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Objective: Our study aimed to review the outcome measures/assessment instruments used and to assess their heterogeneity/homogeneity in eating disorders (EDs) randomised controlled trials. Methods: APA PsycInfo, PubMed, and Embase were searched in December 2022 to identify studies published between and inclusive of January 2012 and December 2022. Inclusion/exclusion criteria were: (1) complete articles published in peer‐reviewed scientific journals, which were: (2) randomised trials, (3) in a clinical setting (4) with human subjects, (5) with an ICD or DSM diagnosis of Anorexia Nervosa, Binge Eating Disorder, or Bulimia Nervosa. The selected papers also: (6) used one or more standardised instruments designed to measure one or more psychometric characteristics associated with ED as a primary or secondary outcome, as judged by the authors of this systematic review, and (7) were published in English or Danish. Results: Ninety one articles were included, and a total of 196 outcome measures were collected. Discussion: The diversity of outcome measures in ED trials hampers result comparability and data integration. We suggest creating a core outcome measure set using the Delphi method, including clinician and patient‐reported ED assessments, along with relevant comorbidity scales. Highlights: There is a significant heterogeneity in outcome measures and a need for standardisation.We identified a predominant focus on female participants and white populations in most randomised controlled trials (RCTs) for eating disorders (EDs), raising concerns about the generalisability of findings to diverse demographic groups.We advocate for the development of a comprehensive core outcome sets' (COS) for ED clinical trials, emphasising the minimum inclusion of a clinician‐rated clinical ED assessment, a patient self‐reported ED assessment, and scales measuring common co‐morbidities. [ABSTRACT FROM AUTHOR]

Objective: The relative merits of inpatient or day‐treatment for adults with anorexia nervosa (AN) are unknown. The DAISIES trial aimed to establish the non‐inferiority of a stepped‐care day patient treatment (DPT) approach versus inpatient treatment as usual (IP‐TAU) for improving body mass index (BMI) at 12 months in adults with AN. The trial was terminated due to poor recruitment. This paper presents outcomes and investigates the reasons behind the trial's failure. Method: Fifteen patients with AN (of 53 approached) participated and were followed‐up to 6 or 12 months. Summary statistics were calculated due to low sample size, and qualitative data concerning treatment experiences were analysed using thematic analysis. Results: At baseline, participants in both trial arms rated stepped‐care DPT as more acceptable. At 12 months, participants' BMIs had increased in both trial arms. Qualitative analysis highlighted valued and challenging aspects of care across settings. Only 6/12 sites opened for recruitment. Among patients approached, the most common reason for declining participation was their treatment preference (n = 12/38). Conclusions: No conclusions can be drawn concerning the effectiveness of IP‐TAU and stepped‐care DPT, but the latter was perceived more positively. Patient‐related, service‐related and systemic factors (COVID‐19) contributed to the trial's failure. Lessons learnt can inform future studies. Highlights: Patient‐related (e.g., treatment preferences) and service‐related (e.g., reduced service capacity) alongside wider systemic (e.g., increased emergency admissions due to COVID‐19) factors seem to have contributed to the failure of the DAISIES trial.Patients and carers identified valued aspects for both inpatient (e.g., weight gain) and day‐patient (e.g., greater link to home environment) treatment settings, but day‐patient treatment was perceived as a more holistic and collaborative approach, and thus as more positive.Although randomised controlled studies investigating intensive treatments for severe anorexia nervosa are important and necessary, alternative study designs should be explored to overcome implementation challenges. [ABSTRACT FROM AUTHOR]

Objective: The DAISIES trial, comparing inpatient and stepped‐care day patient treatment for adults with severe anorexia nervosa was prematurely terminated in March 2022 due to poor recruitment. This qualitative study seeks to understand the difficulties faced during the trial by investigating stakeholders' views on and experiences of its implementation. Method: Semi‐structured interview and focus group transcripts, and trial management and oversight group meeting minutes from May 2020‐June 2022 were analysed using thematic analysis. Participants were 47 clinicians and co‐investigators involved with the DAISIES trial. The Non‐Adoption, Abandonment, Scale‐up, Spread, and Sustainability (NASSS) framework was applied to the interpretive themes to classify barriers and facilitators to implementation. Results: Five themes were identified: incompatible participation interests; changing standard practice; concerns around clinical management; systemic capacity and capability issues; and Covid‐19 disrupting implementation. Applying the NASSS framework indicated the greatest implementation challenges to arise with the adopters (e.g. patients, clinicians), the organisational systems (e.g. service capacity), and the wider socio‐political context (e.g. Covid‐19 closing services). Conclusions: Our findings emphasise the top‐down impact of systemic‐level research implementation challenges. The impact of the Covid‐19 pandemic accentuated pre‐existing organisational barriers to trial implementation within intensive eating disorder services, further limiting the capacity for research. Highlights: The paper highlights the particular challenges to research implementation that arise within an NHS intensive service context.Applying an implementation science framework to the interpretive themes indicated that challenges to implementation spanned the individual to the systemic level, with the latter posing greater barriers and impacting implementation success in other areas.The results suggest that future research into intensive treatment needs to better accommodate patient preferences and emphasise clinician‐researcher relationships and the alignment of clinical and research teams. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. Method and Results: Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence‐based approaches to early intervention for eating disorders and progress is being made in scaling these. Conclusions: We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics. Highlights: Early intervention for eating disorders is in its infancy.We summarise existing early intervention approaches for eating disorders from around the globe.We propose key policy, service, clinician, and research recommendations to progress early intervention for eating disorders. [ABSTRACT FROM AUTHOR]

Background: Eating disorders in childhood and adolescence negatively affect many areas of development and functioning of children, adolescents, and their families. Psychoeducation has an important role in management and treatment of eating disorders. Methods: A systematic literature review was performed using multiple databases (PsycInfo, PubMed, and Web of Science). The inclusion criteria comprised empirical studies of psychoeducation for patients with eating disorders or their caregivers. The study reporting quality was assessed with the revised Cochrane Collaboration's risk of bias tool and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for non‐randomized studies. Results: Ten studies met the inclusion criteria, in three of which the interventions were patient‐centred and in seven of which the interventions were caregiver‐centred. The studies differed in terms of methodology, outcome measures, and quality. The results suggest that psychoeducation is an effective intervention for children, adolescents and caregivers in the treatment of eating disorders. It may lead to weight gain, a decrease in eating disorder symptoms, and a reduction in caregiver burden. Conclusions: There is a need for more randomized controlled trials to determine the effectiveness of psychoeducation for children, adolescents and caregivers in treatment of eating disorders. Key points: Eating disorders in childhood and adolescence negatively impact many areas of development and functioning in children, adolescents, and their families.Psychoeducation for children, adolescents and parents plays an important role in the treatment of eating disorders.Psychoeducation can lead to positive outcomes for patients, their caregivers or both. It can lead to weight gain, a decrease in eating disorder symptoms, and a reduction in caregiver burden.Psychoeducation appears to be an effective treatment for eating disorders, but there is a need for more randomized controlled trials in this area. [ABSTRACT FROM AUTHOR]

Obesity, a common health condition in adolescence leading to severe medical complications, is assumed to be influenced by temperament factors. This paper investigates associations between reactive and regulative temperament, problematic eating behaviours and excess weight. Several self-report instruments were completed by 130 adolescents (mean age 14.13 ± 0.61 years), including 27 overweight and obese individuals (20.8%). Bootstrap analysis revealed a mediating effect of restrained eating on the relation between reactive temperament and body mass index percentile, which differed according to gender: Restrained eating, which predicted weight gain, was more present in girls having a higher sensitivity to reward and in boys showing a higher sensitivity to punishment. No effect of regulative temperament was found. These results have important implications for weight management programmes, as they suggest that reducing restrained eating by working on temperament may help to control weight. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: Eating expectancies (EE) are the anticipation of various benefits or detriments from eating, with mood regulation being a salient type of EE associated with eating disorders. This study examined the convergent and predictive validity of ecological momentary assessment (EMA) mood regulation EE items, including mood improvement and mood worsening EE. Methods: Thirty women with binge‐eating pathology completed a 14‐day EMA protocol, which included measures of mood regulation EE, affect, appetite, appearance‐ and body‐related factors and disordered‐eating behaviours. Results: Greater within‐subjects hunger and lower within‐subjects positive affect and fullness were related to elevated mood improvement EE. Higher within‐subjects appearance concerns, fullness, body social comparisons and thinness pressure were associated with higher mood worsening EE. Greater within‐subjects mood worsening EE predicted greater likelihood of vomiting at the subsequent time point, but there were no within‐subjects associations between mood improvement EE and behaviours. Yet, greater between‐subjects mood worsening EE were associated with more restraint/restriction and binge eating, and greater between‐subjects mood improvement EE were associated with more binge eating. Conclusions: Findings support the convergent validity of EMA mood regulation EE items. There was limited predictive validity evidence, suggesting complexities in how mood regulation EE predict behaviour in daily life. Highlights: The convergent and predictive validity of ecological momentary assessment (EMA) mood regulation eating expectancy (EE) items was examined.Analyses supported the convergent validity of EMA mood regulation EE items.There was limited evidence for the predictive validity of EMA mood regulation EE items. [ABSTRACT FROM AUTHOR]

Objective: Although anorexia nervosa (AN) in males has recently gained attention, knowledge of its psychological and physiological outcomes is still scarce. We explore sex‐specific characteristics of long‐term remitted AN with respect to residual eating disorder (ED) psychopathology, body image, and endocrinology. Method: We recruited 33 patients with AN in remission for at least 18 months (24 women, 9 men) and 36 matched healthy controls (HCs). Eating disorder psychopathology and body image ideals were assessed via clinical interviews, questionnaires, and an interactive 3D body morphing tool. Plasma levels of leptin, free triiodothyronine, cortisol, and sex hormones were quantified. Univariate models controlled for age and weight were used to test for the effects of diagnosis and sex. Results: Both patient groups showed residual ED psychopathology but normal weight and hormone levels relative to HCs. Male remitted patients demonstrated significantly stronger muscularity‐focused body image ideals, evident in interviews, self‐reports, and behavioural data, than both female patients and HCs. Conclusions: Sex‐specific body image characteristics in patients with remitted AN point towards the need to adjust test instruments and diagnostic criteria to male‐specific psychopathology. In the future, sufficiently powered studies should evaluate the risk of men with AN developing muscle dysmorphia in the long term. Highlights: Sex‐specific residual symptoms have been identified in long‐term remitted anorexia nervosa (AN) patients, particularly regarding body image disturbance.The drive for muscularity (DMS) in male remitted patients suggest a possible risk of transition from male AN to muscle dysmorphic disorder.Sex‐specific criteria, especially muscle‐oriented behaviour, need to be included in the description of diagnoses and symptoms in male patients. [ABSTRACT FROM AUTHOR]

Objective: There is a limited understanding of the unique components of negative affect that are most important to disordered eating. Our study tested the contributions and stabilities of unique components of negative affect in the frequency of both binge eating and restricted eating. We examined if: (1) symptoms of depression, anxiety and stress share unique, concurrent associations with binge eating and restricted eating, respectively, and if (2) instability of depression, anxiety, and stress predict binge eating and restricted eating, respectively. Method: 627 first year undergraduate students completed 7 assessments of these constructs across their first academic year. Generalised multilevel modelling was employed. Results: Higher than average anxiety, but not depression or stress, was concurrently associated with restricted eating. No concurrent associations between negative affect and binge eating were found. Instability of depression, but not anxiety or stress, predicted both binge and restricted eating. Conclusion: Anxiety may be a more salient predictor of restricted eating than depression or stress. However, larger monthly changes in depression may confer risk for more frequent binge eating and restricted eating. Highlights: When examined together, symptoms of anxiety, but not depression or stress, shared a positive, concurrent association with monthly restricted eating frequency.When examined together, depression, anxiety, and stress did not share significant concurrent associations with monthly binge eating frequency.Instability of depression, but not of anxiety or stress, predicted both binge eating and restricted eating frequency. [ABSTRACT FROM AUTHOR]

Objective: Parental feeding practices and disordered eating are potential risk factors for the development of disordered eating in children and adolescents. This study measured the relationship between parental dieting behaviours and inpatient treatment outcomes for adolescents with restrictive eating disorders (EDs). Method: Parents of adolescents with restrictive EDs (N = 45) admitted to a specialty integrated inpatient‐partial hospital meal‐based ED treatment programme completed questionnaires assessing parental eating and exercise behaviours. Adolescent clinical data, including percentage median body mass index (%mBMI) at admission and discharge and rate of weight gain, were abstracted from the electronic medical record. Results: Adolescents whose parents reported dieting had a slower rate of weight gain (3.47 lbs./week) compared to participants whose parents were not dieting (4.54 lbs./week; p = 0.017). Additionally, participants whose parents reported dieting had a lower %mBMI at programme discharge (M = 93.56) than participants whose parents did not report dieting (M = 95.99; p = 0.033). Conclusion: Parental dieting behaviours may impact an adolescent's response to inpatient ED treatment. Findings suggest a need to assess parental dieting behaviour, and when appropriate, provide additional psychoeducation regarding the potential risks of weight or shape‐focussed dialogue and the benefits of modelling adaptive meal behaviours. Highlights: Adolescents with restrictive eating disorders whose parents reported dieting had a slower rate of weight gain and lower median body mass index percentile at discharge from inpatient treatment compared to adolescents whose parents were not dieting.Higher frequency of parent exercise was associated with a lower rate of weight gain in adolescents with restrictive eating disorders admitted for inpatient treatment.Findings suggest a need to assess dieting and exercise behaviour in the parents of adolescents admitted for eating disorder treatment and to identify effective educational or therapeutic interventions to reduce familial weight and shape concerns. [ABSTRACT FROM AUTHOR]

Objective: Functional neuroimaging studies have found differential neural activation patterns during anticipation‐related paradigms in participants with eating disorders (EDs) compared to controls. However, publications reported conflicting results on the directionality and location of the abnormal activations. There is an urgent need to integrate our existing knowledge of anticipation, both rewarding and aversive, to elucidate these differences. Method: We conducted an activation likelihood estimation (ALE) meta‐analysis to quantitatively review functional neuroimaging studies that evaluated differences between brain correlates of anticipation in participants with and without disordered eating. PubMed, Web of Sciences, PsycINFO, Medline and EMBASE were searched for studies published up to November 2022. Exploratory sub‐analyses to check for differences between reward and non‐reward anticipation among all anticipation paradigms. Results: Twenty‐one references met the inclusion criteria for meta‐analysis. The meta‐analysis across anticipation all tasks identified a significant hyperactivation cluster in the right putamen in participants with disordered eating (n = 17 experiments) and a significant hypoactivation cluster in the left inferior parietal lobule (n = 13 experiments), in participants with disordered eating compared to controls. Conclusions: These findings and sub‐analyses of reward‐ and non‐reward‐related cues suggest potential pathophysiological mechanisms underlying anticipatory responses to rewarding and aversive cues in ED. Key points: The ALE meta‐analysis showed altered anticipatory brain responses in participants with disordered eating compared to controls.One cluster of significant hyperactivation was identified in the right putamen; another cluster of hypoactivation was found in the left inferior parietal lobule.Anticipatory brain responses to rewarding and aversive cues are altered in participants with disordered eating. [ABSTRACT FROM AUTHOR]

Background: Avoidant/restrictive food intake disorder (ARFID) was a new diagnosis in DSM‐5. This systematic review explores what is known to date about the epidemiology of ARFID in children and adolescents. Method: Embase, Medline and PsycInfo were used to identify studies meeting inclusion criteria. PRISMA guidelines were followed. Results: Thirty studies met inclusion criteria, with most coming from specialised eating disorder services where prevalence rates were 5%–22.5%. Three studies from specialist feeding clinics showed the highest prevalence rates, ranging from 32% to 64%. Studies from non‐clinical samples reported ARFID prevalence estimates ranging from 0.3% to 15.5%. One study, using national surveillance methodology, reported the incidence of ARFID in children and adolescents reaching clinical care to be 2.02 per 100,000 patients. Psychiatric comorbidity was common, especially anxiety disorders (9.1%–72%) and autism spectrum disorder (8.2%–54.75%). Conclusion: The current literature on the epidemiology of ARFID in children and adolescents is limited. Studies are heterogeneous with regard to setting and sample characteristics, with a wide range of prevalence estimates. Further studies, especially using surveillance methodology, will help to better understand the nature of this disorder and estimate clinical service needs. Highlights: ARFID prevalence estimates vary widely across studies and are highest in specialist feeding clinics. The one incidence study to date suggests that new presentations to clinical care are relatively rare.ARFID has a high rate of psychiatric comorbidity especially with anxiety disorders.Further epidemiological studies, especially using national surveillance methodology, will help planning and resource allocation for this patient group. [ABSTRACT FROM AUTHOR]

Objective: Recent neuroscientific findings have highlighted the role of the thalamus in several cognitive functions, ranging from perception to cognitive flexibility, memory, and body representation. Since some of these functions may be involved in the pathophysiology of Anorexia Nervosa (AN), this study aims at exploring thalamic structure in different phases of the disorder. Method: The sample included 38 patients with acute AN, 20 patients who fully recovered from AN (recAN), and 38 healthy controls (HC), all female. All participants underwent high‐resolution MRI. The volumes of the whole thalamus and 25 thalamic nuclei were extracted using an automated segmentation algorithm, and thalamic fractal dimension was estimated using the calcFD toolbox. Results: Patients with acute AN, compared to HC, displayed reduced thalamic volume and complexity both at the whole level and at the level of specific nuclei. In patients recAN, instead, alterations were observed only at the level of the right laterodorsal and central lateral nuclei. Conclusions: In the acute phase of the disorder patients with AN present a widespread reduction in thalamic volume and complexity. However, these alterations seem to normalise almost completely following weight restoration, thus suggesting the involvement of malnutrition‐related mechanisms. Highlights: Patients with acute Anorexia Nervosa (AN) displayed reduced thalamic volume and complexity compared to healthy controls (HC)In patients recovered from AN (recAN) thalamic volumetric indices improved compared to the acute sampleIn patients with acute AN thalamic volume was positively associated with body mass index [ABSTRACT FROM AUTHOR]

Background: Patients with Anorexia Nervosa (AN) show a moderate deficit in overall neuropsychological functioning. Since previous studies on memory performance mainly employed cross‐sectional designs, the present study aims to investigate changes in verbal memory following weight‐gain. Methods: Verbal memory was assessed with the Wechsler Memory Scale‐Revised (WMS‐R; 'logical memory'‐story‐recall‐subtest) and the California Verbal Learning Test‐II (CVLT‐II; 'verbal learning'). Included were 31 female patients with AN (18 restricting‐, 13 purging‐subtype; average disease duration: 5.1 years; average baseline BMI: 14.4 kg/m2) and 24 medication‐free normal‐weight healthy women adjusted for age at baseline (T0). In a post‐treatment assessment of approx. 6 weeks with weight increase (T1), 18 patients with AN and 20 healthy women were assessed again. Group differences in verbal memory (i.e., WMS‐R, CVLT‐II) were assessed for the baseline comparisons with a multivariate ANOVA and longitudinal data were analysed with repeated measures (RM) ANOVAs. Results: At baseline, patients with AN as compared to healthy women displayed deficits in logical memory. In the follow‐up assessment, patients with AN improved their logical memory significantly compared to healthy controls (p < 0.006). Furthermore, groups did not differ in verbal learning neither before nor after inpatient treatment. Conclusions: Enhanced logical memory in patients with AN following weight‐gain is probably due to the impaired memory as compared to healthy controls at T0. A survivorship bias could explain the improved memory performance in longitudinal data in contrast to cross‐sectional studies. Patients with AN with poorer memory performance before inpatient treatment are at higher risk to drop out and need support. Key points: Impaired logical memory before inpatient treatment improves in patients with anorexia nervosa (AN) during weight‐gain, while verbal learning seems to be intact before as well as after inpatient treatment as compared to healthy women.Drop‐out‐analyses revealed that patients with AN with poorer logical memory performance before inpatient treatment are at higher risk to drop out, and should receive further therapeutic support.Results imply, that therapeutic interventions using cognitive strategies may be overwhelming in severely ill patients with AN during early stages of the disease, while early cognitive interventions might be effective in a less sick, more motivated subgroup of patients with AN. [ABSTRACT FROM AUTHOR]

Day programs have received significant consideration within psychological literature as part of a continuum of mental health services. With increasing attention on the prevalence of eating disorders in children and adolescents, and the need for early intervention to minimize the costs and burden of the disorder, eating disorder day programs (also referred as partial hospitalization) have begun to emerge around the world. Despite their widespread use, no reviews to date have examined the efficacy of day programs for the treatment of eating disorders in children and adolescents. The current narrative literature review aims to describe and evaluate the efficacy of day programs for children and adolescents. The literature review was conducted according to the PRISMA guidelines and aimed to explore the outcomes and common program elements of day programs to guide clinical practice and service development. The review found variations amongst the day programs related to program elements, measures utilized and outcomes. Overall, the results suggest that day programs for children and adolescents are effective at restoring body weight, reducing eating disorder symptoms and addressing comorbid mental health concerns. Key points: Day programs (DP)for children and adolescents with eating disorders are becoming increasingly prevalent around the world. These programs vary in their structure, processes and efficacyThe systematic review of 21 programs revealed day programs as effective in restoring body weight, reducing eating disorder symptoms and addressing comorbid mental health concerns. There is evidence to suggest the maintenance of these gains at 3 and 6 month follow‐upThe review highlights promising models of care, and provides guidance on evidence‐based clinical processes, as well as program evaluations of day programs [ABSTRACT FROM AUTHOR]

Objective: To estimate prevalence of lifetime and current eating disorders (ED) in a sample of pregnant women in South‐East London and to describe their sociodemographic and clinical characteristics. Method: Secondary analysis of data from a cross‐sectional survey. Using a stratified sampling design, 545 pregnant women were recruited. Diagnostic interviews were administered to assess lifetime and current ED, depression, anxiety, and borderline personality disorder. Data were extracted from maternity records to assess identification of ED in antenatal care. Estimates of population prevalence of ED were obtained using sampling weights to account for the stratified sampling design. Results: Weighted prevalence of lifetime ED was 15.35% (95% confidence interval [CI] [11.80, 19.71]), and current ED was 1.47% (95% CI [0.64, 3.35]). Depression, anxiety, and history of deliberate self‐harm or attempted suicide were common in pregnant women with ED. Identification of ED in antenatal care was low. Conclusions: Findings indicate that by early pregnancy, a significant proportion of pregnant women will have had ED, although less typically during pregnancy, and psychiatric comorbidity is common. Yet ED were poorly recognised in antenatal care. The findings highlight the importance of increasing awareness about maternal ED to improve identification and response to the healthcare needs of pregnant women with ED. Three key highlights: Weighted prevalence of lifetime eating disorders was 15.35% (95% CI [11.80, 19.71]), and current eating disorders was 1.47% (95% CI [0.64, 3.35]) in a UK inner‐city antenatal sample; however, eating disorders were poorly recognised in antenatal care.Depression, anxiety, and a history of deliberate self‐harm or attempted suicide are common amongst pregnant women with eating disorders.Findings highlight the clinical importance of increasing awareness about maternal eating disorders in maternity professionals to improve identification and response to the healthcare needs of pregnant women with eating disorders. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of two treatments for adolescent bulimia nervosa (BN), family‐based treatment (FBT‐BN), and cognitive behavioral therapy (CBT‐A), on both attitudinal and behavioural outcomes at end‐of‐treatment. These associations were examined specifically relative to motivation for change in obsessive–compulsive (OC) features of eating disorder (ED) symptoms. Adolescents (N = 110) were randomly assigned to FBT‐BN or CBT‐A and completed assessments of eating pathology and OC‐ED behaviour. Across both treatments, greater motivation for change in OC‐ED behaviour was associated with improved attitudinal features of ED at end‐of‐treatment. Motivation for change did not demonstrate a direct or interaction effect on BN behavioural outcomes. Results suggest that adolescents with BN who are more motivated to change OC‐ED behaviours at the start of treatment, FBT‐BN or CBT‐A, are more likely to demonstrate improvements in cognitions, but not behaviours associated with EDs, at treatment conclusion. [ABSTRACT FROM AUTHOR]

This study aimed to investigate associations between oxytocin receptor gene ( OXT-R) polymorphisms (rs53576 and rs2254298), their interaction with maternal care (GxE), and ED behaviours in a community sample. We studied 3698 women from the Avon Longitudinal Study of Parents and Children (ALSPAC) who participated in a two-phase prevalence study of lifetime ED and had genotype data. The GG rs53576 genotype was associated with binge eating and purging, and the rs2254298 AG/AA genotype with restrictive eating lifetime. In addition, the rs2254298 AG/AA genotype interacted with poor maternal care to increase the odds of binge eating and purging (odds ratio = 4.40 (95% confidence intervals: 1.11-17.4)). This study replicates previous findings of an association between OXT-R polymorphisms and ED, and it is the first to show an interaction between OXT-R genotype and poor maternal care. As such, these findings highlight the important role of oxytocin in understanding the pathophysiology of ED. © 2016 The Authors European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Objective High levels of expressed emotions (EE) and depressive symptoms (DS) are often found in caregivers of patients with anorexia nervosa (AN). Both parameters are considered to influence AN symptoms of the patient. Methods One hundred seventy adolescent women with AN and their caregivers were assessed at admission, discharge, at 1-year and 2.5-year follow up to evaluate AN symptoms of the patient and EE and DS of caregivers. Results The EE and DS were elevated at admission and decreased during treatment, criticism (as part of EE) exhibited again at the 2.5-year follow up. Caregivers of more severely ill patients reported significantly greater levels of EE and DS. Mothers were more affected than fathers. EE and DS were interrelated. Conclusion Caregivers of adolescent AN patients suffer from elevated levels of EE and DS. Further studies are needed to examine whether therapeutic interventions to reduce caregivers' EE and DS might have a positive influence on treatment outcome. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine how similar pregnant women with self-reported lifetime eating disorder (ED) were to pregnant women with a hospital diagnosis of ED. A total of 83 731 pregnant women enrolled in the Danish National Birth Cohort reported on ED, and by linkage to the Danish health registers, hospital diagnoses of ED were obtained. Characteristics of women with self-reported ED, hospital diagnosed ED and without ED were compared using chi-square tests, t-test and logistic regression models with robust standard errors. In total, 4.8% women reported ED, and 0.5% had a hospital diagnosis of ED recorded in the health registers. Women with self-reported ED were comparable with women with hospital diagnosed ED on most reproductive and health characteristics, while they differed from women without ED concerning all characteristics studied. Our findings highlight that women with self-reported ED have impaired function and adverse health outcomes, consistent with diagnosable ED. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective Anorexia nervosa (AN) is often first diagnosed in the adolescent years. The treatment with the greatest evidence during this time is family-based treatment (FBT). In FBT, siblings are expected to attend treatment sessions; however, sibling well-being during this time has not been well researched. This study aimed to explore sibling well-being when the ill child was initially diagnosed with AN and after FBT had been completed. Method Eighty-five parents and 55 siblings of adolescents with AN completed the Strengths and Difficulties Questionnaire at diagnosis. In addition, 88 parents and 46 siblings completed the Strengths and Difficulties Questionnaire after finishing treatment. Results Mothers and fathers reported siblings to have lower levels of conduct problems in comparison with population norms. Mothers also reported lower levels of prosocial behaviours. Siblings reported higher levels of emotional difficulties and hyperactivity in comparison with their peers. There were no differences in reported psychosocial well-being of siblings between diagnosis and following FBT. Conclusions Siblings of adolescents with AN have poorer psychosocial adjustment than their peers, both before and after FBT. Clinicians and parents are encouraged to be aware of sibling difficulties and seek additional support if required. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Studies suggest that stimulation of the left dorsolateral prefrontal cortex (DLPFC) reduces food craving in bulimic patients, but evidence supporting repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool is lacking. We investigated the safety and therapeutic efficacy of an adjunct high-frequency rTMS programme targeting the left DLPFC. Forty-seven women with bulimia nervosa were randomised to a real or sham stimulation group. The real group underwent 10 rTMS sessions, each consisting of 20 trains of 5 seconds with 55-second intervals between trains, at a frequency of 10 Hz. The main outcome was the number of binge episodes in the 15 days following the end of stimulation. Overall, no significant improvement in bingeing and purging symptoms was noted after the programme. rTMS was well tolerated. This suggests that 10 sessions of high-frequency rTMS to the left DLPFC provide no greater benefit than placebo. Future studies should consider methodological issues as well as alternative targets. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective Autonomic nervous system function is altered in eating disorders. We aimed to quantify differences in resting state vagal activity, indexed by high-frequency heart rate variability comparing patients with bulimia nervosa (BN) and healthy controls. Methods A systematic search of the literature to identify studies eligible for inclusion and meta-analytical methods were applied. Meta-regression was used to identify potential covariates. Results Eight studies reporting measures of resting high-frequency heart rate variability in individuals with BN ( n = 137) and controls ( n = 190) were included. Random-effects meta-analysis revealed a sizeable main effect ( Z = 2.22, p = .03; Hedge's g = 0.52, 95% CI [0.06;0.98]) indicating higher resting state vagal activity in individuals with BN. Meta-regression showed that body mass index and medication intake are significant covariates. Discussion Findings suggest higher vagal activity in BN at rest, particularly in unmedicated samples with lower body mass index. Potential mechanisms underlying these findings and implications for routine clinical care are discussed. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the family functioning of Spanish parents of patients with an eating disorder (ED) with that of carers of patients with substance-related disorders (SRDs) and families of healthy controls (HC). This cross-sectional study included 48 mothers and 45 fathers of 48 adolescent patients with an ED, 47 mothers and 37 fathers of 47 patients with an SRD and 66 mothers and 50 fathers of 68 HCs. Families of ED patients reported lower levels of criticism, symptom accommodation and negative caregiving experience than families of SRD patients. However, relatives of both ED and SRD patients reported similar levels of quality of life related to their mental health. Furthermore, families of HCs generally exhibited better scores on all scales assessing their caregiving experiences. Regarding gender differences, there was a tendency in mothers, primarily those from the ED group, to report more adverse experiences as caregivers compared with fathers. Symptoms characteristic to each disorder may be associated with differential patterns of family functioning and may require specifically tailored family interventions. Early family intervention in adolescence is crucial, as relatives' quality of life does not seem to have been badly affected at this point in the course of the illness. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa. Method A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents ( n = 196) of adolescents ( n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report. Results Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour was significantly lower in fathers than in mothers. Accommodating behaviours mediated the relationship between objective burden and subjective burden in mothers, whereas EE and carers' skills did not mediate this relationship for either parent. Discussion The objective burden for most mothers is high. In order to reduce subjective burden, it may be helpful to target accommodating behaviours. Trial Registration ISRCTN83003225 - Expert Carers Helping Others (ECHO). Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association [ABSTRACT FROM AUTHOR]

This study examined racial differences in eating-disorder psychopathology, eating/weight-related histories, and biopsychosocial correlates in women ( n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating-disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

In a published 11-week, placebo-controlled trial, 50 and 70 mg/d lisdexamfetamine dimesylate (LDX), but not 30 mg/d LDX, significantly reduced binge eating days (primary endpoint) in adults with binge eating disorder (BED). This report provides descriptions of LDX effects on secondary endpoints (Binge Eating Scale [BES]; Three-Factor Eating Questionnaire [TFEQ]; Yale-Brown Obsessive Compulsive Scale modified for Binge Eating [Y-BOCS-BE]; and the Barratt Impulsiveness Scale, version 11 [BIS-11]) from that study. Week 11 least squares mean treatment differences favoured all LDX doses over placebo on the BES ( p ≤ 0.03), TFEQ Disinhibition and Hunger subscales (all p < 0.05), and Y-BOCS-BE total, obsessive, and compulsive scales (all p ≤ 0.02) and on BIS-11 total score at 70 mg/d LDX ( p = 0.015) and the TFEQ Cognitive Restraint subscale at 30 and 70 mg/d LDX (both p<0.05). These findings indicate that LDX decreased global binge eating severity and obsessive-compulsive and impulsive features of BED in addition to binge eating days. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background Active family engagement improves outcomes from adolescent inpatient care, but the impact on adult anorexia nervosa is uncertain. Aim The aim of this study was to describe the 2-year outcome following a pragmatic randomised controlled trial in which a skill training intervention (Experienced Caregivers Helping Others) for carers was added to inpatient care. Method Patient, caregiver and service outcomes were measured for 2 years following discharge from the index inpatient admission. Results There were small-sized/moderate-sized effects and consistent improvements in all outcomes from both patients and carers in the Experienced Caregivers Helping Others group over 2 years. The marked change in body mass index and carers' time caregiving following inpatient care was sustained. Approximately 20% of cases had further periods of inpatient care. Conclusion In this predominately adult anorexia nervosa sample, enabling carers to provide active support and management skills may improve the benefits in all symptom domains that gradually follow from a period of inpatient care. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective This study aims to investigate the influence of the COMT Val(108/158)Met polymorphism on trait and behavioural impulsivity in binge eating disorder (BED). COMT Val(108/158)Met has been related to impulsivity in previous studies, but so far no study has investigated the role of this polymorphism in the context of BED. Method Impulsivity was assessed via a questionnaire (trait) and on a behavioural level via the antisaccade task in a sample of 69 participants classified into one out of three age-matched groups: (1) obese individuals with BED according to DMS-IV (BED+); (2) obese individuals without BED, matched with the BED+ sample according to body weight (OBED-); and (3) normal-weight healthy controls (NWC). The COMT Val(108/158)Met polymorphism was genotyped in all samples. Results As expected, the BED+ sample showed higher trait and behavioural impulsivity. Furthermore, within the BED+ group, COMT Met/Met homozygous individuals showed stronger deficits in inhibitory control. Discussion COMT Met/Met homozygous individuals with BED might represent a specific group in the BED spectrum, which shows a higher behavioural impulsivity. The association between COMT Val(108/158)Met with inhibitory control should be interpreted with caution because of the small sample size. Larger replication studies are needed to further elucidate the role of the COMT Val(108/158)Met polymorphism in the regulation of disordered eating behaviour. [ABSTRACT FROM AUTHOR]

Individualised measures of quality of life (QoL) refer to instruments that encourage the respondent to actively elicit which areas of their life are most relevant for his/her QoL. The aim of this study is to compare individualised versus standard measures of QoL in a sample of patients with eating disorder (ED). The Schedule for the Evaluation of the Individual Quality of Life (SEIQoL) and a generic measure of QoL [World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF)] were applied on two occasions (one-year follow-up) to a sample of 165 patients with ED, 57 recovered patients with ED, and 349 women from the general population. The areas of 'family', 'education/career or job', 'friends', 'leisure', 'romantic partner' and 'health' were identified as the most important for their QoL for all groups, both times. The WHOQOL-BREF was more sensitive than the SEIQoL in detecting changes that occurred over time. Clinical interventions for ED should consider social components as objectives of intervention. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to investigate the prevalence of eating disorder (ED) risk as well as associated psychopathology and health-related quality of life (HrQoL) in a large population sample of Austrian adolescents. Method A sample of 3610 adolescents aged 10-18 years was recruited from 261 schools representative for the Austrian population. The SCOFF questionnaire was used to identify participants at risk for EDs, and the Youth Self-Report and KIDSCREEN were used to assess general psychopathology and HrQoL. Results In total, 30.9% of girls and 14.6% of boys were screened at risk for EDs. SCOFF scores were significantly associated with internalising and externalising behavioural problems as well as HrQoL after controlling for sex, age and body mass index. The SCOFF score further turned out to be an independent predictor of HrQoL. Discussion The high prevalence of ED risk among Austrian adolescents points out the need for prevention in this field. Variables indicating eating pathology should be included in general mental health screenings. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to identify personality traits and psychiatric comorbidities associated with a lifetime history of a suicide attempt in women with bulimia nervosa (BN). Method Data from two samples of women with BN ( n = 204 and n = 133) were examined. Participants in both samples completed the Dimensional Assessment of Personality Pathology-Basic Questionnaire and reported whether they had ever had a lifetime suicide attempt. Comorbid psychopathology was based on self-reported questionnaire and interview data. Univariate and multivariate logistic regression analyses were run, predicting a lifetime suicide attempt. Results Based on the Dimensional Assessment of Personality Pathology-Basic Questionnaire, identity problems were associated with a lifetime suicide attempt in both samples; cognitive dysregulation, anxiousness and insecure attachment were associated with a lifetime suicide attempt in one but not both samples. Lifetime anxiety disorder was associated with a lifetime suicide attempt in one sample, and depression was associated with a lifetime suicide attempt in both samples. Multivariate analyses revealed that only depression was uniquely associated with a lifetime suicide attempt in both samples. Discussion Although personality traits associated with aspects of emotion dysregulation were associated with a lifetime suicide attempt, depression was found to have the strongest association with a lifetime suicide attempt in two samples of women with BN. These findings suggest that depression severity may be the most important target of treatment and suicide prevention efforts in women with BN. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Physical activity (PA) and sedentary behaviours (SB-i.e. activities involving low-energy expenditure and a sitting/reclining posture) may each have significant implications for weight loss and other bariatric surgery outcomes. While early studies suggested that patients typically comply with clinical recommendations to adopt habitual PA, these data were based on retrospective questionnaires. Conversely, recent studies incorporating mobile health (mHealth) technologies (e.g. objective monitors), which assess PA and SB in real time and in the natural environment, show that most patients are inactive and highly sedentary pre-operatively and only make modest changes in these behaviours postoperatively. In addition to using mHealth technologies for obtaining accurate and detailed information on PA and SB, they are increasingly being employed to intervene on patients' PA and SB and/or evaluate intervention outcomes. Researchers and clinicians are encouraged to consider the benefits of using mHealth technology when studying and treating PA and SB in bariatric surgery patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Bariatric surgery (BS) has proven to be the most effective treatment for weight loss and for improving comorbidities in severe obesity. A comprehensive psychological assessment prior to surgery is proposed to prepare patients for a successful post-surgical outcome. Therefore, the main aim of the present study was to assess psychological and personality predictors of BS outcome. The sample comprised 139 severely obese patients who underwent BS. Assessment measures included the Eating Disorders Inventory-2, the Symptom Checklist-Revised and the Temperament and Character Inventory-Revised. Our results show that favourable BS outcome, after 2 years follow up, was associated with younger age, less depression, moderate anxiety symptoms and high cooperativeness levels. Likewise, metabolic improvements were found to be linked to younger age and certain psychopathological factors. In conclusion, our findings suggest that age, baseline body mass index, psychopathological indexes and personality traits predict successful BS outcome. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Women with type 1 diabetes are at high risk for eating disorders (ED), a combination that can increase medical complications and mortality. As little is known about treatment response in this population, clinical presentation and treatment outcome in an extended case series were assessed. A chart review at the Eating Disorders Day Hospital Program at Toronto General Hospital identified a total of 100 individuals with type 1 diabetes assessed 1990-2012. Of 37 who attended day hospital, most experienced improvement in ED symptoms, but only 18.8% had a good immediate treatment outcome, while 43.8% had an intermediate outcome and 37.5% had a poor outcome (meeting diagnostic criteria at discharge). This is poorer than program outcomes in individuals without diabetes ( χ2 = 12.2, df = 2; p = 0.002). Factors influencing treatment engagement and outcome must be further studied and used to improve treatment results in this high-risk group. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective Oxytocin circuits are implicated in the regulation of appetite and weight. Variants in the oxytocin receptor (OXTR) gene have been associated with bulimic behaviour. This study aimed to investigate the association between the OXTR gene and eating disorders. Method We genotyped six single nucleotide polymorphisms, rs53576, rs237879, rs2228485, rs13316193, rs2254298 and rs1042778, located within the OXTR gene in Korean patients with eating disorders using the single-base extension method. We studied a total of 262 women, including 69 patients with anorexia nervosa, 90 patients with bulimia nervosa (BN), and 103 healthy women. Results We found a positive association between the G allele of OXTR rs53576 and BN. In the BN group, the G carriers showed a high score on the behavioural inhibition system. Conclusions These findings suggest the involvement of the oxytocinergic system in the mechanism that underlies BN. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This study evaluated the validity of the interpersonal model of binge-eating disorder (BED) psychopathology in a clinical sample of women with BED. Data from a cross-sectional sample of 255 women with BED were examined for the direct effects of interpersonal problems on BED symptoms and psychopathology, and indirect effects mediated by negative affect. Structural equation modelling analyses demonstrated that higher levels of interpersonal problems were associated with greater negative affect, and greater negative affect was associated with higher frequency of BED symptoms and psychopathology. There was a significant indirect effect of interpersonal problems on BED symptoms and psychopathology mediated through negative affect. Interpersonal problems may lead to greater BED symptoms and psychopathology, and this relationship may be partially explained by elevated negative affect. The results of the study are the first to provide support for the interpersonal model of BED symptoms and psychopathology in a clinical sample of women. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Although suggested as an important contributor to the development and maintenance of eating disorders, temperament has not previously been studied adopting a meta-analytical approach. We therefore pooled data (N = 14 studies; N = 3315 cases, N = 3395 controls) on Cloninger's temperament traits (novelty seeking, harm avoidance, reward dependence and persistence) in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorders not otherwise specified. Persistence was significantly higher than in the controls in all eating disorders except for BED the highest levels being observed in AN. Correspondingly, the highest effect sizes for harm avoidance were seen in AN. Novelty seeking was significantly elevated relative to the controls only in BN. Harm avoidance was significantly lower, and reward dependence was significantly higher in individuals who had recovered from AN than in those who remained ill. Future studies with a longitudinal design are needed to explore the temporal relationships between eating disorders and temperament traits. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background Although pregnancy can be associated with adaptive changes in weight and eating behaviour for women with eating disorders, less is known about whether these changes are maintained in the postpartum period. We used a longitudinal design to examine gestational and postpartum weight trajectories in mothers with and without eating disorders in the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Methods Fifty-six women reported anorexia nervosa (AN), 636 bulimia nervosa, 3327 binge eating disorder and 69 eating disorder not otherwise specified, purging type. The referent group included 61 233 mothers with no eating disorder. We used a mixed effects model to predict weight change over time by eating disorder subtype. Results Mothers with AN, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified had greater increases in body mass index (BMI) during pregnancy and greater decreases in BMI over the first 6 months postpartum. Women with AN shifted from the underweight BMI range before pregnancy to the normal weight range at 36 months postpartum Conclusions Patterns of maternal weight gain and retention during the perinatal period vary across eating disorder subtype and warrant clinical attention. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]