Journal of Eating Disorders最新文献

Background: Grazing is a disordered eating behavior associated with poor weight control, increased eating disorder psychopathology, and psychological difficulties in adults. Unfortunately, little is known about grazing in adolescence, which is aggravated by the lack of validated measures for this population. This study investigates the psychological aspects of grazing in adolescence and provides psychometric support for a brief self-report measure, the Rep(eat)-Q.

Methods: A community sample of middle/high school students (n = 358, 55.6% females) and a clinical sample with overweight/obesity (n = 204, 59.8% females), completed a set of self-report questionnaires assessing eating and psychological variables including the Rep(eat)-Q. Weight and height data were also collected (Community: M_z-BMI = 0.39, SD = 0.98; Clinical: M_z-BMI = 2.39, SD = 0.74).

Results: Confirmatory factor analysis revealed an adequate fit [(χ2(107) = 389.77; p < 0.001; CFI = 0.99; TLI = 0.99; NFI = 0.99; SRMR = 0.062; RMSEA = 0.098] for a second-order (grazing) model with two first-order factors (repetitive eating and compulsive grazing subscales) with good reliability (0.85 < α < 0.91). Metric and scalar invariance were confirmed, allowing comparisons between samples. Compared with clinical adolescents, community adolescents reported higher scores on the Rep(eat)-Q total (Community: M = 1.86, SD = 1.30; Clinical: M = 1.53, SD = 1.35; t(559) = - 2.81; p = 0.005) and repetitive eating subscale (Community: M = 2.04, SD = 1.44; Clinical: M = 1.52, SD = 1.35; t(560) = - 4.24; p ≤ 0.001). The Rep(eat)-Q total score and subscales scores were significantly positively correlated with eating disorder psychopathology and inversely correlated with intuitive eating, suggesting good convergent validity (0.11 < r < 0.63). Similarly, adolescents scoring higher on grazing also present more psychological distress and poor cognitive and emotional functioning (0.15 < r < 0.50). Psychological variables (i.e., depression, anxiety, and negative urgency) explained 21.8% of the variance in the grazing score, independent of sex, age, and BMI z-score [F(6, 490) = 22.87, p ≤ 0.001; R² = 0.218].

Conclusions: The Rep(eat)-Q is a reliable self-reported measure for assessing grazing in adolescents. These findings provide further support for the conceptualization of grazing in the spectrum of disordered eating and psychopathology in adolescents.

Background: Atypical anorexia nervosa is an eating disorder that involves significant restriction of food intake leading to clinically significant weight loss despite remaining at a normal or above normal weight for age or height. Part of rehabilitation involves increasing calorie intake for nutritional rehabilitation and weight gain to an appropriate percentage of ideal body weight, determined based on patient weight history. This report highlights the importance of considering how increased food intake in a previously malnourished patient can affect the metabolism of medications they are taking for the management of co-occurring psychiatric conditions, including the possibility of the emergence or re-emergence of tardive dyskinesia for a patient on an antipsychotic.

Case presentation: This case presents a 43-year-old female with a history of bipolar disorder type 1, controlled on lurasidone, admitted to an inpatient eating disorder unit for nutritional rehabilitation and weight restoration for atypical anorexia nervosa. Shortly after admission, despite no initial change in medication dosing, the patient began exhibiting symptoms of tardive dyskinesia. These symptoms were reduced once her lurasidone dose was decreased.

Conclusions: Nutritional rehabilitation likely has an impact on the metabolism of certain antipsychotic medications including lurasidone. More research is needed involving patients recovering from a restrictive eating disorder who are on antipsychotic medications and the frequency of increased side effects, including tardive dyskinesia, with refeeding.

Background: As climate change intensifies, ecological concerns and climate worry are becoming more prevalent, paradoxically driving both pro-environmental behaviors and mental health risks. Their impact on eating behaviors remains unclear. This study uses network analysis to examine the complex relationships between eating-related eco-concerns, climate change worry, sustainable dietary behaviors, and disordered eating in the general population.

Methods: The participants filled in the Eating-related eco-concern (EREC), the Eating Disorder Examination Questionnaire (EDE-Q), the Eating Habits Questionnaire (EHQ), Depression Anxiety and Stress Scale (DASS-21), the Climate Change Worry Scale (CCWS), and the Sustainable and Healthy Dietary Behaviors Questionnaire (SHDB). Network analysis was performed using R.

Results: The sample included 846 participants, 13.8% men, 84.3% females, 1.2% non-binary, and 0.7% undisclosed, with a mean age of 35.91 years. Network analysis revealed that EREC and SHDB represented the nodes with the greatest strength centrality. Positive associations emerged between EREC and CCWS, SHDB, and EHQ, as well as between SHDB and EHQ and between CCWS and DASS-21-Stress. Negative associations emerged between EREC and EDEQ, SHDB and DASS-21-Stress, and SHDB and CCWS.

Conclusions: Findings suggest that general heightened concerns about climate change and psychological distress may impede sustainable dietary behaviors, while specific ecological concerns over food choice may motivate such behaviors, albeit favoring disordered eating in terms of orthorexia nervosa symptoms. Longitudinal studies are needed to explore their evolution over time. Eating disorder specialists should consider climate-related distress, especially in environmentally conscious patients.

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.