International Journal of Eating Disorders最新文献

Objective: Having both an eating disorder (ED) and borderline personality disorder (BPD) is associated with heightened clinical complexity, high levels of distress, and challenges in treatment. This study sought to qualitatively investigate the experiences of women with an ED and comorbid BPD as they undergo ED treatment, aiming to better understand factors that shape their perceptions of care.

Methods: Fourteen women with both an ED and BPD in treatment at a public-sector ED clinic were recruited to participate in an open-ended qualitative interview about their lived treatment experiences.

Results: Five overarching themes (with seven subthemes) emerged from the qualitative analysis: (1) Difficulties with emotions as a key factor underlying both ED and BPD; (2) Perceptions of BPD in ED maintenance and treatment; (3) Relational dynamics in treatment; (4) Treatment is "never enough"; and (5) The importance of treating the ED and BPD together.

Discussion: This study highlights the lived experiences of women with both an ED and BPD. Patients expressed the need for ED treatment to target emotion dysregulation, interpersonal difficulties, and their attachment to their therapists and to treatment. This study provides insights into the experiences of patients with BPD of ED treatment that may help guide the approach to care in such individuals.

Objective: The COVID-19 pandemic was associated with a significant rise in the incidence of anorexia nervosa (AN) and atypical anorexia nervosa (AAN), longer wait times and reduced opportunities for in-person medical services. How these changes affected clinical outcomes among adolescents newly diagnosed with AN/AAN remains largely unknown.

Methods: We performed a retrospective analysis of standardized intake and follow-up data from a pediatric eating disorder program to compare clinical outcomes among adolescents newly diagnosed with AN/AAN during pre-pandemic (July/2017-December/2018) and pandemic (July/2020-December/2021) periods. Clinical data were collected at the time of diagnosis and at 1-, 3-, 6-, and 12-month intervals. The primary outcomes were unscheduled AN/AAN-related emergency department visits and need for medical hospitalization.

Results: Overall, 253 patients were included (pre-pandemic = 77; pandemic = 176). By 12-months following diagnosis, 18.8% (95% CI 13.3%-25.3%) of patients diagnosed during the pandemic had unscheduled AN/AAN-related emergency department visits, compared to 7.8% (95% CI 2.9%-16.2%, p = 0.03) of those diagnosed pre-pandemic. Medical hospitalization was required more frequently in the pandemic group (35.8%; 95% CI 28.7%-43.4%) compared to pre-pandemic (15.6%; 95% CI 8.3%-25.6%, p = 0.001). Mean weight gain at 12-months did not differ between groups (8.1 kg pre-pandemic vs. 8.8 kg pandemic; p = 0.35) however the mean time to target weight was longer in the pandemic group (2.7 vs. 4.4 months; p = 0.002).

Conclusion: Patients newly diagnosed with AN/AAN during the pandemic had significantly more AN/AAN-related emergency department visits and hospitalizations and took longer to achieve target weight than those diagnosed pre-pandemic. These findings suggest a more complicated treatment course among adolescents diagnosed with AN/AAN during the pandemic.

Objective: Parents of children diagnosed with anorexia nervosa (AN) are facing multiple burdens when caring for their child. This study uses a psychological network approach to identify central factors among parental caregiving burdens and experiences which then can constitute promising targets for caregiver interventions.

Method: A total of 348 parents (247 mothers, 101 fathers) of children diagnosed with AN (96% female, 90% restrictive type) provided data including parental psychopathology, eating-disorder related burden, high-expressed emotion and perceived caregiver skills at baseline and after having participated in a parental skills training, multi-family therapy or systemic family therapy. Regularized partial correlation networks including 14 variables were estimated for baseline and follow-up data were estimated.

Results: High-expressed emotion, particularly parental emotional overinvolvement emerged as the most central variable in the network showing substantial correlations with depression and low self-care behavior. Emotional overinvolvement also functioned as a bridge variable between parental psychopathology, perceived caregiver skills, and eating disorder-related burden. Moreover, parental criticism was strongly associated with burden due to the child's confrontational behavior and low levels of parental frustration tolerance. Network comparison tests neither revealed statistically significant differences in network structure and global network strength between baseline and follow-up, nor between mothers and fathers.

Discussion: This study highlights the importance of parental high-expressed emotion as a promising treatment target. Adding or intensifying intervention components promoting parental emotion regulation strategies as well as intensified training in Motivational Interviewing may be useful therapeutic approaches to decrease overall parental burden.

Objectives: Borderline personality disorder (BPD) and eating disorders (EDs) are common comorbid diagnoses. Given the various combinations of borderline personality disorder symptoms (BPDS) that can comprise a diagnosis, understanding whether specific BPDS are more likely to be associated with an ED (anorexia nervosa [AN], bulimia nervosa [BN], and binge eating disorder [BED]) is important for the conceptualization and treatment of BPD-ED comorbidity.

Methods: This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study, a nationally representative dataset of US adults (N = 36,309). The association of BPDS with EDs, compared with psychiatric and healthy control groups, was examined in two binomial and two multinomial (i.e., with all ED diagnoses) models.

Results: Compared with the healthy control group, affect instability, emptiness, impulsivity, self-injurious behaviors, and unstable relationships were positively associated with any ED diagnosis (AN, BN, or BED). Compared with the psychiatric control group, impulsivity was positively associated with any ED diagnosis. In the multinomial model with the healthy control group, impulsivity and self-injurious behaviors were positively associated with AN, BN, and BED, emptiness was positively associated with AN and BED, and unstable relationships and affect instability were positively associated with BED. In the multinomial model with the psychiatric control group, self-injurious behaviors were positively associated with AN, and impulsivity and affect instability were positively associated with BED.

Discussion: Results suggest certain BPDS may be more common with certain EDs (AN, BN, and BED), even when controlling for other EDs and a psychiatric control group.

Two recent reviews in the International Journal of Eating Disorders have highlighted the preponderance and unmet needs of neurodivergent people who experience disordered eating. In this commentary, we encourage researchers to engage with the bigger question of "What's Next?" and consider the type of research that is needed to shift the dial by lowering the incidence and persistence of disordered eating in neurodivergent people. As a starting point, we believe that future research must be guided by the needs and priorities of neurodivergent people with experience of eating disorders. Based on our own experience of community collaboration, we make specific recommendations for future research: (1) Broadening the Scope; such that we expand the focus beyond anorexia nervosa, and consider other manifestations of disordered eating, such as restriction, binge eating and emotional eating, and avoidant restrictive food intake disorder (ARFID), but also acknowledge the impact of other forms of neurodivergence beyond autism (e.g., ADHD), (2) Identifying Causal Mechanisms; moving beyond describing prevalence to studying why and how neurodevelopmental traits are associated with disordered eating (which in turn will inform new intervention design), and (3) Adapting Existing Interventions; understanding how current interventions can be adapted to meet the needs of neurodivergent individuals.

Background: Patient and caregiver perspectives are critical in the evaluation of avoidant/restrictive food intake disorder (ARFID); however, little is understood about how caregiver and youth perceptions may differ. This study compared caregiver and youth reports among pediatric patients from an outpatient ARFID program.

Methods: Patients (217 individuals with ARFID, aged 8-17) and their caregivers completed the Nine-Item ARFID Screen (NIAS), a screening tool with parallel youth and caregiver report forms. The NIAS measures ARFID symptomatology across three presentations: sensory-based selectivity (Picky Eating), low appetite/lack of interest in eating (Appetite), and fear of aversive consequences (Fear). Patient and caregiver NIAS scores were compared using t tests, and agreement was assessed via Pearson correlations. We examined the unadjusted bivariate association between patient age and caregiver-patient agreement.

Results: Patient mean age was 12.9 (SD = 2.5) and the majority were male (57.1%) and White, non-Hispanic (68.2%) and with private insurance (88.0%). Caregivers reported higher ARFID symptomatology than patients themselves. Using caregiver scores compared to patients, a larger percentage was classified as all three presentations (23.5% vs. 11.5%) or combined selectivity and appetite (46.0% vs. 31.8%). Caregiver scores were higher on average regardless of patient age.

Discussion: Results support obtaining both patient and caregiver reports whenever possible. Each perspective, as well as areas of discordance, may inform additional evaluation and treatment planning.

Objective: Anorexia nervosa (AN) is an eating disorder characterized by severe weight loss and associated with hyperactivity and circadian rhythm disruption. However, the cellular basis of circadian rhythm disruption is poorly understood. Glial cells in the suprachiasmatic nucleus (SCN), the principal circadian pacemaker, are involved in regulating circadian rhythms. We hypothesize that the circadian rhythm disruption in AN patients is associated with glial cell changes in the SCN.

Method: In the starvation-induced hyperactivity mouse model, mice had free access to a running wheel and received a restricted amount of food once a day, until a 25% body weight loss was reached and maintained their weight loss for two weeks. This was followed by a refeeding phase. Different daily periods of running wheel activity were defined, such as food anticipatory activity up to 4 h before feeding. Circadian rhythmicity was analyzed using the cosinor method. Gene expression was evaluated using real-time polymerase chain reaction. Immunohistochemistry was used to quantify astrocytes, microglia, and oligodendrocytes.

Results: Starvation induced changes in circadian rhythm, as indicated by changes in cosinor-based characteristics. Refeeding reversed these effects. Additionally, there was an increase in cryptochrome circadian regulator 1 expression and a decrease in the density of astrocytes and oligodendrocytes in the SCN after chronic starvation.

Discussion: Starvation-induced alterations in circadian rhythms are associated with molecular, and cellular changes in the hypothalamus. Reduced astrocytes and oligodendrocytes in the SCN in a mouse model of AN suggest that glial pathophysiology may play a role in circadian rhythm disruption.