Journal of Eating Disorders最新文献

Background: Caring for someone with anorexia nervosa is associated with high levels of carer burden and burnout, however, there is a lack of research into caring for individuals who have anorexia nervosa and are also autistic, despite high levels of co-occurrence. This study aimed to offer an in-depth exploration of experiences for this group of caregivers.

Methods: Semi-structured interviews were conducted with six parents with an autistic daughter who had experienced anorexia nervosa. Data was analysed using Interpretative Phenomenological Analysis which enabled in-depth exploration of carers' lived experience.

Results: Three themes and seven sub-themes were identified. These explored the experience of eating disorders services as largely unprepared to work with dual diagnosis; the impact of their daughter being autistic on carers' experience of anorexia nervosa treatment and recovery, with variation depending on several factors; the journey of parenting through anorexia nervosa, and changes to parenting as a result.

Conclusions: This adds to our understanding of the lived experience of this group of carers, highlighting a need for early detection of autism spectrum conditions, enhanced staff understanding of autism spectrum conditions, tailored treatment, and specific carer support for this group.

Background: Only 30% of individuals with eating disorders receive specialized treatment. While preliminary evidence suggests that telehealth-delivered, remote eating disorder treatment may offer improved accessibility with similar effectiveness to in-person treatment, research on these services remains limited, particularly regarding the communities that are disproportionately affected by barriers to standard care. This scoping review sought to map the existing research on real-world patient outcomes in remote eating disorder treatment, identify knowledge gaps, and prioritize areas for future studies.

Methods: This review followed the Joanna Briggs Institute methodology for scoping reviews. It comprises observational evaluations of telehealth-delivered, remote eating disorder treatment conducted in routine clinical settings. An electronic database search was performed in PsycINFO, PubMed, and ProQuest Dissertations & Theses Global in August 2024 and updated in September 2025.

Results: Following the search and screening process, 27 articles, comprising six case reports and 21 cohort/case series designs, were deemed eligible for inclusion. Remote treatments evaluated differed across level of care, therapeutic modalities, provider types, dosage, and adjunctive technologies used. Just under half of the studies compared outcomes from remote and in-person treatment, while the remainder examined remote treatment alone. Articles were published between 2011 and 2025 and, when excluding case reports, nearly 60% evaluated programs that rapidly transitioned to remote delivery due to COVID-19. While demographic reporting was limited and inconsistent, available information indicated that participants ranged from three to 75 years old and were predominantly White, cisgender women/females diagnosed with anorexia nervosa. Though preliminary, findings tentatively suggest that remote eating disorder treatment can yield improvements across core outcome domains, largely comparable to in-person settings. Less is known about how outcomes may differ across demographic groups.

Conclusions: Overall, this body of literature remains small and characterized by limitations and inconsistencies, including differences in the treatment services evaluated as well as disparities in study design, methodology, and reporting. Utilization of remote treatment by historically excluded groups remains low, calling for further reflection around its accessibility for target communities. Additional studies with more rigorous, intentional designs are needed. The field would also benefit from standardization in relation to data collection and reporting to allow for better synthesis of findings.

Background: Overcontrol is a transdiagnostic phenotype which has been associated with restrictive eating disorders and depression. It is characterised by traits such as cognitive and behavioural inflexibility, risk aversion, suppression of emotional expression, reduced reward sensitivity and higher temperamental anxiety. Two aspects of the overcontrol phenotype (inflexibility and the suppression of emotional expression) have been particularly linked with poorer mental health. Additionally, social connectedness has been shown to protect against mental health symptom severity. The current study aimed to test whether the relationship between these factors and mental health symptom severity, namely, eating disorder and depression, is mediated by social connectedness.

Methods: Routine data were collected for adolescents with restrictive eating disorders presenting to either outpatient or intensive day programme treatment in a specialist eating disorder service. Four cross-sectional mediation analyses were planned. The first two models aimed to test the mediating role of social connectedness on the relationship between inflexibility (model 1) and the suppression of emotional expression (model 2) on eating disorder symptom severity. The second two models aimed to test the mediating role of social connectedness on the relationship between inflexibility (model 3) and the suppression of emotional expression (model 4) on depression symptom severity. Baseline weight and comorbid mental health symptom severity were controlled for in each model.

Results: The sample consisted of 109 adolescents (mean age = 15.21 years, 96.3% female). Current findings indicate that social connectedness did not statistically mediate the relationships between inflexibility and eating disorder symptom severity (model 1; Path ab β = .02, 95% bootstrap CI 0.0002-0.05). The planned analysis examining the relationship between the suppression of emotional expression and eating disorder symptoms (model 2) was not tested as the variables did not significantly correlate. Findings also indicated that social connectedness statistically mediated the relationships between both inflexibility (model 3; Path ab β = .82, 95% bootstrap CI 0.33-1.40) and the suppression of emotional expression (model 4; Path ab β = .38, 95% bootstrap CI 0.13-0 .69) on depressive symptoms.

Conclusions: Findings suggest targeting social connectedness, as is the case in Radically Open Dialectical Behaviour Therapy (RO DBT), may be a useful way to improve treatment outcomes for young people with restrictive eating disorders and co-morbid depressive symptoms. This fits with qualitative data that shows that taking a holistic approach during treatment, as opposed to being overly symptom focused, is needed and valued by young people and their family members.

Objectives: Research supports a protective role of self-compassion in guarding against disordered eating, which is especially prevalent in emerging adults (ages 18-25 years old). This set of two studies explored the relevance of self-compassion to emerging adults, expectancies of the impact of having a self-compassion mindset on disordered eating, and the prospective and concurrent acceptability and feasibility of a single-session online workshop targeting self-compassion skills in emerging adults with disordered eating.

Methods: Study 1 examined emerging adults' (n = 536) understanding of self-compassion and expected impact of having a self-compassion mindset on disordered eating, along with prospective workshop acceptability. Study 2 explored the concurrent feasibility and acceptability of the single-session workshop in a large and demographically diverse sample of emerging adults endorsing current disordered eating (n = 515).

Results: Study 1 found that emerging adults understood the concept of self-compassion and appreciated its actual importance in their lives and perceived importance in the lives of others (i.e., peers, parents). Emerging adults with disordered eating expected self-compassion to positively impact their disordered eating symptoms. Study 2 found the online workshop to be feasible and acceptable to emerging adults with disordered eating, as indicated by adequate treatment recruitment and retention, good comprehension of workshop content, and positive expectancies that the self-compassion skills learned would have a positive impact on disordered eating.

Conclusion: A workshop building self-compassion skills is relevant to emerging adults and could be protective for those with disordered eating. Future work to examine the efficacy of the workshop appears warranted. Self-compassion can serve a protective role in guarding against the development of disordered eating. The first study explored how relevant self-compassion is to emerging adults and how much they believe having a self-compassion mindset can impact disordered eating. The second study explored how preferable a one-time online workshop targeting self-compassion skills would be to emerging adults with disordered eating. Emerging adults understood what self-compassion is and appreciated its actual importance in their lives. Additionally, emerging adults expected that having a self-compassion mindset would positively impact their eating disorder symptoms. Further, the online workshop was feasible and acceptable to emerging adults with disordered eating. A workshop building self-compassion skills may be protective for emerging adults with disordered eating.

Background: Anabolic-androgenic steroids (AAS) are used to achieve a muscular and lean body to align with current ideals for boys and men. Identifying associations with intentions to use AAS, a precursor to actual use, is critical for prevention efforts. This study aimed to examine whether boys and men with a probable eating disorder or probable muscle dysmorphia have stronger intentions to use AAS, and whether these intentions differ between these conditions.

Methods: Data from a sample of 1,515 participants from the Study of Boys and Men who had never used AAS were analyzed. To address the study aims, one adjusted linear regression analysis was conducted along with post-hoc Wald tests.

Results: Probable anorexia nervosa/atypical anorexia nervosa, bulimia nervosa, and muscle dysmorphia were associated with greater intentions to use AAS compared to those with none of these conditions. Post-hoc Wald tests revealed that there were no significant differences in intentions to use AAS between those with probable anorexia nervosa/atypical anorexia nervosa, bulimia nervosa, and muscle dysmorphia; however, there were significant differences between these conditions and probable binge-eating disorder.

Conclusion: The findings from this study add to a growing literature underscoring similar muscularity-oriented features across anorexia nervosa/atypical anorexia nervosa, bulimia nervosa, and muscle dysmorphia. Assessment of intentions to use AAS may be warranted among boys and men with eating disorders and muscle dysmorphia to ensure the provision of prevention and early-intervention strategies.

Background: Schema Therapy is an integrative psychotherapy model with a growing evidence base in the successful treatment of eating disorders (ED). To specifically assess schema modes in ED, the Schema Mode Inventory for Eating Disorders - Short Form (SMI-ED-SF) was developed but its English adaptation is still lacking.

Objective: The aim of this study is to evaluate the psychometric properties of the English version of the SMI-ED-SF (EN-SMI-ED-SF) within a community sample and to explore its relationship with ED conditions and personality traits.

Method: An observational design was used, recruiting participants from the general population and specialized clinics for ED treatment. A confirmatory factor analysis was performed to test its factorial structure. A multivariate analysis of variance was conducted to ascertain differences between ED conditions on the dimensions of the EN-SMI-ED-SF. Lastly, the relationship between schema modes and personality traits was explored.

Results: The EN-SMI-ED-SF demonstrated excellent fit indices, with robust validity and reliability for measurement of schema modes. Maladaptive schema modes were systematically higher in ED compared to non-ED individuals, and adaptive schema modes were lower in ED groups compared to non-ED individuals. Whereas maladaptive schema modes showed the strongest positive correlations with neuroticism, adaptive modes were strongly correlated with psychological flexibility.

Discussion: The EN-SMI-ED-SF demonstrated robust psychometric properties, indicating its validity and reliability for assessment of schema modes. The results provide strong evidence for the role of schema modes in ED pathology, and their association with key personality correlates and the protective function of psychological flexibility.

Background: Intensive community treatment (ICT) and home-based treatment (HBT) have emerged as valuable alternatives to institution-based intensive treatments (inpatient or day patient) for severe mental illnesses. Although potential benefits of ICT and HBT for eating disorders (EDs) have been proposed, this area of research remains largely unexplored.

Method: A scoping review was conducted to map the available literature. Four databases (PubMed, PsycInfo, MEDLINE, Web of Science), grey literature, and trial registries were searched. Sources were included if they presented treatments offering more than two planned therapeutic contacts per week for at least part of the program, excluding physical monitoring contacts, for patients diagnosed with any ED across all ages.

Results: Forty-six sources met the inclusion criteria (ICT: n = 31; HBT: n = 15), with most studies from Europe (n = 23) and the USA (n = 18). Among these, 28 reported quantitative data, six reported qualitative data, and three employed a mixed-methods approach. The remainder were either protocol papers or service descriptions only. The majority focused on anorexia nervosa (AN) or mixed EDs, with varying study designs and predominantly low to moderate evidence quality. There were no randomized controlled trials. HBTs primarily targeted children and adolescents with AN, emphasizing family-based approaches, while ICTs exhibited greater variability in age groups and diagnoses, frequently combining cognitive behavioral and dialectical behavioral therapies, often alongside family-based components for children and adolescents. Despite high variability in design, quality, and measurements, studies frequently reported improvements in clinical outcomes. Programs were often described as feasible and acceptable, noting patient satisfaction, strong adherence, and cost-effectiveness due to reduced hospital admissions.

Conclusions: Even though there was variability in implementation and methodologies, ICTs and HBTs appear to be promising alternatives to traditional institution-based intensive treatments. Future research requires higher-quality large-scale randomized trials with improved reporting of treatment characteristics and outcomes to enable robust investigations of effectiveness.

Background: Medical students are exposed to multiple stressors that increase their vulnerability to mental health disorders, including eating disorders (ED). Despite growing concern, limited data are available in France regarding ED symptoms and associated psychosocial, behavioral, and environmental factors in this population.

Objectives: To (1) estimate the risk of ED symptoms among French medical students according to gender and academic stage; (2) identify associated risk factors, including psychological, social, and economic determinants; and (3) explore relationships between ED symptoms and mental health indicators.

Methods: A nationwide cross-sectional survey was conducted from June to July 2024 among medical students in France, from the second year of training through residency. Participants completed a questionnaire assessing sociodemographic characteristics, mental health, experiences of humiliation and sexual violence, risky behaviors, and healthcare access. ED symptoms were screened using the French version of the SCOFF questionnaire (cutoff ≥ 2). Multivariable logistic regression was used to identify factors independently associated with ED symptoms.

Results: Among the 7506 respondents included in the analysis, the overall estimated risk of ED symptoms was 26.2% (95% CI [25.2-27.2]), with significantly higher rates among women (30.9%) and non-binary students (26.0%) compared to men (14.4%) (p < 0.0001). Estimated risk of ED symptoms decreased with academic progression: 36.8% in pre-clinical students, 31.2% in clinical students, and 25.2% in residents (p < 0.001 for trend). In multivariable analysis, ED symptoms were associated with female or non-binary gender, earlier academic stage, anxiety, depression, suicidal ideation, alcohol misuse, tobacco use, experiences of humiliation, sexual harassment or assault, financial hardship, and having forgone healthcare due to financial or confidentiality-related barriers.

Conclusion: ED symptoms are highly prevalent among medical students, particularly women, gender minorities, and students in the early years of training. This burden is compounded by mental health symptoms, exposure to violence, financial insecurity, and care avoidance. These findings underscore the need for targeted, multidimensional prevention strategies and easily accessible mental health services tailored to the needs of medical students.

Objective: This study aimed to elucidate how psychological distress, self-control, and sustainable healthy eating behaviors interact to shape food addiction, by simultaneously modeling their direct and indirect effects in adult population.

Methods: A cross-sectional survey was conducted with 985 adults (mean age: 28.8 ± 10.9) from community health centers in Elazığ, Turkey. Standardized instruments measured depression, anxiety, stress (DASS-21), self-control, sustainable healthy eating, and food addiction (YFAS). Statistical analyses included logistic regression and structural equation modeling (SEM).

Results: Food addiction prevalence was 34.9%. Individuals with food addiction had significantly higher mean depression, anxiety, and stress scores, and lower self-control (37.1 ± 4.3 vs. 40.2 ± 4.3, p < 0.001) and sustainable healthy eating scores (15.0 ± 3.9 vs. 17.6 ± 4.7, p < 0.001) compared to those without addiction. Logistic regression indicated that anxiety (OR[95% CI] = 1.27 [1.20-1.34]) was the strongest predictor, while higher self-control (OR = 0.92[0.88-0.95]) and sustainable eating (OR = 0.94[0.90-0.97]) reduced risk. The final model explained 44% of the variance. SEM showed that self-control and sustainable eating behaviors significantly mediated the relationship between stress and food addiction.

Discussion: Anxiety exerts the strongest direct influence on food addiction, while self-control and sustainable dietary habits serve as key mediators, particularly in the stress-food addiction pathway. These findings underscore the need for multidimensional interventions that integrate psychological and behavioral strategies to effectively prevent and manage food addiction.

Background: The involvement of a caregiver is fundamental in the process of caring for a person with eating disorders (ED). The aim of this study is to evaluate the functioning of family unit and the emotional burden of caregivers of individuals with ED treated at an outpatient service.

Materials and methods: We contacted by telephone the caregivers of individuals in care at ED Centre of the AUSL-Modena and selected a sample of 50 caregivers of 42 individuals with ED, who provided their informed consent. The following scales were administered to caregivers: caregiver burden inventory (CBI), Beck's depression inventory (BDI), family assessment device (FAD), depression, anxiety and stress-scale (DASS-21). The following scales were administered to the care recipients: global assessment of functioning and clinical global impression severity scale. Demographic variables relating to the individuals with ED and their caregivers were collected: sex, age, employment situation, marital status, number of family members, living condition, family role. Clinical variables of care recipients were collected: body mass index, ED diagnosis, duration of ED and treatment and care at ED centre, medical complications, psychiatric comorbidities, substance use. The data was statistically analyzed.

Results: All caregivers were the parents of individuals with ED, in particular the mother (76%), and were employed. Caregivers reported a mild to moderate emotional burden in CBI and mild to severe depressive symptoms in BDI in 62% of cases. Family functioning reported by FAD scale was slightly altered in the areas of "communication", "roles" and "affective involvement". Most care recipients were females (98%), suffering from anorexia nervosa (85.6%) with an average age of 18.54 ± 4.74. At multiple linear regression, two statistically significant associations were underscored with CBI score (dependent variable): the age of individuals in a negative way and the psychiatric comorbidities of the individuals with ED in a positive way.

Conclusions: The parents of sons with ED represented their caregivers, who suffered from a mild emotional burden and depressive symptoms and lived in altered family functioning, especially in communications. Ensuring psychological support for the caregiver may be useful for improving both caring and family relationships.