International Journal of Eating Disorders最新文献

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.

Objective: Despite the availability of several evidence-based treatments for eating disorders (EDs), including Family-Based Treatment (FBT), therapist drift from evidence-based treatments in real-life clinical settings is common. This study explores clinicians' use of FBT techniques and identifies clinician-reported barriers to their use in real-world settings.

Methods: Clinicians (N = 54) who self-identified as using FBT for EDs were recruited through social media, professional listservs, and mental health provider databases. Participants completed an online survey comprised of questions developed alongside ED researchers (n = 5). Questions included quantitative self-rating of frequency of FBT technique use and usefulness, limitations of the treatment, and barriers to effective implementation of FBT.

Results: Descriptive statistics indicated frequent use of most FBT techniques (i.e., Ms > 75 on scales ranging from 0 [never use] to 100 [always use]). On a scale from 0 (not at all a barrier) to 100 (a major barrier), ratings of FBT barriers ranged from 25.07 (i.e., caregiver motivation decreases when learning reasons for ED) to 80.70 (i.e., low time resources). Regarding limitations of FBT, between 37% and 42.6% of participants indicated challenges in establishing an alliance with youth and validating their experiences as barriers to treatment success.

Discussion: Overall, clinicians reported frequent use of FBT techniques. Barriers that received higher mean ratings included items related to emotional processes experienced by caregivers, caregiver/patient beliefs related to weight stigma/diet culture, resource and time-related constraints, and challenges with caregiver buy-in/beliefs about treatment. Future research should explore ways to adapt FBT to address these barriers within naturalistic settings.

Objective: Outcomes for low-weight restrictive eating disorders, including anorexia nervosa, restricting type (AN-R) and avoidant/restrictive food intake disorder (ARFID), are sub-optimal. Reducing dietary restriction is a key treatment target. Understanding heterogeneity in patterns of change in dietary restriction may aid in improving outcomes. We examined latent trajectories of change in dietary restriction during treatment and follow-up in AN-R and ARFID.

Methods: Adolescents and adults with R-EDs (N = 276, 18% ARFID, 90% female, M_age = 18) receiving intensive ED treatment completed assessments at five timepoints. Latent growth mixture modeling examined trajectories of change in dietary restriction, measured using the Eating Pathology Symptoms Inventory Restricting subscale. Classes were compared on clinical features at admission to determine characteristics prospectively associated with trajectory.

Results: A 3-class solution emerged: Class 1 comprising individuals with "good response" (n = 138; 33% of those with ARFID in the sample); Class 2 with "good response, rebounding" (n = 81; 41% of ARFID); and Class 3 with "gradual response, low symptoms" (n = 57; 26% of ARFID). Class 3 had lower anxiety and R-ED symptoms than Classes 1 and 2. Class 2 presented with older age than Class 1.

Discussion: No ARFID-specific classes emerged, underscoring similarities in response to intensive treatment between AN-R and ARFID.

Objective: Self-report measures of ARFID symptoms (e.g., Nine-Item Avoidant/Restrictive Food Intake Disorder Screen [NIAS]) are used to assess symptom differences between groups. Measurement invariance techniques clarify if groups interpret a measure similarly, providing a foundation for examining group differences. Considering age and reporter status (e.g., parent vs. self-report), we investigated measurement invariance of the NIAS in (1) self-reporting adults vs. adolescents; (2) parent reports on children vs. adolescents; and (3) parent reports on adolescents vs. adolescent self-report. If measurement invariance was supported, we examined symptom differences.

Methods: Data were from the ARFID Genes and Environment (ARFID-GEN) project.

Results: Self-reporting adults vs. adolescents and parent reports of adolescents vs. adolescent self-report interpreted the NIAS similarly (measurement invariance was supported). Measurement invariance was not supported in parent reports on children vs. adolescents. Self-reporting adults reported higher appetite scores (i.e., lower appetite) than self-reporting adolescents at the subscale and item level on the NIAS. Although no subscales differences were identified between parent reports on adolescents and adolescent self-reports, parents reported more picky eating and lower appetite in adolescents than self-reporting adolescents at the item level on the NIAS.

Discussion: Findings support using the NIAS to measure symptom differences in self-reporting adults vs. adolescents and in parent reports of adolescents vs. adolescent self-reports. Findings may be leveraged by researchers interested in maturational effects of ARFID symptoms in adolescents and adults via self-reports on the NIAS and clinicians interested in tracking the convergence of parent and adolescent NIAS reports while undergoing treatment for ARFID.

Objective: Artificial intelligence (AI) could revolutionize the delivery of mental health care, helping to streamline clinician workflows and assist with diagnostic and treatment decisions. Yet, before AI can be integrated into practice, it is necessary to understand perspectives of these tools to inform facilitators and barriers to their uptake. We gathered data on clinician and community participant perspectives of incorporating AI in the clinical management of eating disorders.

Method: A survey was distributed internationally to clinicians (n = 116) with experience in eating disorder treatment (psychologists, psychiatrists, etc.) and community participants (n = 155) who reported occurrence of eating disorder behaviors.

Results: 59% of clinicians reported use of AI systems (most commonly ChatGPT) for professional reasons, compared to 18% of community participants using them for help-related purposes. While more than half of clinicians (58%) and community participants (53%) were open for AI to help support them, fewer were enthusiastic about their integration (40% and 27%, respectively) and believed that they would significantly improve client outcomes (28% and 13%, respectively). Nine in 10 agreed that AI may be improperly used if individuals are not adequately trained, and could pose new data privacy and security concerns. Most agreed that AI will be convenient, beneficial for administrative tasks, and an avenue for continuous support, but will never outperform human clinicians on relational skills.

Conclusion: While many clinicians and community participants are open to the use of AI in eating disorder treatment and recognize its possible wide-ranging benefits, most remain cautious and uncertain about its implementation.

Background: Individuals with avoidant/restrictive food intake disorder (ARFID) self-report heightened sensitivity to taste and smell, but neither phenomenon has been systematically explored in the laboratory. We hypothesized that, compared to healthy controls (HC, n = 34), children, adolescents, and adults with full/subthreshold ARFID (n = 100; ages 9 to 23 years) would self-report heightened response to taste/smell stimuli and exhibit stronger bitter taste perception and heightened smell perception in performance-based tasks, and these differences would be especially prominent in those with the ARFID-sensory sensitivity presentation.

Method: We measured self-reported sensitivity to taste/smell with the adolescent/adult sensory profile (AASP). We measured performance-based bitter taste perception with the regional taste intensity test (RTIT) and 6-N-propylthiouracil (PROP) test, and olfactory performance with the Sniffin' Sticks test (including the odor threshold, odor detection, and odor identification subscales).

Results: As expected, the ARFID group self-reported heightened response to taste/smell on the AASP, compared to HC, with an especially large effect size in the subset with the ARFID-sensory sensitivity presentation. Contrary to hypotheses, on performance-based measures, neither the ARFID group-nor the ARFID-sensory sensitivity group specifically-demonstrated heightened sensitivity to bitter taste on the RTIT or PROP tests, nor heightened smell perception on the Sniffin' Sticks test.

Conclusion: These first laboratory findings in a clinically diagnosed sample of individuals with full/subthreshold ARFID highlight the discrepancy between perceived versus actual sensitivity to taste/smell stimuli. Future research should explore whether this discrepancy can be replicated and therapeutically leveraged to facilitate successful food exposures.