Journal of Eating Disorders最新文献

Objective: Most men with binge-spectrum eating disorders (BSEDs) never receive psychological treatment for their conditions, and research on BSEDs typically includes disproportionately low numbers of men. Qualitative information is needed to shape the development of messaging strategies to engage this population in both treatment and research.

Method: Fifteen men (53% White, 80% heterosexual, age range 26-69) who had never gone to therapy for their BSEDs provided semi-structured qualitative feedback about strategies to engage men like them in psychological treatment for and research about BSEDs.

Findings: Reflexive thematic analysis identified four key themes: (1) Serious messages convey the seriousness of BSEDs (2). The ideal message would be simple and relatable and persuade men that seeking therapy makes them more manly, not less (3). Men's intersectional identities shape their reasons for not pursuing therapy (4). Men expressed spontaneous excitement about a messaging campaign to raise awareness of disordered eating in men.

Discussion: These findings demonstrate that no single messaging strategy will appeal to all men. Nonetheless, all men expressed enthusiasm for targeted campaigns that promote the entry of more men into psychological treatment for their BSEDs. Researchers and clinicians could use these findings to increase men's uptake of BSED treatment.

Background: As recovery stories about eating disorders proliferate on social media, many individuals with lived experience are emerging as informal health influencers. While these online spaces can offer community and information, they also shape how individuals understand and perform their identities in recovery. This study examines how young women with clinically diagnosed eating disorders, at different stages of recovery, actively and intentionally document and share their recovery journeys on social media, and how they use these platforms not only to seek support, but also to construct, maintain, and sometimes step away from patient influencer identities.

Methods: We conducted in-depth, semi-structured interviews with 19 women (mean age = 21.47) in the United States who actively documented their eating disorder recovery journeys on platforms like Instagram, TikTok, and YouTube. Using interpretative phenomenological analysis (IPA), we explored how participants made sense of social media's role across different stages of their recovery.

Results: Findings reveal a U-shaped pattern of social media engagement. Participants initially used social media in ways that reinforced disordered behaviors, immersing themselves in content that emphasized dieting, body comparison, and perfectionism. During early recovery, many chose to withdraw from these platforms to protect their mental health and reduce triggers. Later, they re-engaged with social media more intentionally, seeking out pro-recovery communities, reliable health information, and opportunities to tell their stories. Through public storytelling, participants reconstructed their identities, found accountability, and connected deeply with peers. However, some eventually distanced themselves from eating disorder-centered content to grow beyond the patient influencer identity, reflecting the fluid, evolving nature of recovery and online self-presentation.

Conclusions: By centering the voices of patient influencers, this study highlights how social media functions both as a risk and a resource in eating disorder recovery, simultaneously shaping psychological well-being, social support, and identity work. These insights underscore the need to view patients as active agents navigating digital spaces and call for treatment approaches that address the online environments where recovery, support, and stigma are continually negotiated.

Background: Avoidant Restrictive Food Intake Disorder (ARFID) is a recently recognized feeding and eating disorder characterized by restricted or avoidance of food intake due to the sensory characteristics of the food or fear of the unpleasant consequences of eating without concerns about body image. It commonly presents in childhood and can lead to serious nutritional and developmental outcomes. While reports from high-income countries are increasing, data from low-resource settings remain scarce. In such settings, malnutrition is often attributed to food insecurity or infection, making ARFID an under-recognized cause of severe nutritional deficiency.

Case presentation: A seven-year-old male patient presented with generalized edema, night blindness, and growth failure. He had a highly restricted diet, mainly consisting of injera and bread, with complete avoidance of fruits, vegetables, and animal products due to fear. Physical examination and investigations diagnosed both macronutrient (edematous malnutrition) and micronutrient deficiencies (hypoalbuminemia, mixed anemia including iron and megaloblastic anemia, and vitamin A deficiency). Based on the feeding history and clinical features, he was diagnosed with ARFID. Although Hymenolepis nana infection was present and likely contributed to acute clinical deterioration, the child's restrictive eating behavior had been present for several years prior to the infection and represented the primary underlying cause of nutritional deficiency. Nutritional rehabilitation through nasogastric tube feeding and behavioral cognitive therapy led to significant clinical and dietary improvements.

Clinical discussion: Food selectivity may be a common problem in children, especially in pre-school age groups, but it doesn't lead to nutritional deficiency. ARFID is one of the avoidant food disorders commonly found in the childhood age group, which may lead to different nutritional deficiencies in both developed and developing countries. To prevent the acute and long-term complications of ARFID, it's important to have a high index of diagnostic suspicion in varied clinical settings.

Conclusion: This case highlights that ARFID can occur even in low-resource settings, where nutritional deficiencies are often presumed to result solely from poverty or infection. Taking a detailed dietary history and exploring reasons for food avoidance are crucial for differentiating ARFID from other causes of malnutrition. Early recognition and multidisciplinary care can prevent severe complications and improve outcomes.

Background: Morbid obesity is frequently associated with high-risk behaviors such as eating disorders (EDs).

Objective: This study aimed to investigate the prevalence, changes, and predictive factors of EDs before and one year after metabolic and bariatric surgeries (MBS) in Iranian adults.

Methods: This prospective observational study included 96 MBS candidates with class II (BMI 35-40 kg/m² with comorbidities) or class III obesity (BMI ≥ 40 kg/m²). Patients underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB). Demographic data, nutritional status [assessed by a food frequency questionnaire (FFQ)], BMI, and EDs symptoms were collected before and one year after surgery via the EDs Questionnaire (EDE-Q 6.0), and psychological status was assessed via the Symptom Checklist-90-Revised (SCL-90-R).

Results: A total of 22.9% of the participants were identified as having EDs. These individuals had a significantly higher BMI compared to those non-eating disorders (non-Eds) (49.9 ± 9.1 vs. 45.4 ± 5.8; p = 0.039). All MBS types (SG RYGB and OAGB) led to significant reductions in EDs global and subscale scores (p < 0.05), with SG surgery group showed notable numerical improvements in weight and shape concerns. Female sex (β = 0.87; p = 0.002) and younger age (β = - 0.03 per year; p = 0.014) were significant predictors of higher EDs scores after surgery.

Conclusion: MBS reduce symptoms of EDs, with a trend towards SG showing the most prominent effect. Younger age and female sex were independently associated with greater severity of symptoms after surgery. These findings highlight the importance of targeted postoperative psychological support and underscore the interplay between biological and psychological factors.

Background: Eating disorders (EDs) are serious psychiatric conditions with increasing prevalence among university students, often linked to high stress levels and unhealthy coping mechanisms. Medical students are particularly susceptible due to their demanding academic environment. This study aimed to assess the prevalence of EDs risk among medical and non-medical undergraduate students and examine its association with perceived stress and related factors.

Methods: A comparative cross-sectional study was conducted on 319 undergraduate students aged 17-24 years from Ain Shams University, including 173 medical and 146 non-medical students. Participants completed validated Arabic versions of the Eating Attitudes Test (EAT-26), Eating Disorder Examination Questionnaire (EDE-Q), and Perceived Stress Scale (PSS). Students were classified into high- and low-risk groups for EDs based on EAT-26 scores.

Results: EDs risk was significantly higher in medical students (35.8%) compared to non-medical students (24.7%, P = 0.031). Medical students also showed higher perceived stress scores (19.87 ± 7.46 vs. 17.03 ± 7.32, P < 0.001) and more frequent severe stress (24.3% vs. 11%, P = 0.006). EDE-Q scores for restraint, shape concern, weight concern, and global score were significantly higher in medical students. High-risk students had elevated BMI (25.32 ± 4.06 vs. 23.70 ± 3.36, P = 0.001) and higher smoking prevalence (39.8% vs. 9.5%, P < 0.001). Severe stress (OR = 2.091) and smoking (OR = 9.208) were independent predictors of EDs risk.

Conclusions: Medical students are at elevated risk of EDs, largely driven by high perceived stress and unhealthy lifestyle behaviors.

Background: Young adults are increasingly affected by the experiences of disordered eating, body dissatisfaction, and problematic use of appearance-focused social media. However, little evidence exists, particularly for men, regarding the direction of these relationships or if they reciprocally predict change over time The present study aimed to address this gap and examine if appearance-focused social media use predicts exacerbation (increases) or maintenance (stability) of body dissatisfaction and disordered eating over 6-weeks, and whether the reverse occurs.

Methods: A sample of 488 men (N = 247) and women (N = 241) aged 18-30 (M = 26.50, SD = 2.96) were recruited through Prolific and completed an online survey at baseline and 6-weeks (T2).

Results: In univariate and multivariate logistic regression analyses, reciprocal predictors of exacerbation were observed; higher social media use predicted exacerbation (versus asymptomatic-stability) of body dissatisfaction and exacerbation of disordered eating, and higher disordered eating predicted exacerbation of use of social media. Body dissatisfaction was a significant predictor of social media use exacerbation in univariate analyses only. Reciprocal relationships were not observed for prediction of maintenance (versus cessation). Only gender predicted social media use maintenance in univariate analysis (women had higher odds of maintenance than men) and higher body dissatisfaction predicted maintenance of disordered eating in univariate and multivariate analyses.

Conclusion: Findings of small bidirectional prospective associations between appearance-focused social media use, body dissatisfaction, and disordered eating enhance understanding of the direction of relationships. This underscores the importance of addressing bidirectionality in prevention efforts and theories. Outcomes also suggest different factors may maintain, rather than predict these issues, warranting further investigation.

Background and aims: Superior mesenteric artery syndrome (SMAS) is a rare condition favored by weight loss, with nonspecific digestive complaints that may hinder weight recovery in anorexia nervosa. This study aimed to examine the radiological features of aorto-mesenteric (A-M) space reduction in anorexia nervosa and their association with digestive complaints.

Methods: Female patients with anorexia nervosa and a history of computerized tomography angiography for digestive complaints were included. Clinical data were retrospectively collected and computerized tomography scans were reviewed by an independent, experienced radiologist to identify signs of SMAS and of Nutcracker syndrome. Adipose tissue surfaces were also calculated from the scans. Some patients were reassessed after nutritional recovery.

Results: On the 51 female patients included (mean age 27.7 ± 12.3 years) from a cohort of 202 female anorexia nervosa patients, 48 met radiological criteria for SMAS (A-M angle < 25° or distance ≤ 8 mm). A duodenal dilation was present in 35 patients (68.6%) and a left renal vein dilation in 39.2%. The type of digestive complaints did not differ significantly between patients with and without duodenal dilation, although gastroesophageal reflux approached statistical significance (p = 0.06). Body mass index and visceral adipose tissue did not correlate significantly with A-M measurements. Following nutritional recovery in ten patients, there was a significant increase in A-M measurements and a decrease in both duodenal dilation and digestive symptoms.

Conclusion: Radiological features of A-M space reduction are common in anorexia nervosa. Left renal vein compression and its upstream dilation, as well as left dilated ovarian vein and pelvic varicose veins, are frequently associated with radiological signs of SMAS. Nutritional support alleviates digestive complaints related to SMAS.

Background: Men are underserved in research on eating, exercise and body image psychopathology (EEBIP), and remain underrepresented within healthcare settings despite growing clinical need. One barrier to men's help-seeking for EEBIP-related concerns is that public-facing healthcare information/resources often appear unwelcoming to them, suggesting the need for more inclusive, gender-sensitive resources that engage men and address their specific needs. This study aimed to explore men's perspectives on the design of inclusive EEBIP resources, to inform the iterative co-design of guidance for future resource development.

Methods: This study employed a lived experience-led approach, integrating a modified nominal group technique with participatory research methods, as part of an iterative co-design of a guidance document. Six men with lived experience of EEBIP ranked their preferred features of male-inclusive resources from a broader list of content and format ideas generated through a survey of 42 men. Interview and focus group discussions followed, exploring the underlying reasons why the men with EEBIP experience believed these content and format ideas would support men's help-seeking for EEBIP. Finally, a draft guidance document, underpinned by the results of the discussions, was designed and iteratively edited, following feedback from healthcare organisation representatives, academics, and men with lived experience.

Results: Thematic analysis of the discussions identified five themes to inform the development of future resources. The five themes are titled: (1) Designing accessible resources that navigate men's readiness; (2) Authentic voices: inclusive, conversation-led outreach; (3) Self-realisation: refraining from labelling men as 'unhealthy' or 'disordered'; (4) Purpose and progress driven resources; (5) Images: the line between helpful and harmful isn't always clear. These themes are discussed alongside EEBIP and men's mental health help-seeking literature.

Conclusions: This is the first study to centre men's experiential knowledge to explore how healthcare organisations can facilitate men's help-seeking for EEBIP-related concerns via public-facing resources. The themes generated in this study reflect findings of studies exploring the facilitation of men's general mental health help-seeking, whilst contributing novel EEBIP-specific findings. The results of this study can support EEBIP healthcare organisations to develop public-facing resources that are more inclusive of men.

Background: Family functioning encompasses cultural values and behavioral patterns, with family dysfunction referring to pervasive and maladaptive interactions in the latter dimension. In Chinese culture, filial piety is a core familial value, comprising authoritarian filial piety (AFP), rooted in hierarchy and obedience, and reciprocal filial piety (RFP), based on mutual affection and care. This study examines the relationships between AFP, RFP, family dysfunction, and eating pathology among Chinese adults with anorexia nervosa (AN).

Methods: We employed a two-part design that included a cross-sectional analysis of 144 female adults with AN in Chinese mainland and, within the same cohort, a longitudinal follow-up of 75 patients to examine how filial piety and family dysfunction predict changes in eating pathology over time. Correlation, hierarchical multiple regression, and generalized least squares were used for data analysis.

Results: Cross-sectionally, AFP was associated with greater eating pathology (β = 0.161, p < .05). While RFP and family dysfunction were not significantly associated with eating pathology after controlling psychological and biological factors. Longitudinally, AFP did not independently predict symptom progression after controlling for baseline pathology, suggesting that AFP may act not as a primary driver of worsening symptoms.

Conclusion: AFP represents a stable cultural risk factor for eating pathology in Chinese adults with AN. These findings underscore the importance of integrating cultural values like AFP into therapeutic frameworks and developing culturally adapted interventions for Chinese populations.

Background: Anorexia nervosa (AN) and bulimia nervosa (BN) are two primary subtypes of eating disorders (ED), often presenting with overlapping clinical features that complicate diagnosis. Despite shared symptoms, the underlying neural mechanisms of two subtypes remain incompletely understood. Delineating both shared and unique neural alterations may support biomarker discovery and inform targeted interventions.

Methods: We recruited 28 patients with AN, 26 with BN, and 31 matched healthy controls (HC), aged from 14 to 40 years old. Resting-state functional magnetic resonance image (Rs-fMRI) data were acquired to investigate alterations in spontaneous brain activity. Four voxel-wise metrics were analyzed: amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and degree centrality (DC). Symptom severity was assessed using the Eating Disorder Examination-Questionnaire (EDEQ), which includes four subscales: Eating concern (EDEQ_E), Shape concern (EDEQ_S), Weight concern (EDEQ_W), and Restraint (EDEQ_R). Pearson correlation analysis was used to examine associations between altered imaging metrics and clinical variables.

Results: Both AN and BN exhibited convergent alterations, including reduced activity in the bilateral middle frontal gyrus (MFG), insular cortex (INS), superior temporal gyrus (STG), and left parahippocampal gyrus (PHG), alongside increased activity in the bilateral striatum, middle occipital gyrus (MOG), and cerebellum. Disorder-specific alterations in AN included increased activity in the right striatum and right precuneus, increased DC in the right superior frontal gyrus (SFG), and decreased fALFF and DC in the left calcarine. In contrast, patients with BN exhibited elevated fALFF in the right precentral gyrus (PCG_R) and increased DC in the right calcarine. Correlation analyses revealed negative association between the ReHo value of the MOG_L and EDEQ, and positive associations between the DC value of the PCG_R and EDEQ and EDEQ_E in patients with BN.

Conclusion: Our findings revealed both shared and diagnosis-specific alterations in intrinsic brain activity within the cortico- striatal-limbic circuit, underscoring its role in the pathophysiology of ED.