International Journal of Eating Disorders最新文献

Several decades of accumulated evidence highlights that digital health interventions (DHIs) can improve symptoms of eating disorders, but that DHIs may also suffer from issues of engagement and dropout. To date, a number of patient- and design-specific predictors of engagement, efficacy, and dropout have been proposed, yet the evidence base for these variables is weak and inconsistent. In this spotlight article, we propose an entirely new class of predictors premised on the notion that successful use of DHIs requires active learning, and consequently that researchers and DHI developers should focus on the integral roles of learning and learner capability for ensuring benefits of DHI for users. Our user-as-learner perspective posits that: (1) knowledge transmission via DHIs does not guarantee that users appropriately understand and apply this content, (2) the dynamics of effective learning established in other learner contexts may also apply to successful engagement with DHIs, yet (3) the characteristics that ensure this success may not be common and consistent among those who sign up to DHIs. We highlight a small yet emerging body of literature in the context of eating disorder-focused DHIs that provide preliminary support for these postulations, and conclude with a series of recommendations to shape a research agenda that places learning dynamics at the heart of DHI design and engagement.

Compulsory nasogastric tube feeding (CNF) is often a traumatic event for patients and caregivers. Its impact on those administering it, however, is understudied. This commentary responds to the recent qualitative study by Offringa et al., which explores the experiences of clinicians involved in CNF. The authors highlight the physical and emotional strain on healthcare providers, and describe that they find themselves in situations in which the administration of CNF pushes their personal and professional moral boundaries. The clinicians' descriptions of their experiences encourage reflection on the challenges of working with those with eating disorders (EDs) and in particular, working with the very ill who require life-saving measures such as CNF. In this commentary, recommendations for mitigating these difficulties are suggested, including: (1) having clear organizational policies and guidelines for when, how, and to whom to administer CNF; (2) education and training of front-line staff on CNF as well as the nature of EDs; (3) support for team members after the administration of CNF; (4) the involvement of a lived experience perspective in all levels of design and delivery; and (5) helping clinicians tolerate the discomfort of CNF by keeping in mind that ultimately they are likely saving their patient's life. The work of Offringa and colleagues should stimulate research on the effects on both patients and clinicians of various forms of restraint (e.g., chemical, mechanical, and physical) to determine which approach is least traumatizing, as well as longitudinal studies on the effects of CNF and its relation to patient outcome.

Objective: Although screening for bots and/or using costly panel services for recruiting participants online has become increasingly necessary, such efforts may no longer ensure the validity of data collected online. Newly released agentic AI models, such as the ChatGPT agent, have the ability to complete surveys relatively indistinguishably from humans.

Methods: The current paper outlines efforts that the body image, weight, and eating disorders (BIWED) lab has undergone to screen for and detect AI data completion reliably and validly.

Results: There are some tasks that ChatGPT agents do not perform identically to human responders (e.g., video tasks, online games, open-ended responses, and reCAPTCHA). We present the methods that have been the most successful at identifying AI agent survey completion.

Discussion: We discuss potential solutions, field-wide concerns, and future directions for the field more broadly.

Objective: Suicidal ideation represents a serious experience common in individuals with eating disorders. To inform screening and clinical assessment and advance theoretical work, the current study compared clinical characteristics between adult women with and without current suicidal ideation and examined whether binging, fasting, and purging behaviors are uniquely associated with suicidal ideation above and beyond existing psychiatric diagnoses.

Method: Data come from four studies conducted between 2000 and 2023 (N = 732) that evaluated current suicidal ideation in all participants. Participants completed diagnostic interviews assessing lifetime psychiatric diagnoses and current eating disorder diagnoses and behavioral symptom frequencies. Five hundred and fifty-three participants had DSM-5 eating disorders (54.6% bulimia nervosa, 15.0% purging disorder [PD], 28.2% other specified [excluding PD], 1.4% anorexia nervosa, and 0.7% binge-eating disorder).

Results: Individuals with current suicidal ideation had a greater prevalence of most psychiatric diagnoses and greater frequency of binging, fasting, and purging. Additionally, purging frequency was associated with current suicidal ideation independent of binging, fasting, and lifetime psychiatric comorbidities.

Discussion: Results support prior work suggesting that purging may fall on the self-harm continuum with nonsuicidal self-injury. Further, findings support screening for purging and suicide risk assessment in individuals with eating disorders.

Objective: For children with avoidant/restrictive food intake disorder (ARFID), research on factors contributing to elevated BMI is lacking. Using a sample of children diagnosed with ARFID through an outpatient, multidisciplinary feeding clinic, this study aimed to identify the proportion of children within each BMI category, compare fruit and vegetable (FV) intake between children with sensory sensitivity and non-sensory sensitivity ARFID, and determine whether FV intake was associated with BMI.

Method: Data were collected retrospectively from an outpatient, multidisciplinary feeding clinic. The sample included 271 children (2-18 years; Mage = 6.71, SD = 3.05) and one parent/legal guardian per child who completed a feeding evaluation. Child height/weight, demographics, FV checklist, and two items assessing FV intake from the Behavioral Pediatrics Feeding Assessment Scale were collected. A pediatric psychologist established ARFID diagnosis using a multi-method approach.

Results: Classifications of underweight, healthy weight, overweight, and obesity were 9.6%, 64.9%, 11.4%, and 14.0%, respectively. No differences were found in average FV intake between children with sensory sensitivity ARFID versus those with non-sensory sensitivity ARFID. Accounting for relevant covariates, lower FV intake (number of accepted FVs but not frequency of FV intake) was significantly associated with higher BMI z-score.

Discussion: Findings support the existence of ARFID across the BMI spectrum and suggest that among children with ARFID, those with fewer accepted FVs may present with higher BMI. Food selectivity may be a valuable intervention target, particularly among youth with higher BMI. Further research is needed to elucidate factors relevant to BMI in children with ARFID.

Objective: Racial trauma, defined as the psychological and physiological harm caused by racism and racial discrimination, has been associated with mental health problems. Although traumatic experiences have consistently and robustly been associated with eating disorders, it is unknown whether racial trauma is associated with eating disorders. This study examined the link between racial trauma symptoms and positive eating disorder screens using a large, population-based sample of US college students.

Method: Cross-sectional data came from young adults (18-30 years) in the 2022-2023 Healthy Minds Study (n = 57,439). Associations between racial trauma symptoms and positive eating disorder screens (SCOFF ≥ 2) were examined using modified Poisson regression models adjusted for age, sex, race-ethnicity, and financial situation growing up. Associations were examined among the overall sample and then stratified by race-ethnicity and sex.

Results: Nearly one-third (31.7%) of the sample screened positive for an eating disorder. Among the overall sample, racial trauma symptoms were associated with positive eating disorder screens (prevalence ratio [PR]: 1.58; 95% CI: 1.51, 1.66). This association was stronger for males than females among the whole sample (interaction p < 0.001) and among most races and ethnicities. The association of racial trauma with positive eating disorder screens was strongest for Non-Hispanic Black individuals (PR: 2.08; 95% CI: 1.75, 2.48), with about equal magnitude for males and females.

Discussion: Racial trauma symptoms may be a modifiable risk factor for eating disorders to target in treatment and prevention efforts across races and ethnicities, with particular relevance for non-Hispanic Black young adults.

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.