Eating Disorders最新文献

Objectification theory posits that self-objectification can lead to disordered eating, with significant positive correlations between self-objectification and eating disorder (ED) psychopathology found in women in both clinical and non-clinical samples. Maladaptive rumination is another process frequently associated with EDs, but its relationship with self-objectification and ED psychopathology needs further investigation. Our aim was to conduct a preliminary test to investigate whether maladaptive rumination mediated the relationship between self-objectification and ED psychopathology in women. Data were collected online from a general community sample of 243 women. Correlation and mediation analyses were undertaken. Significant positive associations were found between rumination, self-objectification, and ED psychopathology. Rumination significantly mediated the relationship between self-objectification and ED psychopathology, accounting for 20.52% of the variance, suggesting that a greater tendency to ruminate may contribute to ED vulnerability in those with high self-objectification. These preliminary findings may inform assessment and formulation of women presenting with ED psychopathology in addition to supporting psychological interventions (e.g. CBT or acceptance-based approaches), which can target both self-objectification and rumination processes. Future research involving replication with clinical samples is warranted to corroborate the relationship between these constructs, their impact on ED psychopathology over time and to investigate their utility in assessment and treatment approaches.

Anorexia nervosa (AN) is an eating disorder that is significantly associated with severely impaired physiological functions, multiple organ failure, and suicidal ideation. This study aims to estimate the global, regional, and national secular trends of AN burden based on Global Burden of Diseases (GBD) 2019 data. The pertinent data for AN were collected from the GBD Study 2019. The long-term trends of the burden of AN were analyzed in different Social Demographic Index (SDI) regions by Joinpoint regression, Age-Period-Cohort analysis, and the Estimated Annual Percentage Changes. This study found that the global burden of AN gradually increased over the past 30 years, with the highest burden remaining in high-income countries, but the biggest increasing trend was observed in Asian region. AN was more common in adolescents and young women, but it was growing rapidly in adolescents and young men. Disability-adjusted life years (DALYs) caused by AN was the highest in the age group of 15-24 years among all SDI levels. The risk of AN rapidly increased since the beginning of the twenty-first century apart from high SDI regions, and it was higher in later-born cohorts than the earlier ones in various SDI areas. Future studies could verify our findings by using individual-level data. Our findings could help policy makers around the world understand the burden of AN in their countries and develop appropriate health policies for prevention and early intervention for high-risk populations.

This study reports the outcome of a low intensity pre-treatment intervention (a guided e-health podcast) for patients with anorexia nervosa and bulimia nervosa, delivered between assessment and the start of the full outpatient treatment programme. A case series design was used. A total of 254 patients at a specialist eating disorder service were offered a pre-treatment three-week psychoeducational intervention (Keeping Myself Safe; KMS), and 203 undertook the intervention. The intervention consisted of six podcasts (107 mins), an accompanying workbook, and a follow-up review appointment. Body Mass Index and Eating Disorder Examination-Questionnaire scores were taken at assessment, end of the KMS intervention (mean duration = 21.9 days) and start of treatment (mean = 79.8 days post KMS intervention). Generalised Linear Mixed Models were used to test main and interaction effects (diagnosis x time). There were improvements on most variables following the KMS intervention. The effects were more pronounced for patients with bulimia nervosa across several measures. Pre-treatment guided e-health psychoeducational interventions can be associated with early attitudinal and behavioural change in patients with bulimia nervosa and anorexia nervosa whilst on the waiting list for treatment. They allow greater, affordable accessibility to effective psychoeducation and enhance potential engagement. More research is required to investigate the longer-term impact on retention and outcome, particularly in anorexia nervosa.

There is a notable overlap between autism and eating disorders (EDs), and autistic individuals may experience poorer ED treatment outcomes than non-autistic peers. To make meaningful change in this field, it is imperative that we actively engage in co-production of research, however there are currently no guidelines to support co-production with autistic people with eating disorders. This paper reports on best practice guidelines that were co-produced across a series of workshops bringing together autistic people with EDs, researchers, clinicians, third-sector organisations, and parents/carers. The guidelines are intended to be used as a foundation for future co-produced autism and ED research. By creating a trusted, ethical co-production relationship, we hope to generate more clinically meaningful and translatable research.

This study aimed to evaluate the efficacy of Acceptance and Commitment Therapy (ACT) in mitigating perceived stress, rumination, and distress tolerance among women diagnosed with Bulimia Nervosa (BN) in Ahvaz, Iran. A quasi-experimental pre-test-post-test design with a control group was employed. The target population consisted of all female BN patients referred to the Ahvaz Binge Eaters Association between February and May 2022. Patients were definitively diagnosed with BN by a clinical specialist using a structured clinical interview adhering to DSM-5 criteria. From an initial pool of 91 patients, 50 were randomly selected for participation and subsequently assigned to either the experimental or control group, with each group comprising 25 individuals. Pre-test analysis revealed no significant group differences in perceived stress, rumination, or distress tolerance among women with BN. However, post-test scores indicated a significant decrease in both perceived stress and rumination within the experimental group compared to the control group (p < .01). Furthermore, the post-test analysis demonstrated that ACT intervention significantly improved distress tolerance in women with BN (p < .01). These findings suggest that ACT may be a promising therapeutic approach for alleviating psychological distress and enhancing emotional regulation in individuals grappling with BN.

Peer support is a promising approach to increasing hope, engagement, and connection for those with eating disorders (EDs). Emerging literature explores peer mentors' experiences of providing support, suggesting that mentors often benefit from providing peer support, particularly when well trained and supervised. We conducted semi-structured interviews or focus groups with 15 individuals providing peer support (one-on-one, group, or chat) to individuals with EDs. We identified 3 themes using reflexive thematic analysis (RTA) through a critical realist lens. Participants emphasized the importance of ongoing training and support to help them deliver high-quality peer support. They highlighted the importance of value-alignment in this work in terms of organizational valuing of lived experience and alignment with social justice. Participants reflected on how doing this work contributed to a sense of "giving back" and providing the kind of support they wished they had experienced. Providing peer support was described as emotion work; a challenging and rewarding experience for peer mentors. Findings carry implications for integrating peer support into the continuum of care for EDs, providing insight into approaches that can support peer support delivery in a way that promotes safety for those providing and receiving it.

Cognitive-behavioral therapy (CBT) is the best examined treatment for eating disorders. However, previous meta-analyses of cognitive-behavioral therapy have not examined absolute outcomes, which are important from a clinical perspective. We updated a meta-analysis and conducted new searches in PubMed, Embase, PsycINFO and CINAHL. We included randomized trials comparing CBT with control conditions in adults with a diagnosed eating disorder. We used random effects models in all analyses. We included 36 trials with 44 comparisons between CBT and controls (2,809 participants), 22 trials on binge eating disorder (BED), 11 on bulimia nervosa (BN), and three on anorexia nervosa and mixed disorders. The overall effect of CBT compared to controls was g = 0.88 (95% CI: 0.71; 1.04), with high heterogeneity (I² = 74; 95% CI: 65; 81; PI: -0.06; 1.81) and no significant difference between BED and BN. Effects were smaller studies with low risk of bias. The absolute abstinence rate was 0.36 (95% CI: 0.31; 0.43) for CBT and 0.10 (95% CI: 0.08; 0.12) in controls. CBT is probably effective in the treatment of bulimia nervosa and binge-eating disorder, but there is also a large group of patients who do not respond sufficiently.

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

The Body Advocacy Movement (BAM) is a novel, cognitive-dissonance-based intervention designed to target fatphobia and anti-fat bias as mechanisms to drive reductions in eating disorder (ED) risk. Previous dissonance-based programs (i.e. the Body Project; BP) have successfully targeted thin-ideal internalization as an intervention mechanism. As burgeoning research indicates that fatphobia and anti-fat bias may play a central role in the maintenance of ED pathology, a focused intervention designed to target these constructs could bolster prevention efforts. The aims of this pilot study include confirming acceptability and feasibility of BAM and developing preliminary estimates of its effects on intervention targets, along with benchmarking these effects against the BP intervention. BAM was found to be accepted by participants and feasible to facilitate in a peer-led model. Preliminary results from 50 participants (BAM: N = 26; BP: N = 24) reveal small-to-moderate pre-to-post intervention effects on fatphobia, anti-fat bias, thin-ideal internalization, and eating pathology, which dissipated at 8-week follow-up. The BAM intervention has the potential to supplement the existing suite of ED prevention programs by specifically targeting anti-fat bias, though additional testing in larger and more diverse samples is necessary to clarify its impact on both hypothesized risk mechanisms and ED outcomes.

This study estimated the social and economic costs of body dissatisfaction and appearance-based discrimination (specifically, weight and skin-shade discrimination) in the United States (USA) in the 2019 calendar year. We used a prevalence-based approach and a cost-of-illness method to estimate the annual cost of harmful appearance ideals for cases of body dissatisfaction and discrimination based on weight and skin shade. Impacts on conditions/illnesses such as eating disorders that are attributable to body dissatisfaction, weight discrimination and skin-shade discrimination were identified through a quasi-systematic literature review, which captured financial, economic, and non-financial costs. For each impact attributable to body dissatisfaction or appearance-based discrimination, annual health system and productivity costs (or labor market costs) were primarily estimated by using a population attributable fraction methodology. Only direct costs that resulted from body dissatisfaction and appearance-based discrimination were included (for example, costs associated with conditions such as depression attributable to body dissatisfaction or appearance-based discrimination). In contrast, indirect costs (e.g. costs associated with a health condition developed following skin bleaching, which was undertaken as a result of body dissatisfaction) were not included. In 2019 body dissatisfaction incurred $84 billion in financial and economic costs and $221 billion through reduced well-being. Financial costs of weight discrimination and skin-shade discrimination were estimated to be $200 billion and $63 billion, respectively, and reduced well-being was estimated to be $206.7 billion due to weight discrimination and $8.4 billion due to skin-shade discrimination. Sensitivity testing revealed the costs likely range between $226 billion and $507 billion for body dissatisfaction, between $175 billion and $537 billion for skin-shade discrimination, and between $126 billion and $265 billion for weight discrimination. This study demonstrates that the prevalence and economic costs of body dissatisfaction and weight and skin-shade discrimination are substantial, which underscores the urgency of identifying policy actions designed to promote prevention.