Journal of Eating Disorders最新文献

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.

Background: Disordered eating (DE) affects millions of individuals each day as they are exposed to diet culture, normalization of restricting foods, and public perception of a "healthy" body and diet. Persistent DE behaviors may progress in severity and frequency, leading to harmful behaviors that result in physical and psychological health outcomes, ultimately meeting the diagnostic criteria for an eating disorder (ED). The purpose of this study was to identify what factors influence disordered eating and eating disorders (DEED), why individuals do not disclose their experiences, and what could have been done to help them with their DEED.

Methods: Using the Communication Privacy Management theory to develop questions, qualitative semi-structured interviews were conducted with 15 participants. A thematic analysis was conducted from interview transcripts to develop overarching themes.

Results: Five key themes emerged from participant interviews: family influence and comments, social media influence, healthcare influence, justification factors, and comorbidities. These themes reflect influences on participants developing DEEDs and barriers to getting help such as stigma associated with mental health issues and healthcare providers' unwillingness to discuss their DEED. Many participants also noted that family influences, particularly mothers, were a contributing factor to their DEED as well as playing sports and social media like Tumblr or "What I eat in a day" videos on TikTok.

Conclusion: These findings highlight the complex social, cultural, and structural factors that shape privacy management and the development and disclosure of DEED. Public health professionals can use these results to help bridge the gap between education, policy reform, and accessible healthcare to address the often-overlooked public health issues of DEED.

Background: Parents often remain the primary carers for their adult children with anorexia nervosa (AN) for an extended time. Carer strain and unhelpful behaviours have been extensively investigated as contributors to the maintenance of the illness and suggested several differences between fathers and mothers. However, the skilful dimensions of parental caregiving have been overlooked, and no longitudinal research has examined the caregiver abilities and psychological well-being of parents during their child's transition from an intensive treatment. This exploratory study compares the trajectories of change in perceived carer skills and psychological distress between fathers and mothers of adult patients with AN over an 18-month period during the transition from intensive hospital care.

Methods: Fifty two fathers and 224 mothers of adult AN patients were included in this study. A secondary analysis was conducted on data from the TRIANGLE trial using linear mixed-effects models. Outcomes were the total and subscale scores from the Caregiver Skills Scale (CASK) and the Depression, Anxiety, and Stress scale (DASS-21) in fathers and mothers at baseline, 6, 12, and 18 months.

Results: Post-hoc tests revealed that fathers and mothers did not show significant differences in the CASK scores at any time-point (except for higher paternal "Self-Care" and "Biting-your-tongue" skills at baseline). However, the trajectories of change in their abilities differed between parents. Mothers showed significant increases over time in the overall CASK and in several of the subscales from baseline to month 18 (but not months 6 or 12), whereas fathers did not show significant changes in the total or subscale scores at any time point. In contrast, the changes in distress levels (DASS-21) followed similar trajectories for fathers and mothers over time.

Conclusions: Fathers and mothers may have distinct needs in order to enhance their caregiving skills in the long-term. Although the findings require validation in future research involving father-mother dyads, effort should be made to ensure that carer support is tailored to be fit-for-purpose for both fathers and mothers.

Trial registration: The TRIANGLE trial whose parental data was used in this study was pre-registered on the ISRCTN registry (ISRCTN14644379).

Background: Eating disorders are a major public health concern in Australia and Aotearoa New Zealand, with significant morbidity, mortality, and economic burden. Despite substantial government investment in eating disorder care, there is limited infrastructure to evaluate treatment outcomes, particularly in community settings. Clinical Quality Registries (CQRs) offer a mechanism for systematic data collection, benchmarking, and feedback to improve care quality. The Australia and New Zealand Clinical Quality Registry for the Treatment of Eating Disorders (TrEAT Registry) was developed to address this gap.

Methods: The TrEAT Registry is a multi-centre, longitudinal CQR that collects clinician- and client-reported data across outpatient, day patient, residential, and inpatient settings. Data are collected at treatment commencement, during treatment, and at discharge or follow-up. Clients aged 13 years and older provide informed consent to contribute de-identified data to a research databank. Core measures include the Eating Disorder Examination Questionnaire (EDE-Q), Clinical Impairment Assessment (CIA), and Depression Anxiety and Stress Scale (DASS-21).

Results: Between September 2021 and June 2025, 754 clients were invited to contribute their clinical data to the registry databank, with 88.1% consenting and 93.7% of consenting participants completing the pre-treatment survey. The sample was predominantly female (91.8%), young (mean age = 26.0 years), and urban-dwelling (> 85%). Most clients in the registry were treated in privately operated outpatient settings. Mean scores on the EDE-Q (Global = 3.80), CIA (Total = 30.92), and DASS-21 subscales (Depression = 10.29, Anxiety = 7.00, and Stress = 10.67) indicated clinically significant symptomatology.

Conclusions: The TrEAT Registry is a pioneering initiative in eating disorder care, providing infrastructure for health surveillance, quality improvement, and research. The registry has supported real-world research and clinical trials, including ongoing evaluations of residential and virtual day programs, and planned evaluation of Medicare and credentialing systems. Its unique inclusion of private sector clinics and client consent enhances ethical standards and data richness. Planned expansion and digital enhancements aim to improve coverage, data accessibility, and follow-up rates, supporting a learning health system across Australia and New Zealand. Trial registration Registered on the Australian Register of Clinical Registries (#ACSQHC-ARCR-279).