Journal of Eating Disorders最新文献

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.

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.