International Journal of Eating Disorders最新文献

Objective: Binge-eating disorder (BED) is a serious psychological condition, often associated with trauma, as well as many critical physical and psychological consequences. Despite the availability of several evidence-based treatments, full remission rates and long-term recovery rates remain suboptimal. Eye movement desensitization and reprocessing (EMDR) therapy has demonstrated early promise in the treatment of eating disorders (EDs) but has yet to be examined in those with BED. To our knowledge, the current study was the first pilot randomized controlled trial to examine the feasibility and preliminary efficacy of EMDR therapy in the treatment of core BED symptomatology.

Method: The clinical trial protocol was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR Registration Number: ACTRN12614000894695, 05/08/2014). A two-arm (EMDR vs. waitlist control), single-blind, pilot RCT was utilized to examine the feasibility and preliminary efficacy of this approach. Eligible participants (N = 38) were fluent English-speaking Australian adults (18+ years) who met the diagnostic criteria for BED. An existing EMDR treatment protocol for bulimia nervosa (BN) was adapted for BED (10 sessions). Outcomes were examined before and immediately after treatment completion.

Results: A treatment completion rate of 68.8% supported the feasibility of the treatment protocol. Intention-to-treat (ITT) analyses demonstrated largely positive effects in favor of the intervention, including significantly larger reductions in binge eating (symptoms, days, and frequency), meta-cognitive beliefs about eating, eating and shape concerns, anxiety, and sleep disturbance. However, there was no significant benefit of the intervention over control for dietary restraint, weight concerns, self-esteem, or sexual problems. There were mixed findings for depressive symptoms and dissociative symptoms between the ITT sample and treatment-completers.

Discussion: This pilot RCT supports the feasibility of applying this protocol to a larger-scale, well-powered effectiveness trial. It also addresses a critical gap in the literature by being one of the first to examine the potential efficacy of EMDR therapy for adults with BED, and thus contributes foundational preliminary data in support of an additional model of care for those with BED.

Objective: Research on the incidence trends of eating disorders remains limited in Asia. This study aims to analyze the annual incidence rates and incident case characteristics in the Korean general population.

Method: The National Health Insurance Service database was used to examine the incidence rates of eating disorders from 2012 to 2021. A total of 34,615 patients with incident eating disorders aged 0-49 years were analyzed. Comorbidity and medication analyses used a 2013-2020 subset. Linear regression analyses and Mann-Kendall trend tests were conducted to examine temporal trends across age and sex. Chi-square and Wilcoxon rank-sum tests were applied for epidemiological and clinical characteristics of the 0-19 and ≥ 20 age groups.

Results: Adults' annual incidence rates increased over the study period (τ = 0.689, p = 0.007). The 20-24 age group had the highest incidence (16.75-38.38 per 100,000 person-years). Individuals aged 0-19 years showed a stable incidence rate (τ = 0.244, p = 0.371), although males aged 0-19 years demonstrated a decreasing trend (B = -0.272, SE = 0.091, p = 0.018, 95% CI = [-0.483, -0.061]). Mood and anxiety disorders were the most frequent comorbidities. The 0-19 age group more frequently utilized tertiary healthcare institutions. Antidepressants were prescribed more frequently than antipsychotics. Fluoxetine and aripiprazole were the most common antidepressant and antipsychotic, respectively.

Discussion: The findings show distinct age- and sex-specific patterns in eating disorder incidence, underscoring the need for a tailored approach. Worldwide differences may offer etiological insights. A limitation is the aggregation of eating disorder subtypes.

Objective: Individuals with eating disorders (EDs) often face significant barriers to accessing care, including prolonged waitlists and systemic delays. Digital interventions, such as mobile apps, offer a scalable way to enhance pre-treatment engagement during this high-risk period. This pilot study evaluated the feasibility and acceptability of MI-Coach: ED, a program-led mobile app designed to support motivation among female-identifying individuals awaiting ED treatment.

Method: Twenty-three female-identifying individuals on waitlists at ED clinics across British Columbia, Canada, participated in a 4-week single-arm pilot trial of MI-Coach: ED. The app delivered motivational interviewing-informed content through seven sequential modules containing reflective exercises, psychoeducational articles, and psychologist-led videos. Feasibility was assessed via service-provider uptake, participant enrollment, engagement, and retention metrics. Acceptability was measured using the user version of the Mobile App Rating Scale and adapted Technology Acceptance Model ratings. Exploratory analyses descriptively examined pre-to-post changes in motivation and related symptoms.

Results: Feasibility was constrained at the service-provider level, with 6% of contacted sites agreeing to distribute study materials. At the participant level, 67.6% initiated app use and 44% completed at least four modules, and 78% completed pre- and post-assessments, indicating partial engagement across the sample. Participants rated the app positively across domains of quality, ease of use, and perceived usefulness. Small-to-medium reductions in global ED severity and depressive symptoms, as well as increases in motivational confidence, were observed with confidence intervals that did not cross zero. Change scores were moderately correlated across select motivational and symptom measures.

Discussion: Findings suggest that MI-Coach: ED was acceptable among users who engaged, while feasibility was substantially influenced by system-level recruitment constraints and variable participant engagement. Observed engagement patterns were lower than those reported for general mental health apps but consistent with prior digital ED intervention literature, underscoring the importance of disorder-specific feasibility benchmarks. Results will inform ongoing refinements and implementation strategies for a future randomized trial.

Objective: This review aimed to quantify rates of uptake (treatment initiation), adherence (program completion), and attrition (study dropout) in randomized trials of digital eating disorder (ED) interventions, and to synthesize engagement reporting practices, their consistency, and associations with clinical outcomes.

Methods: Randomized trials of digital interventions (web, app, computerized, chatbots, etc.) delivered to people with diagnostic, subthreshold, or self-reported EDs were included. Random-effects meta-analyses were conducted to compute absolute rates of uptake, adherence, and attrition, while a narrative synthesis summarized engagement patterns and reporting.

Results: Forty-eight trials were included. The weighted mean uptake rate from 44 intervention conditions was 89.7% (95% PI = 67.0-97.0) and the weighted mean adherence rate from 14 intervention conditions was 41.8% (95% PI = 0.9-83.3). These estimates remained similar in a series of sensitivity analyses that adjusted for biases, outliers, and when limiting to specific clinical population groups. The weighted trial attrition rate was 23.3% (95% PI = 0.8-54.4); for intervention arms specificially it was 29.7% (95% PI = 9.7-62.3) and for waitlist arms it was 18.7% (95% PI = 4.6-52.3). Attrition was lower in trials that had human-participant interaction, offered therapeutic guidance, provided monetary reimbursement, tested a web/computer program (compared to a smartphone application), and had a longer follow-up (> 6 weeks). Reporting of engagement was inconsistent and heterogeneous, with nearly 90 different metrics recorded across trials. There was some evidence linking sustained user engagement to greater clinical benefit.

Conclusion: Findings offer practical benchmarks to inform future trial planning and highlight design elements that could be leveraged to enhance user engagement and retention.

Pediatric patients with medical/developmental conditions face increased risk for avoidant/restrictive food intake disorder (ARFID). Diet-managed chronic illnesses may heighten risk for disordered eating, with emerging research finding medical symptoms predating disordered eating behaviors. Pediatric-onset immunoglobulin E-mediated food allergy ("food allergy") is on the rise, affecting an astonishing 8% of US children. The relationship between food allergy and ARFID is puzzlingly understudied despite food allergy clearly altering the individual's relationship with food, posing continuous danger, and requiring persistent, fundamental eating changes to maintain safety. Food allergy is managed through strict dietary avoidance of allergen(s) and confers well-documented risk to psychosocial functioning. Dietary restriction exceeding medically required avoidance (as observed in ARFID) further compounds risk for adverse health and psychosocial impacts. In this Spotlight, our team of clinical researchers working at the intersection of ARFID and food allergy proposes a model identifying three areas of food allergy-specific impact that may drive the higher prevalence of ARFID within this population. Failure to successfully regulate these universal drivers to preserve daily functioning may precipitate the development of ARFID. We propose (1) unique characteristics of allergic reactions and medical treatment, (2) the impacts of chronic vigilance and avoidance, and (3) response to learning paradigms and physiological upregulation disrupt the development of feeding/eating for both patients and caregivers. Patients with food allergy + ARFID may also be especially vulnerable to iatrogenic harm from the imprecision of current allergy testing modalities. We outline the sparse literature on food allergy + ARFID comorbidity and call for ARFID-focused research in this area.

Objective: Eating disorders (EDs) often emerge in adolescence, but developmental trajectories across different core features remain largely unclear.

Method: The prospective, community-based study included N = 898 participants aged 9.5-17.5 years (47.6% female, age 11.8 ± 1.4 years) with annual follow-up over 2-6 (3.4 ± 1.2) years. Multivariate trajectories of binge eating, restraint, weight-compensatory behaviors (Eating Disorder Examination-Questionnaire for Children), and body mass index-standard deviation score (BMI-SDS) derived from objective anthropometrics were analyzed using group-based multi-trajectory modeling (GBMTM) separately for girls and boys. ED and general psychopathology were used for validation and outcome comparisons.

Results: GBMTM identified five distinct trajectories of ED symptoms and BMI-SDS in girls and six in boys. Low-symptom trajectories at lower, normal, and higher BMI-SDS were most common and showed only mild, transient ED symptoms. In boys, trajectories were largely characterized by stable ED symptoms at different BMI-SDS levels, whereas in girls, ED symptoms showed more pronounced change over time. In both sexes, two high-risk subgroups reflected bulimic and binge-eating patterns and followed trajectories with elevated or increasing ED symptoms across ages, which in girls were particularly associated with increased ED and general psychopathology at last assessment.

Discussion: GBMTM results support the developmental specificity of bulimic/binge-eating syndromes and noneating-disordered overweight across adolescence. High-risk subgroups in both sexes-and their particularly unfavorable outcomes in girls-underscore the need for sex-specific early identification strategies that consider longitudinal constellations of multiple ED symptoms and weight status rather than single indicators.

Objective: A standardized definition of recovery would advance treatment outcome research. This study examined combinations of different physical, behavioral, and cognitive recovery criteria to identify the operationalization of eating disorder (ED) recovery with the most empirical support based on concurrent and predictive validity.

Method: Participants included 223 females with a history of an ED and 105 age-matched female controls who completed questionnaires, interviews, and weight/height measurements at baseline and ~1-year follow-up. To examine different comprehensive operationalizations of recovery, we considered two approaches to assessing each of the following domains of recovery: physical (BMI ≥ 18.5 kg/m²; BMI ≥ 19 kg/m²), behavioral (no binge eating, purging, or fasting in the past 3 months; none of these ED behaviors in the past 6 months), and cognitive (all four EDE-Q subscale scores within 1 SD of age- and gender-matched norms; Global EDE-Q scores within 1 SD of norms). Allowing for all possible combinations across these domains yielded eight operationalizations of comprehensive ED recovery to test.

Results: Results showed that operationalizations were more similar than different, with high rates of stability in recovery (77%-86%) and low relapse rates (7%-15%) over time.

Discussion: Based on the holistic consideration of the patterns of findings, we propose using BMI ≥ 18.5 or 19 kg/m² (physical recovery), no binge eating, purging, or fasting over the past 3 months (behavioral recovery), and all four EDE-Q subscale scores within 1 SD of age- and gender-matched norms (cognitive recovery) as a standardized operationalization of recovery for research purposes.

Objective: Previous research has revealed negative effects of appearance-related social media content, such as fitspiration, on body satisfaction. However, specific interventions to reduce these detrimental effects are scarce. Therefore, this randomized controlled pilot trial investigated the efficacy of the four-week online intervention body image booster (BIBo), which aims to reduce the negative influence of social media on body image by addressing theoretically proposed underlying mechanisms.

Method: N = 157 female participants with elevated eating disorder (ED) symptoms were randomly allocated to the BIBo training or a waitlist control condition (WLC). The final sample included n = 38 completers in the BIBo training group and n = 46 completers in the WLC. Before and after the four training sessions, ED symptoms and reactivity to fitspiration content were assessed, as well as body dissatisfaction, social comparison processes, and internalization of body ideals.

Results: BIBo participants showed significant pre-post reductions in ED symptoms (d = -0.72) and reactivity to fitspiration content (d = -0.58), while WLC participants showed no significant change. The same pattern of results emerged for upward social comparison (d = -0.59), appearance comparison on social media (d = -0.89), body dissatisfaction (d = -0.40), and internalization of a thin body ideal (d = -0.42). There were no pre-post changes in internalization of muscularity or attractiveness ideals in either the BIBo or the WLC group.

Discussion: Overall, the results suggest that BIBo is effective in altering pertinent outcome and mechanistic measures related to social media use and body image, demonstrating its therapeutic potential in the prevention and treatment of EDs.

Objective: Eating disorders (ED) and psychological distress are highly prevalent in individuals with Class 3 obesity (BMI ≥ 40 kg/m²). With the increasing use of glucagon-like peptide-1 receptor agonists (GLP1-RA), concerns have emerged about the potential worsening of ED symptoms. This study aimed to compare ED risk and psychological distress in adults with Class 3 obesity: (1) between those already on GLP1-RA and those not and (2) between baseline and 12 months in individuals initiated on GLP1-RA in the program.

Method: This retrospective observational cohort study included adults with Class 3 obesity enrolled in a publicly funded multidisciplinary weight management program in Sydney from January 2018 to June 2024. Participants completed the Eating Disorder Examination-Questionnaire Short (EDE-QS), Kessler Psychological Distress Scale (K10), and Depression, Anxiety and Stress Scale-21 (DASS-21) at baseline and 12-months.

Results: Among 666 participants, 59 (9%) were on GLP1-RA at baseline, with no significant differences in EDE-QS, K10, or DASS-21 scores compared to those not on GLP1-RA. Of 203 participants not on a GLP1-RA at baseline and having 12-month data, 31 (15.3%) initiated GLP1-RA treatment, with the majority on semaglutide 1 mg and a mean duration of use of 7.1 ± 3.7 months. Those initiated on GLP1-RA had a significant reduction in median weight, from 131.0 (118.7-149.6) kg at baseline to 120.0 (109.2-135.3) kg at 12 months, p < 0.001. There were no statistically significant changes in EDE-QS, K10, and DASS-21 scores from baseline to 12 months, and none stopped GLP1-RA due to ED symptoms or psychological distress.

Discussion: This study suggests that GLP1-RAs may not significantly worsen ED risk or psychological distress in adults with Class 3 obesity.

Objective: This study explored eating disorder and Artificial Intelligence (AI) professionals' perspectives on how AI might support eating disorder treatment. Successful implementation requires insight into implementation partners' perspectives.

Method: This study is an explorative qualitative analysis of two interdisciplinary focus groups (consisting of 22 eating disorder and AI professionals in total). Qualitative analysis with ATLAS.ti using a hybrid thematic analysis approach combined deductive coding with inductive theme development. The groups discussed (1) the opportunities and challenges-including ethical and safety considerations-of AI in eating disorder care, and (2) the types of evidence and evaluation frameworks required for adoption in practice.

Results: Themes were categorized into "opportunities," "challenges," "concerns," "solutions," and "evidence needed." Opportunities focused on AI's potential to enhance efficiency, support treatment delivery and monitoring, and reduce human error. Challenges concerned barriers to adoption in clinical practice, responsibility, and explainability. Concerns included ethical and legal risks, also related to data sharing. Proposed solutions emphasized the need for human oversight, cross-sector collaboration, and clinician training. With regard to evidence needed, participants mentioned safety and accuracy, and the need for scientific testing and validation.

Discussion: This study highlighted the potential and complexity of integrating AI into eating disorder care from the viewpoint of eating disorder and AI professionals. While there is value in AI in improving efficiency and clinical support, successful implementation requires addressing ethical concerns, legal uncertainty, and infrastructural barriers. Collaboration across disciplines, rigorous validation, and clinician involvement are essential to ensure that AI applications are safe, meaningful, and ethically sound.