Eating Disorders最新文献

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.

We investigated how the COVID-19 pandemic shift impacted access to and quality of eating disorder (ED) care via telehealth (TH) for adolescents and young adults (AYA), focusing on demographic trends for patients in the pre- and pandemic periods. Retrospective analysis of patients aged 10-26 with ED-related ICD-10 codes at a tertiary care hospital in Northern California was conducted. Using electronic health record data, we compared care access (visit types, missed appointments) and quality (hospital length of stay, readmissions) across pre-pandemic (Feb 2018-Feb 2020) and pandemic (June 2020-June 2022) periods. Outpatient visits increased 29% in the pandemic (n = 740 vs. 575). Hispanic patient representation rose by 59%, while non-Hispanic White and Asian patients decreased. During the pandemic, 531 patients used TH, and 209 were seen in person visits. In-person patients had over twice the odds of missing appointments. No differences were found in hospital length of stay (LOS) or readmission rates between TH and in-person care. TH use increased significantly during the pandemic, improving appointment adherence and access while maintaining care quality. The rise in Hispanic patients and changes in insurance patterns highlight the need for further research into equity and the long-term implications of TH in ED treatment.

Intelligence Quotient (IQ) scores, typically considered stable throughout life, may be impacted by anorexia nervosa (AN). This study investigated whether IQ scores change following treatment in adolescents with AN (N = 110; age = 14.65 ± 2.49 years; 85% female). We analyzed changes in vocabulary, matrix reasoning, and full-scale IQ (FSIQ-2) scores on the Wechsler Abbreviated Scale of Intelligence, with developmental weight suppression and duration of illness as covariates. Results indicated end of treatment improvements in vocabulary (F(1, 107) = 7.46, p = .01, η_p² = .07), matrix reasoning (F(1, 107) = 4.44, p = .04, η_p² = .04), and FSIQ-2 (F(1, 107) = 11.00, p < .01, η_p² = .09) scores. A shorter illness duration was associated with greater gains in vocabulary (p = .04) and FSIQ-2 (p = .02) scores. These findings suggest that IQ scores can improve throughout treatment, with shorter illness duration linked to greater improvements, underscoring the importance of early nutritional intervention.

Yoga is associated with improvements in factors that protect against the development of eating disorders (EDs), such as mindfulness, self-compassion, and body appreciation. Additionally, yoga is associated with lower body dissatisfaction (BD) and disordered eating. However, research on how yoga reduces BD and ED symptoms is limited. This study examined how protective factors such as mindfulness, self-compassion, and body appreciation may mediate the relationship between yoga self-efficacy, BD, and ED symptoms. A sample of 174 college students with previous yoga experience (Mage = 20.10, SD = 2.49) and varying degrees of BD and ED symptoms participated. Mediations were performed using Hayes PROCESS (Model 6) and were significant (p = .012 and p < .0001). Yoga self-efficacy predicted lower BD and ED symptoms through increased mindfulness, which predicted higher self-compassion and then greater body appreciation. Findings suggest yoga self-efficacy could reduce BD and ED behaviors through increased awareness of internal and external cues, leading to increased self-kindness and appreciation for one's body. Given our current findings, ED prevention or treatment programs incorporating yoga could focus on elements including mindfulness, self-compassion, and body appreciation.

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.