Eating Disorders最新文献

Eating disorders (EDs) have a harmful impact on the lives of millions of individuals in the United States. Research indicates that comorbid trauma could negatively impact treatment outcomes, reinforcing ED symptomology. Transdiagnostic approaches underscore experiential avoidance as a maintaining factor for EDs and other comorbid concerns, while mindfulness and adaptive coping help disrupt avoidance of emotional experiences. In addition to treatment approaches, clinicians must consider cultural identity factors, such as religion and spirituality (R/S), to engage in culturally responsive treatment. In the present study, we examined transdiagnostic factors in a clinical sample of 1153 individuals with comorbid EDs and post-traumatic stress disorder (99.6% of the sample), specifically considering differences between those who identified as religious, spiritual, or neither. Using a one-way analysis of variance, we found statistically significant differences in ED symptomology and adaptive coping scores across groups. Conversely, we found no statistically significant differences in mindfulness and experiential avoidance scores across groups. Despite the small effect sizes, these preliminary findings add to the existing body of research on R/S using a transdiagnostic framework, supporting the integration of spirituality into ED treatment to promote adaptive coping. Future research is needed to address the study's limitations, such as exploring adaptive coping styles that may further explain these relationships.

Eating disorders are a persistent and debilitating problem, especially among college age men and women. This problem is exacerbated in occupations such as the military, where maintenance of strict standards regarding weight, fitness and appearance is important for job retention and promotion. Also, previous research confirms that stress is a contributing element to eating disorders. It is thus important to identify factors that may assist individuals to remain resilient and avoid stress-related health and eating difficulties. The present study utilizes historical data to examine the impact of stress on health and eating disorder symptoms in a representative sample of West Point military academy cadets, while testing the role of gender and hardiness as stress moderators in this relation. A survey containing measures of stress, hardiness and eating disorders symptoms was completed by 387 cadets in the fall and spring of 2000-2001. Moderation effects were tested with advanced conditional process analysis procedures developed recently by Hayes (2022). Results show that hardiness was a significant moderator, with cadets low in hardiness showing increased eating disorder symptoms and more general health symptoms. While gender was not a significant moderator with respect to eating disorder symptoms, it was significant for general health symptoms; female cadets showed more stress-related health symptoms than their male counterparts. These results suggest that eating disorder symptoms in military academy cadets and college students more generally may be reduced through programs aimed at developing hardiness attitudes and stress coping approaches.

Cognitive Behavioural Therapy for Avoidant and Restrictive Food Intake Disorder (CBT-AR; ARIFD) is a psychological treatment that targets many of the core symptoms of ARFID. Although a growing literature supports the efficacy of behavioural interventions for paediatric feeding and eating disorders, including ARFID, the applicability of these methods to adults remains undetermined. Telehealth delivery of CBT-AR in adults with autism has yet to be tested. With this study, we conduct a preliminary evaluation of CBT-AR delivered virtually to a 26-year-old white British female, with mixed ARFID and elevated autistic traits. She attended 23 remote CBT-AR sessions facilitated through a dedicated telehealth platform. Adjustments were made to accommodate her lived experience of neurodiversity. Using a pre-post treatment design, changes on measures of subjective goal attainment, eating-related and general psychosocial impairment, general anxiety, and depression were evaluated. Following treatment, the participant had made significant progress towards personally meaningful goals, with improvements observed in nutritional intake, general well-being, and reductions in eating-related psychosocial impairment and general anxiety. The results offer preliminary insights into acceptability and efficacy of virtual CBT-AR for neurodiverse individuals.

This review of 16 prevention-related publications in Eating Disorders during 2022 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; and (3) definitions of and links between disordered eating (DE) and eating disorders (EDs). Seven articles fell into the category of prevention rationale (including screening studies) and relevant reviews, while nine articles addressed correlates of/risk factors (RFs) for various aspects of DE and EDs. One implication of the 16 articles reviewed is that RF research toward construction of selective and indicated prevention programs for an expanding array of diverse at-risk groups needs to address, from a nuanced, intersectional framework, a broad range of factors beyond negative body image and internalization of beauty ideals. Another implication is that, to expand and improve current and forthcoming prevention programs, and to shape effective advocacy for prevention-oriented social policy, the field in general and Eating Disorders in particular need more scholarship in the form of critical reviews and meta-analyses; protective factor research; prevention program development and multi-stage evaluation; and case studies of multi-step activism at the local, state (province, region), and national levels.

Given the numerous barriers to accessing child and adolescent eating disorder treatment, there is a need for innovation in how this care is delivered. Primary care-based eating disorder treatment has established proof-of-concept, yet it is unclear whether this model can bridge the treatment-access gap. This retrospective chart review study compared demographic and illness characteristics of 106 adolescents (M age = 15.1 years)  SD = 1.8 consecutively evaluated in a primary care-based eating disorder clinic with 103 adolescent patients (M age = 15.2 years)  SD = 2.2 seen consecutively in a specialty eating disorder clinic at the same medical center. Relative to adolescents in specialty care, those in the primary care group presented at a significantly higher BMI percentile, had less weight suppression, a shorter illness duration, lower rates of amenorrhea and lower scores on the EDE-Q Dietary Restraint subscale. In addition, more patients in the primary care group identified as non-white and had government/public assistance insurance compared to those in the specialty group. The results suggest that, compared to traditional specialty care clinics, embedded eating disorder treatment in primary care may reach a more racially and socioeconomically diverse group of adolescents when they are earlier in the course of their illness. Future research determining the relative effectiveness of this model as compared to interventions delivered in specialty care is needed.

Research has identified trait sensitivity as a potential risk factor and treatment target of eating disorders. Conceptualizations of trait sensitivity have depicted individuals with high and low trait sensitivity metaphorically as orchids and dandelions, highlighting their responsiveness to environmental conditions and associated outcomes. While orchids require careful tending to survive, with such care, they emerge extraordinary. In contrast, dandelions can survive a broad range of environmental conditions. Within a scientific framework, trait sensitivity can be conceptualized as neurobiologically-based, with heightened sensory, interoceptive, interpersonal, and emotional processing. While trait sensitivity may increase susceptibility to eating disorders, when therapists view these traits through the lens of environmental responsiveness, they can facilitate their client's inherent resilience and potential. Incorporating a model of trait sensitivity into eating disorders treatment using psychoeducation, modifying environmental stimuli, and selecting optimal interventions has the potential to increase treatment engagement, deepen therapeutic collaboration, and improve outcomes.

Empirical evidence is unequivocal in illustrating that the majority of patients with eating disorders will not fully recover during treatment. To that end, the need for optimized treatment approaches and improved patient outcomes cannot be overstated. While empirical efforts are underway to optimize outcomes, this article reviews treatment-related research findings published in Eating Disorders: The Journal of Treatment & Prevention during 2023. Importantly, this review encapsulates research addressing (i) between-session patient behaviors, (ii) the integration of technology into treatment approaches, (iii) methods to augment emotional regulation in the context of eating disorder treatment, (iv) methods to measure progress, and potentially risk markers for patient dropout, during treatment, (v) optimizing treatment approaches for inpatient settings, and (vi) augmenting family therapy-based approaches. Incorporating novel technological advances may be critical in enhancing the scalability of eating disorder treatments, since treatment uptake remains an ongoing challenge for the field. Moreover, expanding the scope of non-outpatient eating disorder treatment settings, while ensuring fidelity to theoretical models developed in outpatient settings, is critical as treatment is effectively administer across the spectrum of levels of patient care.

Residential treatment programs for eating disorders (EDs) have gained popularity in recent years, expanding beyond the United States to countries such as Canada, Italy, and the United Kingdom. These programs offer a "home-like" environment where individuals reside for several weeks or months, emphasising both physical restoration and psychological recovery. This scoping review aimed to provide an update since the most recent reviews on the literature regarding outcomes of residential treatment programs for EDs and to explore clinical features that were associated with these outcomes. Methods used followed the Joanna Briggs Institute guidelines for scoping reviews. A systematic search of electronic databases was conducted, and 12 studies met the inclusion criteria. All studies reported improvements in various outcomes from admission to discharge, including changes in eating psychopathology, weight restoration, depression, anxiety, and quality of life. Additionally, three studies reported positive outcomes at intervals after discharge and three predictive factors (self-compassion, personality organisation, and resistance to emotional vulnerability) were reported in a small number of studies. While residential treatment facilities consistently showed positive outcomes, the review highlights the need for randomised controlled studies to establish the efficacy of these programs for EDs. Future research should include controlled studies comparing residential facilities to other treatment settings and incorporate long-term follow-up outcomes and further studies of emergent predictive factors identified in this review.

Community evidence indicates high eating disorder (ED) and comorbid symptom severity among LGBTQ+ compared to cisgender heterosexual (CH) individuals. Little is known about such disparities in ED treatment samples, especially in outpatient treatment. We aimed to descriptively characterize and investigate baseline group differences in symptom severity between LGBTQ+ and CH ED outpatients at treatment intake. Data from 60 (22.3%) LGBTQ+ and 209 (77.7%) CH ED outpatients were used to examine: (1) demographic and diagnostic differences; (2) differences in ED, depressive, and emotion dysregulation symptoms. Objectives were tested using Fisher-Freeman-Halton exact and independent samples t-tests, and analyses of covariance adjusted for age and diagnosis, respectively. Most LGBTQ+ outpatients were bisexual (55.2%), and 6.5% identified as transgender and non-binary. LGBTQ+ outpatients presented to treatment at younger ages (Mean Difference [MD] = -3.39, p = .016) and reported more severe depressive symptoms (MD = 5.73, p = .004) than CH patients, but endorsed similar ED symptom and emotion dysregulation severity. Groups did not differ in other demographic or diagnostic characteristics. LGBTQ+ individuals may develop more severe depression and similarly severe EDs at earlier ages but seek outpatient care sooner than CH peers. Managing depressive symptoms may be particularly important for LGBTQ+ ED patients.