Journal of Eating Disorders最新文献

Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition manifest by persistent instability in emotions, relationships, self-perception, and behavior. Eating disorders (EDs) are multifaceted neuropsychiatric conditions involving dysfunctional eating behaviors and psychological impairments, leading to adverse health outcomes and reduced quality of life. They are also associated with some of the highest mortality rates in psychiatry. EDs are typically classified to three main types: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Personality disorders are reflected as potential risk factors in the development of EDs. This study aimed to investigate the association between EDs and BPD among youth in Saudi Arabia.

Methods: A total of 433 participants aged 18-34 were included in this study. The research employed a quantitative, cross-sectional design, conducted between September and November 2024. Data were collected via an online questionnaire comprising three sections: demographic and health-related information, the McLean Screening Instrument (MSI-BPD) for BPD, and the Eating Disorder Questionnaire-Online (EDQ-O) for EDs. The design aimed to validate self-reported BPD symptoms and explore their association with EDs.

Results: The majority of the participants were female and educated Saudi persons who had no chronic illnesses; a notable 22.2% reported a formal diagnosis of BPD. The prevalence of EDs among the participants was found to be 67.9%. The findings revealed that BED was the most prevalent EDs among participants (45.03%), followed by BN at 22.17%, while AN was the least common (0.69%), indicating a higher occurrence of BED in the studied population. MSI-BPD screening results showed that 150 participants (34.64%) tested positive for BPD, with a higher prevalence among females (37.17%) compared to males (18.64%). A notably higher prevalence of EDs, particularly BED (74.67%) and BN (42.67%), was observed among participants with BPD, while AN remained rare in both groups. Pearson correlation analysis revealed statistically significant correlations (p < 0.01) between BPD and each EDs subtype (AN, BN, and BED), and the overall EDs symptom score.

Conclusion: This study indicates a notable comorbidity between BPD and EDs, particularly BED and BN, reinforcing the strong tendency of these disorders to co-occur.

Background: Access to eating disorder care for child and adolescent patients is challenging especially for patients from rural and/or lower-resourced health systems. In order to improve the availability of eating disorder treatment, we developed Family-Based Treatment for Primary Care (FBT-PC), for primary care delivery. Although research has shown that FBT-PC has a significant effect on young patients' eating disorder symptoms, the model has not been evaluated in rural settings. The purpose of this study was to establish proof-of concept of an adaptation of FBT-PC for rural settings, in preparation for a pilot feasibility/acceptability trial.

Methods: This study describes adaptations made to the FBT-PC protocol for implementation in small town and rural areas, as well as a case series of six children and adolescents with restrictive eating disorders who received FBT-PC in these settings.

Results: Findings from this case series establish proof-of-concept for FBT-PC implementation in rural primary care clinics. Specifically, the majority of patients either completed treatment (n = 3) or were referred to standard FBT (n = 1) which is consistent with the intention of FBT-PC as offering a lower-step eating disorder intervention.

Conclusions: These promising preliminary cases support further evaluation of FBT-PC in rural settings. Future research is needed to assess clinical outcomes and acceptability of the intervention. Trial Registration Clinicaltrials.gov #22-011880.

Background: Adolescents and caregivers from the Latino community face significant barriers to accessing treatment for eating disorders (ED) and disordered eating (DE) including cultural stigma, language barriers, and limited availability of culturally congruent care. Most existing ED/DE interventions were developed for non-Hispanic White populations, often limiting their application to families from the Latino community. To address this disparity, we are developing First Approach Skills Training- Trastornos de la Conducta Alimentaria (FAST-TCA), a culturally adapted version of FAST-DE, a brief workbook-based intervention for ED/DE designed for implementation in pediatric primary care.

Methods: This study used a community-engaged iterative process to inform the first steps of the cultural adaptation of FAST-DE into FAST-TCA. Two rounds of semi-structured focus groups were conducted with each of two stakeholder groups: Latino caregivers of adolescents with ED/DE histories and Latino adolescents with lived experience of ED/DE. Focus groups were recorded, transcribed, and analyzed using a codebook thematic analysis informed by a phenomenological perspective.

Results: Seven themes emerged from caregiver focus groups: psychological and social influences on ED/DE development, treatment experiences, family context, barriers to care, treatment priorities, caregiver empowerment, and workbook design and accessibility. Four themes were extracted from adolescent focus groups: navigating cultural identity and ED/DE, family dynamics and support, the need for sensitive and thoughtful content delivery, and ED/DE recovery experience reflections. Across both groups, participants emphasized the importance of accessible, culturally congruent, family-centered care and offered specific feedback that informed the revisions to the FAST-TCA workbook, including the incorporation of culturally relevant foods and expanded caregiver psychoeducation.

Conclusions: Focus group insights guided the development of the first draft of FAST-TCA, an initial cultural adaptation of FAST-DE. This study demonstrates the utility of community-engaged methods in enhancing the cultural relevance of ED/DE interventions. The next phase of the cultural adaptation will occur following the pilot implementation of FAST-TCA, where additional feedback from adolescents and caregivers will inform further refinement of the intervention.

Background: Anorexia nervosa (AN) is a severe psychiatric disorder with limited biomarkers for diagnosis and treatment monitoring. We investigated endocannabinoid system (ECS) dysregulation in AN through integrated epigenetic and genetic analysis of saliva.

Methods: We analyzed DNA methylation patterns of cannabinoid receptor 1 (CNR1) and fatty acid amide hydrolase (FAAH) genes, characterized genetic polymorphisms, and quantified expression of exosomal microRNAs targeting these genes in AN patients versus healthy controls.

Results: We discovered a novel bidirectional epigenetic dysregulation of the ECS: CNR1 promoter hypermethylation coupled with FAAH promoter hypomethylation. This dual-target mechanism systematically impairs endocannabinoid signaling by simultaneously reducing receptor availability while increasing endocannabinoid degradation. Compensatory miRNA responses (upregulated miR-342-3p, miR-23b-3p targeting CNR1; upregulated miR-4505, miR-1275 targeting FAAH) revealed dynamic regulatory attempts to counterbalance these primary epigenetic changes. This convergent pathway dysfunction demonstrates how multiple molecular mechanisms work in concert to dysregulate appetite regulation in AN. Combined biomarker panels showed superior diagnostic precision compared to individual markers.

Conclusions: Our findings establish this bidirectional epigenetic dysregulation as a central mechanism underlying ECS dysfunction in AN, providing mechanistic insights that identify novel therapeutic targets and advance precision medicine approaches for this challenging disorder.

Background: Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterised by the avoidance or restriction of food intake, associated with high sensory sensitivity, disinterest in eating, or fear of adverse consequences. It can lead to nutritional deficiencies, impaired growth, or psychosocial difficulties. Although recognition of ARFID has increased internationally, prevalence data in Portugal remain scarce.

Methods: This cross-sectional, descriptive observational study assessed the prevalence of ARFID in children aged 2-10 years attending a private outpatient clinic. Paediatricians applied DSM-5-TR diagnostic criteria during routine consultations. Parents completed online questionnaires, including the Children's Eating Behaviour Questionnaire (CEBQ) and the Child Feeding Questionnaire (CFQ).

Results: Of the 163 children assessed, ARFID was diagnosed in 3.1% of cases. Four of the five identified children were male (80%), with a mean age of 5.8 years (SD = 2.17). On the CEBQ, children with ARFID showed the highest mean scores on the food fussiness and satiety responsiveness subscales, indicating greater selectivity and heightened sensitivity to fullness. The lowest mean scores were observed in emotional overeating and desire to drink. On the CFQ, perceived responsibility and monitoring were the subscales with the highest mean values.

Conclusions: This study provides the first prevalence estimate of ARFID in Portuguese clinical practice. Although the small sample limits generalisability, the findings emphasise the need to raise awareness among both clinicians and parents to promote earlier recognition, thereby improving support for children and families and helping to reduce the long-term impact of ARFID.

Background: Grazing is a disordered eating behavior associated with poor weight control, increased eating disorder psychopathology, and psychological difficulties in adults. Unfortunately, little is known about grazing in adolescence, which is aggravated by the lack of validated measures for this population. This study investigates the psychological aspects of grazing in adolescence and provides psychometric support for a brief self-report measure, the Rep(eat)-Q.

Methods: A community sample of middle/high school students (n = 358, 55.6% females) and a clinical sample with overweight/obesity (n = 204, 59.8% females), completed a set of self-report questionnaires assessing eating and psychological variables including the Rep(eat)-Q. Weight and height data were also collected (Community: M_z-BMI = 0.39, SD = 0.98; Clinical: M_z-BMI = 2.39, SD = 0.74).

Results: Confirmatory factor analysis revealed an adequate fit [(χ2(107) = 389.77; p < 0.001; CFI = 0.99; TLI = 0.99; NFI = 0.99; SRMR = 0.062; RMSEA = 0.098] for a second-order (grazing) model with two first-order factors (repetitive eating and compulsive grazing subscales) with good reliability (0.85 < α < 0.91). Metric and scalar invariance were confirmed, allowing comparisons between samples. Compared with clinical adolescents, community adolescents reported higher scores on the Rep(eat)-Q total (Community: M = 1.86, SD = 1.30; Clinical: M = 1.53, SD = 1.35; t(559) = - 2.81; p = 0.005) and repetitive eating subscale (Community: M = 2.04, SD = 1.44; Clinical: M = 1.52, SD = 1.35; t(560) = - 4.24; p ≤ 0.001). The Rep(eat)-Q total score and subscales scores were significantly positively correlated with eating disorder psychopathology and inversely correlated with intuitive eating, suggesting good convergent validity (0.11 < r < 0.63). Similarly, adolescents scoring higher on grazing also present more psychological distress and poor cognitive and emotional functioning (0.15 < r < 0.50). Psychological variables (i.e., depression, anxiety, and negative urgency) explained 21.8% of the variance in the grazing score, independent of sex, age, and BMI z-score [F(6, 490) = 22.87, p ≤ 0.001; R² = 0.218].

Conclusions: The Rep(eat)-Q is a reliable self-reported measure for assessing grazing in adolescents. These findings provide further support for the conceptualization of grazing in the spectrum of disordered eating and psychopathology in adolescents.

Background: Atypical anorexia nervosa is an eating disorder that involves significant restriction of food intake leading to clinically significant weight loss despite remaining at a normal or above normal weight for age or height. Part of rehabilitation involves increasing calorie intake for nutritional rehabilitation and weight gain to an appropriate percentage of ideal body weight, determined based on patient weight history. This report highlights the importance of considering how increased food intake in a previously malnourished patient can affect the metabolism of medications they are taking for the management of co-occurring psychiatric conditions, including the possibility of the emergence or re-emergence of tardive dyskinesia for a patient on an antipsychotic.

Case presentation: This case presents a 43-year-old female with a history of bipolar disorder type 1, controlled on lurasidone, admitted to an inpatient eating disorder unit for nutritional rehabilitation and weight restoration for atypical anorexia nervosa. Shortly after admission, despite no initial change in medication dosing, the patient began exhibiting symptoms of tardive dyskinesia. These symptoms were reduced once her lurasidone dose was decreased.

Conclusions: Nutritional rehabilitation likely has an impact on the metabolism of certain antipsychotic medications including lurasidone. More research is needed involving patients recovering from a restrictive eating disorder who are on antipsychotic medications and the frequency of increased side effects, including tardive dyskinesia, with refeeding.

Background: As climate change intensifies, ecological concerns and climate worry are becoming more prevalent, paradoxically driving both pro-environmental behaviors and mental health risks. Their impact on eating behaviors remains unclear. This study uses network analysis to examine the complex relationships between eating-related eco-concerns, climate change worry, sustainable dietary behaviors, and disordered eating in the general population.

Methods: The participants filled in the Eating-related eco-concern (EREC), the Eating Disorder Examination Questionnaire (EDE-Q), the Eating Habits Questionnaire (EHQ), Depression Anxiety and Stress Scale (DASS-21), the Climate Change Worry Scale (CCWS), and the Sustainable and Healthy Dietary Behaviors Questionnaire (SHDB). Network analysis was performed using R.

Results: The sample included 846 participants, 13.8% men, 84.3% females, 1.2% non-binary, and 0.7% undisclosed, with a mean age of 35.91 years. Network analysis revealed that EREC and SHDB represented the nodes with the greatest strength centrality. Positive associations emerged between EREC and CCWS, SHDB, and EHQ, as well as between SHDB and EHQ and between CCWS and DASS-21-Stress. Negative associations emerged between EREC and EDEQ, SHDB and DASS-21-Stress, and SHDB and CCWS.

Conclusions: Findings suggest that general heightened concerns about climate change and psychological distress may impede sustainable dietary behaviors, while specific ecological concerns over food choice may motivate such behaviors, albeit favoring disordered eating in terms of orthorexia nervosa symptoms. Longitudinal studies are needed to explore their evolution over time. Eating disorder specialists should consider climate-related distress, especially in environmentally conscious patients.

Background: Anxiety and eating disorder (ED) symptoms often emerge during adolescence and frequently co-occur, considerably impairing the physical health and psychosocial functioning. Previous research has largely focused on assessing only one direction of the association between anxiety and ED symptoms. Limited understanding exists regarding the potential bidirectional associations and the role of childhood household dysfunction (CHD) in this association. This study aims to examine the bidirectional association between anxiety and ED symptoms in adolescents and further explore whether CHD moderates this association.

Methods: This longitudinal study was conducted among students from nine high schools in China. A total of 8,703 participants (mean [SD] age at baseline, 15.89 [0.60] years; 47.4% female) completed the self-reported questionnaires at baseline (June-August 2023) and at a 4-month follow-up (October-December 2023). Anxiety symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale, and ED symptoms using the Sick, Control, One, Fat, Food questionnaire. Information on eight indicators of CHD was collected at baseline. Cross-lagged panel models (CLPM) were applied to examine the bidirectional association between anxiety and ED symptoms, and moderation analyses were performed to assess the moderating role of CHD. Bonferroni corrections were applied with significance thresholds adjusted for multiple testing.

Results: The CLPM results showed that anxiety and ED symptoms exhibit a bidirectional association, with anxiety at baseline predicted subsequent increased ED symptoms (β = 0.13, 95% CI = 0.11-0.15) and ED symptoms at baseline also predicted subsequent increased anxiety symptoms (β = 0.06, 95% CI = 0.04-0.08). The cumulative CHD score was positively associated with both anxiety (β = 0.07, 95% CI = 0.04-0.11) and ED symptoms (β = 0.06, 95% CI = 0.02-0.09) at follow-up, but did not significantly moderate their relationship. Individual CHD indicators demonstrated distinct moderating effects for boys and girls; none of these effects remained significant after Bonferroni correction.

Conclusions: These findings indicate that anxiety and ED symptoms reinforce each other over time, highlighting the potential value of integrated strategies to address both conditions simultaneously. Future research is warranted to clarify the mechanisms underlying this bidirectional association, explore additional moderating factors, and develop targeted prevention strategies.

Background: Evidence-based practice (EBP) for pediatric eating disorders (EDs), including the strongly recommended family-based treatment (FBT), is not always available to children, adolescents or emerging adults and their families. Our aim was to investigate clinician knowledge and perspectives of EBP, including FBT, and explore barriers and facilitators to its implementation.

Methods: Clinicians working in Western Canada who were engaged in care for pediatric EDs were invited to participate. A multimethod design was employed using an online survey and subsequent phone interview for data collection. Descriptive data was summarized using means and frequencies. Qualitative data was analysed using a mixed approach encompassing inductive and deductive techniques.

Results: Eighty-four clinicians completed the survey and 24 completed the interview. A total of 64% of clinicians providing therapy were offering FBT in their practice. Of these, 12.5% had no formal training in the modality. Clinicians identified a range of barriers and facilitators to EBP, including FBT, such as service-centered reasons (inadequate training, staff beliefs around which professionals should be involved, program mandates, and private practice therapists struggling to get other professionals on the 'same page' in FBT), clinician-centered reasons (desire to offer more holistic care, lack of inclusion of dietetics, belief that FBT was better suited to hospital settings), and patient/family-centered reasons (co-occurring conditions in parents or children, lack of financial privilege).

Conclusions: The barriers to delivering EBP, and low rates of formal FBT training indicate a need to improve capacity building efforts for pediatric ED clinicians, including improved access to training and consultation.