Eating Disorders最新文献

The aims of this quality improvement programme were to enable providers of mental health in-patient services for children and young people in England to review their prescribing practice alongside the views and experiences of children, young people and their parent carers. Three online tools were developed. First was a medication census tool to be completed by provider clinicians to capture prescribing practices around psychotropic medication. The two other online tools were questionnaires that provided an opportunity for inpatient children and young people and their parent carers to express their views of the medication. 193 children and young people had a primary diagnosis of eating disorders. Antidepressants were the most widely prescribed (56%), followed by antipsychotics (41%), benzodiazepines, and antihistamines as sedatives (18%) and hypnotics (11%). Of those receiving regular psychotropic medications, 67% were prescribed two or more. Both the children and young people and their parent carers expressed concerns about the high level of psychotropic medication, the number of prn administrations, the number of psychotropic medications prescribed and the extent of side effects. Psychotropic medications are widely prescribed both on a regular and on a prn basis for children and young people with eating disorders in mental health in-patient services.

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.

While diagnostic pathways for identifying Autism in eating disorder (ED) populations have been developed, the field continues to lack validated psychometric tools to measure EDs for use in the Autistic population. Many commonly used measures for EDs potentially lack validity and reliability in the Autistic population limiting theoretical and practical advancements in the field. This paper outlines current conflicts in autism and ED research and how these can be addressed through psychometric methodology. We discuss: (1) the lack of differentiation between ED pathology and Autistic eating behaviours, as well as the limited inclusion of autism-specific mechanisms in existing tools; (2) the subsequent theoretical and practical implications for researchers, clinicians, and Autistic people; and (3) future directions for psychometric research. Scholars are encouraged to employ participatory designs with autistic people before carefully considering which analytical strategies are used in the Autistic population.

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.

Early intervention is key to improving prognosis for youth with eating disorders (EDs). Caregiver groups may be an effective way to intervene early in the treatment of youth with EDs, in conjunction with speciality medical care. A 12-session online caregiver skills group (CARE Skills Group) was designed and offered to caregivers of youth with recent onset, newly diagnosed restrictive EDs at two different Canadian sites. The CARE Skills group integrated family-based treatment (FBT) principles and was led by experienced ED clinicians. The group was feasible, with some preliminary evidence that youth whose caregivers participated in the CARE Skills Group benefited in terms of weight restoration. The CARE Skills Group model represents a brief, and replicable early intervention model that has potential utility for implementation in community-based ED settings.

Eating disorders (EDs) are prevalent mental health conditions that occur globally and affect all population subgroups. Despite their severity and widespread impact, EDs are frequently underdiagnosed and undertreated, particularly among individuals from minoritized racial and ethnic backgrounds, and groups that have been historically excluded from ED research. Early intervention (EI) has been shown to improve outcomes by reducing untreated illness duration, yet its implementation remains limited. This commentary examines patient-, clinician-, and systemic-level barriers to the timely detection and treatment of EDs, with an emphasis on how these barriers impact individuals from minoritized backgrounds. Evidence-based strategies to improve access to EI are also discussed as pathways to more equitable and effective care. Increasing access to EI and culturally informed treatments is essential to mitigating the burden of EDs and improving outcomes across populations.

We examined associations between potentially traumatic events (PTEs) and lifetime eating disorders (EDs) in the Eating Disorders Genetics Initiative-Mexico [EDGI-MX; N = 298; 174 cases, 124 controls, ages 13-78 years (M = 28.9 SD = 11.3), 81% cisgender women]. ED diagnoses and symptoms were from an online questionnaire capturing DSM-5 diagnoses via algorithm; PTEs were assessed with the Life Events Checklist for DSM-5; and depression, anxiety, and obsessive-compulsive (OC) symptoms with validated self-report measures. Logistic regressions and analyses of covariance were adjusted for age and gender. PTEs were reported by 75% of cases and 53% of controls (adjusted odds ratio [aOR] 3.6; 95% confidence interval [CI] 2.04, 6.62), including fire/explosions (13.6; 1.30, 141.76), transportation accident (2.1; 1.13, 4.06), serious accidents (10.0; 2.03, 49.64), sexual assault (5.9; 2.57, 13.91), other uncomfortable sexual experiences (3.2; 1.68, 6.41), and other stressful event (4.3; 1.95, 9.76). Although PTEs were not significantly associated with greater depression, anxiety, or OC symptoms in cases, these co-occurring symptoms may still be relevant clinically. Results highlight the importance of assessing PTEs in Mexican individuals with EDs and encourage exploration of timing of PTE exposure to clarify their role in ED development and course.

Dialectical behaviour therapy (DBT) has a developing evidence base for treating complex multi-diagnostic eating disorder presentations, including for individuals with long-standing eating disorders. A retrospective analysis of pre- and post-test data collected at 12 months from 16 adult participants in a "DBT for Multi-diagnostic Eating Disorders" (MED-DBT) programme run in New Zealand was conducted. Psychological outcomes were assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21) and Difficulties with Emotion Regulation Scale (DERS). Clinical indicators consisted of body mass index (BMI) and scores on the Eating Disorder Examination Questionnaire (EDE-Q). Significant differences were found for difficulties with emotion regulation scores (U = 8.571, p = .007), eating disorder examination questionnaire global scores (U = 47.5, p = .003), and anxiety scores (U = 42.0, p = .040), favouring those who completed the 12 months of the MED-DBT programme including the skills group. No significant differences were found for depression or stress symptoms. BMI increased for those who completed 12 months of the programme (Mdn = 1.265) and decreased (Mdn = -.580; U = 6.0, p = .019) for non-completers. The findings suggest that completing 12 months of MED-DBT including the group component may result in clinically meaningful change when compared to non-completion. Although participants were still experiencing eating disorder symptoms at the end of 12 months, these were significantly reduced and were paired with improved emotional wellbeing.

Recent prospective studies identified risk factors that predict future onset of anorexia nervosa (AN), but none have differentiated between those predicting restrictive (AN-R) versus binge-eating/purging (AN-BP) AN subtypes. Identifying shared versus unique risk factors may clarify whether these subtypes reflect distinct subtypes of AN or phases of the same disorder. This exploratory study combined data from four eating disorder prevention trials involving young women at risk for eating disorders (N = 1,952, mean age = 19.7 years) and collected annual diagnostic data over a 3-year follow-up. We assessed which baseline variables predicted future onset of AN-R and AN-BP, including subthreshold cases classified as Other Specified Feeding and Eating Disorder. Over 3-year follow-up, 34 participants developed AN-R and 24 developed AN-BP. Elevated negative affect and low BMI emerged as shared risk factors for both AN subtypes. Unique risk factors for AN-R were elevated thin-ideal internalization, fear of weight gain, and dietary restraint. Psychosocial impairment was the only unique predictor for AN-BP. The presence of distinct risk factors suggests that AN-R and AN-BP represent distinct subtypes rather than developmental stages of the same disorder. Shared risk factors should be prioritized as targets in prevention efforts for AN, particularly negative affect, and low prodromal BMI.

People who have experienced trauma are at higher risk of developing an eating disorder than those who have not suffered a traumatic event. While the association between posttraumatic stress disorder (PTSD) symptoms and anorexia nervosa (AN) symptomatology is widely discussed, research on complex PTSD (CPTSD) in relation to AN symptoms is scarce. In this context, we investigated the specific relationship between CPTSD symptoms (defined by ICD-11 criteria) and restrictive and binge-purging AN, in a clinical sample. We also tested, as possible explanatory mechanisms of these relationships, dissociative symptoms and emotion dysregulation. The questionnaire was completed by 91 participants, all patients in Austrian and German hospitals and clinics in departments for eating disorders, all with a diagnosis of AN. The sample comprised predominantly of women (80%) with a mean age of 20.84. Participants completed scales assessing CPTSD, restrictive AN, binge-purging AN, and dissociative symptoms, and emotion dysregulation. Our findings show that CPTSD symptoms are more strongly associated than PTSD symptoms with restrictive and binge-purging AN. Moreover, CPTSD symptoms are a significant predictor of both AN manifestations. Further findings indicate that dissociative experiences fully mediate the link between CPTSD symptoms and restrictive and binge-purging AN. However, emotion dysregulation did not mediate these relationships, as expected. Therefore, for patients diagnosed with anorexia nervosa, regardless of its type, screening and interventions for CPTSD symptomatology and dissociative experiences can contribute to treatment and recovery.