International Journal of Eating Disorders最新文献

Objective: Despite advances in treatment, up to 20% of cases of bulimia nervosa and anorexia nervosa (AN) persist chronically, with about 25% of individuals with AN being re-hospitalized. This study examined demographic and clinical characteristics associated with one versus multiple admissions to an inpatient eating disorder unit.

Method: The sample included 1609 individuals, treated on an inpatient medical stabilization unit, diagnosed with an eating disorder. Of those, 25.4% (n = 326) required multiple admissions. Cox proportional hazard models evaluated adjusted associations of age, gender, eating disorder diagnosis, race, ethnicity, length of stay, presence of non-suicidal self-injury (NSSI), body mass index (BMI), and insurance type at initial admission with the likelihood of multiple admissions.

Results: No significant group differences were found in age, gender, BMI, initial length of stay, or ethnicity. Adjusting for other variables, multiple admissions were more likely for those with NSSI (adjusted HR = 1.46) hazard ratio (HR) and with lower BMI at initial admission (adjusted HR = 0.96) as well as Black patients (adjusted HR = 2.07). Relative to individuals with anorexia nervosa, those with Avoidant Restrictive Food Intake Disorder demonstrated a lower likelihood of multiple admissions (adjusted HR = 0.54).

Discussion: NSSI, lower BMI at initial admission, and Black race were associated with greater likelihood of multiple admissions, suggesting that emotion dysregulation, greater illness severity, and demographic factors contribute to rehospitalization. Future research may consider integrating interventions such as Dialectical Behavior Therapy into inpatient care to reduce risk of readmission. Early identification of high-risk behaviors (e.g., NSSI) is critical to tailoring treatment and improving long-term outcomes.

Many countries are investigating options to reduce the risks of social media (SM) for children. This is driven by: evidence of harm; deteriorating mental health in youth; a lack of evidence for the current SM minimum age of 13 years; extensive underage use of these platforms; and, recognition of the challenges parents face in managing this issue. Specific to the eating disorder field, SM is highly visual with constant image and video-based content that can give young users the message that their appearance, shape and weight are important features of self-worth; and the exposure to such content in late childhood and early adolescence is at the very stage of development when acceptance by peers is of the highest importance, making these messages even more potent and potentially harmful. On November 29, 2024, Australia passed legislation to delay SM access until 16 years of age. It is the first country in the world to pass such legislation, with this taking effect from December 10, 2025. This Forum outlines the considerations that led to this legislation, the debate on changes to SM minimum age and, historical comparisons for legislative changes in other areas to improve safety. Further it highlights the need for a comprehensive response, including wide-scale dissemination of evidence-based prevention and early intervention programs, and increased evidence-informed support for parents and schools. Decisive action is urgently needed to protect and improve the wellbeing of youth.

Objective: Adolescence is the peak onset period for eating disorders (EDs), making ED prevention critical during this time. Comorbid depression and anxiety can put adolescents at further risk for EDs. Chatbots can be a scalable solution, yet minimal research has explored this tool in diverse adolescents for ED prevention and addressing comorbidities. This study utilized user-centered design to tailor a rule-based chatbot to diverse adolescents.

Method: Fifteen adolescents in the USA aged 14-17 years who owned a smartphone screened at risk for an ED (high weight and shape concerns) based on an online screening tool. Participants completed a 30- to 60-min semi-structured interview on Zoom where they viewed the chatbot app's layout and chatbot scripts via screen share and provided feedback in think-aloud format. Interview transcripts were coded using an inductive approach.

Results: Participants' (60% minoritized sexual identity: lesbian/gay, bisexual, pansexual, aromantic/asexual, queer, or questioning; 20% minoritized gender identity; 80% non-White) feedback converged on three themes: "User Experience with Chatbot Structure and Content," "Barriers and Facilitators to App Use and Engagement," and "Relatability of Content to Target Adolescent Population." Participants appreciated the chatbots' interface, stepwise psychoeducation, and relatability of content. Participants noted time constraints and motivational barriers to use, as well as the strict schedule and binge-eating focus within the regular eating content.

Discussion: Overall, the chatbot resonated with participants and showed potential for use with adolescents at risk of developing EDs once content is adapted to their feedback. The next stage of our work will integrate feedback and investigate the effectiveness of this intervention.

Objective: This study explored the experiences of lower-income adults in accessing and engaging with an adapted digital guided self-help cognitive behavioral intervention for binge and/or purge-type eating disorders. This study sought to inform future adaptation of evidence-based eating disorder interventions to improve accessibility, acceptability, and engagement among this population.

Method: Participants (N = 9) were adults with public insurance or no insurance coverage who endorsed ≥ 6 binge eating episodes, ≥ 6 vomiting episodes, and/or ≥ 6 laxative/diuretic episodes in the past 3 months, had a BMI ≥ 18.5 kg/m², with annual household income ≤ 200% of the federal poverty level. Participants completed 4 weeks of intervention usability testing, followed by a semi-structured interview examining barriers and facilitators to intervention engagement. Interviews were analyzed using inductive qualitative thematic analysis.

Results: Participants identified barriers and facilitators related to intervention accessibility, acceptability, and engagement. Barriers included psychosocial and structural stressors, treatment readiness, and concerns about representation and intervention fit. Facilitators included feeling understood and supported, perceived symptom improvement, and hopefulness. Participants emphasized the importance of tailoring interventions to individual identity and lived experience.

Discussion: Findings highlighted the need for continued adaptation of digital interventions to better meet the specific needs of lower-income individuals with eating disorders. Incorporating flexibility, representation, and personalization may enhance engagement and support more equitable access to care. This study increased representation of the lived experiences of this underrepresented population and contributed to ongoing efforts to reduce disparities in eating disorder treatment through expanded access to evidence-based care.

The past decade has witnessed a marked shift in research and clinical efforts toward scalable approaches to eating disorder (ED) treatment, driven by the need to overcome barriers related to cost, access, and specialist availability. This shift has given rise to a diverse range of scalable treatment options, spanning abbreviated versions of traditional therapy protocols, digitally delivered interventions in the form of web-based programs, smartphone apps, and chatbots, and highly concentrated, mechanism-focused approaches designed to be delivered within a single session. The purpose of this narrative review is to provide a broad overview of scalable treatments for non-underweight EDs by synthesizing empirically mature evidence and highlighting key trials, outcome studies, and meta analyses that can guide future innovation and implementation. Emerging research supports the promise of these approaches, with scalable interventions producing meaningful improvements in symptoms, wellbeing, and comorbid mental health problems. While these findings highlight the promise of scalable treatment formats for non-underweight EDs, translating this progress into lasting, population-level impact will require a unified research agenda that redefines how such interventions are conceptualized, tested, and embedded with the broader mental health ecosystem. Advancing this next phase of progress will hinge on several key research priorities, including redefining the ED workforce to leverage competent generalists to deliver structured interventions, developing data-driven recommendation systems that personalize care through adaptive algorithms, and building and piloting interoperable infrastructures that seamlessly integrate digital and human-delivered services.

Objective: Eating disorders (ED) present a significant health burden to children, adolescents, and young adults globally. Despite the importance of disordered weight control behaviors (DWCB) in ED development, little is known about the progression from DWCB to ED.

Methods: We synthesized available national surveillance and longitudinal data in Canada, as well as broader epidemiologic literature, to develop a state-transition microsimulation model to simulate the natural history of DWCB and ED for a synthetic cohort of 300,000 children. Using the calibrated model, we generated mean estimates and 95% uncertainty intervals (UI) for nationally representative point prevalence, cumulative incidence, and median time to progression of DWCB and ED from age four to 30 years, by sex assigned at birth.

Results: Point prevalence of DWCB peaked at age 16 years at 32.8% (UI: 24.6%-42.5%) for female and at 11.0% (UI: 6.9%-16.1%) for male individuals. By age 30 years, 67.7% (UI: 60.8%-76.9%) of female and 48.7% (UI: 38.7%-68.0%) of male individuals had ever engaged in DWCBs. Female individuals who engaged in DWCB did so for a median of 3 (UI: 2-4) cumulative years, and 22.5% (UI: 11.5%-37.9%) later developed ED.

Discussion: We estimated substantial DWCB engagement among young people in Canada, especially female youth, which contributed to considerable burden of ED. This is the first known study to provide nationally representative estimates of DWCB and ED outcomes in Canada that cannot be obtained directly from empirical data. The results have significant implications for prevention and early intervention among children and adolescents.

Objective: According to DSM-5-TR, avoidant/restrictive food intake disorder (ARFID) cannot be diagnosed alongside anorexia nervosa (AN), bulimia nervosa (BN), or any other body image disturbance. This does not accurately reflect real-world symptomatology and recent research, indicating the potential need to revise DSM-5-TR Criteria. We investigated the co-occurrence of weight- and/or shape-motivated restriction (WSR) in adults who screened positive for ARFID, providing evidence to inform such changes.

Method: The sample comprised 5747 adults who consented to participate in the ARFID-Genes and Environment (ARFID-GEN) research study, screened positive for ARFID on the NIAS and PARDI-AR-Q, and completed the EDE-Q. We placed our participants into four groups: groups one and two screened positive for AN (ARFID-AN; n = 147) or BN (ARFID-BN; n = 193), group three endorsed WSR without meeting AN or BN criteria (ARFID-WSR; n = 2159), and group four endorsed ARFID symptoms only (ARFID-nWSR; n = 3248). We used generalized linear models to test group differences on the NIAS, PARDI-AR-Q, and EDE-Q.

Results: Where significant differences were present, ARFID-nWSR demonstrated lower scores than all other groups across ARFID dimensions on the NIAS and PARDI-AR-Q, and lower odds of meeting DSM-5-TR Criteria A1 to A3 (i.e., weight loss; nutritional deficiencies; dependence on nutritional supplements).

Discussion: These findings indicate a mixed phenotype with features of both ARFID and WSR associated with more severe ARFID symptomatology. The DSM-5-TR Criteria may not capture complex real-world symptomatology in adults with probable ARFID, potentially precluding those with the most severe symptoms from receiving accurate diagnoses and appropriate care.

Objective: Earlier meta-analyses showing low rates of abstinence in treatments for bulimia nervosa (BN) and binge-eating disorder (BED) have spurred growing efforts to improve outcomes. In response, numerous trials have tested augmented, novel, or streamlined treatment protocols. However, it remains unclear whether these efforts have translated into improvements in meaningful abstinence outcomes. This meta-analysis provided updated estimates of abstinence and examined whether rates have changed over time.

Method: Trials of psychological treatments for BN and BED that reported abstinence rates were identified from two prior reviews, with an updated search (January 2018-September 2025). Pooled abstinence rates were calculated using random-effects models. Meta-regressions tested associations between trial year and abstinence.

Results: Ninety-nine trials (18 new) were included, 47 in BN and 52 in BED. For BN, the pooled abstinence rate was 29.4% (95% CI = 26.0, 33.1) among all randomized participants, marginally higher among completers (35.3%) and almost a third higher in all randomized augmented treatment conditions (42.9%). BN abstinence rates showed little change over time. For BED, the abstinence rate was 43.3% (95% CI = 39.2, 47.5), which was slightly higher among treatment completers and stable in various sensitivity analyses. Meta-regressions indicated BED outcomes have declined over time under certain conditions.

Conclusion: Many patients do not respond to front-line treatments, with no observable improvement in outcomes over four decades. Moving forward, meaningful progress will require a shift in how treatments are conceptualized and tested to achieve better outcomes, with promise emerging for strategically augmenting standard protocols and offering targted support to gradual responders.

Objective: To understand the discrepancies between people with lived experience, significant others, clinicians specializing in the treatment of eating disorders, and eating disorder researchers in the endorsement of transdiagnostic processes (mechanisms that are either a risk or maintaining factor across psychiatric disorders) hypothesized as being important to target in interventions for eating disorders. We examined processes of relevance to early intervention and treatment augmentation.

Method: A secondary data analysis of a modified Delphi study was conducted. Participants (N = 138) across all four panels were mostly female, White, heterosexual, and residing in Australia with a mean age of 38 years. Participants completed three rounds of consultation seeking to reach consensus on the importance of 49 transdiagnostic processes for both early intervention and augmentation of evidence-based eating disorder treatment (98 items). χ² analyses were conducted to explore the differences in endorsement rates between panels across the three rounds.

Results: Post hoc analyses demonstrated that researchers had significantly lower rates of endorsement for 70 (71%) of the items, while people with lived experience had significantly higher rates of endorsement for 25 (26%) items. Consensus was impacted by lower endorsement rates by one panel only for 16 items (16%), with researchers contributing to this for 12 of the impacted items.

Discussion: Findings suggest a marked discrepancy between lived experience and researcher perspectives on what is important to target in interventions for eating disorders. We encourage researchers to lean into this dissent to support rigorous best practice in the development and refinement of mental health interventions.