Eating Disorders最新文献

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.

National Health Service (NHS) England highlights the need for preventative, specialist support for adults with mild eating difficulties. This evaluation explored the effectiveness of an Adult Eating Disorder Integrated Mental Health Service (AEDimhs) in reducing mild eating difficulties, within primary care. The lived experience of service users (n = 12) and staff (n = 12) was thematically analysed and levels of staff wellbeing and burnout reported. Individual service-level data (N = 363) were gathered; however, 59.6% of outcome data were Missing Not At Random and n = 69 pre-post intervention mental health outcomes were available for analysis. Statistically significant improvements were found in ED-related thoughts and actions (EDE-Q) and psychosocial difficulties (CIA), while overall distress (CORE-OM), depression (PHQ-9) and anxiety significantly reduced (GAD-7; all measures p < .001). Staff reported moderate levels of wellbeing and low burnout. Thematic analysis identified four themes: 'bridging the gap', 'empowering interventions', 'adaptability and flexibility' and 'shaping the future'. Findings suggest that AEDimhs can potentially provide effective, preventative, specialist support within primary care. Research with larger and more diverse populations is required to strengthen the evidence base and enable evaluation of long-term follow-up.

Youth with restrictive-eating disorders (EDs) often experience significant distress and difficulty with treatment adherence during nutritional rehabilitation. This study assessed whether youth with restrictive EDs and premorbid overweight/obesity admitted for inpatient nutritional rehabilitation experience greater psychological distress and difficulty with treatment adherence than youth with premorbid BMI <85th percentile. A retrospective chart review examined 150 youth hospitalized for medical complications of restrictive EDs. Rates of nasogastric tube (NGT; used when youth could not complete meals), agitation medication use, and disposition recommendation were compared across premorbid BMI groups. Patients with premorbid overweight/obesity were three times more likely to require NGT feeds. These findings suggest greater challenges with nutritional rehabilitation, specifically consuming nutrition orally, in patients with premorbid overweight/obesity, highlighting the need for early and individualized psychological support for this vulnerable patient population.

Objective: We investigated weight stereotypes in the recognition and referral of eating disorders (EDs) by assessing if recognition, health care referral, perceived acceptability, perceived distress, and perceived prevalence of an ED differ depending on the weight of the subject in the vignette.

Method: Community participants (N = 180, age = 19-74) read three different vignettes describing three females with different EDs [anorexia nervosa/atypical anorexia nervosa (AN/AAN), bulimia nervosa (BN), binge eating disorder (BED)] and were randomized to three different experimental conditions concerning an individual with a different weight (overweight, normal, and underweight).

Results: Across EDs, participants were more likely to recognize a problem, refer for treatment, and rate a higher perceived level of distress in the vignettes of overweight individuals than in the vignettes of normal weight individuals. For BED, a larger proportion of participants in the overweight condition classified the issue described in the vignette as a form of eating pathology compared to the normal weight condition.

Discussion: These results highlight several weight stereotypes that exist in the recognition and health care referral of EDs. Future ED education and awareness programs should emphasize that EDs can occur in any individual, regardless of their weight.

A broad array of important and diverse studies surrounding the treatment of eating disorders were published in Eating Disorders: The Journal of Treatment & Prevention in 2024. Anorexia nervosa is the most lethal and arguably the most well-studied eating disorder, yet treatment outcomes have been slow to advance. Herein, we review advances to both measuring AN symptom severity specifiers, identifying key treatment targets, and overview treatment advances. With regards to binge spectrum eating disorders, we review how purging and non-purging compensatory behaviors impact illness severity, and carefully review evidence relating to treatment outcomes. In this review, we also review novel treatment developments including yoga-based and ayahuasca-based interventions, as well as novel treatments for augmenting weight restoration in restrictive eating disorders. Additionally, we review evidence relating to eating disorder comorbidities, elucidating the impact on illness severity and treatment outcomes, and evidence addressing access to care for specialized eating disorder treatment, and lastly, how non-outpatient levels of eating disorder care may augment outcomes. Overall, the articles published in Eating Disorders: The Journal of Treatment & Prevention in 2024 evidence the promise of treatment advances in the field and requires further work to address the development of efficacious treatments to achieve greater outcomes for those with eating disorders.

Adolescents and young adults are at heightened risk for eating disorder (ED) and muscle dysmorphia (MD) symptoms; yet, these symptoms and their relationships to harmful behaviors may also vary by gender. Thus, this study examined: 1) the prevalence of attempts to lose, gain, or maintain the same weight across gender identities, 2) purposes of weight change attempts, and 3) relationships between weight change attempts and ED and MD symptoms across cisgender men, women, and transgender and gender expansive (TGE) youth. 940 adolescents and young adults (57.4% cisgender women, 33.8% cisgender men, 8.8% TGE) completed questionnaires about weight change attempts, ED and MD symptoms. Women and TGE individuals attempted to lose weight more often than men, while men attempted to gain weight more often. All genders endorsed weight loss and gain attempts for different purposes. Weight loss attempts related to ED symptoms and appearance intolerance, whereas weight gain attempts related to MD symptoms across genders. In women, all weight change attempts related to greater functional impairment due to exercise. Findings highlight the need for tailored interventions to address desires to change one's body and underscore the harmful effects of weight change attempts across genders.

Pregnancy represents a crucial timepoint to screen for disordered eating due to the significant adverse impact on the woman and her infant. There has been an increased interest in disordered eating in pregnancy since the COVID-19 pandemic, which has disproportionately affected the mental health of pregnant women compared to the general population. This systematic review is an update to a previous review aiming to explore current psychometric evidence for any new pregnancy-specific instruments and other measures of disordered eating developed for non-pregnant populations. Systematic searches were conducted in PubMed, ProQuest, PsycInfo, CINAHL, Scopus, MEDLINE, and Embase from April 2019 to February 2024. A total of 20 citations met criteria for inclusion, with most studies of reasonable quality. Fourteen psychometric instruments were identified, including two new pregnancy-specific screening instruments. Overall, preliminary psychometric evidence for the PEBS, DEAPS, and EDE-PV was promising. There is an ongoing need for validation in different samples, study designs, settings, and administration methods are required. Similar to the original review on this topic, we did not find evidence to support a gold standard recommendation.