International Journal of Eating Disorders最新文献

Objective: Eating disorder (ED) symptoms have been studied in adults with other rare genetic conditions but not in Williams syndrome (WS). This study examined the prevalence of ED symptoms in adults with WS and associated clinical and demographic factors. We hypothesized that a proportion would screen positive for an ED, primarily with avoidant/restrictive food intake disorder (ARFID) or binge-eating presentations.

Method: Adults with WS completed modified versions of the Eating Disorder Assessment for DSM-5 and the Pica, ARFID, and Rumination Disorder Questionnaire, administered as semi-structured interviews by trained research staff. Participants also completed a medical history questionnaire. We used descriptive and between-group analyses to examine clinical and demographic characteristics of ED-positive and ED-negative groups.

Results: Of the 86 participants, more than one quarter (n = 24, 28%; 95% CI [20%, 38%]) screened positive for an ED. Adults who screened positive for an ED most commonly had binge-type EDs (n = 15, 63%; 95% CI [43%, 79%]) and ARFID-type EDs (n = 7, 29%; 95% CI [15%, 49%]). Of those who screened positive, 96% reported they had never been previously diagnosed with an ED.

Discussion: Our study provides initial evidence of a high frequency of positive ED screens in adults with WS, most commonly ARFID-type and binge-type EDs. Our findings also suggest that, while prevalent in WS, EDs typically go undetected, and that it may be difficult to identify at-risk individuals. There is a need to validate ED screeners for adults with WS to enhance detection and access to care.

Objective: Anxiety and avoidance behaviors are increasingly recognized as key drivers of anorexia nervosa. Exposure therapy, rooted in the inhibitory learning model, targets these drivers by violating threat expectancies. This translational study investigated the dynamics of fear and threat expectancies within and between 417 individualized exposure sessions for female patients with anorexia nervosa. It was hypothesized that the violation of individual threat expectancies during exposure experiments would reduce threat expectancies and fears, both within and between sessions. Whether the focus of the exposure experiments (eating-related or body-related) influenced outcomes was also examined.

Method: Individually tailored exposure sessions were designed and performed to challenge idiosyncratic threat expectancies. A total of 2895 datapoints from 417 sessions were collected and analyzed.

Results: Linear mixed models revealed significant within-session reductions in threat expectancies and fear levels following the exposure experiments and postexposure discussions of experiences and outcomes. Both fear levels and threat expectancies also decreased across sessions. Notably, body-related exposures evoked stronger fears and threat expectancies than eating-related exposures, though both types of exposure led to similar threat expectancy and fear reductions over time.

Discussion: These fine-grained analyses of the dynamics of fears and threat expectations during exposure sessions highlight threat expectancy change as a likely mechanism of therapeutic change. The study supports the use of exposure in the treatment of anorexia nervosa to break avoidance cycles and promote recovery.

Objective: This study examined the role of maintenance mechanisms not specific to eating disorders, as conceptualized in enhanced cognitive behavioral therapy (CBT-E)-namely clinical perfectionism, low core self-esteem, mood intolerance, and interpersonal problems-in patients with anorexia nervosa receiving intensive focused CBT-E. The aim was to assess changes in these mechanisms during treatment and their predictive value for outcomes.

Method: In this prospective cohort study, 113 patients aged 16-65 years were admitted for intensive CBT-E. Body mass index (BMI), eating disorder psychopathology, general psychopathology, and functional impairment were assessed at baseline, end of intensive treatment (EOIT), and 20-week follow-up. Non-eating disorder-specific variables were evaluated at baseline and EOIT.

Results: Ninety-nine patients (87.6%) completed treatment, and 75 (75.8%) attended follow-up. All non-eating disorder-specific mechanisms showed significant improvement during treatment. No variable predicted the dropout rate. In intention-to-treat analyses, lower self-esteem at baseline predicted increased eating disorder psychopathology at EOIT, while lower self-esteem at EOIT predicted increased psychopathology at follow-up. Additionally, lower baseline sociability and interpersonal ambivalence at EOIT-features of interpersonal problems-predicted decreased BMI at EOIT and follow-up, respectively.

Conclusions: The focused form of intensive CBT-E is associated with significant improvements in non-eating disorder specific mechanisms in patients with anorexia nervosa. However, when low self-esteem or specific interpersonal difficulties are present, these factors significantly predict poorer outcomes in eating-disorder psychopathology and weight restoration. This suggests that, for a subset of patients, addressing these non-eating disorder specific mechanisms more directly may be necessary to optimize treatment response and sustain improvements over time.

In this narrative review, I highlight diversity-related developments in eating disorder (ED) research, situate my own program of work on adult men within the broader literature on boys and men, and focus on risk factors, symptoms, diagnosis, and treatment in boys and men. I build on recent reviews on gender in EDs but adopt a gender-critical perspective that asks why males remain comparatively invisible in epidemiology, diagnosis, and services despite their substantial burden of illness. EDs in males span the full diagnostic spectrum and often present with muscularity-oriented body dissatisfaction, compulsive exercise, and performance-enhancing substance use that are poorly captured by traditional, thinness-focused tools. Internalized stigma regarding the construction of EDs as "women's disorders" and traditional masculinity norms create gender-specific barriers to recognition and help-seeking in males. Minority stress (i.e., stress related to discrimination, stigma, or social rejection among sexual and gender minorities) can further shape the manifestation and maintenance of EDs in sexual and gender minority males. Given the emerging evidence for distinct male phenotypes and pathways into care, there is a high need for gender-sensitive diagnostics, treatment settings, and health policies that make EDs in males more visible, more intelligible, and more treatable across developmental stages.

Objective: When a young person has an eating disorder (ED), the entire family, including siblings, is affected. Despite recommendations in clinical guidelines and treatment manuals to involve and support siblings, little is known about how this is enacted and documented in practice. The aims of this study were: (1) to audit documentation of sibling information and involvement in child and adolescent ED services and its alignment with clinical guidelines, and (2) to explore healthcare professionals' perspectives on sibling involvement.

Method: A mixed-methods design was used. Clinical records of 102 young people receiving ED treatment were reviewed, and data were extracted using a data collection tool. Data were analyzed descriptively. A focus group discussion was conducted with 14 healthcare professionals. Data were analyzed qualitatively, applying thematic analysis.

Results: Eighty-six of 102 patients (84%) had siblings (n = 160 siblings across the sample). Attendance in sessions was documented for 20 of the 160 siblings (13%) across 19 of the 102 patients (19%). Across all records, one record documented sibling perspective and support offered. Qualitative analysis of the focus group identified six themes. Sibling involvement was seen as overwhelming, constrained by workload, privacy concerns, and lack of appropriate resources, and conceptualization of involvement was limited to session attendance. Perceived benefits included enhanced systemic insight and improved family communication.

Discussion: In this study, documentation of sibling involvement in child and adolescent ED care was limited. Clearer documentation practices, broader conceptualizations of sibling involvement, and further research are needed to ensure siblings receive appropriate support.

Objective: Food insecurity is increasingly linked to binge eating and weight-related health issues like type 2 diabetes mellitus, but no eating disorder interventions have been tested among individuals with food insecurity. We conducted a single-arm pilot test of FoodSteps-FI, a guided self-help digital intervention for binge eating adapted for food insecurity, among adults with food insecurity, recurrent binge eating, and type 2 diabetes mellitus. Our aims were to test the feasibility and preliminary efficacy of FoodSteps-FI delivery.

Method: Participants were 31 non-pregnant, English-speaking adults (≥ 18 years old) with self-reported type 2 diabetes mellitus, recurrent binge eating (≥ 12 episodes in the past 3 months), and past 30-day food insecurity who were interested in intervention and owned a smartphone with internet access. All participants received FoodSteps-FI with messaging-based coaching (~2×/weekly) for 16 weeks, and a weekly stipend. Participants completed assessments at mid-intervention (8 weeks) and post-intervention (16 weeks). Intent-to-treat analyses assessed feasibility and changes in clinical outcomes from baseline to post-intervention.

Results: The trial demonstrated feasible recruitment, high study retention, and high intervention completion, adherence, and ratings of usability. Participants achieved improvements in binge eating, weight, past 30-day food security status, eating concerns, shape concerns, weight concerns, eating disorder impairment, depressive symptoms, shame, and guilt. Nearly all participants rated the stipend as helpful for making behavior changes, but substantially fewer said it was sufficient.

Discussion: This pilot trial demonstrated the early promise of an adapted digital binge-eating intervention for this population, and the need for future research on its effectiveness and implementation.

Objective: Within sport environments, athletes are exposed to norms that circulate narrow meanings about the body and food, contributing to the high prevalence of eating disorders (EDs). While social media can support ED recovery, it can also further constrain food- and body-related messages for athletes. The purpose of this study was to examine the role of social media in athletes' ED and recovery experiences.

Method: Data were drawn from a broader study on athletes' support networks during ED recovery, where 29 participants (17 athletes, 12 social agents) completed one-on-one semi-structured interviews. For the present study, all discussion of social media was extracted from the interviews and analyzed using reflexive thematic analysis.

Results: We identified four themes. The first theme, Positive Aspects of Social Media Undermined by Harmful ED Content, describes how, despite facilitating connection, social media often exacerbates existing food- and body-related pressures for athletes. The second theme, Establishing a New Relationship With Social Media to Protect ED Recovery, showcases how athletes applied social media literacy skills. The third theme, Using Social Media to Challenge ED Stigma and Diet Culture, describes how some athletes initiated conversations about EDs and countered harmful diet culture messages through their platforms. The fourth theme, Online Visibility as a Recovery Stressor, depicts how increasing pressures for athletes to curate a personal brand on social media may reexpose them to ED-related content.

Discussion: Findings highlight the need for athlete-specific social media literacy within ED prevention and treatment programs, and for sport organizations and media platforms to support safer online environments.

Objective: Emerging evidence indicates that the COVID-19 pandemic has had a profound impact on mental health globally, including an increase in the incidence of eating disorders. This study aims to characterize individuals diagnosed with anorexia and bulimia nervosa in Colombia and to estimate changes in the monthly age- and sex-adjusted treatment prevalence before and after the COVID-19 pandemic.

Method: An ecological observational time series study was conducted, estimating the monthly treatment prevalence of anorexia and bulimia in Colombia from 2011 to 2023, adjusted by sex and age. Data were extracted from national administrative records and corrected for underreporting. Pre- and post-pandemic onset trends were compared using non-parametric tests and segmented regression models.

Results: Between 2011 and 2023, 54,471 individuals received treatment for anorexia or bulimia in Colombia. Most cases occurred among women and individuals aged 15-29 years. The adjusted monthly treatment prevalence of anorexia ranged from 0.06 to 0.5 per 100,000 population, and bulimia from 0.11 to 0.82. Following the onset of the COVID-19 pandemic, the median monthly number of visits for anorexia increased by 120% (p < 0.01) and for bulimia by 18.1% (p = 0.07). Significant inflection points were identified, with heterogeneous increases observed across departments. Antioquia exhibited the highest monthly percentage increase for both conditions.

Discussion: The observed increase in health care utilization for anorexia and bulimia following the pandemic suggests a substantial impact of the health crisis on eating disorders. These findings highlight the urgent need to strengthen mental health services and to develop evidence-based, targeted interventions to address the growing burden of these conditions in Colombia.

Objective: This pilot randomized controlled trial evaluated the feasibility and acceptability of Emotion Regulation Group Therapy (ERGT) as an adjunct to Enhanced Cognitive Behavioral Therapy (CBT-E) for adults with eating disorders and co-occurring impulsive and destructive behaviors.

Method: Participants were recruited from a specialist outpatient eating disorder service in Stockholm, Sweden. Thirty-two adults meeting eligibility criteria were randomized (1:1) to either CBT-E plus ERGT (n = 16) or CBT-E only (n = 16). Assessments were conducted at pre-treatment, during treatment, post-treatment, and 3-month follow-up. Pre-specified feasibility outcomes included recruitment and retention, treatment engagement, acceptability, adverse effects, and completeness of outcome data. Exploratory outcomes examined changes in eating disorder symptoms, impulsive destructive behaviors, and emotion dysregulation.

Results: Feasibility and acceptability criteria were largely met in this sample, with strong recruitment and retention and high engagement in ERGT. Both groups showed small-to-moderate improvements in eating disorder symptoms, while CBT-E + ERGT yielded greater gains in emotion regulation at follow-up. No serious adverse events were observed.

Discussion: Concurrent delivery of ERGT and CBT-E was feasible, acceptable, and safe in specialist outpatient care, supporting progression to a fully powered randomized controlled trial to evaluate efficacy and sequencing.

Defining recovery in eating disorders remains a major challenge due to the absence of standardized, empirically validated criteria. Bardone-Cone et al. (2025) address this gap by testing multidimensional, transdiagnostic recovery criteria spanning physical, behavioral, and cognitive domains. This commentary evaluates the suitability of these criteria for anorexia nervosa (AN). Applying a partial version of the proposed criteria to two independent AN datasets, a high-severity inpatient/day-patient sample and an outpatient sample, revealed very low rates of full recovery and marked instability over time. These findings suggest that, when applied to AN, the criteria may be overly restrictive and insufficiently sensitive to clinically meaningful change, defining recovery as rare and fragile. Three key implications emerge: AN recovery definitions should incorporate broader functional outcomes such as social functioning and quality of life; lived experience perspectives are essential for capturing subjective and identity-related aspects of recovery; and recovery should be conceptualized as a nonlinear, evolving process rather than a binary state. Although Bardone-Cone et al.'s work represents an important step toward standardizing recovery definitions, further refinement is needed to ensure that recovery criteria are clinically meaningful and diagnosis-sensitive for AN.