Journal of Eating Disorders最新文献

Cognitive behavioural therapy (CBT) is widely described as an evidence-based psychological treatment, including within eating disorder (ED) care. However, evidence claims are only valid within the boundaries of the populations, outcome measures, and service contexts represented in the underlying trials. This paper argues that CBT is not universally evidence-based and that extending its evidentiary status to neurodivergent people and Indigenous, First Nations, and Māori communities is not currently justified. Drawing on decolonial and neurodiversity scholarship and lived experience-led literature, the paper shows how research designs prioritising internal validity have contributed to an evidence base that functions as a methodological echo chamber, reproducing findings drawn predominantly from white, Western, largely neurotypical samples. As a result, CBT trials often lack external validity for communities whose experiences of distress are shaped by sensory processing differences, executive functioning difficulties, systemic discrimination, food insecurity, and the colonial legacy of trauma, erasure, and dispossession. In ED care, these limitations are amplified by diagnostic frameworks and outcome measures that privilege weight-centric approaches and neuronormative and Eurocentric cognitive models while overlooking sensory, somatic, cultural, and socio-political drivers of illness. Evidence from autistic and Indigenous participants documents mis-attunement and iatrogenic harm within standard CBT-based pathways for EDs. The paper concludes that universal claims about CBT are not supported by the current evidence base and are better understood as population-specific evidence claims grounded in co-designed trials, culturally valid measurement, and implementation research demonstrating safety, relevance, and benefit for diverse communities.

Background: Carers are crucial to the recovery process of people with eating disorders (EDs). The Caregiver Skills (CASK) scale was developed to assess key caregiving skills among carers of individuals with EDs. While psychometric evaluations of the English, German and Spanish versions have supported the original six-factor model, no validated Dutch version exists to date. This study aimed to examine the psychometric properties of a Dutch translation of the CASK. Validated caregiving outcome measures can assist in exploring coping skills in clinical practice and support research evaluating both caregiving interventions and ED treatments.

Methods: A total of 248 carers (139 female, 109 male; mean age = 48.3 years) completed the CASK prior to assessment at a specialized ED treatment center in the Netherlands. The internal consistency of the total scale and six subscales was assessed using McDonald's omega. Confirmatory factor analysis (CFA) was used to test the original six-factor structure. Gender differences in subscale and total scores were explored using linear mixed-effects models (LMM).

Results: The original six-factor structure could not be confirmed in CFA, and model fit remained suboptimal after post hoc modifications. However, CFA results for the six subscales separately showed good to acceptable fit, and internal consistency was satisfactory. No gender differences were found in total CASK scores, though male carers reported higher skills on 'Self-Care' and 'Insight and Acceptance', and female carers reported higher skills on 'Frustration Tolerance' and 'Emotional Intelligence'.

Conclusions: The Dutch version of the CASK did not replicate the original six-factor structure at the full-scale level. Nonetheless, the six subscales demonstrated adequate psychometric properties and appear particularly suitable for use at the group level, making the instrument relevant for research and care improvement policies. Further studies are needed to determine whether the CASK can also provide added value at the individual level, for example to guide individualized treatment content, and to evaluate its applicability in more diagnostically and culturally diverse samples. While male and female carers reported comparable overall skills, differences in specific subscale scores highlight the importance of considering gender in the context of skill development and support for carers of individuals with EDs.

Success rates in eating disorder treatments are disappointing, and many calls have been made in recent research literature for innovative approaches to improve outcomes. This Comment article offers an argument for the importance of behaviour and agency in supporting eating disorder recovery, where behaviour encompasses eating and other everyday actions and habits and agency is an individual's capacity to set priorities and intentions, generate insights, draw conclusions, make decisions, and perform actions. Current treatments often deprioritize eating and other behaviours as well as individual agency for the patient/client, with lower importance often attributed to behavioural change than to physiological or psychological change. Reasons for deprioritizing behaviour may include beliefs about the therapeutic alliance, the intellectual appeal of psychological exploration, and the ready measurability of physiological factors. Reasons for deprioritizing personal agency may relate to an only partial shift away from the paternalistic model of medicine, influenced by the physical severity of EDs and by gender dynamics between clinician and client/patient. Drawing on principles and practices from solution-focused coaching and solution-focused brief therapy, we argue that low-agency forms of healthcare are likely to perform poorly in general, given the problematic effects that typically result from the giving and following of advice. Low-agency and low-behaviour approaches are also likely to work poorly for EDs in particular, thanks to both the centrality of eating behaviours and the fact that EDs are often experienced as initially egosyntonic exercises of personal agency. We describe how a high-agency-high-behaviour model of ED treatment could help improve recovery rates by scaffolding a process of progressive empowerment in which the affected individual identifies how personal agency has been lost in the experience of their ED and decides whether, why, and how they wish to reassert it. We survey existing applications of solution-focused methods in the ED domain and suggest ways of testing the proposed ideas. We conclude by sketching broader ways for the field to continue its evolution towards higher-behaviour and higher-agency methods, as part of a general shift to forms of healthcare that are truly responsive to the individual and firmly grounded in the realities of practical change.

Background: Negative parenting styles are known correlates of disordered eating (DE), yet existing studies have largely focused on construct-level associations, leaving the specific item-level pathways between parenting styles and DE unclear. Identifying these fine-grained mechanisms may offer more targeted insights for prevention and intervention.

Methods: A large sample of Chinese college students (N = 2,008) completed the short-form Egna Minnen av Barndoms Uppfostran for Chinese (s-EMBU-C; paternal rejection, maternal rejection, paternal overprotection, and maternal overprotection subscales) and the Eating Attitudes Test-19 (EAT-19). Applying Gaussian Graphical Models, item-level bridge network analyses were conducted to estimate conditional associations (edges) among individual parenting and DE items (nodes), and Bridge Expected Influence was used to identify nodes that link the two communities. A simulation-based intervention analysis was then conducted to examine how constraining individual bridge nodes-and their sequential removal-reduced cross-community connectivity, quantified using the CrossCut (Cross-Community Coupling) metric.

Results: For rejection, bridge nodes included unexplained parental anger, being treated as a scapegoat, and shaming treatment (plus maternal public criticism), along with food avoidance despite hunger and preoccupation with body fat. For overprotection, bridges involved excessive parental worry, exaggerated safety anxiety, and intrusive interference (plus maternal control over appearance), together with desire for an empty stomach and perceived thinness by others. Simulation analyses showed that clamping individual bridge nodes reduced the CrossCut by approximately 13-30%, whereas cumulative clamping produced substantial overall reductions (up to 76-83%), yet displayed clear marginal effects.

Conclusions: These findings highlight that hostile, shaming parental treatments and anxious, intrusive over-involvement, intertwined with restrictive and body-image focused symptoms, constitute the core pathways linking negative parenting styles and DE. Targeting high-impact bridge nodes, rather than the full set, was sufficient to substantially weaken the connection between the parenting and DE communities. These insights provide a useful reference for developing more efficient support strategies for college students.

Background: The pathogenesis of anorexia nervosa (AN) involves multiple factors, among which childhood traumatic experience has attracted attention. Emotional abuse, as a form of trauma, may exert a predictive effect on AN. In addition, childhood traumatic experience is closely linked to impulsivity, yet the trauma-impulsivity-AN mediation pathway has not been directly validated. The purpose of this study is to compare differences in childhood traumatic experience of patients with different subtypes of AN, as well as exploring the mediating role of impulsivity between emotional abuse in childhood traumatic experience and symptom severity of AN.

Methods: This study included 157 female patients with AN, including 76 with the restricting type (AN-R) and 81 with the binge-eating/purging type (AN-BP), as well as 124 matched healthy controls (HC). Childhood traumatic experience was evaluated using Early Trauma Inventory-short form (ETI-SF), impulsivity assessed by Barratt Impulsiveness Scale 11th Version (BIS-11), and clinical characteristics via Eating Disorder Examination-questionnaire (EDE-Q 6.0), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Furthermore, inter-group differences in childhood traumatic experience were determined by one-way analysis of variance and analysis of covariance, the correlation between childhood traumatic experience and AN by Pearson correlation analysis, and the mediating role of impulsivity between emotional abuse and symptom severity was clarified by the Bootstrap method.

Results: Cases in the AN-BP group had significantly higher exposure to childhood traumatic experience compared with the AN-R and HC groups (both p < 0.05). Significant differences were likewise observed in emotional-abuse scores across the three groups (F = 10.574, p= 0.000, partial η² = 0.084). Emotional abuse was positively correlated with impulsivity and symptom severity of AN (both p < 0.05). In addition, the mediation effect of impulsivity between emotional abuse and symptom severity was 0.073 (95% CI 0.013 ~ 0.153), with an effect proportion of 19.363%.

Conclusion: AN-BP patients have more significant childhood traumatic experience than AN-R patients, and difference was mainly reflected in the emotional abuse factor. Emotional abuse has established correlation with impulsivity and symptom severity in AN, with impulsivity playing a mediating role between emotional abuse and symptom severity.

Background: Eating disorders (EDs) are increasingly recognised among neurodivergent and transgender and gender diverse (TGD) individuals, yet most assessment and treatment models remain grounded in cisnormative and neuronormative assumptions and frameworks. Sensory processing, spanning interoception and exteroception, has been proposed as a potential factor that may help explain observed associations between neurodivergent traits, gender incongruence, and EDs. Empirical evidence, however, remains limited. This study examined whether sensory processing characteristics accounted for variance in observed associations between neurodivergent traits (with a focus on Autism and attention deficit/hyperactivity disorder, ADHD), gender incongruence, and ED symptoms in an adult community sample.

Methods: Participants (N = 195) completed an online Qualtrics survey involving validated self-report measures of exteroception, interoceptive sensibility, gender congruence, and ED symptoms (for example, Eating Disorder Examination Questionnaire Short, EDE-QS and Nine Item Avoidant or Restrictive Food Intake Disorder Screener, NIAS). Correlation, regression, and effects analyses were used to explore associations among self-reported neurodivergent traits, gender incongruence, sensory processing, and ED symptoms.

Results: Gender incongruence and Autistic traits showed positive associations with restrictive and avoidant ED symptoms. ADHD traits showed positive associations with a broader range of ED symptoms, including restrictive, avoidant, and binge eating presentations. Gender incongruence also showed positive associations with sensory processing differences across both exteroceptive and interoceptive domains: namely, elevated visual and auditory sensitivity and reduced body trust. Furthermore, interoceptive sensibility, particularly lower body trust, showed significant statistical relations with ADHD motor traits and EDE-QS scores. Interoceptive sensibility also showed significant statistical relations in models including gender incongruence and EDE-QS scores. Exteroceptive hypersensitivity showed a partial statistical relation in models examining gender incongruence and NIAS scores.

Conclusions: To the authors' knowledge, this study provides the first lived experience-led empirical intersectional investigation linking interoception and exteroception with neurodivergent traits, gender incongruence, and ED symptoms. Results highlight the relevance of intersectional, sensory-informed, and identity-affirming perspectives for future research and the ongoing development of ED assessment and care.

Background: Muscle dysmorphia (MD) refers to distressing concerns about being insufficiently muscular and is increasingly reported among gym-going men. Evidence from Saudi Arabia is limited. This study estimated the proportion of gym-going men in Riyadh who screened positive for elevated MD symptomatology and examined associations with disordered eating symptoms and sociodemographic factors.

Methods: A cross-sectional survey was conducted among male gym-goers in Riyadh. Elevated MD symptomatology was assessed using the Muscle Dysmorphic Disorder Inventory (MDDI), and disordered eating symptoms were screened using the Patient Health Questionnaire-Eating Disorders Module (PHQ-ED). Group differences were examined using appropriate bivariate tests. A stepwise binary logistic regression model was used to identify predictors of screening-positive status for elevated MD symptomatology (MDDI ≥ 39).

Results: Of 303 participants, 49.8% screened positive for elevated MD symptomatology (MDDI ≥ 39). Screening-positive PHQ-ED status was associated with screening-positive MDDI status (Fisher's exact test, p = 0.030). In the final stepwise multivariable model, marital status and graduate-level education were associated with screening-positive MDDI status. Body mass index (BMI) was not retained in the final stepwise model, and PHQ-ED status could not be evaluated in the multivariable model due to sparse data/complete separation (non-estimable odds ratios).

Conclusions: Nearly half of the surveyed gym-going men screened positive for elevated MD symptomatology, indicating a high symptom burden in this selected sample. These findings should not be interpreted as diagnostic prevalence. Screening-based approaches in gym settings may help identify individuals who report high distress or interference and may benefit from further clinical assessment. Larger studies using probability sampling and structured diagnostic interviews are needed to estimate diagnostic prevalence and clarify associated factors.

Background: Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by restrictive eating that leads to weight loss or failure to grow, nutritional deficiency, supplement dependence, and/or psychosocial impairment. The aim of the present study was to culturally adapt and investigate the psychometric properties of the Persian version of the adult Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS), among general population of Iranian adults.

Methods: This methodological cross-sectional study was conducted among 936 Persian-speaking adults, living in Isfahan, Iran. Translation of the NIAS was performed using forward-backward method. Intra Class Correlation (ICC) and Cronbach's α were used to assess test-retest reliability and internal consistency, respectively. Construct validity was investigated by using exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Convergent and divergent validity was determined using BMI, adult eating behavior questionnaire (AEBQ), and Hospital Anxiety and Depression Scale (HADS).

Results: Persian version of the NIAS showed excellent test-retest reliability in all domains (ICCs: 0.989-0.995). The computed Cronbach's alpha coefficients for dimensions of Persian-NIAS were in the range good to excellent (alpha: 0.803-0.879). Persian-NIAS showed good known-group validity and differentiated persons with different levels of BMI from each other (P < 0.05). Construct validity evaluated by EFA led to extraction of three factors (picky eating, appetite, and fear), and the CFA confirmed the adequacy of extracted construct from EFA (CFI = 0.979, TLI = 0.958, SRMR = 0.037 and RMSEA = 0.077). Convergent and divergent Validity revealed significant positive or negative correlations between Persian-NIAS dimensions and different dimensions of the AEBQ, and HADS.

Conclusions: The Persian version of the NIAS is a reliable and valid instrument with applicability in a broad range of the population of Persian-speaking adults for assessing AFRID eating disorders in research projects.

Background: Minoritised ethnic individuals have comparable eating disorder rates to White populations in the United Kingdom (UK) yet face inequalities in treatment access and experiences. Understanding healthcare professional perspectives is essential for addressing these disparities. This study explores health care professional views on the access of minoritised ethnic young people to specialist eating disorder services through Levesque's bidirectional access framework, which considers both supply and demand factors.

Methods: Semi-structured qualitative interviews were conducted with 12 health care professionals from diverse personal and professional backgrounds, recruited from four National Health Service (NHS) community specialist eating disorder services in the West Midlands - the UK's second most ethnically diverse region. Participants completed sociodemographic questionnaires and online interviews via Microsoft Teams. Transcripts were analysed using reflexive thematic analysis.

Results: Health care professionals observed that young people of minoritised ethnic backgrounds accessed specialist eating disorder services less frequently than White British peers. Analysis revealed six interconnected themes spanning service-level and service-user-level factors. At the service level, systemic barriers included gatekeeping mechanisms (particularly GP referral requirements), service invisibility within minoritised ethnic communities, and inaccessible locations. Cultural and linguistic barriers were prominent, with communication challenges extending beyond language proficiency to fundamental differences in expressing distress. Health care professionals identified critical gaps in developing culturally sensitive services, citing limited resources, lack of workforce diversity, top-down organizational constraints, and insufficient cultural humility training. At the service-user level, education and awareness emerged as key barriers, with lower mental health literacy and limited eating disorder knowledge within minoritised ethnic communities as hindering recognition and help-seeking. Shame and stigma compounded these challenges, driven by eating disorder stereotypes and cultural beliefs about mental health that discouraged disclosure and treatment-seeking. Health care professionals noted that these barriers disproportionately affected minoritised ethnic individuals compared to their White British peers.

Conclusions: Findings highlight multilevel barriers to accessing eating disorder services requiring comprehensive system changes including removing gatekeeping barriers, enhancing workforce diversity and cultural competency, developing targeted educational initiatives, and challenging eating disorder stereotypes. Culturally responsive services integrating these interventions are essential to improve access and outcomes for minoritised ethnic young people.