International Journal of Eating Disorders最新文献

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.

Objective: According to DSM-5-TR, avoidant/restrictive food intake disorder (ARFID) cannot be diagnosed alongside anorexia nervosa (AN), bulimia nervosa (BN), or any other body image disturbance. This does not accurately reflect real-world symptomatology and recent research, indicating the potential need to revise DSM-5-TR Criteria. We investigated the co-occurrence of weight- and/or shape-motivated restriction (WSR) in adults who screened positive for ARFID, providing evidence to inform such changes.

Method: The sample comprised 5747 adults who consented to participate in the ARFID-Genes and Environment (ARFID-GEN) research study, screened positive for ARFID on the NIAS and PARDI-AR-Q, and completed the EDE-Q. We placed our participants into four groups: groups one and two screened positive for AN (ARFID-AN; n = 147) or BN (ARFID-BN; n = 193), group three endorsed WSR without meeting AN or BN criteria (ARFID-WSR; n = 2159), and group four endorsed ARFID symptoms only (ARFID-nWSR; n = 3248). We used generalized linear models to test group differences on the NIAS, PARDI-AR-Q, and EDE-Q.

Results: Where significant differences were present, ARFID-nWSR demonstrated lower scores than all other groups across ARFID dimensions on the NIAS and PARDI-AR-Q, and lower odds of meeting DSM-5-TR Criteria A1 to A3 (i.e., weight loss; nutritional deficiencies; dependence on nutritional supplements).

Discussion: These findings indicate a mixed phenotype with features of both ARFID and WSR associated with more severe ARFID symptomatology. The DSM-5-TR Criteria may not capture complex real-world symptomatology in adults with probable ARFID, potentially precluding those with the most severe symptoms from receiving accurate diagnoses and appropriate care.

Objective: Anorexia nervosa (AN) has one of the highest mortality rates among psychiatric disorders. This systematic review and meta-analysis examined the all-cause mortality of AN patients compared to the general population using the standardized mortality ratio (SMR).

Method: MEDLINE, PsycINFO, EMBASE, WOS, Dissertations and Theses A&I, and Google Scholar were searched from inception to May 2025 for longitudinal studies reporting all-cause SMR for AN patients. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted and presented as a forest plot. Subgroup and meta-regression analyses were done. SMRs for male- and female-specific samples were compared.

Results: Thirty studies involving 33,176 patients were identified. The pooled SMR from 22 studies was 5.06 (95% CI [3.47-7.38]). Suicide and cardiac deaths accounted for 21% and 19% of deaths, respectively. Studies with lower mean BMI were associated with higher SMRs before correction for multiple testing (p = 0.018, adjusted p = 0.252). The pooled SMR of male-specific samples was 3.47, 95% CI (1.60-7.52), similar to female-specific samples (3.86, 95% CI [1.82-8.20]).

Discussions: Our findings confirm that AN remains a severe psychiatric disorder, underscoring the clinical importance of suicide prevention and monitoring cardiac complications. A low BMI is a crucial clinical indicator for high-risk groups and allocating resources. Limitations include excluding studies with zero deaths, substantial heterogeneity among included studies, the underrepresentation of male and non-Western populations, and most studies originating from specialist clinics.

Objective: Body dissatisfaction has been linked to negative and positive emotions. The validity of self-report methods to assess emotions in individuals with eating disorders is limited, prompting a shift towards methods like natural language processing to analyze speech content. Using artificial intelligence, this study aimed to identify specific body-related emotions elicited by looking at oneself in the mirror in individuals with eating disorders.

Method: Women with anorexia nervosa (n = 24), women with bulimia nervosa (n = 36), and healthy women (n = 72) completed a three-minute mirror exposure task, verbally expressing their body-related emotions while viewing themselves in a three-winged mirror wearing underwear. N = 132 audio recordings were transcribed and analyzed using the GermanEmotions model (based on RoBERTa) to identify 28 emotions. Univariate ANOVAs and post hoc tests were conducted to identify group differences in expressed emotions. Prediction of symptom severity was analyzed across groups.

Results: Compared to healthy women, those with anorexia and bulimia nervosa expressed anger, disappointment, disgust, embarrassment, fear, grief, nervousness, remorse, and sadness significantly more frequently (all ds = |0.53|-|1.11|), and admiration, approval, joy, love, optimism, and pride significantly less frequently (all ds = |0.64|-|1.12|). Disgust predicted higher eating disorder symptom severity across all groups (p < 0.001).

Discussion: A distinct range of body-related emotions differentiates women with anorexia and bulimia nervosa from healthy women. Elicited negative emotions, especially higher disgust, and diminished positive emotions suggest that body-related interventions could benefit from fostering positive emotions instead of merely reducing negative emotions.