Eating Disorders最新文献

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.

Objective: Trauma exposure is associated with disordered eating, with recent evidence suggesting PTSD symptoms may be a more proximal predictor. Intuitive eating is a well-established protective factor against disordered eating; however, no previous studies have assessed whether intuitive eating buffers the association between PTSD symptoms and disordered eating.

Methods: Two hundred sixteen women who had experienced intimate partner violence (IPV) and were residing at a domestic violence shelter completed a survey. The current study assessed the moderating role of intuitive eating in the associations between PTSD symptoms and two types of disordered eating behaviors: binge eating and compensatory behaviors.

Results: Intuitive eating did not moderate the association between PTSD symptoms and a dichotomous measure of binge eating (no binge eating vs. any binge eating). However, intuitive eating did moderate the association between PTSD symptoms and binge frequency, among participants endorsing any degree of binge eating, such that PTSD symptoms were significantly associated with binge frequency at low, but not moderate or high, levels of intuitive eating. Intuitive eating did not moderate the association between PTSD symptoms and compensatory behaviors.

Discussion: Results suggest intuitive eating may be protective against binge eating frequency among women who have experienced IPV.

Those with eating disorders (EDs) characterized by purging behaviors tend to show more impulsivity than those diagnosed with restrictive eating, who tend to show more compulsivity. Impulsive choice (i.e. a type of impulsivity) is a common factor among eating disorders that is less understood. Delay discounting is a measure of choice impulsivity, examining the decrease in value of delayed outcomes. In this exploratory study, we examined associations between eating disorder type, age and delay discounting among patients at a residential ED treatment center (N = 178). Our findings showed that those diagnosed with bulimia nervosa had higher delay discounting (i.e. more impulsivity) at intake compared to anorexia nervosa, binge eating disorder, and other eating types but there were no significant differences. Those diagnosed with bulimia nervosa, as well as those with ARFID and unspecified ED showed a preference for delayed rewards at discharge, but there were no significant differences among ED types. Moderation analyses showed that age, ED type, nor the interaction did not significantly predict delay discounting at intake or discharge. To conclude, those with bulimia nervosa demonstrate less impulsive choice at discharge from a residential ED treatment center. However, additional research is needed given the variability of sample sizes in this study.