International Journal of Eating Disorders最新文献

Objective: Avoidant/restrictive food intake disorder (ARFID) is characterized by limited dietary volume and/or variety due to fear of aversive consequences, lack of interest in eating, and/or sensory sensitivity. Uncontrolled studies suggest that cognitive-behavioral therapy for ARFID (CBT-AR) is beneficial, but neural mechanisms remain unknown. Prior work has shown hyperactivation in regions of the salience network (SN) during the presentation of food stimuli in ARFID compared to healthy controls, and the SN shows reduction from pre- to post-CBT in anxiety disorders. We tested hypotheses that (1) higher pre-treatment food-related activation in the SN (anterior cingulate cortex [ACC], anterior insula, amygdala) would be prospectively associated with greater reductions in ARFID severity at post-treatment, and (2) food-related activation in the SN would decrease from pre- to post-treatment.

Method: In a validated functional magnetic resonance imaging (fMRI) food cue paradigm, youth with ARFID viewed images of food and non-food in a fasted state at pre-treatment (N = 24) and a subset (N = 14) also completed post-treatment scans.

Results: Pre-treatment activation in response to food versus objects was not associated with changes in ARFID severity or remission post-treatment. However, hyperactivation in the right ACC (MNI coordinates: 3, 53, 17; k(E) = 579, p(FWE_corr) = 0.013) decreased from pre- to post-treatment with a large effect size (d = 1.1).

Conclusion: These pilot findings raise the possibility that changes in SN neural activity may be candidate mechanisms through which CBT-AR exerts its effects. Randomized controlled trials are needed to replicate and extend these results.

Trial registration: ClinicalTrials.gov identifier: NCT02963220.

Objective: Eating disorders (EDs) in men are underdiagnosed and undertreated, partly due to stigma hindering help-seeking. This randomized waitlist-controlled study tested the efficacy of the iSMEsH online anti-stigma intervention targeting German general practitioners (GPs) and medical students. The program aimed to reduce stigmatizing attitudes toward men with EDs and improve knowledge and self-efficacy in managing ED symptoms.

Method: A total of 292 participants (130 GPs, 162 medical students) were randomly assigned to immediate intervention or waitlist control. The intervention consisted of six video-based, on-demand modules co-developed with men who have lived experience of an ED, combining education and contact-based strategies. Outcomes included cognitive stigma (knowledge), affective stigma (biased attitudes), and behavioral stigma (treatment self-efficacy), assessed at three timepoints.

Results: The iSMEsH anti-stigma intervention significantly increased knowledge of male-specific ED presentations and enhanced treatment self-efficacy in both GP and medical student populations. Effects on affective stigma were less consistent.

Discussion: Findings support the efficacy of the iSMEsH anti-stigma intervention in improving knowledge and treatment self-efficacy regarding EDs in men among healthcare professionals. Effects on affective stigma were limited and may require longer follow-up periods to be comprehensively captured. The intervention shows promise as a scalable tool to reduce stigma and improve care for men with EDs.

Trial registration: On July 1, 2024 (#181,415; https://aspredicted.org/tzds-h5yq.pdf) and a study protocol is published under Lehe et al. (2025).

Objective: Eating disorders (EDs) are severe and complex psychiatric illnesses, with adolescence and young adulthood representing particularly vulnerable periods for onset, relapse and disruptions in treatment. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is especially complex, raising concerns about continuity of care and support for young people and their families. The Transition for Eating Disorders Youth intervention (TEDYi) aims to address these challenges by developing a person-centered, peer-led intervention grounded in lived experience to facilitate smoother transitions across ED services.

Method: This study represents the second phase of TEDYi and employed an Experience-Based Co-Design (EBCD) methodology. EBCD integrates the perspectives of young people, carers, and mental health professionals to improve transition services collaboratively. We conducted seven co-production workshops with 37 co-designers and analysed the data using reflexive thematic analysis.

Results: Three key themes emerged: (1) Being there-the importance of ongoing, reliable support; (2) Exploring readiness-factors shaping preparedness for transition; and (3) Enhancing engagement-the role of accessible psychoeducation. Insights were further refined through two Steering Groups, which considered delivery format, setting, and intervention materials.

Discussion: Co-designers valued EBCD for creating a safe space where young people and carers could openly share lived experiences and for fostering a sense of community with shared goals. They highlighted that lived experience interventions in EDs can foster more optimal outcomes while helping individuals feel recognized. These findings will inform the finalization of the TEDYi prototype and subsequent piloting across clinical sites.

Objective: This study aimed to evaluate the effectiveness of a digital self-help intervention based on dialectical behavior therapy (DBT) principles, delivered via a WeChat mini-program, in reducing binge-eating symptoms among Chinese adults.

Methods: In a randomized controlled trial, 101 adult females with binge-eating-related disorders (BN, BED, or AN-BP) were randomly assigned to a 4-week DBT-based mini-program or a psychoeducation control. The primary outcome was binge-eating severity (binge eating scale, BES); secondary outcomes included eating disorder psychopathology (EDE-Q), emotion regulation (DERS-16), impulsivity (BIS-11), depression (PHQ-9), and anxiety (GAD-7). Between-group effects were examined from baseline to post-treatment using linear mixed-effects models under the intention-to-treat principle. The intervention group was further followed for 1 and 3 months to assess maintenance of effects. Post-treatment qualitative interviews explored user experience using reflexive thematic analysis.

Results: Compared with the control group, participants in the DBT condition showed a significantly greater reduction in binge-eating severity from baseline to post-treatment (Cohen's d = 1.07, p = 0.013). Both groups demonstrated large within-group improvements in eating disorder cognitions (EDE-Q), while changes in emotion regulation, impulsivity, and mood symptoms were nonsignificant. Within the intervention group, gains in binge-eating and EDE-Q scores were largely maintained at follow-up. Qualitative findings indicated high perceived helpfulness and usability, with feedback emphasizing the program's structured design and practical skills, alongside suggestions for improving efficiency and self-monitoring features.

Discussion: Findings provide preliminary evidence that Wise Eating is a feasible, scalable, and culturally relevant low-intensity DBT-based intervention for binge eating in China. Future trials should include more diverse samples, longer durations, and enhanced engagement strategies.

Trial registration: ClinicalTrials.gov identifier: NCT07143214.

Objective: Around one to two in five patients prematurely disengage from eating disorder therapy. This Forum paper suggests innovative strategies to increase retention and strategies for evaluating these with patients who have eating disorders.

Method: We start by clarifying the definition of premature discontinuation and note one obstacle in the field is a lack of routine and uniform reporting across treatment studies and clinical practice. We then examine common reasons for discontinuation, suggest evidence-informed strategies to improve retention, and ways to evaluate the success of these strategies.

Results: We outline seven underutilized solutions for decreasing risk of premature discontinuation, including: offering low resource interventions while patients are on the waitlist; integrated multidisciplinary care; recovery-oriented treatment augmentation; treatment choice; session measures accompanied by feedback; personalized treatment; paying attention to the relational aspects of treatment.

Discussion: While each of these solutions is evidence-informed, they are rarely the focus of research in eating disorders, and we outline a research agenda for examining which of these approaches have the most promise in improving retention of patients in therapy.

Objective: Despite significant health and psychosocial impairments, many individuals with eating disorders (ED) view their disorder as an integral part of their identity. Because this "ego-syntonicity" is associated with low treatment motivation and treatment dropouts, we investigated the acceptability, feasibility, and effects of a newly developed externalization exercise in virtual reality (VR) for EDs.

Method: N = 51 inpatients with EDs (42 women, 8 men, 1 not reported; mean age = 31.9 years) imagined that an object simulated in VR (a sphere) represented their ED. They then modified the object using controller-assisted actions (controlling distance, size, color, and cutting it up). The perceived valence, activation, and difficulty of each action as well as user experiences were recorded. Effect parameters (self-ED overlap as a measure of relative externalization, general self-efficacy) were recorded before and after the exercise.

Results: Patients rated their experience predominantly positive. Self-ED overlap decreased (Cohen's d = 0.46, 95% CI [0.22, 0.69]) and self-efficacy increased from before to after participation (Cohen's d = -0.22, 95% CI [-0.43, -0.01]). The effects were comparable between anorexia nervosa and other diagnostic groups.

Conclusion: The results indicate the feasibility and potential efficacy of the newly developed VR procedure for externalizing EDs and provide a basis for planning controlled studies.

Objective: Harmful consequences of having an eating disorder can be exacerbated by engagement in digital groups that promote eating disorder-related content, particularly related to anorexia nervosa, and are often called pro-Ana. This study aims to synthesize qualitative research regarding individuals' experiences of participating in these digital groups to elucidate the underlying personal drivers of the engagement and how it can affect eating problems.

Methods: A systematic database search for first-person experiences yielded 27 relevant studies. We used an ethnographic approach and a thematic analysis for the meta-synthesis.

Results: We identified three meta-themes across the studies: (1) "Pro-Ana feels like a safe space where I can be myself", (2) "Pro-Ana is a dangerous path", and (3) "Pro-Ana becomes a joint project for living with an eating disorder".

Discussion: Participants' experiences in pro-Ana communities relate to concepts on offline stigmatization, fundamental needs for belonging, and the inherent ambivalence toward the online community-balancing the pursuit of emotional support with the risks of indirect digital self-harming. Helpers and clinicians are recommended to directly engage with clients regarding their digital activities and associated risks, including engagement in pro-Ana, with openness and respect to mitigate feelings of shame and guilt.

Objective: Emotional inertia, the tendency for emotions to persist over time, has received little attention in relation to eating disorders (ED). However, emotional inertia may reflect poor emotion regulation and unresponsiveness to environmental cues, and individuals may use ED behaviors to distract from or escape persistent emotions. We aimed to characterize emotional inertia and its relationship with ED behavior frequency among adults with EDs.

Method: Adults (N = 94) with bulimia nervosa (BN) or binge eating disorder (BED) spectrum EDs completed 7-14 days of ecological momentary assessment, reporting negative affect (NA), positive affect (PA), and ED behaviors. Inertia was computed using within-person autoregressive estimates in a multilevel model. We compared NA and PA inertia between diagnostic groups, and as predictors of ED behavior frequency.

Results: Average NA and PA inertia did not differ by diagnostic group. Higher NA inertia was cross-sectionally associated with greater overall frequency of compensatory behaviors in participants with BN-spectrum EDs. NA inertia was not cross-sectionally associated with binge eating but was positively associated with overall frequency of dietary restriction. The cross-sectional association of NA inertia with binge eating and dietary restriction was not moderated by diagnostic group. PA inertia was not cross-sectionally associated with frequency of any ED behaviors.

Discussion: Emotional inertia may be important for understanding the development and maintenance of ED behaviors, particularly dietary restriction. Future research should explore temporal relationships. Interventions promoting flexible emotional responding may help to reduce emotional inertia and its effect on ED behaviors.

Objective: The interpersonal model of binge eating postulates that interpersonal distress (ID) leads to elevated negative affect (NA), which in turn promotes risk for binge eating. This model has received some support in young people, including within momentary study designs, but between-person factors that may modulate real-time associations among ID, NA, and dysregulated eating are unknown. This study aims to (1) replicate prior momentary research on the interpersonal model and (2) examine trait-level moderators that may impact observed momentary relationships.

Methods: Children aged 8-14 years (N = 40) with a body mass index ≥ 85th %ile completed measures of trait-level (stable/enduring) eating expectancies and perceptions of teasing prior to participating in a 2-week ecological momentary assessment protocol evaluating state-level (momentary) ID, NA, and loss of control (LOC) eating severity. Dynamic structural equation modeling assessed whether trait-level expectancies and teasing perceptions moderated associations between state-level ID, NA, and LOC eating severity.

Results: At the between-person level, children with greater ID, on average, reported more severe LOC eating. At the within-person level, greater momentary ID was contemporaneously associated with higher NA. Relationships between ID, NA, and LOC eating were significantly moderated by frequency of weight-related teasing, though weakened between ID and LOC eating.

Discussion: Results from this study replicated and expanded prior research supporting aspects of the interpersonal model of binge eating in youth. Future studies should identify resilience factors that protect youth from adverse behavioral effects of weight-based interactions to inform early intervention efforts.

Objective: Diet culture refers to the ubiquitous sociocultural system which conflates bodyweight with health, perpetuates myths about food and eating, and upholds a moral hierarchy of bodies derived from patriarchal, racist, and capitalist forms of domination. Diet culture promotes a hierarchy of bodies and weight-based moralism that can contribute to anti-fat bias and the development of eating disorders (EDs). Despite growing recognition of these harms, accessible interventions targeting diet culture beliefs remain limited. In this study, we evaluated a brief, single-session digital mental health intervention (DMHI) designed to challenge diet culture beliefs (e.g., fat = unhealthy).

Method: A sample of 455 cisgender women (M _age = 32.6) completed the DMHI, which included psychoeducation and cognitive restructuring techniques aimed at disrupting weight stigma and misinformation about weight and health. Of the 455 participants enrolled, between 284 and 296 completed post-intervention measures depending on the outcome. Attrition analyses indicated no significant baseline differences between completers and non-completers on ED pathology or weight stigma variables; the only exception was the interpersonal relationships subscale of fat acceptance, where non-completers reported slightly lower baseline scores. Pre- and post-intervention assessments measured ED pathology, fat acceptance, and anticipated weight stigma.

Results: We found increased fat-accepting health beliefs and decreased fear of weight stigma and ED symptoms, specifically fear of weight gain, following the intervention. However, interpersonal respect for fat individuals slightly decreased, and fat activism showed limited improvement, suggesting that certain components of fat acceptance may require more sustained or relational formats.

Discussion: These findings highlight the potential of DMHIs to shift belief systems related to diet culture and ED risk, particularly as scalable, low-barrier tools for prevention and early intervention. Future work should examine the durability of effects and test enhancements targeting activism and interpersonal change. Hypotheses, variables, and analyses were pre-registered at https://osf.io/27ym3.