Eating Disorders最新文献

Empirically supported treatments for eating disorders (EDs) recommend weighing all patients regularly and sharing that weight with patients (i.e. open weighing). However, many ED treatment providers and programs practice blind, or concealed weighing, in which patients are weighed but not informed of their weight. This Last Word article presents the authors' experiences with recruitment and retention in the concealed weighing arm of a pilot study assessing open versus concealed weighing in a treatment program that is historically accustomed to practicing open weighing. Although clinician anxiety has been associated with the use of blind weighing, it may arise whenever clinicians use a weighing method with which they are less familiar. Careful training and support of all multidisciplinary team members and research study personnel is necessary in order to effectively assess the utility of these different weighing methods to determine whether one is associated with better treatment outcomes for patients.

Anorexia nervosa requires early intervention for optimal treatment outcomes, yet extended waiting periods for specialized care often delay treatment, as occurred during the COVID-19 pandemic. This study evaluated the outcomes of a structured waiting-list intervention provided to adolescents awaiting entry into specialized eating disorder treatment. A retrospective analysis examined 56 adolescents (ages 10-18 years) who participated in the intervention between July 2020 and March 2022. The intervention included weekly nutritional monitoring and virtual psychoeducational support groups for parents. The study collected data on weight, BMI and treatment referral changes. Findings indicated that most patients remained clinically stable during the waiting period, and increases in weight and BMI were observed, particularly among those whose parents attended more group sessions. Additionally, 32% of participants had changes in treatment recommendations, and 23% were redirected to less intensive levels of care based on clinical assessment. In the absence of a control group, findings should be interpreted as associations rather than causal effects. While limited by its retrospective design, findings suggest that structured support during the wait period may help mitigate deterioration and reduce the need for more intensive treatment. This model may help manage demand in eating disorder services during resource-limited periods.

Other Specified Feeding and Eating Disorder (OSFED) has the highest prevalence of any eating disorder (ED), yet limited resources are available to help clinicians and researchers reliably differentiate between the different OSFED diagnoses. A tool capable of clarifying differences between OSFED subtypes and other EDs is needed to ensure that individuals receive accurate and specific diagnoses across clinical and research settings. To this end, the present report describes the development of a diagnostic flowchart developed for use in a research laboratory to allow research assistants without specialized training in EDs to make accurate and reliable diagnoses. We also provide guidelines for use of the flowchart alongside existing ED assessments and discuss evidence demonstrating its utility in improving interrater reliability among diagnostic raters, even those with minimal training. We envision this flowchart as an adaptable tool which will continue to be modified as the ED field works towards consensus definitions of OSFED diagnoses.

This case study presents a 74-year-old woman with a 60-year history of anorexia nervosa (AN). Despite the long duration and severity of her illness, the patient achieved significant recovery through a multidisciplinary treatment approach. The treatment included a combination of nutritional therapy, psychotherapy, and pharmacotherapy, along with a strong emphasis on the patient's active involvement. Outcomes demonstrated substantial improvements in weight, mental health, and quality of life. This case highlights the importance of hope and perseverance in treating AN, even in cases considered difficult to manage. Findings suggest that an individualized and long-term approach, addressing both the physical and psychological aspects of the illness, may be crucial for achieving recovery in patients with chronic AN.

With rapid technological advancements, eHealth-based guided self-help interventions have become accessible, flexible, cost-effective, and stigma-reducing treatment options for binge eating disorder (BED). This meta-analysis evaluated the effectiveness of these interventions in individuals diagnosed with BED or showing BED symptoms, based on eight randomized controlled trials with 1,575 participants. Intervention length varied between a single session to four months. Six studies focused solely on web-based guided self-help interventions, one study implemented a hybrid approach combining face-to-face and online components, and another study employed two distinct online guided self-help methods. The interventions included psychoeducational modules, therapist feedback, online behavior monitoring, and self-assessments. eHealth-based guided self-help significantly reduced binge eating psychopathology (SMD: 0.53; 95% CI: 0.20-0.86) and objective binge eating (OBE) days (SMD: 0.49; 95% CI: 0.12-0.85) compared to controls. These interventions offer effective solutions for individuals facing barriers to traditional treatment access.

Binge Focused Therapy (BFT) is a 3-session, group-based, guided self-help treatment for binge-eating disorder (BED). In this parallel-group randomized controlled trial (RCT), adults with BED were randomized to virtual BFT or a traditional unguided self-help approach (Overcoming Binge Eating; Fairburn, 2013). Self-report measures were collected at baseline, week 6, week 10 (posttreatment), 6- and 12-month follow-up. We hypothesized BFT (n = 82) would lead to better BED outcomes and lower dropout than unguided self-help (n = 82). Our intention-to-treat analysis demonstrated a significant effect of treatment group on BED symptomatology (primary outcome; β= - 5.04, p < .001, 95% CI [ - 7.57,  - 2.52]), binge frequency (β= - 3.24, p = .001, 95% CI [ - 5.22,  - 1.26]), general ED symptomatology (β= - 0.91, p < .001, 95% CI [ - 1.17,  - 0.65]), clinical impairment (β= - 6.27, p < .001, 95% CI [ - 8.78,  - 3.77]), confidence to change binge eating (β = 1.22, p < .001, 95% CI [0.56, 1.89]), BED remission (OR = 4.98, p = .003, 95% CI [1.72, 14.40]), and treatment attrition (β = 0.456, p < .001), with the BFT group reporting greater improvements and lower dropout. We did not find evidence of a significant effect of group on binge-eating abstinence (OR = 2.01, p = .103, 95% CI [0.87, 4.64]). BFT may be an effective BED treatment that could overcome common barriers to treatment implementation and accessibility.

This review of 20 prevention-related publications in Eating Disorders during 2024 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion ➔ types of prevention ➔ case identification/referral for 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 eating disorder psychopathology, disordered eating behavior, and eating disorders. Nine articles were in the category of prevention rationale (including screening studies) and gaps/shortcomings in the prevention field; three addressed correlates and putative risk factors for eating pathology; and eight articles involved creation, adaptation, or upscaling of programs: three pilot projects, one efficacy study, and four investigations of effectiveness. Seven implications for prevention improvement are presented. For example, because multidimensional sociocultural factors are of paramount importance to risk for the spectrum of disordered eating, all forms of prevention should be designed, from the outset, to establish and maintain non-hierarchical, participatory collaboration between academic researchers and inclusive groups of stakeholders. In this process, it is essential to include people (including academic researchers) whose voices are typically ignored (e.g. LGBTQ+ people of color, low income and unmarried working mothers, and adolescents of ages 11 through 14).

Cognitive flexibility (CF) has been proposed as a potential trait marker in anorexia nervosa (AN), although findings have been inconsistent. To address this inconsistency, we applied a model that distinguishes between three subtypes of CF: task switching, switching sets, and stimulus-response mapping, which we then assessed using a paradigm-based task battery. The aim of the study was to investigate how AN is associated with these three CF subtypes. Thirty-three women with AN and 37 age- and education-matched controls performed a battery of computerized cognitive tasks to assess the three CF subtypes. Compared to the control group, individuals with AN exhibited poorer performance on the task switching and switching sets subtypes, as measured by response time switch cost, but not on the stimulus-response mapping subtype. No differences were found between the groups in response accuracy. Furthermore, switching sets as compared to the task switching and stimulus-response mapping subtypes was found to better explain the differences between the groups. These findings indicate a domain-specific impairment in CF among patients with AN, reflecting deficits observed in subtypes related to the disorder's characteristics, particularly that associated with visual perception. Therefore, CF impairment in AN should not be viewed dichotomously, but rather as a relative impairment that varies depending on the specific CF subtype.

Objective: Dietary restraint is a primary target of CBT-E. However, little research has examined how specific types of dietary restraint change during CBT-E for bulimia-spectrum eating disorders (BN-EDs) or the association between changes in dietary restraint and treatment response. This study examined latent trajectories of change in eating enough, eating a range of macronutrients, and following dietary rules during CBT-E for BN-EDs and the relationships between these trajectories and pre- to post-treatment change in BN symptoms and remission.

Method: Participants were 56 adults with BN-EDs who received 16 sessions of CBT-E and completed the Eating Disorder Examination and ecological momentary assessments (EMA) of eating behaviors and BN symptoms. Latent growth mixture modeling identified trajectories of change in dietary restraint, which were compared on pre- to post-treatment BN symptom change and remission.

Results: Three trajectories of change were identified for eating enough, eating a range of macronutrients, and food rules. Trajectories of change in eating enough were differentially associated with pre- to post-treatment change in BN symptoms, and trajectories of change in eating a range of macronutrients and food rules were differentially associated with remission.

Conclusions: CBT-E yields heterogeneous trajectories of change in dietary restraint, which are associated with treatment response.

Despite a significant amount of research theoretically demonstrating the benefits of positive body image, limited studies have empirically examined its protective role over women's body concerns and behaviors. Based on the objectification theory, this study explored whether the associations between body objectification, disordered eating symptoms, and depression are moderated by positive body image. We considered four specific constructs of positive body image using the Body Positive Scale (BP Scale) which includes BP-Feeling, BP-Acceptance-even if, BP-Response, and BP-Conceptualization. We conducted moderated mediation analysis using PROCESS model on data from an online survey completed by 400 Korean women ages 20-64 years. The results showed that the associations between body objectification and disordered eating symptoms were not significant at high levels of BP-Feeling and BP-Acceptance-even if. The results also revealed that indirect associations between body objectification and depression via disordered eating symptoms were not significant at high levels of BP-Feeling and BP-Acceptance-even if. While the overall results suggest the protective role of positive body image against disordered eating and depression, this study further provides specific information on positive body image that should be included in the prevention and treatment of disordered eating.