 2021 and 2025 met the criteria for the review.

Results: The included articles were predominantly cross-sectional studies (n = 4) and one case series (n = 1). Researchers used a mixture of self-reported and clinically recorded eating disorder diagnoses, as well as validated measures, including the Eating Disorder Examination Questionnaire and the Nine-Item Avoidant/Restrictive Food Intake Disorder Scale. The literature highlights that the prevalence of eating disorders/disordered eating behaviours is high in the Autistic TGD population, and suggests that atypical presentations may be particularly common. Possible drivers and maintenance factors include sensory hypersensitivity, co-occurring Attention-Deficit Hyperactivity Disorder, gender dysphoria and passing concerns, and appearance pressures idealising thinness. Limited data were available on the role of gender-affirming medical care or eating disorder treatments, or on treatment outcomes.

Discussion: Further research is needed to better understand the nuances of eating disorders/disordered eating behaviours in Autistic TGD people. Key to future research inquiries should be the adoption of an intersectional approach, co-production of research with Autistic TGD people, and research considering treatment outcomes.