Journal of Eating Disorders最新文献

Background: Despite the increasing use of dialectical behaviour therapy (DBT) as a treatment for eating disorders (EDs), there is little published evidence of its effectiveness for treating restrictive eating disorders. DBT for EDs may be particularly helpful for those who live with severe and enduring eating disorders (SE-EDs) given that it targets those for whom first-line treatments have not been effective, its focus on factors thought to maintain symptoms and its focus on improving quality of life. This study sought to evaluate the experiences of participants in a comprehensive DBT programme for people with SE-EDs.

Methods: Semistructured interviews were conducted with seven participants who were treated in the 'DBT for Multidiagnostic Eating Disorders (MED-DBT)' programme at a regional eating disorders service in New Zealand. The interviews were transcribed verbatim and analysed via thematic analysis.

Results: The findings indicate that the MED-DBT programme was perceived as effective by participants. The skills learned provided participants with valuable tools that could be used to better manage emotions, crises, and tasks of daily life, which improved their quality of life and improved their management of their eating disorder symptoms. Several participants reported that the programme saved their lives. A key component of the MED-DBT programme was having access to phone coaching that supported participants with the acquisition and consolidation of skills to reduce crises and generalise learning of the skills. These skills have continued to be used by participants more than five years posttreatment.

Conclusions: The qualitative findings of the present study suggest that the MED-DBT programme is an effective and valuable treatment for participants. All participants endorsed the MED-DBT programme for ED treatment. The treatment programme was seen as a highly beneficial and feasible treatment that could provide greater options for treating complex clients with severe and enduring eating symptomology with confidence.

Background: The factorial structure of the Eating Attitudes Test (EAT-26) has been found to be inconsistent across studies and samples. This study aimed to resolve inconsistencies in the factorial structure of the Arabic version of the EAT-26 by identifying the best-fitting model and test its measurement invariance across sexes and BMI categories in a large non-clinical Saudi sample.

Methods: 1,734 Saudi adults (M_age 26.88 and SD 9.13), predominantly female, completed an online survey. Several existing models were tested (e.g., original 26-item three-factor model, second order 26-item three-factor model, 20-item four-factor model, and 16-item four-factor model) using confirmatory factor analysis (CFA). Fit indices including the CFI, SRMR, and RMSEA were used to identify the best-fitting model for Arabic version of the EAT-26. Multi-group confirmatory factor analysis (MGCFA) was used to test measurement invariance.

Results: The original three-factor model and two other common models demonstrated poor fit (e.g., CFI = 0.727; SRMR = 0.0911; RMSEA = 0.085 [90% CI 0.082-0.087] for the original three-factor model). Instead, a 16-item, four-factor structure [(Self-Perceptions of Body Weight), (Dieting), (Awareness of Food Contents), and (Food Preoccupation)] showed acceptable fit ([CFI = 0.904; SRMR = 0.0554; RMSEA = 0.073 [90% CI 0.068- 0.077]). Internal consistency was good (α and ω = 0.88), and measurement invariance was supported across sex (male and female) and BMI categories (underweight, normal weight, overweight, and obese).

Conclusions: These findings underscore the need for culturally relevant validation of the EAT-26 among Arabic-speaking populations, as the revised factorial structure diverged from previously established models. Future research should further examine this revised 16-item, four-factor structure in clinical settings.

Background: Unlike eating disorders (ED) that are officially recognized and focusing on the quantity of food, Orthorexia Nervosa (ON) revolves around an unhealthy fixation on the quality of food eaten. Existing ON scales differ in how these conceptualize and define ON, ensuing inconsistency in assessments that not only affects the validity and reliability of ON related research, but also impacts the ability of healthcare professionals to identify and provide support for individuals struggling with ON.

Objective: Create the first Eastern locally validated tool that considers the cultural nuances and specificity of the Lebanese general population's eating attitudes and their social context, addresses the limitations of existing scales and thereby provides a valid instrument that can be used in Lebanon and culturally-similar countries.

Methods: Data were collected between September 2023 and February 2024, enrolling 320 participants for the exploratory factor analysis and 658 for the confirmatory analysis.

Results: Starting from an initial pool of 25 items, the exploratory-confirmatory (EFA-CFA) factor analyses retained 13 items. The LONI showed a unidimensional factor structure, and satisfactory convergent and concurrent validity with a composite reliability (ω and α) of 0.90 providing clear evidence of its high reliability, supporting the stability and consistency of LONI scores across different subsamples. The structural characteristics, factor loadings, and item intercepts of the LONI remained consistent regardless of gender, affirming the tool's stability and reliability in measuring ON traits across diverse populations.

Conclusion: The LONI is a valid tool for assessing ON, particularly in accounting for Lebanese and culturally similar populations. The scale's unidimensional structure allows for straightforward calculation of the score, making it practical for both clinical and research applications, while offering a unique advantage in considering regional dietary patterns compared with existing ON screening tools due to its cultural specificity and psychometric strengths. The ON prevalence was high in the present sample, underscoring the significance of sociocultural and behavioral factors in its manifestation.

Background: Higher level of care (HLOC) treatment for eating disorders (EDs) is sometimes necessary, but research is lacking on whether HLOCs are actually more effective than less structured, lower levels of care. The purpose of the current study was to compare outcomes for patients with EDs at low weights who entered 24/7 care (inpatient and residential) to those entering non-24/7 care (partial hospitalization programming and intensive outpatient programming).

Methods: Participants were 1104 adults with body mass indices (BMI) between 14 and 17 receiving treatment for an ED at a large multisite treatment facility offering HLOCs between August 2019 and February 2024. The Eating Disorder Examination-Questionnaire (EDE-Q), assessing ED psychopathology, was completed at admission and discharge. Weight was taken throughout treatment.

Results: In unadjusted analyses, there was a significant difference between those receiving 24/7 care (3.79) versus non-24/7 care (2.17) in BMI increase during treatment. In adjusted analyses controlling for ED diagnosis, length of stay, and admission BMI, results remained the same. Weight gain per week was significantly greater for patients in 24/7 care. Changes in ED psychopathology, as measured by the EDE-Q, were not significantly associated with 24/7 care.

Conclusions: The current study suggests that patients with EDs at low BMIs gain more weight at a faster rate when participating in 24/7 care compared to non-24/7 care. Entering treatment at an appropriate level may result in shorter overall lengths of stay and may increase the chances of a positive long-term outcome.

Background: Anorexia nervosa (AN) is a serious multifactorial eating disorder characterized by insufficient nutritional intake to maintain a minimum normal weight for one's age and height, a fear of gaining weight and a distorted body image. It affects mainly adolescents, but a decreased age at diagnosis has been reported, leading to the definition of a rare form of AN called early-onset or prepubertal anorexia nervosa (EOAN; ORPHA 525738), with reported epidemiological and clinical specificity. Current knowledge and specific treatments for this particular condition remain scarce. We aim to summarize the literature review and synthesize actual knowledge on EOAN for preliminary guidelines to harmonize the diagnosis, treatment and follow-up.

Methods: A scoping literature review was performed from 2010-2021 using PubMed, Web of Science, PsycInfo and Cochrane via the following search terms: (anorexia nervosa) AND (early-onset OR premenarchal OR prepubertal OR childhood). International guidelines were screened for additional hits. Data extraction was limited to findings relevant to the key topic questions: epidemiology and clinical specificities section, diagnosis and initial evaluation section, treatment section, and follow-up and prognosis section.

Results: A total of 1257 titles were retrieved via the initial search strategy. Finally, 42 records were included in the present article (30 articles and 11 international guidelines and 1 literature review). We identified 15 articles relevant for the epidemiology and clinical specificities section, 11 for the diagnosis and initial evaluation section, 3 for the treatment section, and 1 for the follow-up and prognosis section. Despite the growing literature on the epidemiological and clinical features of EOAN, knowledge of specific treatments and prognoses remains scarce in the absence of extensive standardized data collection and few age-specific clinical research protocols. Current international guidelines generally extrapolate strategies proposed for adolescents and young adults to children with a low level of evidence.

Conclusions: Continuing research efforts in this specific younger population is needed to validate child-specific care strategies, enabling the establishment of age-appropriate recommendations with a higher level of evidence targeting specific determinants and clinical specificities of EOAN.

Objective: Eating disorders are complex illnesses with high morbidity and mortality. Yet, there is promising evidence to support the effects of nutrition on the brain and behaviour. One proposed example is the use of tyrosine as an adjunct treatment in anorexia nervosa (AN). However, recruitment and retention in eating disorder clinical trials has posed difficulties for researchers. The aim of this study was to pilot test a parallel randomised controlled trial (RCT) of tyrosine supplementation to explore the feasibility of recruitment and retention, intervention adherence and data collection methods from the perspective of participants and researchers.

Method: Feasibility was assessed using numbers participating, questionnaire completion in patients and parent/carers completing and declining participation, a researcher implementation record and clinical measures. Subjects included adolescents aged 12-17 years with AN. The study was conducted over a 12-week period, with the intervention group receiving 5 mg of L-tyrosine supplement and the control group receiving a placebo.

Results: Recruitment targets were not met and recruitment to a full RCT based on the current study protocol and recruitment sites did not prove feasible. Of the 39 approached for RCT participation, seven were recruited to the RCT (18% response rate) despite extending recruitment periods, with 100% retained and analysed. Patients or parents/carers identified barriers to study participation including burden, the need to consume tyrosine as tablets, and the use of blood, urine and psychological testing. Blood tyrosine rose markedly for subjects in the intervention group. No side effects were reported or measured.

Conclusions: This study offers a unique exploration of the feasibility of a tyrosine trial in anorexia nervosa and is of relevance to assist the success of future nutrition trials. Exploring the suitability of future study designs for nutrition intervention research is warranted.

Background: Co-production is increasingly used in mental health research and clinical settings. Maze Out is a digital game co-produced by clinicians, patients with eating disorders (EDs), an art director with lived experience in EDs, and a game-developing company. Maze Out is based on everyday challenges when suffering from EDs and is currently being evaluated as a supplement tool in EDs treatment. Several studies on co-producing mental health interventions focus on design and effectiveness, but the experiences of those involved in the co-production process remain unexplored. An in-depth exploration of stakeholders' experiences offers valuable insights into the impact of co-production on different groups and generates crucial knowledge for successful implementation.

Objectives: This study evaluated and explored the co-production process and the meaning that EDs patients, clinicians, and game designers attributed to their participation in the co-production of Maze Out. The objectives were to determine (1) how stakeholders experienced their collaboration in the co-production of Maze Out.; and (2) to what extent the stakeholders involved in developing Maze Out followed Cahn's principles of equality, diversity, accessibility, and reciprocity.

Methods: Five stakeholders (two patients, two clinicians, and a game designer) who participated in the co-production completed semi-structured interviews. Two patients and one clinician's diaries supplemented the interviews. Reflexive thematic analysis was used to interpret the data.

Results: The results of this study highlight the importance of building a common language between clinicians, patients, and other professionals involved in developing new forms of treatment and interventions. A recommendation for researchers and clinicians to implement co-production in the future is that Cahn's principles: equality, reciprocity, accessibility, and diversity, serve as a strong foundation for successful co-production. In this study, three and partially one of the four Cahn's principles about co-production were identified: equality, reciprocity, and accessibility. When applied in an ED context, these principles provided stakeholders with valuable insights, enriching practice-based knowledge, using the knowledge applicable to clinical practice, and demonstrating their crucial role in fostering effective co-production processes.

Background: The pronounced changes in reproductive hormones, such as oestradiol and progesterone, that occur during the menopause transition can contribute to increased risk of eating disorder onset or exacerbate a pre-existing eating disorder. Despite this heightened risk, there is a lack of available education and support that takes into consideration the unique challenges of experiencing an eating disorder during the menopause transition. This research aimed to qualitatively explore the perspectives of people with a lived experience of an eating disorder during the menopause transition, and to co-design a support option that addressed their unmet needs.

Methods: A Double Diamond co-design process was followed involving four phases: discover, define, develop, and deliver. Seventeen women in Australia with a lived experience of an eating disorder during the menopause transition participated in online workshops across the four phases to identify their unmet health educational needs in experiencing an eating disorder during this transition, develop potential solutions and ultimately deliver a prototype solution in the final phase. All online workshops were recorded, transcribed verbatim and analysed using qualitative thematic analysis. The findings from the previous phase informed the next leading to the prototype creation.

Results: Qualitative thematic analysis identified six major themes across the four phases; lack of awareness of the intersection of menopause and eating disorders, lack of education, limited and stigmatising services, learning from lived experience, resource impact and resource development.

Conclusions: Findings from this study provided preliminary acceptability of a novel online resource to address the unmet educational needs of people experiencing an eating disorder during the menopause transition. Overall positive feedback on the potential for the resource to improve knowledge and empower treatment-seeking was provided by women with lived experience.

Background: Adolescents, particularly vulnerable during puberty, often face heightened concerns about dieting and body image. Transfeminine youth, especially in Asian cultures, are understudied in this context. This study investigates eating disorder risks among Thai transfeminine youth and compares to cisgender females, focusing on the association with body dissatisfaction. This study aims to explore 3 objectives: (1) to assess and compare the prevalence of eating disorder risks between Thai transfeminine youth and cisgender females; (2) to examine the link between body dissatisfaction and eating disorder risks; (3) to identify risk factors associated with abnormal eating disorder screening outcomes.

Method: This is a cross-sectional comparative study conducted between September 2021 and October 2022. The study questionnaire includes Thai version of the Eating Attitude Test-26 (EAT-26) to assess the risks of eating disorders and Thai version of the Body Image Concern Inventory (BICI) to assess body dissatisfaction. The questionnaire was distributed through social media platforms to transfeminine and cisgender females, aged 12-25 years. The correlation between eating disorder risks and body dissatisfaction was analyzed with linear regression, while the comparisons between transfeminine individuals and cisgender female groups were analyzed with Wilcoxon rank-sum test.

Results: The study included 241 transfeminine individuals and 388 cisgender females, median age 19.0 years (interquartile range [IQR] 18-21) and 18 years (IQR 16-20), respectively. Ninety (37.3%) transfeminine individuals had an EAT-26 score ≥ 20, suggesting concerns for dieting and eating behaviors, compared to 70 (18%) cisgender females (p < 0.001). Risk factors for EDs included obesity (odds ratio [OR] 3.22, confidence interval [CI] 1.36-7.6) and low income (OR 3.66, CI 1.59-8.4). Protective factors were negligible exercise (OR 0.24, CI 0.09-0.66), gender identity disclosure (OR 0.27, CI 0.1-0.77), and high levels of happiness (OR 0.85, CI 0.73-0.98). There is a significant correlation between the positive eating behavior screening and the body dissatisfaction scores.

Conclusions: Transfeminine youths show significantly higher concerns about dieting, body weight, and eating behaviors than their cisgender females, highlighting the unique challenges they face. These results emphasize the needs for targeted screening, health care access for treatment and support for eating disorders in transfeminine youths.