Journal of Eating Disorders最新文献

Background: Eating disorders (ED) and disordered eating behaviours (DEB) in older adults have important implications for physical morbidity and mortality. Thus far, there has been no attempt to systematically evaluate the research landscape of ED and DEB in older adults.

Methods: A scoping review adhering to PRISMA-ScR reporting standards was conducted. We searched MEDLINE, Google Scholar, and PsycINFO (2000-2025) for English-language, peer-reviewed articles on ED/DEB in older adults covering diagnosis, epidemiology, determinants, clinical features, progression, or treatment, in any setting.

Results: A total of 53 publications were included in the final review, comprising four systematic reviews, five longitudinal studies, and 44 cross-sectional studies. All original studies were observational in design. Research was predominantly community-based and relied on single-step screening, limiting diagnostic validity. Healthcare facility-based studies have examined ED in patients with comorbidities such as obesity, diabetes, and those undergoing bariatric surgery. Most study participants were Caucasian, with limited representation from minority groups. ED in older adults were mostly in women, with presentations characterised by dietary restriction, binge-purge behaviours, and body image preoccupation. The data on prevalence of subtypes of ED was variably reported. Most late-onset cases were precipitated by psychosocial stressors such as bereavement, caregiving responsibilities, or social isolation. Biological factors, particularly menopausal age in women, were found to be associated with an increased prevalence of DEBs, such as binge eating and restrictive eating patterns. Comorbid depression, anxiety, and medical conditions were frequent. Combined behavioural and pharmacological interventions offered better outcomes. Poorer outcomes were linked to chronicity, low body mass index, presence of comorbidities, and poor treatment engagement. Protective factors, including cognitive adaptation and positive attitudes toward ageing, may confer resilience.

Conclusion: ED and DEB in older adults are a significant but underrecognized public health issue. Existing research is constrained by limited diversity, Western-centric samples, and reliance on self-reported measures, underscoring the urgent need for inclusive, longitudinal, and interventional studies that better capture biopsychosocial determinants of EDs and DEBs, while also promoting the provision of age-sensitive care.

Background: The ubiquity of social media has increased exposure to idealised beauty standards, often unrealistic and harmful. Repeated exposure has been linked to body dissatisfaction, harmful behaviours, and potentially the development of eating disorders (ED). Given the volume of content produced daily, effective harm mitigation strategies (automated or user-driven) are essential, requiring an informed understanding of the contexts and nuances surrounding harmful content.

Objective: The study has two key aims: (1) to understand the perspectives of experts by profession and people with lived experience of ED, on what makes social media content harmful in the context of body image and ED, including why and how this harm occurs; and (2) to explore how technology might help mitigate these effects.

Methods: We engaged n = 30 participants, including 12 interviews with experts by profession (n = 2 ED support service providers and n = 10 body image and ED experts), and five focus groups with experts by lived experience (n = 18 people with lived experience of ED).

Results: Using the Framework Method guided by inductive thematic analysis, we developed six prominent themes: (1) Spectrum of harmful and ambiguous content on social media, (2) The "echo chamber" of harmful content amplified by social media algorithms, (3) Balancing safety, freedom and responsibility in social media moderation, (4) Shared responsibility and collaboration for safer social media environments, (5) The role of representation and diversity in social media recovery and support, and (6) Harnessing digital innovation to reduce harm on social media. We developed an eight-category framework of harmful social media content, offering an underlying contextual understanding of harmful content and guidance for harm-reducing technologies.

Conclusions: Manual safeguards place significant responsibility on users. This work supports informed distinctions between harmful, ambiguous and safe content and provides design insights for classification systems and adaptable automated moderation.

Background: Many researchers have expressed concerns that weight stigma may cause adverse health effects and worsen weight issues in a vicious cycle. However, empirical evidence evaluating this cycle is scarce, especially among Eastern Asians. The present study investigated the temporal associations among perceived weight stigma, weight-related self-stigma, psychological distress, perceived behavioral control, physical activity, eating behaviors, and body mass index (BMI) changes.

Methods: A one-year longitudinal survey was carried out to explore if the weight cycle exists among young adults in Hong Kong. The study comprised 345 participants at Time 1 (T₁), 253 participants at T₂, 233 participants at T₃, and 235 participants at T₄. Participants completed self-reported psychometric instruments in an online survey. The analysis employed parallel process latent growth curve modeling and a random intercept cross-lagged panel model.

Results: Temporal relationships existed in the connections between perceived stigma and self-stigma, and self-stigma and perceived behavioral control. A negative relationship between self-stigma and future BMI was found, whereas future self-stigma showed no significant association with previous BMI.

Conclusion: The growth trajectories of the studied variables did not correlate with changes in BMI. However, self-stigma showed a negative association with subsequent BMI in a different model. Further research is needed to clarify whether weight stigma is impacted by changes in BMI.

Written by a researcher with lived experience of long-standing bulimia nervosa, this Matters Arising piece commends Robinson et al. (2024)'s study for its focus on exploring the subjective experiences of patients who are often overlooked in clinical and academic discussions. However, several concerns can be raised about the epistemological, methodological, and ethical foundations of this research. These include the limited engagement of participants with the terminology used to describe their experiences, and the use of language which remains contested. The author highlights how this approach risks imposing external narratives on participants, arguing instead for more equitable co-production methodologies which include participants as epistemic agents in their own right. Recommendations for future research include the equitable inclusion of people with lived experience, recognising the limits of current evidence, respecting and promoting diversity, and prioritising reflexivity and rigour in qualitative research. These recommendations aim to ensure that future studies reflect the complexity and heterogeneity of lived experiences while maintaining scientific and ethical integrity.

Background: Anorexia Nervosa (AN) was first classified 150 years ago, although descriptions of pathology consistent with the illness can be traced as far back as the Hellenistic era and the Middle Ages. Despite decades of clinical theorising and a wide range of treatment approaches, recovery rates remain very low. In light of the limited efficacy of current therapeutic paradigms, there have been growing calls to critically reassess the taxonomy and conceptualisation of AN. This narrative review paper traces the evolution of theoretical frameworks surrounding AN, from early historical accounts in the 4th Century BCE to contemporary models. By examining these shifting perspectives, the paper aims to provide a foundation for renewed inquiry into the phenomenology of the illness and to support the development of more effective, nuanced approaches to treatment and understanding.

Method: PubMed and Scopus databases were searched for relevant articles. Additional articles were identified through references in published studies. Abstracts were screened for relevance and studies were included if their design and findings addressed theory of illness or phenomenology in AN.

Discussion: AN has been viewed over time through psychodynamic, family systems, feminist and evolutionary lenses, among others. The conceptualisation of the illness is historically fragmented, shaped by shifting cultural, medical, and psychological paradigms rather than a linear theoretical progression. Modern understanding recognises AN as biopsychosocial yet lacks a unified, coherent model and mostly treats under a psychological paradigm. Dominant therapies like FBT and CBT-E show modest outcomes and high dropout rates, reflecting deeper issues in theoretical alignment and treatment efficacy. Calls for an integrated, individualised framework stress the need for empirical, multidisciplinary theory to support flexible, evidence-based treatment innovation.

This study is the first to comprehensively examine psychometric characteristics of the three main DSM-5 eating disorder (ED) diagnoses (Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED)) amongst adult ED patients. Data was collected via an online survey from 126 licensed therapists treating an adult with an ED. Therapists provided an ED DSM-5 diagnosis for a randomly selected patient, as well as endorsed the presence of symptoms from a list of DSM criteria. Criteria endorsement varied across both the entire sample and within diagnoses. Convergence and cohesion also varied within diagnoses. The first factor analysis for DSM-5 ED criteria yielded a five-factor solution for ED criteria accounted for 78.3% of variance: (1) Binge eating, (2) Compensatory and purging behaviors, (3) Shape/weight overvaluation, (4) Drive for thinness, and (5) Absence of binging and purging. Finally, diagnostic efficiency statistics were consistent with this factor model. Overall, our findings support a new, transdiagnostic model with fear of weight gain and weight being main aspects of self-evaluation as common underlying factors amongst all EDs.

Background: Individuals with eating disorders (EDs) often exhibit impairments in executive functioning, including nonverbal reasoning. However, little is known about how nonverbal reasoning interacts with illness duration, influences ED symptom changes over time, or differentially affects phenotypically distinct EDs. This study examined associations among nonverbal reasoning, illness duration, and changes in ED symptoms in individuals with anorexia nervosa (AN) and bulimia nervosa (BN).

Methods: Adults with AN or BN (N = 83; mean age = 25.9) completed baseline assessments of ED symptoms, illness duration, nonverbal reasoning, height, weight, and anxiety and depressive symptoms. ED symptoms and weight were reassessed at 3 and 6 months after baseline. Linear regression analysis and multilevel modeling were used to evaluate associations between nonverbal reasoning, illness duration, and ED symptom trajectories.

Results: In the AN group, longer illness duration was significantly associated with poorer baseline nonverbal reasoning, even after adjusting for BMI. There was no significant association between illness duration and nonverbal reasoning in the BN group. Among individuals with BN, better baseline nonverbal reasoning predicted a greater reduction in ED symptoms over 6 months, while poorer baseline nonverbal reasoning was associated with no significant change in symptoms. In AN, nonverbal reasoning did not predict ED symptom change from baseline to follow-up.

Conclusions: In AN, longer illness duration was linked to poorer nonverbal reasoning, whereas in BN, better nonverbal reasoning predicted improvement in symptoms over time. These findings support the relevance of nonverbal reasoning to AN and BN. Future longitudinal studies are needed to confirm the findings and gain additional insights into associations among nonverbal reasoning, illness duration, and ED symptoms.

Objective: This study aimed to investigate the relationships between smartphone screen time, eating disorder tendencies, and self-esteem in obese and normal-weight individuals, and to evaluate potential correlation patterns among these variables.

Methods: A cross-sectional, comparative study was conducted with 130 participants (64 obese, 66 normal-weight) at Dokuz Eylül University Obesity and Healthy Life Outpatient Clinic. Anthropometric measurements were obtained, daily smartphone screen time was recorded from device settings, and participants completed the Eating Disorder Examination Questionnaire (EDE-Q-13) and Rosenberg Self-Esteem Scale (RSES). Data were analyzed using descriptive statistics, t-tests, chi-square tests, and correlation analyses.

Results: Obese individuals demonstrated significantly higher daily smartphone screen time (6.4 ± 1.8 vs. 5.5 ± 1.5 h; p = 0.019) and greater eating disorder symptoms, including higher total EDE-Q-13 scores (24.3 ± 6.9 vs. 18.7 ± 5.8; p < 0.001), body dissatisfaction, and weight/shape concerns. No significant differences in self-esteem were observed between groups (p = 0.478). Correlation analyses revealed positive associations between body mass index (BMI) and body dissatisfaction (r = 0.537, p < 0.001) and between smartphone screen time and body dissatisfaction (r = 0.203, p = 0.021). Self-esteem was negatively correlated with body dissatisfaction (r = - 0.244, p = 0.006) and binge eating (r = - 0.229, p = 0.010), but not with smartphone screen time (p > 0.05).

Conclusion: Obese individuals exhibited higher smartphone screen time and more pronounced eating disorder-related tendencies, particularly body dissatisfaction and weight concerns, compared to normal-weight individuals. However, self-esteem levels did not differ significantly between groups, suggesting that cultural and psychosocial factors may buffer self-esteem despite obesity. These findings highlight the importance of addressing digital media use and eating behaviors in obesity management and prevention strategies.

Introduction: Eating disorders (EDs) are serious mental disorders that often remain untreated for many years. Digital mental health interventions could provide low-threshold support especially in underserved areas. However, the knowledge of mental health professionals (MHPs), who could integrate such interventions into routine care, is still limited.

Objective: This study aimed at the development and evaluation of a web-based toolkit to provide evidence-based knowledge about digital interventions for EDs for MHPs.

Methods: A mixed methods design was chosen to iteratively evaluate the toolkit. First, three focus groups with 16 MHPs were conducted, who tested the toolkit and gave feedback. Then, N = 66 MHPs completed an online survey with self-developed questionnaires on the perceived quality of the toolkit and its modules. Further, several scales were used to measure website clarity (Web-CLIC), visual aesthetics (VisAWI-S), system usability (SUS), e-therapy attitudes (ETAM) and elements of the Unified Theory of Acceptance and Use of Technology (UTAUT).

Results: The focus groups resulted in a number of suggestions that were used to improve the toolkit. The results of the quantitative study showed that the toolkit reached high ratings in website clarity, visual aesthetics and system usability. E-therapy attitudes were positive in 51 (77.3%) cases. While perceived usefulness was M = 2.75 (SD = 0.62, range = 1-3.86), relative advantage remained lower with M = 1.08 (SD = 0.54, range = 0-2.5). Results following the concept of UTAUT, showed a medium Behavioural Intention to use digital interventions for their patients with M = 3.60 (SD = 1.01) and a medium Performance Expectancy of M = 3.50 (SD = 0.93) with lower values for anorexia nervosa than for other kinds of EDs.

Conclusions: In general, MHPs show positive attitudes towards the use of digital interventions for patients with EDs to complement conventional psychotherapy. However, there is also a clear need for more knowledge in the field. The web-based toolkit may serve as a promising educational resource to meet the needs of MHPs. The effectiveness of the toolkit regarding learning success can be tested in future studies.

Background: Eating disorders affect millions worldwide and are associated with serious medical complications, functional impairment, and increased risk of mortality. Yet current treatments are only effective for 40-55% of people, underscoring a dire need for improved and novel interventions. Limited treatment response may be due to (a) the high heterogeneity of eating disorder symptoms and (b) high rates of co-occurrence with other transdiagnostic symptoms, which are not currently addressed in standard treatments.

Main body: To address this gap, recent work has adopted a symptom-focused perspective to clarify how transdiagnostic symptoms interact and maintain pathology. This approach aims to guide more personalized treatment by identifying symptoms most relevant for each individual. However, this requires a clearer understanding of how eating disorder symptoms and co-occurring symptoms relate to one another. The present review synthesizes 30 common eating disorder and co-occurring symptoms and outlines the associated evidence-based treatments. These symptom-treatment connections are derived from prior empirical symptom network analysis and organized to help clinicians and researchers better understand the functional role of each symptom and the interventions used to address them.

Conclusion: By linking symptoms with their corresponding treatment approaches, this review offers a comprehensive and practical reference to support refinement of existing treatment and development of personalized, symptom-level interventions. This framework may assist clinicians and researchers in selecting targeted strategies for individuals.