Journal of Eating Disorders最新文献

Background: Anorexia nervosa (AN) often requires nutritional rehabilitation including nasogastric feeding. However, achieving shared treatment goals between clinicians, patients, and families can be challenging. Weight prediction can be a valuable tool in this process; however, conventional approaches rely largely on clinical experience and lack precision. We therefore developed a simplified calorie-based weight prediction model grounded in the revised Harris-Benedict equation.

Case presentation: This case report describes the clinical application of this model in a woman in her twenties with AN. By visualizing predicted weight trajectories under different caloric intake strategies, the model facilitated consensus building between the patient, her family, and the treatment team, leading to the acceptance of nasogastric feeding and structured behavioral therapy.

Conclusions: The present case may suggest the potential utility of a calorie-based weight prediction model as a dynamic, noninvasive, and quantitative tool for inpatient management of AN. While the approach could facilitate understanding and agreement regarding treatment for AN, further evaluation in larger cohorts is required to assess accuracy and clinical impact.

Menstrual disturbances are a common yet often overlooked feature of eating disorders, impacting individuals across diagnostic categories and age groups. This Matters Arising piece responds to Porter (2025), a survivor-led qualitative study highlighting that menstruation is often treated as a simple health indicator, with little attention to emotional or psychosocial aspects. Specifically, I discuss broader intersections between eating disorder pathology and menstrual health, including functional hypothalamic amenorrhea, oligomenorrhea and menopause-related changes, illustrating how menstrual irregularities reflect disruptions in hormonal and metabolic regulation and carry psychological and identity-related implications. Current clinical approaches frequently overlook these dimensions, focusing narrowly on the presence or absence of menstruation rather than holistic well-being. Drawing on research evidence and clinical experience, I recommend a patient-centred approach that includes routine assessment of menstrual history and symptoms, integration of menstrual considerations into nutritional, medical and psychological treatment plans and sensitive communication regarding emotional and identity-related experiences. Interdisciplinary collaboration and further research are essential to better understand menstrual experiences across the lifespan. Recognising menstrual health as a meaningful component of overall treatment can enhance recovery and provide more comprehensive, empathetic care.

Background: Research has suggested that consuming appearance-related content on social media is associated with eating disordered thoughts, but social media also contains content that supports recovery. There is some evidence that TikTok algorithm fed more appearance-related content for people with eating disorders (EDs). However, there are no studies on how people with EDs experience and negotiate the way in which algorithms steer them towards specific social media spaces, which is the original aim of our research.

Methods: Semi-structured interviews were conducted with 31 UK people, 28 women and 3 men, aged 18-49 years, and self-identified as having past or present experience of EDs, most of whom defined themselves as in recovery. The interviews were analysed using reflexive thematic analysis.

Results: In analysing the material we developed a novel spatial approach to algorithms, analysing how they shaped participants' movement across social media and identified three key themes: (i) negative and positive repetitive refrains, (ii) wayfaring between helpful and unhelpful spaces and (iii) being enveloped in a gendered body and wellness landscape. First, algorithms encouraged repetitive viewing or refrain, which made participants to veer into or, when unwell, to steer themselves into social media and psychological spaces characterised by constant thoughts and practices of restricting eating; yet, participants could also repetitively view self-compassion messages on social media to move to a space of self-affirmation. Second, participants wandered into and between helpful mental health and body positive spaces and unhelpful diet and beauty spaces, being mostly casually informed by algorithms and their own interests but also critically reflecting on the steer. Third, wandering between seemingly antithetical diet and recovery spaces still enveloped participants in stereotypically gendered landscape focusing on bodies and wellness and did not cultivate other interests.

Conclusion: The findings suggest that participants recovering from EDs often sought to steer themselves towards social media spaces that enhanced their well-being, but algorithms frequently complicated these journeys, which merits further attention in research, practice and policy.

Background: Eating disorders (EDs) are complex mental health conditions influenced by genetic, psychological, and sociocultural factors. In Saudi Arabia, rising ED prevalence among youth underscores the need for early diagnosis, increased awareness, and targeted intervention. This study examined the relationship between Mental Health Literacy (MHL) and EDs stigma within the Saudi population.

Methods: Utilizing a cross-sectional design, data were collected from 370 participants across all Saudi provinces through a convenience sampling method. Data analysis was conducted by the R software version 4.2.2.

Results: Findings from this study showed generally high MHL and low to moderate stigma. There was a significant inverse relationship between MHL and stigma. Unadjusted linear regression indicated that higher MHL was associated with lower ED stigma. Other predictors of greater stigma included male gender, older age, being married, employment in the private sector, and higher income. Exposure to EDs, such as knowing someone with an ED or having self-diagnosed, was associated with reduced stigma.

Conclusions: The findings of this study underscore the central role of MHL in mitigating stigma toward EDs. Enhancing public education about EDs and promoting accurate understanding may reduce stigmatizing attitudes, improve early intervention, and support better health outcomes in Saudi Arabia.

Background: Compulsive exercise (CE) is commonly observed in eating disorders (ED) and is associated with a more severe clinical picture. Including 3105 participants from the Eating Disorders Genetics Initiative-Sweden, the aim of this cross-sectional study was to expand the knowledge of how CE relates to ED symptoms and other core psychological features.

Methods: Through multiple linear regression analyses, we investigated simple and unique associations between CE, measured with the Compulsive Exercise Test (CET) including its subscales and ED symptoms, obsessive compulsive disorder (OCD) symptoms, anxiety, perfectionism, depression, and health-related quality of life.

Results: Results suggested that ED symptoms, OCD symptoms, and perfectionism all have unique positive associations with CE, and depressive symptoms a negative association when controlling for the other constructs. Each CET subscale showed its own specific pattern of associations with the examined constructs.

Conclusions: Overall, results were consistent with previous research and the proposed cognitive-behavioral model of CE. Implications support the idea that CE may not be clinically relevant in the absence of ED symptoms, but an important symptom domain when they are present. Future research should focus on the directionality of associations between OCD symptoms, perfectionism, and CE, including samples without ED experience.

Background: Individuals with type 1 diabetes (T1D) are at increased risk of developing disordered eating (DE) and eating disorders (ED). Diabetes self-management focuses on food and insulin administration, which may contribute to development of EDs. The dual diagnosis may contribute to suboptimal glycemia, early diabetes-related complications and mortality. Evidence for ED prevention programs for this high-risk population remains limited. This systematic review aims to evaluate the feasibility and efficacy of available interventions to prevent EDs and improve glycemia in people with T1D.

Methods: A literature search of PubMed, Embase, PsycINFO, CINAHL and Web of Science was conducted on 25 January 2025. Studies using randomized controlled, quasi-experimental or cohort design that targeted ED prevention in T1D population were included.

Results: Nine studies met the inclusion criteria, featuring interventions such as cognitive dissonance based programs, psychoeducation and self-compassion programs. Cognitive dissonance based programs demonstrated the most consistent reduction in ED risks and symptoms. However, most studies showed negligible improvement in glycemia. Common limitations were small sample sizes, high drop-out rates and short follow-ups.

Conclusion: Future research should focus on well-powered RCTs to evaluate interventions over longer timeframes, younger age groups, both genders, carer involvement and additional modifications to improve glycemia concurrently.

Binge Eating Disorder (BED) is the most prevalent eating disorder and is associated with psychiatric comorbidities, health impairments, and decreased quality of life. Emerging evidence suggests that psilocybin-assisted therapy may promote cognitive and emotional flexibility and disrupt maladaptive behavioral patterns, making it a promising candidate for BED treatment. This open-label pilot study evaluated the feasibility, safety, and preliminary therapeutic effects of a single 25 mg dose of psilocybin administered in the context of Acceptance and Commitment Therapy (ACT)-based psychotherapy in adults with BED (N = 5). Primary outcomes included safety measures, and exploratory outcomes included self-reported binge eating frequency, depression, anxiety, psychological flexibility, anthropometric indices, and neuroimaging biomarkers assessed over a 14-week follow-up. Psilocybin was well tolerated, with no serious adverse events. Reductions in self-reported binge eating frequency were observed across all participants and sustained through week 14. Improvements were also noted in depression, anxiety, and psychological inflexibility. Three participants showed reductions in body mass index and waist circumference. Given the open label design and small sample size, causality cannot be inferred. fMRI analyses generated preliminary signals of change-such as increased functional activation from pre- to post-intervention in the middle frontal gyrus, angular gyrus, and supramarginal gyrus in response to processed versus unprocessed food cues. Psilocybin-assisted therapy was feasible and well-tolerated in individuals with BED. The clinical and neurobiological observations provide directions for future adequately powered trials.

Background: Online training programs offer accessible, cost-effective solutions to disseminate evidence-based interventions. Yet, online training is typically insufficient without additional clinical case consultation (CCC). This is particularly salient in adolescent eating disorders treatment, where clinical demand far outstrips capacities of providers trained in evidence-based treatment approaches. This study seeks to better understand attitudes and barriers to receiving CCC among private practice clinicians treating adolescent eating disorders.

Methods: Licensed private practice clinicians (n = 47; 100% female, average age 36 y old; 75% master's degree; average of 4y experience) across the United States enrolled in a randomized trial offering online training (webinar or e-learning) in family-based treatment (FBT) for anorexia nervosa. Post online training, participants were asked before and after 12 sessions of expert CCC to self-report attitudes and barriers to obtaining CCC.

Results: Prior to CCC, participants rated expert CCC in learning FBT as important/very important (100%). The majority participated in CCC since licensure (82%) and in the last year (68%), rating it valuable or very valuable (77%). Participants predicted that CCC would be valuable (96%) and an important motivation in completing the training study (96%). After CCC, participants viewed CCC as important/very important in learning FBT (94%). Common obstacles included finding a study-eligible patient (44%), scheduling constraints (19%), lost wages (16%), mismatch with consultant (3%), and hesitation to discuss cases (3%).

Conclusions: Clinicians reported favorable perspectives on CCC in complimenting learning FBT via online training. Future studies are needed to determine methods to deliver, assess, and scale CCC to enhance treatment fidelity.

Background: Patients with eating disorders (EDs), particularly anorexia nervosa (AN), experience a complex psychiatric condition often characterized by extreme food restriction, intense fear of weight gain, elevated levels of emotional dysregulation, body image disturbance, and comorbid trauma. Several of these factors can undermine the therapeutic alliance and reduce engagement with treatment, contributing to poorer outcomes. MDMA, a non-classical psychedelic, is being explored as a novel PTSD treatment adjuvans due to its ability to rapidly reduce trauma symptoms and enhance therapeutic alliance. Recent clinical trials and regulatory considerations, as highlighted in emerging research, are shaping its potential therapeutic role, and MDMA may offer a unique mechanism to disrupt maladaptive neural circuits, enhance cognitive flexibility, and facilitate emotional processing in EDs.

Objective: To comprehensively evaluate the potential of MDMA-assisted therapy for EDs with a particular focus on the distinct neurobiological and psychological profiles of AN and comorbid PTSD.

Methods: This paper synthesizes current research literature on MDMA, PTSD, and EDs, with an emphasis on clinical trial outcomes, neurobiological mechanisms, and therapeutic frameworks. Both pharmacological and psychotherapeutic components of MDMA-AT are reviewed.

Results: No clinical trials of MDMA-AT have been conducted in ED populations to date. Findings from clinical trials in patients with PTSD suggest that MDMA's pro-social and fear-reducing and neuroplastic properties may enhance emotional processing, therapeutic alliance, and cognitive flexibility - key factors that often hinder eating disorder treatment. The ability of MDMA to increase emotional openness, reduce fear responses, and promote cognitive flexibility could support deeper engagement with the therapeutic process and improve treatment outcomes in EDs with comorbid trauma.

Conclusions: The current evidence base suggests that MDMA-AT may hold promise as an adjunctive treatment for EDs echoing its demonstrated therapeutic potential in PTSD. By facilitating deeper emotional processing, enhancing patient-therapist attunement, and fostering openness to change, MDMA may help overcome avoidance, cognitive rigidity, and therapeutic impasses that often hinder progress in EDs. Its integration into clinical practice will require rigorous validation through well powered trials, alongside careful ethical and regulatory oversight, and integration into multidisciplinary treatment frameworks. Tailored dosing, patient selection, and therapist training will be essential for safe and effective implementation. Further research is warranted to fully explore this potential application.

Background: Despite suggestions that Day Programs can be efficacious, little is understood about which mechanisms create positive change for young people and their family in this setting. The aim of this study was to explore clinician perspectives on how change occurs in an adolescent eating disorder Day Program in Australia.

Methods: Twelve clinicians working as a team on an adolescent Day Program participated in semi-structured qualitative focus groups. Focus groups explored the clinicians' perspectives on change processes in the Day Program treatment model and the impact on young people and their families. Data generated from each focus group was analysed using reflexive thematic analysis.

Results: The structure, predictability and intensity of the Day Program along with tailored and responsive treatment was perceived as leading to a main theme of structural containment. Additionally, the combination of a strong relational treatment focus with team mutuality was perceived as leading to a second main theme of relational containment. The combination of structural and relational containment for families was perceived by clinicians as the leading mechanisms in supporting parental effectiveness in treatment and the settling and engaging of the young people. Levels of containment were also understood to create safety for all (parents, young people, and clinicians) providing a wraparound approach allowing effective treatment to be delivered.

Conclusions: The findings of this study speak to the importance of safety as a foundation for working with families needing higher levels of care. Treatment approaches that are both structurally and relationally containing might be needed for families requiring more intensive care. Findings also highlight the importance of the clinical team working cohesively and the potential need for clinicians/services to consider how to create a therapeutically supportive environment that maximises the effectiveness of treatment.