International Journal of Eating Disorders最新文献

Objective: To evaluate moderators and predictors of response to cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) for binge-eating disorder (BED).

Method: Moderators/predictors of treatment outcome, central to CBT and to DBT treatment, were chosen from an aggregated dataset of two clinical outcome studies with non-random allocation to treatment groups (N = 203). Both studies compared DBT-BED (n = 71) to a more intensive outpatient CBT program (CBT+, n = 132) in individuals with BED. Generalized linear models examined moderators and predictors of objective binge-eating (OBE) frequency at end of treatment (EOT) and six-month follow up (FU).

Results: Baseline shape/weight overvaluation, shape concerns and low self-esteem significantly predicted and moderated reductions in OBE frequency at EOT whereas difficulty in identifying feelings predicted and moderated outcome at FU. Emotional eating predicted outcome at FU (medium effect) and moderated outcome at EOT (large effect). Depression levels predicted, but not moderated, treatment outcome at both EOT and FU. For shape/weight overvaluation, shape concerns and low self-esteem, low levels were related to fewer reductions in outcome in DBT-BED than in CBT+. Individuals with the highest levels of emotional eating and difficulty identifying feelings showed more decrease in OBE episodes with DBT-BED than with CBT+ at EOT and FU respectively.

Discussion: Findings suggest that BED treatment outcomes could be enhanced by matching individuals with certain symptom presentations to treatment overall, and to DBT-BED or CBT+ specifically. DBT-BED may be a promising alternative to CBT+ for those with more severe psychopathology.

Objective: Generative artificial intelligence (AI) has the potential to be used in supporting people with eating disorders (EDs), but this also presents certain risks. This study aimed at comparing the psycholinguistic attributes (language markers of cognitive, emotional, and social processes) and lexico-semantic characteristics (patterns of word choice and meaning in text), and assessing potential harms of AI responses versus human responses in online communities (OCs).

Method: We collected pre-COVID data from Reddit communities on EDs, consisting of 3634 posts and 22,359 responses. For each post, responses were generated using four widely used state-of-the-art AI models (GPT, Gemini, Llama, and Mistral) with prompts tailored to peer support. The Linguistic Inquiry and Word Count (LIWC) lexicon was used to examine psycholinguistic features across eight dimensions, and a suite of lexico-semantic comparisons was conducted across the dimensions of linguistic structure, style, and semantics. Additionally, 100 AI-generated responses were qualitatively analyzed by clinicians to identify potential harm.

Results: Using OC responses as a comparison, AI responses were generally longer, more polite, yet more repetitive and less creative than human responses. Empathy scores varied among models. Qualitative analysis revealed themes of possible reinforcement of ED behaviors, implicit biases (e.g., favoring weight loss), and an inability to acknowledge contextual nuances-such as insensitivity to emotional cues and overgeneralized health advice. All AI chatbots produced responses containing harmful content, such as promoting ED behaviors or biases, to varying degrees.

Discussion: Findings highlight differences between AI and OC responses, with potential risks of harm when using AI in ED peer support. Ethical considerations include the need for safeguards to prevent reinforcement of harmful behaviors and biases. This research underscores the importance of cautious AI integration; further validation, and the development of guidelines are needed to ensure safe and effective support.

Objective: To synthesize the evidence on the associations between vegetarian and/or vegan diets (VVDs) and symptoms of orthorexia nervosa (ON) compared with omnivorous diets in the adult population.

Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines, we conducted a systematic review and meta-analysis. We searched the MEDLINE/PubMed, Embase/Scopus, PsycINFO, and Web of Science databases up to June 17, 2025, with no language or date restrictions. Random effects models with the Sidik-Jonkman method were used to estimate pooled effect sizes.

Results: The meta-analysis included 26 cross-sectional studies with a total of 23,783 participants (72.0% female; mean age range: 19.6-51.0 years). Adults who followed VVDs had moderately higher ON symptoms compared to omnivores (standardized mean differences using Cohen's d index = 0.46; 95% confidence interval [CI]: 0.33, 0.60; inconsistency index [I ²] = 81.0%). Additionally, categorical data revealed that VVD adherents were approximately twice as likely to report ON symptoms as omnivores (odds ratio = 1.99; 95% CI: 1.21-3.25; I ² = 92.8%). Vegetarians and vegans were similarly associated with ON symptoms compared with omnivorous (p = 0.855).

Discussion: Adherence to VVD is associated with higher ON symptoms in young and middle-aged adults. However, these results should be interpreted with caution due to high heterogeneity and the low overall methodological quality of the exclusively cross-sectional studies included. Higher-quality longitudinal studies using validated assessment tools are needed to establish clearer causal relationships and inform clinical screening and intervention strategies.

Objective: Interoceptive impairments have been suggested as an etiological factor in anorexia nervosa (AN) but have not been consistently confirmed across interoceptive dimensions and bodily systems. This systematic review and meta-analysis provides a focused investigation of cardiac interoceptive accuracy (IAcc) in AN. We examined whether individuals with AN show reduced cardiac IAcc compared to healthy controls (HC) and whether this difference is moderated by age, sex, task type, guessing instructions, illness duration, or study quality.

Method: A systematic literature search was conducted in the databases PsycINFO, PubMed, MEDLINE, Web of Science, and relevant journals. Studies measuring heartbeat perception using behavioral tasks in patients with AN and HC were included. Standardized mean differences were compared between groups using a random-effects model.

Results: A meta-analysis with 16 studies revealed no significant difference in cardiac IAcc between individuals with AN and HC. Only illness duration emerged as a significant moderator, with lower IAcc in samples with shorter illness duration.

Discussion: The findings do not confirm consistently reduced cardiac IAcc in AN. Cardiac IAcc may change over the course of illness, with deficits potentially limited to the early stages. A major limitation of the literature concerns the almost exclusive reliance on the heartbeat counting task, the validity of which has been questioned. Future research should develop and employ alternative tasks, consider a broader conceptualization of interoception across dimensions and bodily systems, and include longitudinal investigations.

Objective: This spotlight highlights a critical gap in the research literature. Despite evidence that combined cognitive-behavioral therapy (CBT) and lisdexamfetamine dimesylate (LDX) for binge-eating disorder (BED) is superior to either intervention alone, no studies have examined whether psychotherapy can support gradual tapering off LDX while preserving treatment gains. While evidence shows higher rates of binge-eating relapse after LDX discontinuation, long-term use is complicated by concerns regarding side effects (e.g., hypertension), misuse-potential, cost, and/or drug interactions. Unfortunately, without current research on optimal LDX tapering strategies, clinicians lack guidance at a critical juncture.

Method: Given the absence of studies that have examined tapering psychiatric medications in BED, let alone any established protocols for doing so, the authors offer two spotlighted examples to illustrate the potential utility and clinical challenges of therapist guided LDX discontinuation during psychotherapy for BED.

Results: The spotlighted examples demonstrate that binge relapse can be avoided through gradual LDX tapering embedded within psychotherapy, with treatment gains sustained at long-term follow-up (up to 5 years after LDX discontinuation).

Discussion: This spotlight highlights the need for further research to investigate discontinuing LDX and whether gradual, therapist-supported tapering might enable the superiority of combined treatment to be sustained. Spotlighted examples were used to illustrate the conceptual framework and clinical relevance of this spotlight's central argument: that systematically evaluating optimal approaches to medication discontinuation, specifically LDX for BED, is an idea worth researching. We describe potential obstacles and limitations while also highlighting clinical or policy implications for future study.

Objective: Over the past 60 years, the proportion of highly processed foods rich in refined carbohydrates and added fats in the food environment has increased, coinciding with a rise in binge eating. While past research has focused on individual vulnerabilities for binge eating, emerging evidence suggests highly processed foods may exacerbate these vulnerabilities. This Research Forum addresses a critical research gap by synthesizing the foods reported in binge-eating episodes across 41 studies and identifying limitations in current food-reporting practices.

Method: Systematic searches were conducted in PubMed, Google Scholar, and PsycINFO through February 2025. Eligible studies reported specific foods consumed during binge-eating episodes among human participants. Foods were coded as highly processed based on the presence of refined carbohydrates and/or added fats.

Results: All 41 (100%) eligible studies reported at least one highly processed food in binge-eating episodes. Only 31.7% of studies (n = 13) reported minimally processed food consumption in a binge-eating episode. Of the food types reported across all studies (n = 404), 70.3% were classified as highly processed and 14.9% as minimally processed. However, vague food descriptions limited the ability to categorize many foods. The most frequently reported foods were cake, ice cream, cookies, and chocolate.

Discussion: Across published studies, highly processed foods were highly prevalent in binge-eating episodes, but interpretations are constrained by vague and incomplete food reporting. We outline recommendations for standardized food-reporting practices to improve the characterization of foods reported in binge-eating occasions to strengthen the clinical relevance of future research.

Objective: Previous literature has primarily employed cross-sectional designs to investigate associations between gastrointestinal (GI) symptoms and eating disorder (ED) psychopathology, a closely correlated, potentially bidirectional phenomenon; yet few studies have examined the longitudinal directionality of these relationships. This study examined the bidirectional associations between GI symptoms and ED psychopathology in cisgender Chinese adults.

Method: Using a two-wave, 6-month longitudinal design, data were collected from 400 men (M_age = 31.86 years at baseline) and 400 women (M_age = 29.71 years at baseline) via online self-reported questionnaires. GI symptoms and three types of ED psychopathology were measured at baseline (T1) and 6 months later (T2). Data analyses were conducted separately for men and women. Pearson correlation analyses were used to examine bivariate correlations among the variables. Cross-lagged models examined the bidirectional associations of GI symptoms with three types of ED psychopathology, after adjusting for demographic covariates and baseline levels of ED psychopathology.

Results: Thinness-oriented disordered eating (βs = 0.12-0.16) and avoidant/restrictive food intake disorder (ARFID) symptoms (βs = 0.12-0.13) were found to have positive bidirectional associations with GI symptoms in men. No significant bidirectional associations were identified in women. However, in women, thinness- and muscularity-oriented ED psychopathology significantly predicted more GI symptoms, and GI symptoms significantly predicted more ARFID symptoms.

Conclusions: Findings provide valuable insights for potential intervention strategies that target GI symptoms to reduce thinness-oriented ED psychopathology and ARFID symptoms in men. For women, the non-significant bidirectional results also underscore the need for future research to further clarify associations between GI symptoms and ED psychopathology.

Objective: Numerous publications utilize data from the Adolescent Brain and Cognitive Development (ABCD) Study. This review aimed to evaluate how data from the ABCD cohort contributes to understanding the pathophysiology of incipient eating disorders.

Method: Searches were completed using PubMed and the ABCD Study research publications database. All available neuroimaging articles assessing prevalence and predictors of disordered eating/eating disorders were included.

Results: Thirty-eight articles met inclusion criteria, 10 of which presented neuroimaging results, all analyzing baseline brain data. The majority (n = 9) assessed brain structure and function in children with binge eating (BE)/binge eating disorder (BED). Results were inconsistent across imaging modalities. Structural MRI studies included widespread increases in gray matter density and reductions in cortical thickness associated with eating pathology. Task-based fMRI studies reported conflicting findings, with frontostriatal activation during reward processing in children with BE/BED reduced, increased, or not different compared to controls. Resting-state fMRI analyses consistently identified reduced functional connectivity in key frontal circuits, although patterns differed when samples were stratified by sex or BMI. Non-imaging studies showed positive associations between eating disorders/disordered eating and several sociodemographic, cognitive, behavioral, and biological correlates.

Discussion: Alterations in brain structure and function associated with binge eating are identified in neuroimaging analyses of baseline scans from the ABCD cohort, with inconsistent results. One potential pattern suggests alterations in reward system function, although the direction and exact location of such alterations are unclear. Consistency in methodological approaches is necessary to allow patterns in neural alterations to be more clearly identified. There is significant and ongoing potential for the ABCD Study dataset to quantify developmental aspects of binge eating. Recommendations for future analyses as the sample progresses through puberty and eating disorder prevalence increases are also presented.

Objective: Social comparison has been widely implicated in the etiology and maintenance of body dissatisfaction and eating disorders. At the same time, however, the magnitude of this relationship remains unclear, with existing studies varying widely in methodology, measurement, and sample characteristics.

Method: To address this gap, we conducted a systematic literature review and meta-analysis (PROSPERO ID: CRD42024626732) to estimate the overall effect size of the association between social comparison and disordered eating symptoms and examine key moderators that may influence this relationship.

Results: Searches of databases (PubMed/Medline, Web of Science, PsycINFO, Scopus, ProQuest, ETHoS, MedRxiv, and PsyArXiv) identified 305 studies comprising 383 distinct samples, with a total of 126,702 participants included. The methodological quality of the included studies was assessed. A multi-level meta-analysis found a significant overall medium effect size, Zr = 0.43, p < 0.0001, 95% CI [0.4-0.45], although studies were heterogeneous, Q (1150) = 20004.8418, p < 0.001. Moderator analyses showed that effect sizes were larger in more recent studies, in samples with a higher proportion of female participants, in studies examining upward and eating-related comparisons, and in studies that used the BEECOM (Body, Eating, and Exercise Comparison Orientation Measure) and the BSQ (Body Shape Questionnaire). Based on our quality assessment, a primary limitation among included studies was unclear inclusion and exclusion criteria, although most of them used appropriate analyses.

Discussion: By synthesizing existing evidence, our findings support the relation between social comparison and disordered eating symptoms and inform future theoretical frameworks and prevention interventions.

Objectives: Despite the rapid growth of generative artificial intelligence (AI), virtually no research exists examining the psychological impacts of viewing or interacting with AI-generated images of people. Additionally, it remains relatively unknown whether informing viewers when images are AI-generated is an effective way to lessen harm or improve public perception of technology. The present study examined the impact of informing image viewers about the role AI played in their creation on body dissatisfaction and trust in technology.

Methods: Two hundred ninety-six female regular social media users were randomized to either the uninformed group or the informed group. They completed two measures of body image and a measure of trust in technology before and after viewing and rating 10 AI-generated Instagram images of female content creators.

Results: On both measures of body image, there was no significant interaction (p = 0.117; p = 0.693), but there was a significant effect of time such that both groups reported decreased body satisfaction after viewing the images (both p < 0.001). For trust in technology, there was a significant interaction, p = 0.010, such that the informed group had a steeper decline in their trust in technology after viewing the AI-generated images.

Discussion: The findings of this study demonstrate that viewing AI-generated images of influencers negatively impacts body image regardless of whether the role of AI is known. These findings suggest that while labels may help keep the user informed, they are not enough, underscoring the need for clearer guidance on whether and how AI tools can be safely used online.