International Journal of Eating Disorders最新文献

Objective: Adolescents with higher weight status (HWS; body mass index > 85th percentile adjusted for age and sex) are at greater risk of eating disorders (ED). This study examined factors associated with HWS adolescents' increased risk and how weight status interacts with other risk factors to influence ED onset.

Method: Australian adolescents (N = 1333; 51.2% female; 11-19 years) completed questionnaires examining ED symptoms and established and emerging risk factors (sex, age, premorbid weight/shape concerns, psychological distress, dieting, and weight-related bullying) at two timepoints 12 months apart (Waves 1 and 2).

Results: Compared to lower weight peers, those with HWS had greater odds of ED onset when adjusting for sociodemographic variables (OR = 2.96, 95% CI [1.84, 3.93]), other ED predictors (OR = 2.18, 95% CI [1.46, 3.25]), and experiences of weight-related bullying (OR = 2.20, 95% CI [1.47, 3.28]). The effect of weight status was less pronounced once premorbid dieting, weight/shape concerns, and psychological distress were accounted for, with evidence that weight/shape concerns (OR = 1.17, 95% CI [1.05, 1.30]) and psychological distress (OR = 1.33, 95% CI [1.17, 1.51]) were independently associated with ED onset. No moderation effects were observed.

Discussion: Higher levels of premorbid weight/shape concerns and psychological distress for those with HWS appear to contribute to greater ED risk and should be considered for screening and targeted in prevention.

Background: Maladaptive mealtime behaviors (e.g., cutting food up into small pieces, eating foods in a particular order) are common among individuals with eating disorders (EDs) and are associated with higher meal anxiety, lower caloric intake, and longer duration of treatment (Gianini et al. 2015). Few studies have focused on maladaptive mealtime behaviors, which are often overlooked in ED treatment.

Methods: The current study used a retrospective chart review of inpatients with EDs (N = 142) admitted to a behavioral specialty unit to create a comprehensive list of maladaptive mealtime behaviors and examine their correlates with respect to admission psychopathology and treatment progress.

Results: We identified 31 unique maladaptive mealtime behaviors. The most commonly observed behaviors were aimed at disposing of food (i.e., hiding, refusing, wasting) or dicing and cutting up food. Greater variety of maladaptive mealtime behaviors was associated with lower normative eating self-efficacy, lower admission BMI, longer hospital stays, and slower rates of weight gain, but were unrelated to BMI at discharge.

Discussion: Maladaptive mealtime behaviors were a marker of illness severity (i.e., lower BMI and inability to engage in normative eating without distress). These behaviors may impair the progression of treatment by slowing down weight gain and contributing to a longer hospital stay. Maladaptive mealtime behaviors represent an understudied intervention target to help normalize eating behavior, facilitate faster nutritional rehabilitation, and shorten hospital stays.

Objective: Specific diagnostic criteria for purging disorder (PD) are not currently provided in the DSM-5. The current study aims to compare point prevalence estimates and evidence of predictive validity for four alternative criteria sets for PD for men and women.

Method: Survey data collected in college (N = 3291) and at 10-year follow-up (n = 2223) were used in analyses. Point prevalence was assessed at both time points and compared in men versus women as well as in college versus at 10-year follow-up. Predictive validity was assessed using multiple linear regressions to determine prospective associations for each PD definition versus no eating disorder across external validators.

Results: Point prevalence was greater in women than in men in college across all definitions of PD, and no sex differences were found at follow-up. Point prevalence was greater in college than at follow-up in all but the narrowest definition of PD which required purging, on average, twice per week. Predictive validity was supported for PD defined by self-induced vomiting, laxative or diuretic misuse, with evidence of lower satisfaction with work and career at follow-up.

Discussion: Together, findings support defining PD through self-induced vomiting, laxative use, or diuretic use to influence body shape or weight, on average, at least once per week. Specifying diagnostic criteria for PD that demonstrate evidence of concurrent and predictive validity will contribute to improved diagnostic reliability, screening, assessment, and support future research efforts to improve treatment.

Objective: There is a great need for the development of scalable augmentations to treatments for anorexia nervosa (AN) and bulimia nervosa (BN), as most individuals with AN/BN are currently not able to access treatment. Mindfulness-based interventions (MBIs) may be promising for AN/BN and lend themselves well to digital delivery, increasing access. We aimed to develop and test the initial acceptability and feasibility of Mindful Courage, a digital MBI for AN/BN and atypical AN/BN.

Method: We evaluated an 8-week version of Mindful Courage including 32 modules (8 core multi-media lessons, 24 brief audio-guided mindfulness practices) in N = 32 participants, who also received weekly phone coaching conducted by psychology students. Ten participants (31.2%) were enrolled in outpatient ED treatment while receiving the intervention. Participants completed assessments at baseline, post-intervention (8 weeks), and 2-month post-intervention follow-up.

Results: Acceptability was demonstrated by relatively high ratings for perceived usability (81.34/100), understandability (4.6/5.0), engageability (4.1/5.0), visual appeal (4.1/5.0), helpfulness (4.2/5.0), skills acquisition (4.3/5.0), and confidence applying skills (4.2/5.0). Feasibility was demonstrated by high module completion (an average of 28/32 modules). There were significant reductions in target outcomes: ED symptoms (d = 1.21), body dissatisfaction (d = 0.73), depression (d = 0.76), anxiety (d = 0.62), and clinical impairment (d = 1.15). In addition, there were significant improvements in target mechanisms: mindfulness (d = 0.79), emotion regulation difficulties (d = 0.65), and savoring beliefs (d = 0.58).

Discussion: Mindful Courage is a viable and potentially effective intervention. A future randomized-controlled trial is warranted.

Objective: We aimed to determine if the high co-occurrence rates between food addiction (FA) and binge-spectrum eating disorders (BSEDs) are partially due to their respective measures assessing similar symptoms. Specifically, we aimed to clarify whether the Yale Food Addiction Scale 2.0 (YFAS 2.0) assesses a distinct symptom profile from common BSED measures (e.g., measures of binge-eating disorder (BED) or bulimia nervosa). Because FA does not include compensatory behaviors, our comparison focused specifically on FA and binge-related features of BSEDs.

Method: We conducted a content analysis on the YFAS 2.0 and five of the most cited BSED measures. Five trained coders inductively assigned symptom codes to every item from each measure. Because FA does not include compensatory behaviors, we removed compensatory-behavior items from the BSED measures prior to coding to focus on binge-related content. We then calculated Jaccard similarity coefficients to quantify symptom overlap between measures.

Results: The YFAS 2.0 showed very low symptom overlap with the BSED measures (Jaccard range = 0.08-0.19). However, nearly half (47%) of its symptoms were captured by at least one BSED measure. The symptoms assessed by the YFAS 2.0 and not the BSED measures tended to focus on the impairment and consequences of eating behavior, whereas the BSED measures focused more on the cognitive features of eating behavior.

Discussion: This comparison revealed both differences and similarities between FA and BSED measures. Although the YFAS 2.0 showed limited overlap with any single BSED measure, about half of its symptoms were represented in at least one BSED measure, indicating partial shared content. The FA and BSED measures also reflect different theoretical emphases, with FA focusing on impairment and BSEDs emphasizing cognitive and behavioral features. Further clarifying how FA and BED relate will require integrating measurement patterns with evidence on mechanisms and clinical course.

Objective: To assess clinical outcomes and parental experiences following an intensive multidisciplinary intervention (IMI) for children with Avoidant Restrictive Food Intake Disorder (ARFID).

Method: A prospective cohort of 28 children (aged 2-8 years) with severe eating difficulties, all meeting ARFID diagnostic criteria at baseline, participated in a 3-day assessment and an 8-day IMI involving guided mealtimes, play-based exposures, nutritional counseling, and caregiver coaching. Clinical outcomes were assessed using the Pica, ARFID, and Rumination Disorder Interview (PARDI) at baseline and at 7-15 months post-intervention. Parental experience was evaluated using the Experience of Service Questionnaire (ESQ) and the study-specific Eating Intervention Experience Questionnaire (EIEQ).

Results: At follow-up, 27 of 28 children continued to meet ARFID criteria; however, overall symptom severity decreased significantly (M = 3.55 → 2.57, d = 0.80, p < 0.001), with reductions in both the sensory (M = 2.77 → 2.21, d = 0.63, p = 0.002) and low-interest profiles (M = 3.48 → 2.50, d = 0.93, p < 0.001), alongside improvements in nutritional status and growth-related criteria. Parents reported high satisfaction with the intervention, valuing the multidisciplinary approach, tailored support, and practical strategies.

Discussion: Findings suggest that intensive, multidisciplinary, nondirective interventions may yield clinically meaningful benefits for young children with severe ARFID, particularly those with combined sensory sensitivity and low interest in eating profiles. Although full remission was uncommon within the follow-up period, the intervention supported symptom reduction and caregiver competence. Larger controlled studies are needed to establish efficacy and guide development of sustainable models of care.

Objective: Anorexia nervosa (AN) is a severe eating disorder associated with extreme weight loss, hyperactivity, and amenorrhea. Neuroimaging studies revealed brain atrophy and disruption of white matter integrity in the corpus callosum (CC) of patients with AN. However, the underlying pathophysiological mechanisms remain unclear. Emerging evidence indicates that starvation induces changes in mitochondrial metabolism and dynamics. We hypothesize that disturbances in white matter integrity arise from modifications in oligodendrocytes, associated with changes in the morphology of myelinated fibers and mitochondrial structure.

Method: The starvation-induced hyperactivity (SIH) model was used, in which mice received a restricted daily amount of food in combination with free access to a running wheel. A body weight loss of 25% was maintained over 2 weeks, followed by a 3-week refeeding phase. Oligodendrocyte density and staining intensity of oligodendrocyte lineage transcription factor 2 (OLIG2) in the CC were analyzed using immunohistochemical staining. Morphometric investigation of myelinated fibers and mitochondria was conducted by transmission electron microscopy (TEM) analysis.

Results: Starvation led to decreased oligodendrocyte density and reduced anti-OLIG2 staining intensity in the CC, which was reversible following refeeding. Additionally, starvation induced a decrease in axonal caliber and an increase in mitochondrial density in the white matter, accompanied by a reduction of mitochondrial area.

Discussion: The findings suggest that oligodendroglial and axonal alterations, alongside disrupted mitochondrial dynamics, impair structural integrity in the white matter and contribute to the pathophysiology of AN.

Objective: This study examined everyday exposure to fitspiration, thinspiration, body positivity, and body neutrality content on image-based social media and its associations with body image, mood, self-esteem, and disordered eating behavior using ecological momentary assessment (EMA) in women with and without eating disorders.

Method: Women with self-reported anorexia nervosa or bulimia nervosa (n = 62) and women without eating disorders (n = 81) reported their social media use, mood, body image, self-esteem, appearance comparisons, and disordered eating behavior via a smartphone app for 7 days.

Results: Viewing fitspiration and thinspiration content was significantly associated with lower happiness, higher body dissatisfaction, and lower body appreciation, but not with daily-reported restrained eating. Only thinspiration content was significantly associated with higher sadness and lower self-esteem. Upward appearance comparisons mediated the associations of exposure to fitspiration and thinspiration content with all outcomes. Except for higher body appreciation after viewing body neutrality content, there were no main effects of body positivity and body neutrality. Compared to women without eating disorders, those with self-reported anorexia nervosa or bulimia nervosa showed a greater reduction in self-esteem after viewing thinspiration.

Discussion: The results highlight the possible detrimental effects of exposure to fitspiration and thinspiration content on mood, body image, and self-esteem in women with and without self-reported anorexia nervosa or bulimia nervosa alike, while only body neutrality content was related to higher body appreciation. Women with and without eating disorders should be educated about the possible negative influences of content purporting to improve one's appearance.

Background: The perinatal period is a critical risk period for changes in eating disorder (ED) symptoms. However, extant research is mixed regarding the direction of these changes, with some studies identifying relief from ED symptoms and others finding evidence of worsening symptoms during this time. To account for heterogeneity in ED symptom change among pregnant and postpartum individuals, the current study aimed to explore ED symptom trajectories and their psychosocial correlates during pregnancy and the first postpartum year using person-centered statistical approaches.

Method: A community sample of pregnant people recruited online (N = 315) completed assessments of ED symptoms and psychosocial factors during pregnancy, 8-weeks postpartum, and 1-year postpartum between October 2020 and January 2023. ED symptom trajectories were identified using group-based multivariate trajectory modeling. Multinomial logistic regression tested if psychosocial factors (anxiety, depression, stress, emotion regulation difficulties, self-compassion, social support, and body mass index) during pregnancy and across postpartum were associated with trajectory groups.

Results: Four distinct groups were identified: decreasing ED cognitions group (34% of the sample), increasing ED symptoms group (29%), early postpartum ED risk group (22%), and early postpartum alleviation group (15%). Postpartum weight retention and increasing depression from pregnancy to 1-year postpartum were associated with higher odds of membership in the increasing ED symptoms group, relative to other groups.

Discussion: Although perinatal ED symptoms were commonly endorsed, symptom changes were heterogeneous. It is important to continue to investigate prospective correlates of perinatal ED symptoms and utilize idiographic modeling to inform prevention and early intervention approaches.

Objective: Pioneer studies suggested the effectiveness of food-specific electroencephalography (EEG) and real-time functional near-infrared spectroscopy (rtfNIRS) neurofeedback (NF) trainings in the treatment of binge-eating disorder (BED). These trainings aim to improve participants' neurophysiological self-regulation. However, pretreatment neurophysiological activity, a supposed key predictor of NF outcomes, remains unexplored.

Method: This preregistered analysis (https://osf.io/xsrj3) used data from a randomized-controlled trial (DRKS00014752) on 47 adults (47 ± 13 years, 81% women) with interview-assessed BED having undergone food-specific EEG- or rtfNIRS-NF (12 sessions, over 8 weeks). Bayesian linear models explored pretreatment fronto-central high beta power (23-28 Hz; indicating increased attention) in EEG, pretreatment prefrontal oxygenation in fNIRS (indicating increased cognitive control), and rapid response (RR; early reductions in binge eating) as predictors of treatment outcomes reflecting mental and physical health at posttreatment and 6-month follow-up.

Results: Higher high beta power during passive viewing of food pictures, lower high beta power, and less oxygenation during regulatory NF tasks, as well as RR predicted more favorable primary outcomes, including reduced objective binge-eating episodes and increased abstinence from binge eating. Overall, neurophysiological predictors-especially EEG activity-showed greater predictive value than RR.

Conclusion: The preliminary findings suggest the relevance of neurophysiological activity in the prediction of NF treatment outcomes in BED. While patients with increased involuntary attention in response to food stimuli profited most from EEG-NF, those with greater difficulties in voluntary recruitment of food-related cognitive control profited most from rtfNIRS-NF. The predictors identified could guide future treatment allocation and represent a first step toward more individualized therapy approaches.