Eating Disorders最新文献

Avoidant/restrictive food intake disorder (ARFID) is distinct from other restrictive eating disorders in that body image disturbance or fear of weight gain do not drive restrictive eating. ARFID occurs across the full weight spectrum and youth with ARFID may still experience body weight/shape concerns, not necessarily pathological like body image disturbance is, but research is currently very limited. The current study examined how body weight/shape concerns vary across the full weight spectrum in youth with ARFID. As an exploratory aim, this study also assessed whether body weight/shape concerns differ by ARFID subtypes, age, and gender. Participants included 272 youth between the ages of 8 and 19 presenting for ARFID care at an urban pediatric hospital. Non-parametric Kruskal-Wallis tests were used to examine relations between weight/shape concerns and weight status (i.e. underweight, normal weight, overweight/obesity), ARFID subtypes, age, and gender. Results showed that youth with ARFID and overweight/obesity weight status endorsed greater weight/shape concerns than those with ARFID and normal and underweight statuses (p = .009). Youth who identified as gender identity other than male or female endorsed greater weight/shape concerns than those identifying as cis-male or cis-female (p = .01). However, there were no differences in weight/shape concerns by age or ARFID subtype. These findings demonstrate body weight/shape concerns among youth with ARFID, especially those with overweight/obesity weight status and who are gender diverse.

Trauma is a risk factor for eating disorders (EDs). Enhanced understanding of the pathways from trauma to EDs could identify important treatment targets. Guided by theory, the present study sought to replicate previous findings identifying posttraumatic stress disorder (PTSD) symptoms and shape/weight overvaluation as important pathways between trauma and ED symptoms and extend this work by investigating the role of posttraumatic cognitions in these associations. The sample included 825 female and 565 male post-9/11 veterans who completed cross-sectional survey measures of trauma, posttraumatic cognitions, PTSD symptoms, shape/weight overvaluation, and ED symptoms. Gender-stratified structural equation models were used to examine direct and indirect pathways from trauma exposure to EDs via PTSD symptoms and shape/weight overvaluation (replication) and posttraumatic cognitions (extension). Results suggested that trauma exposure was indirectly associated with ED symptoms via shape/weight overvaluation and posttraumatic cognitions. There was no indirect association between trauma exposure and ED symptoms via PTSD symptoms. Overall, findings from this study highlight the potential role of posttraumatic cognitions in understanding the association between trauma and ED symptoms. However, future longitudinal research is needed to verify the directionality of these associations and investigate cognitions as a potentially targetable risk mechanism in co-occurring trauma and EDs.

Research has found that difficulties in emotion regulation negatively impact mental health, whereas cognitive flexibility may promote stress resilience and positive mental health. Little is known about cognitive flexibility and emotion regulation in people with comorbid eating disorder (ED) and anxiety and stress disorders. A transdiagnostic ED population (N = 227) at an outpatient ED treatment facility completed several self-report instruments that measured cognitive flexibility, emotion regulation difficulties, posttraumatic stress disorder (PTSD) symptoms, and generalized anxiety disorder (GAD) symptoms upon admission. We investigated cognitive flexibility and emotion regulation differences for those with an ED without comorbidity and those with various combinations of comorbidity. In a one-way between-groups ANOVA, we investigated differences in cognitive flexibility for those with GAD, PTSD, neither, and both comorbidities. We found a statistically significant difference between these groups, with mean cognitive flexibility inventory scores being the lowest in the group with both comorbidities. However, when controlling for emotion regulation, a one-way between-groups ANCOVA indicated no significant differences in cognitive flexibility between comorbidity groups F(3, 222) = 1.20, p = .31 Partial η² = .02. Though self-reported cognitive flexibility levels differ among ED patients with and without comorbidities, it appears that these differences are better explained by emotion regulation. Therefore, addressing emotion regulation early in treatment for all individuals with EDs, regardless of comorbidity, is recommended as a future research focus to enhance treatment outcomes. Further research is needed to understand the impact of treating emotion regulation on ED treatment engagement, dropout, and effectiveness.

Even though appetitive traits are found to be related to thinness-oriented eating disorder (ED) symptomatology, findings are generally based on younger populations, such as children and young adults. Given both the global and China's rapidly aging population and the impacts of eating behaviors on malnutrition and geriatric health decline, identifying potential correlates for disordered eating is a public health priority. To our knowledge, the relationship between appetitive traits and thinness-oriented ED symptomatology in older adults remains unexamined. Given the strength of longitudinal designs in clarifying temporal directionality, this study investigated the prospective relationships of appetitive traits with thinness-oriented ED symptomatology among Chinese older adults. A sample of 202 Chinese older adults aged 56-76 years (45% women) participated in an online survey at baseline (T1) and one year later (T2). We conducted univariate and multivariable analyses to explore the prospective relationships of eight appetitive traits at T1 with thinness-oriented ED symptomatology at T2, controlling for covariates and outcome variables at T1. Univariate analyses showed that higher emotional undereating and higher satiety responsiveness at T1 were related to higher thinness-oriented ED symptomatology at T2. Multivariate analyses further revealed that higher emotional undereating at T1 was uniquely related to higher thinness-oriented ED symptomatology at T2. This study is the first to explore the prospective relationships of appetitive traits with thinness-oriented ED symptomatology in an older adult sample, underscoring the potential of targeting appetitive traits to promote eating behaviors in older adults.

Disordered eating (DE) often begins in early adolescence and follows heterogeneous developmental patterns. This study had two main objectives: (1) to identify homogeneous developmental trajectories of DE in adolescents aged 11-16 years and (2) to investigate factors predicting the likelihood of belonging to specific developmental trajectories. Data from a four-wave longitudinal study were analyzed, including participants aged 11 to 16 years (girls n = 167, boys n = 131). Using Growth Mixture Modeling based on the Children's Eating Attitude Test (ChEAT), three distinct developmental trajectories were identified: Low-Stable (16% of participants, exhibiting few DE symptoms that remained stable), High-Stable (36% of participants, consistently displaying high levels of DE), and Medium-Increasing (48% of participants, experiencing moderate DE that increased with age). Important gender differences emerged: more girls belonged to the High-Stable and more boys to the Low-Stable trajectory. Multinomial logistic regression analysis showed that being a girl, higher BMI, perceived social pressure for thinness, and perfectionism were associated with an increased likelihood of belonging to the High-Stable trajectory. Among the ChEAT subscales, Body Concerns was the only one to exhibit exclusively stable trajectories over time. In conclusion, strongly manifested DE symptoms tend to follow a stable course between ages 11 and 16, whereas individuals with moderate DE are more likely to experience an increase in symptoms during this period. Identifying developmental trajectories and their associations with risk factors can facilitate early detection of adolescents in need of urgent attention or targeted interventions and improve the planning of preventive measures.

Telehealth-based intermediate level of care programs for eating disorders largely yield comparable outcomes to in-person settings. However, extant research is primarily based on programs that transitioned to virtual formats in response to the COVID-19 pandemic, rather than those intentionally designed for remote delivery. Additional research is needed to evaluate programs specifically created for telehealth environments (i.e. intentionally-remote) and to understand how outcomes vary across age groups. In this retrospective chart review, clinical outcomes at end-of-treatment for 116 patients enrolled in an intentionally-remote eating disorder treatment program were analyzed, including eating disorder symptomatology, quality of life impairment, depressive symptoms, trait anxiety, body mass index, and percentage of ideal body weight. Mixed ANOVAs revealed significant improvements (ps < .001) from admission to discharge across all outcomes with large effects and no interaction by age, suggesting similar effectiveness across groups. By discharge, mean eating disorder symptomatology scores were below the clinical cut-off, quality of life impairment was within the minor to moderate range, depressive symptoms were mild, and weight restoration benchmarks were achieved for all age groups. While these findings support the potential of remote care as an accessible means of offering effective eating disorder treatment, further research is needed to determine generalizability to diverse populations, assess the impact of program features, and examine longitudinal outcomes.

Background: Transgender and nonbinary (TGNB) individuals are at an increased risk for developing eating disorders (EDs) and ED-related symptoms. Despite this heightened vulnerability, research on clinical interventions is limited. This scoping review aims to map the extent and type of existing evidence related to clinical care and interventions for TGNB individuals with eating pathologies, while also focusing on the process and course of treatment at the individual level.

Methods: A scoping review was conducted following the PRISMA-ScR guidelines. PubMed/Web of Science/(EBSCO)PsycINFO was searched for studies on TGNB individuals with EDs/ED-related symptoms published until 27/06/2023. We included primary research studies with detailed information on treatment and clinical course (protocol: https://osf.io/crhga).

Results: Twenty-one articles encompassing 32 case reports were included. The results were organized into five timeframes: studies published before 2004 (k = 2); between 2004 and 2008 (k = 1); 2009-2013 (k = 0); 2014-2018 (k = 10); and 2019-2023 (k = 8). Interventions ranged from psychotherapy, gender-affirming hormones and surgery, nutritional counseling, to pharmacological treatments. Reported outcomes varied, with some studies showing improvements in body dissatisfaction and ED symptoms' reduction, while others highlighted clinical challenges such as frequent relapses and co-existing mental health conditions.

Conclusion: This scoping review highlights the heterogeneity of stories of clinical care in TGNB individuals with eating pathologies, warranting individualized treatment approaches. Early studies often pathologized gender identity and used non-affirming language, whereas more recent studies emphasize inclusive, gender-affirming approaches. This evolution reflects a growing recognition of the unique challenges faced by TGNB individuals who seek help for EDs. Future research should overcome barriers to accessing care.

Anorexia nervosa (AN) is a serious health condition with insufficient treatment options. Radically Open Dialectical Behavior Therapy (RO-DBT) offers a new treatment approach targeting maladaptive overcontrol, a proposed underlying mechanism in AN. This study evaluated the feasibility, acceptability, and the preliminary efficacy of a 32-week standard RO-DBT intervention for individuals with AN in an outpatient setting. Twenty-three participants with AN (median age 20 years; median illness duration 5 years; 95.7% female) were included. Feasibility was demonstrated by a high retention rate (83%) and satisfactory completion of outcome measures, while acceptability was demonstrated by high treatment satisfaction. Participation in RO-DBT was associated with significant reductions in eating disorder psychopathology (95% CI: 0.34-1.45, Cohen's d = 0.90), significant increase in BMI (95% CI: 0.22-1.24, Cohen's d = 0.74), and increased use of the emotion regulation strategy cognitive reappraisal (95% CI: 0.19-1.20, Cohen's d = 0.70). These findings suggest that RO-DBT is a feasible, acceptable, and potentially effective treatment for AN.

Mentalizing refers to an individual's capacity for inferring intentions, thoughts, and emotions from verbal and nonverbal cues. Impairments in mentalizing are well established in anorexia nervosa (AN). It is unclear, however, whether these deficits only occur in the acute phases of AN (state-like), or if deficits remain once remission has been achieved (trait-like). The current study aimed to determine the predictive value of the severity of AN in determining the severity of mentalizing deficits and whether mentalizing differs in acute and recovered stages of AN. The final sample comprised of 161 participants aged 18-30. Participants were allocated to the acute-AN group (BMI under 17, n = 15), remission-AN group (BMI over 17 with previous history of AN, n = 64) or the general population control group (no history of AN, n = 82). Participants provided demographic information and completed a battery of online tests and surveys. No significant differences were found on mentalizing between the acute and remission groups. The control group demonstrated significantly better mentalizing than the remission-AN group. Severity of AN (measured by BMI) was a significant predictor of mentalizing when measured objectively but not subjectively. The findings suggest no categorical improvement in mentalizing following remission and demonstrated mentalizing improvements as BMI increased, suggesting mentalizing deficits may be trait-based and observable in AN regardless of stage of illness.

Though effective evidence-based treatments for child and adolescent eating disorders exist, there are significant barriers for families looking to access this care. One potential solution is the development of interventions, such as Family-Based Treatment for Primary Care (FBT-PC), that can be delivered in more accessible settings by primary care providers. FBT-PC has been evaluated in one health system in the Midwest United States and found to have a large effect on patient outcomes and comparable rates of retention and hospitalization to gold-standard FBT. To have maximum reach, however, FBT-PC needs to be adaptable for a wide range of primary care settings with different patient populations and clinical needs. We describe the adaptation of FBT-PC for a unique healthcare setting, including adjustments to context, content, and training. Findings suggest that the adapted intervention is acceptable to providers for use with a diverse patient population.