Eating Disorders最新文献

Family-based treatment (FBT) is the recommended approach for adolescents with eating disorders (EDs), but long waitlists hinder its delivery. This study aimed to explore the feasibility and acceptability of a brief 5-week outpatient FBT psychoeducation group for parents/caregivers of adolescents with anorexia nervosa (AN). The secondary aim of this study was to examine its preliminary effectiveness of increasing parental self-efficacy and decreasing expressed emotion and accommodation of the eating disorder. Eighteen parents/caregivers of adolescents (n = 9; aged 9-18) with AN were recruited. Parental accommodation, parental self-efficacy, and expressed emotion were assessed at baseline, end of treatment (week 5), and 1-month follow-up (week 9). Qualitative interviews were collected weekly. Quantitative results were analysed using linear mixed modelling, while qualitative interviews underwent reflexive thematic analysis. Numerical evaluation of feasibility/acceptability included rates of enrollment, retention, and attendance. Parental self-efficacy significantly improved during treatment, with gains sustained at 1-month follow-up (p < .001). Parental accommodation also significantly decreased across treatment (p < .001) but significantly resurfaced at 1-month follow-up (p = .001). Qualitative results demonstrated high acceptability of the group; participants found this intervention to be helpful and better equipped them to address their child's ED after group completion. Feasibility/acceptability metrics showed moderate enrollment (75%), high retention (94.4%), and attendance (97%). A modified 5-week FBT group for parents/caregivers of adolescents with AN shows preliminary feasibility and acceptability, informing future FBT treatment planning and service provision for ED providers.

Perfectionism and flexible thinking are frequently reported as impaired in anorexia nervosa (AN), however, the role of perfectionism and cognitive flexibility in eating disorder (ED) symptoms is unclear. Further, it is unclear how individuals with AN may differ in these domains compared to the general community with high or low ED symptoms. Sixty-seven individuals with lifetime AN, 112 community controls with high ED symptoms (high ED-CCs) and 111 community controls with low ED symptoms (low ED-CCs) completed an online survey examining perfectionism, cognitive flexibility, and divergent thinking. Participants with lifetime AN and high ED-CCs showed significantly elevated perfectionism compared to low ED-CCs. Participants with lifetime AN also reported significantly poorer cognitive flexibility. No group differences were found for divergent thinking. A mediation analysis across the entire sample revealed that perfectionism mediated the relationship between cognitive flexibility and ED symptoms, but did not remain significant when only the AN group was included in the model. This study provides a greater understanding of self-reported cognitive flexibility and perfectionism in AN which can be used to enhance treatments that focus on improving specific thinking skills. Further, it highlights different types of perfectionism and provides potential avenues for treatment personalisation.

Cognitive Behavioural Therapy Ten (CBT-T) is a new intervention for non-underweight eating disorders (EDs), developed as a cost-effective alternative to current NICE recommended interventions. We present a mixed methods review of the implementation of CBT-T in a large moderate-severe adult ED NHS service. This includes qualitative feedback from clinicians and patients alongside data on outcomes. Clinician and patient feedback demonstrated CBT-T as realistic, feasible and acceptable to implement in NHS settings. Statistical analysis showed that CBT-T was effective across diagnoses on a range of measures. For anorexia nervosa (AN) and bulimia nervosa (BN), there was a significant reduction in concern around weight, shape and eating; with further reductions around eating restraint, total Eating Disorder Examination Questionnaire (EDE-Q) scores, and bingeing frequency. For BN, there were also significant improvements in psychological functioning and depression, with significant decreases in vomiting and exercise frequency. Findings demonstrate the usefulness of CBT-T as a cost-effective alternative intervention for non-underweight EDs and highlight areas for further research such as for binge eating disorder (BED).

The aim of this study was a systematic review and meta-analysis of the relationship between eating disorders and mortality. Based on this, eating disorders were investigated concerning all causes of mortality. Information sources including PubMed, Scopus, and Web of Science were used based on a systematic search. Google Scholar and Research Gate were also searched. The search in these databases started without a time limit and was done until December 2023. This search was done in English. The results extracted were pooled together based on the Standardized Mortality Ratio (SMR) with a 95% confidence interval. The random effects method was used to pool studies together. An analysis was performed based on eating disorders and mortality, and the relationship between three types of eating disorders and mortality was reported as subgroups. Sixty studies were included in the meta-analysis. The obtained results showed that eating disorders have a significant relationship with the risk of mortality; SMR was 4.42 (CI 3.55-5.50; Z = 13.31; p < .001; I² = 96.3%). Anorexia nervosa has a significant relationship with the risk of mortality, SMR was 5.31 (CI 4.15-6.79; Z = 13.30; p < .001; I² = 93.1%). For bulimia nervosa the risk of mortality was SMR 2.69 (CI 1.85-3.91; Z = 5.16; p < .001; I² = 66.6%). For eating disorders not otherwise specified the risk of mortality was SMR 2.50 (CI 1.45-4.33; Z = 3.28; p = .001; I² = 91.8%). From the findings of this research, it was determined how serious the risk of death is in patients with eating disorders. Therefore, it is necessary to pay more attention to this issue in the processes of prevention, screening, and treatment of eating disorders.

Global sleep disturbance is robustly linked with a subjective sense of loss-of-control over eating (LOC). Depressed mood has been proposed as a mechanism to explain the bi-directional relationship between sleep disturbance and LOC eating. The current study evaluated whether sleep disturbance indirectly affects LOC eating via depressed mood. Adults seeking treatment for a DSM-5 binge-spectrum eating disorder (e.g. bulimia nervosa, binge-eating disorder) were recruited (n = 79) and asked to complete self-report questionnaires assessing sleep disturbance and depression, and a semi-structured interview assessing LOC eating. Tests of indirect effects evaluated the effect of depressed mood on the association between global sleep disturbance and LOC frequency covarying for BMI and parent study. A significant indirect effect of depressed mood on the association between global sleep disturbance and frequency of LOC eating was identified (Est = 1.519, S.E. = 0.859, p = .033). The indirect effect of depressed mood on the association between sleep disturbance and LOC eating may indicate that depressed mood serves as a mechanistic link between sleep disturbance and LOC eating. The findings offer preliminary support for adjunctive treatments targeting both sleep disturbance and depressed mood for LOC eating. Future research should explore these pathways in a larger clinical sample.

TikTok, a social media platform with substantial youth engagement, has been used to examine eating disorder (ED) recovery; however, no studies have described the experience of ED treatment as told on TikTok. The purpose of this study was to describe content related to ED treatment using the hashtag #EDtreatment. The 100 most-viewed videos using #EDtreatment were downloaded, transcribed verbatim, and coded. Using qualitative thematic analysis, a coding framework was created; themes were generated and reviewed by coauthors until consensus was reached. Ultimately, 55 videos were included in the analysis. The videos included in the analysis had, in total, 15.6 million views, 3 million "likes", 36647 comments, and were shared by users 26,673 times. Themes generated included Aspects of Treatment, Interpersonal Relationships, Emotions and Psychiatric Comorbidities, and ED Experiences. Content ranged from uplifting and encouraging to negative and serious. Videos used dramatic reenactments, music, humor, and other entertainment methods, suggesting that creators attempted to generate high volume viewer consumption. When combined with TikTok's brief video format, users may consume large amounts of content rapidly. Individuals considering treatment may be influenced by viewing TikTok content. When clinically engaging individuals with EDs, the perceived significance of this content is a topic of consideration.

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.