International Journal of Eating Disorders最新文献

Objective: Avoidant/restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by extensive avoidance and/or restriction of food. Existing research demonstrates that ARFID is over-represented in Autistic populations and vice-versa, with both groups exhibiting shared characteristics. This meta-analysis investigated the co-occurrence between ARFID and autism via determination of autism prevalence in ARFID populations, and ARFID prevalence in Autistic groups.

Method: This review systematically identified literature evaluating those with ARFID and Autistic individuals. Literature was searched for using SCOPUS, MEDLINE, and Web of Science. Selected publications included Autistic individuals and those with ARFID who either received a formal diagnosis of autism and/or ARFID or met clinical threshold cut-off scores on validated autism and/or ARFID questionnaires. Prevalence was reported in proportion-based values alongside 95% confidence intervals (CIs).

Results: This meta-analysis identified 21 studies (kARFID = 18 papers; kAutism = 3 papers) comprising of n = 7442 participants (nARFID = 1708; nAutism = 5734). Prevalence of autism diagnoses was 16.27% in those with ARFID (95% CI = 8.64%-28.53%), and ARFID prevalence in Autistic groups was 11.41% (95% CI = 2.89%-35.76%). Gender and ethnicity served as significant sources of heterogeneity in ARFID papers. There was insufficient data to provide comparator values or prevalence across study population and distinct underpinning drivers of ARFID.

Discussion: Meta-analytic findings highlight significant rates of co-occurrence between autism and ARFID, suggesting that in clinical settings, it may be beneficial to consider screening Autistic individuals for ARFID and vice-versa. Future research should further investigate co-occurrence across ARFID profiles, gender, and ethnicity.

Objective: Prior work has documented inequities in disordered eating behavior (DEB) prevalence across gender identity, race, and ethnicity, yet has often ignored the fact that individuals belong to multiple social groups simultaneously. The present study assessed DEB inequities at the intersection of gender identity and race/ethnicity.

Method: The sample included n = 10,287 adolescents (68% gender-diverse, 33% belonging to marginalized racial/ethnic groups). Past-year prevalence of dietary restriction, self-induced vomiting, diet pill use, and binge eating was assessed. Data were analyzed with multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). MAIHDA nests individuals within social strata defined by all combinations of gender identity and race/ethnicity (a proxy for exposure to structural (cis)sexism and racism). MAIHDA allows for comparison of outcome prevalence across strata and identifies strata with disproportionately high or low prevalence.

Results: Hispanic gender-nonconforming youth had a high prevalence of multiple DEBs: restricting prevalence was 67.1% (95% CI [62.1%-72.2%]), vomiting prevalence was 25.9% (95% CI [21.6%-31.0%]), and binge eating prevalence was 46.0% (95% CI [40.2%-51.4%]). For all outcomes, at least one stratum had disproportionately low prevalence; for all outcomes except vomiting, at least one stratum had disproportionately high prevalence, indicative of intersectional interactions between gender identity and race/ethnicity.

Discussion: DEB prevalence among adolescents varies substantially at the intersection of gender and race/ethnicity, with the highest prevalence among those belonging to multiple marginalized groups. Future research is needed on the multilevel drivers of DEBs.

Objective: Difficulty updating information in working memory has been proposed to underlie ruminative thinking in individuals with anorexia nervosa (AN). However, evidence regarding updating difficulties in AN remains inconclusive, particularly among adolescents. It has been proposed that exposure to negative emotion and disorder-salient stimuli may uniquely influence updating in AN. This study examined the influence of exposure to negative emotion on updating of food and non-food stimuli among adolescents with AN.

Method: The study included 41 female adolescents with restrictive AN (M_age = 15.2) and 43 female controls (M_age = 16.9) who performed a modified version of the N-back task requiring updating of food and non-food content after supraliminal exposure to emotionally neutral and negative images.

Results: Medium-to-large effects revealed significantly higher updating errors among adolescents with AN compared to controls for food targets and after exposure to negative stimuli. In contrast, during exposure to both negative images and food targets, the groups performed similarly, as this condition also increased updating errors among controls. Additionally, a higher proportion of updating errors was associated with greater eating disorder symptoms severity.

Discussion: The findings indicate that exposure to negative emotion and food stimuli separately compromise working memory updating in adolescents with AN. These results underscore the role of environmental triggering cues in compromising working memory updating in AN and highlight the importance of considering ecological cues when evaluating cognitive functioning in eating disorders.

Introduction: Studies have shown that early weight gain in family-based treatment (FBT) predicts treatment response in adolescents with anorexia nervosa (AN); however, research examining factors associated with early weight gain in FBT is limited. This study tested the feasibility and acceptability of ecological momentary assessment (EMA) in early FBT, particularly to capture momentary data on family climate during mealtimes.

Methods: Using multiple methods, quantitative (EMA) and qualitative (interviews) data were collected in the first 4 weeks of FBT. Participants (11 families; 9 adolescents, 19 parents/caregivers) completed EMA assessments daily on the emotional climate during meals, parental strategies and confidence/agreement in renourishment. Qualitative interviews obtained technological and procedural data using EMA. Completion rates and markers of change were explored using repeated measures ANOVA. Interviews were analyzed using reflexive thematic analysis.

Results: The EMA completion rate for all family members was 78%: 84% for adolescents, 83% for mothers, 64% for fathers. Results demonstrated changes in caregivers' use of renourishment strategies and in the emotional climate (decreased anger) at mealtimes. No changes were observed in caregiver confidence/agreement in renourishment. Qualitative analyses revealed factors interfering with and facilitating the use of EMA.

Discussion: EMA is an acceptable and feasible tool for use with adolescents and their families in early FBT, particularly to capture momentary data on family climate during mealtimes. Future research is needed with larger sample sizes to examine the mechanisms of change in early FBT, and the utility of EMA as a clinical tool in FBT.

Ali et al.'s (2024) systematic review and meta-analysis updated a previous meta-analysis on the gap between the need for eating disorder treatment and rates of seeking and receiving eating disorder treatment. They found that less than one-third of individuals with eating disorders sought help for their eating disorder, which was an improvement of only 8% over more than a decade. This updated analysis makes it apparent that we need to dedicate research and resources to meeting this treatment need. Building on this work, this commentary reviews changes in help-seeking behaviors, particularly online help-seeking. The commentary also discusses binge-eating disorder (BED) help-seeking because the addition of BED as a diagnosis occurred in the time between the original and updated meta-analysis. Barriers to seeking eating disorder treatment, including identifying behaviors as indicative of an eating disorder and problematic, appear pronounced among individuals with BED. The commentary concludes by highlighting that it is essential to direct research and policy efforts along multiple pathways to close the gap between those who need and those who seek eating disorder treatment.

Objective: A larger number of younger children are being diagnosed with an eating disorder (ED), with parents typically reporting a delay between early warning signs (EWS) and seeking help. The aim of the current investigation was to identify the common EWS for EDs in children noticed by caregivers and consumers as reported on websites to inform earlier detection and intervention.

Method: A realist synthesis of websites summarizing caregiver and consumer perspectives on the EWS for EDs in children was conducted by searching Google, Bing, and Yahoo! for all years covered through 24 October 2023.

Results: The initial search identified 140 websites, of which 62 met criteria for eligibility (93.5% summarized content targeted at caregivers, 6.5% included direct perspectives). Six categories and 24 sub-categories of EWS were identified across 214 individual EWS. The most common EWS, mentioned in at least 40% of websites, were: excessive or compulsive exercise, any weight loss, obsession or preoccupation with food or food preparation, and cutting out major food groups.

Discussion: This web synthesis identified the EWS of developing EDs in children most reported by caregivers and consumers; however, many of the websites contained subjective interpretations of people's experiences which were unverified and may capture potential bias. Future prospective research is required to verify caregiver and consumer experiences and to explore whether these EWS are predictive of ED onset. These results can then inform early detection strategies for EDs and may assist caregivers in recognizing when clinical assessment for an ED is required.

Ali et al. (2024) found that help-seeking rates remain low among individuals meeting the diagnostic criteria for eating disorders (EDs). Their review highlighted variability in definitions of help-seeking and a lack of adequate representation of marginalized groups across the included studies. Building on these findings, this commentary offers four recommendations to guide future researchers toward a more unified and inclusive approach when studying help-seeking patterns in ED populations by: (1) capturing alternative and indirect forms of help-seeking by engaging partners with lived experience of EDs; (2) prioritizing the inclusion of marginalized groups in the pursuit of understanding diverse help-seeking behaviors; (3) establishing a consensus on standardized measures of help-seeking within the research community; and (4) simultaneously collecting data regarding the receipt of help and treatment when conducting help-seeking research. These recommendations aim to expand upon the authors' work by proposing new ways for researchers to more accurately capture where individuals are seeking help for their ED concerns, which is an essential step in ensuring that accessible care is available to meet their needs.

This commentary responds to the recent paper by Ali et al on the unmet treatment need for eating disorders. The commentary examines the ongoing barriers to accessing evidence-based treatments for eating disorders and considers the example of Australian initiatives like the Medicare Benefit Scheme's Eating Disorder Plan, which offers subsidized psychological and dietetic services. A recent review of the plan revealed uptake has been low, with significant disparities in access, particularly in underserved populations and those in rural and remote areas. The commentary highlights new areas to guide our thinking about closing the treatment gap, such as the role of virtual and/or hybrid models of care delivery, digital health tools, improving how we communicate about what we do, and the importance of shifting from a top-down approach to service design to human-centered, co-created models that better meet the needs of consumers. If we are to truly close the gap in the next 10 years, the landscape of eating disorder treatment requires bold, forward-thinking solutions-solutions that are not only reflective of the real, lived experiences of those affected but are also continuously evaluated and refined as they scale.

Introduction: Accumulating research suggests both eating disorders (EDs) and internalizing disorders (e.g., anxiety, depression) are associated with gastrointestinal disease (e.g., irritable bowel syndrome, inflammatory bowel disease). However, the mechanisms underlying comorbidity with gastrointestinal disease-and whether they may differ for eating and internalizing disorders-remain poorly understood. Addressing these gaps is a critical first step to refining etiologic models of comorbidity and identifying potential targets for intervention.

Method: Participants included female and male twins ages 18-65 from the population-based MSU Twin Registry (N = 5883). Lifetime history of EDs, internalizing disorders, and gastrointestinal disease was assessed via questionnaire. We first examined whether EDs and internalizing disorders were independently associated with gastrointestinal disease phenotypically. We then used trivariate Cholesky decomposition twin models to investigate whether EDs and internalizing disorders were related to gastrointestinal disease through overlapping or distinct genetic/environmental pathways.

Results: Eating (OR = 2.54, p = 0.009) and internalizing (OR = 2.14, p < 0.001) disorders were independently associated with gastrointestinal disease. Conclusions were unchanged after adjusting for important covariates (e.g., body mass index, age) and did not significantly differ across sex. Twin models suggested genetic influences shared by all three conditions explained their co-occurrence, with 31% of the variance in EDs and 12% of the variance in gastrointestinal disease attributable to genetic influences shared with internalizing disorders.

Conclusion: Shared genetic mechanisms may contribute to comorbidity between EDs, internalizing disorders, and gastrointestinal disease. Identifying overlapping molecular pathways could potentially lead to novel interventions that simultaneously address all three conditions.

Objective: Family-based treatment (FBT) is the leading evidence-based treatment for adolescent eating disorders, but research exploring access and engagement in FBT is sparse. This paper focuses on findings from a broader study, specifically addressing the social determinants of health (SDH) impeding access and engagement in FBT for diverse families (i.e., families belonging to identity groups subject to systemic barriers and prejudices).

Methods: Forty-one FBT clinicians were recruited globally using purposive and snowball sampling. Clinicians participated in individual interviews or focus groups, discussing their experiences engaging diverse families in FBT. Qualitative data were transcribed verbatim and analyzed using reflexive thematic analysis.

Results: The findings underscore the pervasive impact of SDH on equitable access to FBT, specifically, the critical need for tailored approaches by clinicians to enhance access and engagement in FBT for diverse families experiencing practical, resource, and systemic barriers. Recommendations include broader dissemination of FBT knowledge, telehealth options to mitigate geographical barriers, community resource collaborations, and sensitivity to cultural and systemic factors impacting treatment engagement.

Discussion: Results of this study may inform future FBT planning (tailoring treatment approaches to address barriers), clinician training, clinical decision-making tools, and opportunities for supporting under-resourced families within the model, leading to more equitable FBT treatment access and engagement for diverse families.