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Objective: While co‐occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. Method: The literature on managing mental health conditions that co‐occur with eating disorders is outlined and reviewed. Results: In the absence of clear evidence to inform managing co‐occurring mental health conditions, we advocate for use of an iterative, session‐by‐session measurement to guide practice and research. We identify three data‐driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co‐occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four‐step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. Discussion: Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co‐occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co‐occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co‐occurring conditions; (5) detailed specification on how to determine which adjuncts to add. Public significance: Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence‐based techniques. This paper outlines data‐driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested. [ABSTRACT FROM AUTHOR]

Objective: This paper highlights the gap in understanding and meeting the needs of individuals with eating disorders (EDs) who are engaged in manual labor and proposes a novel solution for meeting those needs. Methods: In this paper, we describe the rationale, considerations, and opportunities for research and practice that can be adapted and created to meet the needs of individuals with EDs who are engaged in manual labor, a group that may be underserved by current methods for treating EDs. We highlight the potential utility of the industrial athlete (IA) framework for this population, propose the term Relative Energy Deficit in Occupation ("RED‐O"), and describe the potential applications of this framework and term for research, treatment, and public health promotion for EDs among individuals engaged in manual labor. Results: The IA framework and RED‐O provide opportunities to address the unique needs of individuals with EDs who are also engaged in manual labor and who are disproportionately of low socioeconomic status through new and adapted research and clinical applications as well as advocacy and public health promotion. Discussion: Equitable recovery for people with EDs requires the ability to engage in activities necessary for occupational functioning, including the physical capacity necessary to participate fully in their work. As access to treatment increases, it is imperative that the needs of IAs are adequately addressed, especially those who are of lower socioeconomic status. Public Significance: The industrial athlete and relative energy deficit in occupation (RED‐O) frameworks will enhance opportunities for identification and treatment of underserved and disadvantaged populations with eating disorders and reduce public health burden of eating disorders. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Discussion Dialectical behavior therapy (DBT) is an evidence‐based treatment for disorders characterized by recurrent binge eating. Yet, access to specialized treatment like DBT remains limited. To increase the accessibility of DBT, we developed a DBT skills training app (Resilience: eDBT) for the management of eating disorder (ED) symptoms. This paper delineates the developmental process of Resilience and tests its usability.Descriptive information on the development and features of Resilience is provided, including its framework, content structure and delivery formats, functionality, data storage procedure, and privacy protocols. Usability was assessed via a mixed methods approach in 10 symptomatic individuals. Qualitative data were organized based on an existing framework, which included six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance.Resilience demonstrated good usability via a Systems Usability Scale score of 85.5, which exceeded the recommended cutoff of 68. Positive aspects of the app, according to interview data, were the ease of use and the visual design, while the addition of peer support was suggested as an opportunity for improvement.A novel DBT‐based app may serve as an acceptable, low‐intensity option or adjunct to traditional treatment for targeting ED symptoms that emerge in daily life. However, notable limitations include the small sample size and the single time point at which the usability assessment was conducted. [ABSTRACT FROM AUTHOR]

ABSTRACT This commentary discusses a principal contribution of Monocello et al.'s paper presenting a cultural models approach to body fatness perceptions, which provides a rigorous and systematic means of identifying analytic categories that are locally meaningful, in contrast to categories derived from a solely universalizing perspective. In situating their work within an underrepresented population in eating disorders research—young men in South Korea—the authors step beyond the constraints of a universalizing, or etic, framework for probing how body dissatisfaction relates to eating disorder risk. The value of an alternative analytic framework, based on a culturally local, or emic, perspective on how bodies are perceived is demonstrated through the use of a cultural models approach exploring the relationship between culturally defined conceptualizations of body image and eating disorder risk. Understanding such relationships and the meanings attributed to the myriad aspects of body image through locally grounded frameworks provides an essential tool for investigators and clinicians to better understand the lived experience of body dissatisfaction and disordered eating, and also to inform more culturally salient approaches to diagnosis, treatment, and prevention. An emic approach that centers local perspectives and priorities also facilitates participation of communities underrepresented in research in knowledge production. [ABSTRACT FROM AUTHOR]

Public Significance Avoidant/restrictive food intake disorder (ARFID) is a heterogeneous disorder wherein restrictive eating is primarily attributed to non‐shape/weight‐based reasons (e.g., sensory sensitivity) that empirical research continues to explore. Mounting evidence suggests that ARFID often presents alongside neurodevelopmental diagnoses (NDs) or divergent neurodevelopment broadly. Executive functioning (EF) differences often characterize divergent neurodevelopmental trajectories. Additionally, restrictive eating in anorexia nervosa has been conceptualized as related to EF factors (e.g., set shifting). Given the neurodevelopmental phenotype that may be associated with ARFID and the role of EF in anorexia nervosa, this paper proposes EF as a potentially important, yet understudied factor in ARFID pathology. We posit that various observed ARFID behavioral/cognitive tendencies can be conceptualized in relation to EF differences. We contextualize commonly observed ARFID presentations within “core” EF components (i.e., cognitive flexibility, working memory, inhibitory control), leading to hypotheses about EF in ARFID. Finally, we offer additional considerations/directions for future research on EF in ARFID. Increased research on EF in ARFID is needed to consider this potential common factor in the etiology and maintenance of this heterogeneous disorder. We aim to promote further consideration of EF in ARFID etiology, maintenance, and treatment‐outcome research.This article proposes that aspects of executive functioning (EF) may play a role in the onset and maintenance of avoidant/restrictive food intake disorder (ARFID), although this notion is largely untested by existing research. Further research on the role of EF in ARFID may assist with refining models and treatments for this heterogeneous disorder. [ABSTRACT FROM AUTHOR]

Earlier pubertal onset has been associated with increased disordered eating symptoms in cisgender girls. Although this finding has been replicated across studies of disordered eating, most studies have focused on white samples. The lack of studies is surprising given that early pubertal timing may impact disordered eating risk in Black and Latinx girls differently due to trends of earlier pubertal onset in these groups and increased stressors related to interpersonal and structural racism and economic marginalization. Current methods of examining pubertal timing among Black and Latinx girls may also not fully capture their experience. Contextual factors (e.g., neighborhood and school racial/ethnic composition) may influence how minoritized girls both perceive and are affected by their pubertal timing. Moreover, factors such as ethnic–racial identity development and experiences of discrimination may be important mechanisms explaining the association between pubertal timing and disordered eating risk. This paper aims to provide a brief overview of studies examining pubertal timing and disordered eating risk among Black and Latinx girls in the US and to discuss recommendations for future research that integrate contextual factors in the examination of pubertal timing and its effects. Public significance: Early pubertal timing has been associated with increased risk of disordered eating symptoms among cisgender girls; however, studies have been limited due to the use of predominantly white samples. The article provides a brief overview of findings related to pubertal timing effects among Black and Latinx girls, discusses considerations for the measurement of pubertal timing, and highlights the need for inclusion of contextual factors in future research. [ABSTRACT FROM AUTHOR]

Objective: The present longitudinal study examined sex-specific, symptom-level relationships among emotion regulation (ER), interpersonal problems (IP), and eating disorder (ED) psychopathology in a large sample of Chinese adolescents., Method: Data were from a project with four waves of data collection (N = 1540; 710 boys and 830 girls) at 6-month intervals over 18 months. Questionnaires assessed ED psychopathology, ER, and IP at each wave of data collection. Longitudinal network analyses were conducted separately for boys and girls. Sex differences in the network structures were also examined., Results: The results revealed pronounced heterogeneity in the presentation of ED psychopathology, ER, and IP across Chinese adolescent boys and girls longitudinally and intra-individually. For example, weight/shape preoccupation in ED psychopathology and awareness in ER emerged as important nodes in the temporal network for boys. However, weight/shape preoccupation and dissatisfaction in ED psychopathology were identified as the most important nodes in the temporal network for girls. Regarding bridge strength, awareness in ER emerged as the node with the highest connectivity in the temporal network for boys. At the same time, weight/shape dissatisfaction in ED psychopathology was the node with the highest connectivity for girls., Discussion: The current study extended network theory to better understand the longitudinal interplay among ER, IP, and ED psychopathology in Chinese adolescents and their sex differences in the importance of symptoms. Such insights may pave the way for developing targeted prevention and treatment strategies for adolescent boys and girls in China., (© 2024 Wiley Periodicals LLC.)

The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra‐articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN. Therefore, a better understanding is needed to elucidate: (1) the relationship between abnormal connective tissue and AN, (2) the impact of starvation toward the development of abnormal connective tissue and how this manifests clinically, (3) the etiology of autonomic nervous system changes contributing to the dysautonomia in AN, and (4) how the sensory signals sent from potentially abnormal connective tissue to the central nervous system impact interoception in AN. A conceptual model incorporating abnormal connective tissue is provided. Public Significance: The etiology of AN remains poorly understood and current theories fail to account for the direct impact of starvation on the health of the organs and tissues of the body. There is significant clinical overlap between AN and hereditary connective tissue disorders. This paper attempts to provide a new conceptual model for AN in which abnormal connective tissue contributes to the underlying pathogenesis. [ABSTRACT FROM AUTHOR]

Objective: "Feeling fat", the somatic experience of being overweight not fully explained by objective body weight, is considered to be an eating pathology maintenance factor. The traditional clinical understanding of "feeling fat" is based on the body displacement hypothesis, which suggests that negative emotions are projected onto the body and experienced as "feeling fat" in lieu of adaptive emotion regulation. A more recent theory suggests that "feeling fat" occurs in response to thought-shape fusion (TSF), a cognitive distortion in response to the imagined consumption of perceived fattening food. The present experimental study compared the roles of these two proposed mechanisms of "feeling fat" using self-report and psychophysiological measures., Method: Eighty-two women (41 with binge eating, 41 control participants) self-reported "feeling fat" and had their heart rate variability (HRV), a physiological index of emotion regulation, measured before and after imagined inductions. Participants imagined either a personalized negative affective experience or consuming a preferred, so-called 'fattening' food., Results: The TSF induction increased self-reports of "feeling fat" among participants with binge eating but not among control women. The negative affect induction did not increase self-reported "feeling fat" in either group. HRV did not significantly change in response to either induction for either group., Discussion: TSF may be a more potent precursor to "feeling fat" than negative affect for individuals with binge eating. This may suggest new treatment directions, such as cognitive defusion from TSF when patients experience "feeling fat." The utility of HRV in monitoring "feeling fat" is questionable., (© 2024 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Background: Determining an accurate treatment goal weight (TGW) is critical for treating eating disorders requiring weight restoration. This is challenging in adolescents since body mass index (BMI) normally increases over time. Median BMI (mBMI) is often used to determine TGW, though use of historical growth trajectories is increasingly common. Using the appropriate method to set TGW may be particularly important in treating individuals with anorexia nervosa (AN) whose prior growth was substantially above or below the median, and in atypical anorexia (AAN) where prior growth is, by definition, above the median., Objectives: (1) Compare differences between TGWs based on mBMI and historical BMI percentile (hBMI) in patients with AN and AAN. (2) Determine whether either TGW method better predicted scores on the Eating Disorder Examination (EDE), heart rate, and menstrual status during treatment., Method: Retrospective chart review of 197 adolescents with AN or AAN completing a partial hospitalization program (PHP)., Results: For AN, the within-person variation between methods varied up to 11.3 kg, though the average TGW was similar if derived from the mBMI or hBMI. In AAN, the average hBMI TGW was higher than mBMI TGW, and within-person variation was up to 19.3 kg. Associations between hBMI TGW and mBMI with heart rate, menstrual status, and EDE scores varied., Discussion: Within-person differences in TGWs derived from hBMI versus mBMI can be large, with prominent differences in AAN, where hBMI TGW is significantly higher., (© 2024 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Theoretical models highlight body image disturbances as central to the maintenance of eating disorders, with empirical evidence finding negative body image to be a robust predictor of treatment nonresponse, relapse and symptom persistence. Accessible, scalable, and inexpensive interventions that can effectively target negative body image across the eating disorders are needed. We developed an online single session intervention (SSI) for negative body image and evaluated its acceptability and efficacy in a randomized controlled trial in individuals with recurrent binge eating., Method: Participants with recurrent binge eating were randomly assigned to the SSI (n = 99) or a waitlist (n = 101). Assessments were conducted at baseline, 4 week follow-up, and 8 week follow-up., Results: 81% of participants accessed the SSI, demonstrating reasonable uptake. However, issues with attrition were apparent; a 32% study dropout rate was observed at posttest, while a 58% dropout rate was observed at follow-up. 87% of participants who completed satisfaction measures would recommend the SSI. SSI participants experienced greater improvements in negative body image at both 4 (d = -0.65) and 8 week (d = -0.74) follow-up. Significant between-group effects were also observed on most other secondary symptom measures, though no differences were found for motivations and help-seeking beliefs and intentions., Conclusion: Body image-focused self-guided SSIs for recurrent binge are largely accepted by those who are retained in the trial, but are associated with significant attrition. Although SSIs are not intended to replace standard treatment, they may help with short-term symptom management and could play an important role in eating disorder care., Public Significance: Single session interventions (SSI) are a potentially accessible, scalable, and cost-effective way to deliver evidence-based treatment content to people with eating disorders. This study shows that an online (SSI) designed to target body image among people with recurrent binge eating is accepted and produced short-term symptom relief., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Family-based treatment (FBT) is an efficacious treatment for adolescent anorexia nervosa (AN). A parent-only guided self-help version of FBT (GSH-FBT) demonstrated preliminary efficacy in pilot investigations. To address challenges in access to care, we adapted GSH-FBT into a parent-only multi-family group format (MF-GSH-FBT) delivered via videoconferencing., Method: This report details the feasibility and acceptability of a parent-only group-based multi-family GSH-FBT (MF-GSH-FBT) for adolescent AN delivered virtually. The MF-GSH-FBT intervention consisted of 12 weekly 60-min sessions facilitated by a clinician in addition to online FBT video content and recommended readings. Adolescents and parents completed assessments at baseline and post-treatment. Parents reported their child's weight each week., Results: A total of 13 adolescents (15.57 + 1.63 years; 92% female; 23% Hispanic) with AN and their parents enrolled and initiated treatment. Four consecutive cohorts of groups of 3-4 families were completed from April 2022 to April 2023. Across cohorts, parents attended 85% of sessions. Most parents rated the treatment sessions as helpful (79%; agree/strongly agree) and felt supported by the other group members (84%). All parents (100%) reported MF-GSH-FBT helped their child, and most (90%) reported their child had improved by end-of-treatment. On average, adolescents gained 3.53 kg (SD: 3.76) from pre- to post-treatment, with percent estimated mean body weight increasing 5% on average. Parental self-efficacy also increased from baseline to end-of-treatment., Discussion: MF-GSH-FBT for AN appears feasible and acceptable to parents participating in this pilot study. Challenges with recruitment and adolescent data collection remain questions for future investigation., Public Significance: This study describes initial pilot testing of a virtual guided self-help family-based treatment for adolescents with anorexia nervosa delivered in a multi-family group format. This treatment aims to enhance access to family-based treatment for anorexia nervosa whilst providing additional support to parents., (© 2024 Wiley Periodicals LLC.)

Objective: Few individuals with eating disorders (EDs) receive treatment. Innovations are needed to identify individuals with EDs and address care barriers. We developed a chatbot for promoting services uptake that could be paired with online screening. However, it is not yet known which components drive effects. This study estimated individual and combined contributions of four chatbot components on mental health services use (primary), chatbot helpfulness, and attitudes toward changing eating/shape/weight concerns ("change attitudes," with higher scores indicating greater importance/readiness)., Methods: Two hundred five individuals screening with an ED but not in treatment were randomized in an optimization randomized controlled trial to receive up to four chatbot components: psychoeducation, motivational interviewing, personalized service recommendations, and repeated administration (follow-up check-ins/reminders). Assessments were at baseline and 2, 6, and 14 weeks., Results: Participants who received repeated administration were more likely to report mental health services use, with no significant effects of other components on services use. Repeated administration slowed the decline in change attitudes participants experienced over time. Participants who received motivational interviewing found the chatbot more helpful, but this component was also associated with larger declines in change attitudes. Participants who received personalized recommendations found the chatbot more helpful, and receiving this component on its own was associated with the most favorable change attitude time trend. Psychoeducation showed no effects., Discussion: Results indicated important effects of components on outcomes; findings will be used to finalize decision making about the optimized intervention package. The chatbot shows high potential for addressing the treatment gap for EDs., (© 2024 Wiley Periodicals LLC.)

Objective: Accessible treatment options for avoidant/restrictive food intake disorder (ARFID) in children are limited. The current study sought to assess acceptability, feasibility, and preliminary efficacy of a brief, virtual intervention for ARFID in children ("ARFID-PTP")., Method: Families of children ages 5-12 with ARFID (n = 30) were randomized to immediate or waitlist treatment groups, with both groups ultimately receiving ARFID-PTP. ARFID-PTP consists of two, 2-h individual treatment sessions with an optional booster session at 4-week follow-up. Families completed acceptability and feasibility measures at end-of-treatment, as well as preliminary efficacy measures at 4-week, 3-month, and 6-month follow-up., Results: Of 30 families who completed an intake session, 27 (90%) completed treatment. Families rated acceptability as high (M CEQ-C  = 7.75). Treatment was feasible by participant retention. Exposure adherence was lower than expected, and booster session requests were higher than expected, indicating that achieving feasibility across measures may require treatment modifications. Regarding preliminary efficacy, children in the immediate treatment group had a decrease in ARFID symptoms compared to those on the waitlist. Overall, at 6-month follow-up linear mixed models showed participants had significantly reduced ARFID symptoms by presentation (p < 0.05) and in follow-up completers, children incorporated eight new foods on average., Discussion: ARFID-PTP is acceptable and preliminarily efficacious. The protocol may benefit from modifications to increase feasibility; however, booster session content and treatment outcomes suggest a priori feasibility markers may not accurately capture the utility of ARFID-PTP. Further work should continue to examine the efficacy ARFID-PTP, particularly in diverse samples where treatment accessibility is urgently needed., Trial Registration: ClinicalTrials.gov identifier: NCT04913194., (© 2024 Wiley Periodicals LLC.)

Objective: A growing body of research, primarily cross-sectional, suggests a relationship between the practice of tracking one's food intake and exercise behaviors using fitness-tracking smartphone applications ("apps") or wearable devices ("wearables") and disordered eating symptomatology. The aim of the present study was to explore longitudinal relationships between fitness tracking and disordered eating outcomes among college-aged women, as well as to determine whether the individual-level risk factors of pre-existing eating concerns, perfectionism, and rumination about food moderated the relationship., Method: N = 68 female undergraduates used the MyFitnessPal app for 8 weeks while completing a series of self-report measures., Results: At the trait level, fitness tracking frequency was positively associated with weight/shape concerns, but not with the other outcome measures. Daily levels of fitness tracking did not predict next-day levels for any of the outcome measures. Within-day fitness tracking at one timepoint was associated with lower reports of dietary restraint efforts at the next timepoint. None of the proposed moderators significantly interacted with the relationships over time., Discussion: These results suggest that while those who engage in fitness tracking may experience higher weight/shape concerns as a trait, over time fitness tracking was not associated with an increase in concerns. Further work exploring whether fitness tracking may affect particular subgroups in different ways is warranted., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Cognitive rigidity, or difficulty adapting to changing demands, is commonly observed in anorexia nervosa. Less is known, however, about cognitive flexibility (CF) in bulimia nervosa (BN) and, particularly, adolescence. Clarifying this relation and best assessment practices may guide informed clinical decision-making. The current study compared how two measures of CF (i.e., Wisconsin Card Sort Task [WCST] and Trail Making Task [TMT]) relate to BN symptoms among adolescents., Methods: Data from a subsample (n = 78) of adolescents with BN were analyzed. Linear and hurdle regressions were used to compare the effects of WCST perseverative errors and TMT performance on Eating Disorder Examination Global Scores, objective binge episodes, and self-induced vomiting episodes (SVEs) at baseline and end-of-treatment (EOT)., Results: Neither CF measure associated with baseline BN symptoms. TMT performance positively associated with the likelihood of engaging in SVEs at EOT (𝛽 = 0.47, p = 0.01, 95% confidence interval [CI] = [0.11-0.84]) and, among adolescents who endorsed ≥1 SVE at EOT, WCST perseverative errors (𝛽 = 0.05, p = 0.005, 95% CI = [0.01-0.08]) positively associated with SVE frequency at EOT., Discussion: The overall lack of associations between CF and outcomes suggests that cognitive rigidity may not be as relevant to the clinical profile of adolescent BN as for anorexia nervosa. In the few significant associations that emerged, the WCST and TMT uniquely predicted the severity of vomiting at EOT in this sample. Given the lack of CF deficits, future work should aim to test the role of other executive functions (e.g., impulsivity), in addition to CF, to determine which deficits are present in adolescent BN and may predict outcomes., Public Significance: Patients with eating disorders often have difficulties thinking flexibly, which may interfere with their recovery. We tested two ways of measuring flexible thinking in adolescents with BN. Overall, flexible thinking was not associated with symptom-level outcomes. However, less flexible thinking at the start of treatment predicted self-induced vomiting at EOT. If findings are replicable, then assessing and addressing flexible thinking could improve outcomes for adolescents with BN., (© 2024 Wiley Periodicals LLC.)

Objective: Inefficiencies in executive functioning (EF), more specifically cognitive flexibility and an overly detailed processing style, are frequently observed in individuals with Anorexia Nervosa (AN) and have been identified as potential targets in treatment. Cognitive Remediation Therapy (CRT) is an adjunctive treatment approach specifically designed to have a positive impact on EF. Mainly evaluated in adults, CRT has been criticized for its perceived ineffectiveness in promoting weight restoration or directly reducing eating disorder symptoms., Method: We argue that we need to refocus our conceptual framework for using CRT as an adjunctive treatment and specifically explore its potential benefit in adolescents., Results: Adolescence is a critical window for EF development during which CRT has the potential to have the most impact. While it may not specifically ameliorate eating disorder symptoms and directly improve weight gain, CRT may mitigate the impact of malnutrition on adolescent brain development, reduce attrition rates in treatment, and improve cognitive flexibility and (indirectly) other maintaining factors, thereby improving global functioning., Discussion: More research needs to be done to understand the development of EF in adolescents with AN and how best to employ CRT as an adjunctive treatment to support development and target maintaining factors. The current article broadly reviews findings on executive functioning inefficiencies in adolescents with AN and discusses the purpose and role of CRT in treating AN. Finally, we highlight key critiques of using CRT and pose questions for future research., Public Significance: Treatments targeting executive functioning in adolescents with AN are limited. We need to better understand how CRT can benefit adolescents in treatment. Increasing treatment options, including adjunctive treatments, is necessary to reduce the long-term impact of AN., (© 2024 Wiley Periodicals LLC.)

Objective: Anorexia nervosa (AN) is a serious illness with a high mortality rate and multiple physiological complications. The vague definition of atypical AN allows for subjective interpretation. This retrospective study aimed to focus future research on the operational definition of atypical AN by examining four factors associated with atypical AN at admission to higher level of care treatment., Methods: Adults with atypical AN (n = 69) were examined within sample analyses among four groups: (1) >10% versus ≤10% weight loss; (2) weight loss within the previous 3 months versus >3 months; (3) engaging in purging behaviors versus absence of purging behaviors; and (4) endorsing versus not endorsing significant cognitive aspects of AN., Results: Patients with atypical AN endorsed elevated ED cognitions on the Eating Disorder Examination-Questionnaire and depressive symptoms; a lack of association was found between weight loss severity and weight loss time frame with depressive symptoms, eating concern, and restraint. Purging behavior was associated with a higher expected body weight percentage (%EBW) and dietary restraint, while greater AN cognitions were associated with a higher EBW and weight loss percentage. Few patients demonstrated bradycardia, hypophosphatemia, or amenorrhea., Discussion: This study demonstrated the severity of ED cognitions and depressive symptoms in this atypical AN sample and provided directions for future studies in the nosology of atypical AN. It may be important to distinguish between individuals with atypical AN who are purging and those who are not. Atypical AN was associated with a low frequency of physiological disturbances., Public Significance: This study provides further clarification regarding the operational definition of atypical AN; currently, a constellation of symptoms under Other Specified Feeding or Eating Disorders. This study was consistent with previous research in reporting severe eating disorder cognitions in adults with atypical AN, and noted the potential importance of distinguishing a purging distinction. A minority of patients in this study had physiological impairments., (© 2024 Wiley Periodicals LLC.)

Objective: Little is known about how individuals with atypical anorexia nervosa (AN) respond to eating disorder (ED) treatment in a partial hospitalization program (PHP), nor how certain factors such as trauma, childhood abuse, psychiatric comorbidity, and suicidal thoughts and behaviors might contribute to poor treatment outcomes. Thus, the current study (1) compares prevalence of these factors between individuals with AN and atypical AN upon admission to an ED PHP, (2) compares PHP treatment response between groups, and (3) investigates whether experiencing these factors impacts treatment outcomes., Method: We conducted a retrospective chart review of young adults admitted to a PHP with AN (n = 95) and atypical AN (n = 59). Histories of psychiatric comorbidities and adverse childhood experiences were obtained from initial psychiatric evaluations. ED symptoms were assessed at intake and discharge with the Eating Disorder Examination-Questionnaire (EDE-Q)., Results: No significant differences were found at intake in ED symptom severity or prevalence of lifetime trauma, childhood abuse, number of psychiatric diagnoses, or suicidal thoughts and behavior. Symptomatology at discharge also did not differ between groups. Emotional abuse was significantly related to discharge shape and weight overvaluation. No other intake characteristics were significantly related to discharge symptomatology., Discussion: To our knowledge, this is the first study to compare the prevalence of comorbidities for both AN and atypical AN, as well as differential treatment outcomes for these individuals in a PHP. Results add to growing literature suggesting that, other than weight, AN and atypical AN have few properties that reliably distinguish them from one another., Public Significance: This study adds to a growing body of literature that raises questions about whether anorexia nervosa (AN) and atypical AN are truly different diagnoses. Our findings suggest these two groups present to treatment in a partial hospitalization program (PHP) with similar ED symptoms, as well as prevalence of lifetime trauma, childhood abuse, suicidal thoughts and behavior, and number of psychiatric comorbidities, and demonstrate similar treatment trajectories in PHP., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self-criticism and self-critical perfectionism act as key mechanisms exacerbating ED, and self-compassion protects against self-criticism. This meta-analysis examines associations between self-criticism and self-critical perfectionism on disordered eating (DE), and reviews how self-compassion and self-criticism relate to each other with respect to DE., Method: Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self-criticism measures, self-compassion measures, between clinical and nonclinical samples, and between cross-sectional and experimental studies were also conducted., Results: Random-effects models showed a medium positive link between self-criticism and DE (r = .37), and 10 subgroups pertaining to various measures of self-criticism utilized in literature showed small to large positive links with DE (r = .20-.52). Preliminary evidence also suggests negative relationships between self-compassion and DE (r = -.40 to -.43) and negative relationships between self-compassion and self-criticism (r = -.04 to -.88)., Discussion: Greater levels of self-criticism is linked with greater levels of DE and reduced levels of self-compassion, suggesting a need to tackle self-criticism and nurture self-compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self-criticism and self-compassion for people with DE., Public Significance Statement: Higher levels of self-criticism are linked with higher levels of DE and lower self-compassion. Self-compassion interventions could be more effective and efficient in reducing ED symptoms if self-criticism is tackled early in such treatments., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: This study explored the relationship between unhealthy weight control behaviors (UWCBs) and their associated economic costs among adolescents using the 2014-2018 Longitudinal Study of Australian Children (LSAC)., Methods: LSAC data in Wave 6 (n = 3538 adolescents aged 14-15 years), Wave 7 n = 3089 adolescents aged 16-17 years), and Wave 8 (n = 3037 adolescents aged 18-19 years) were derived from a representative sample of Australian adolescents. UWCBs were measured using the self-reported Branched Eating Disorder Test questionnaire. UWCBs were sub-classified into having fasting behaviors, using weight loss supplements or purging behaviors. Economic costs include healthcare and productivity costs to caregivers. Healthcare costs were measured using data from the Medicare and Pharmaceutical Benefits, which includes both medical and pharmaceutical costs. Productivity losses were measured using caregivers' lost leisure time due to UWCBs among adolescents., Results: The mixed effect model identified statistically significant higher economic costs (mean difference = $453, 95% CIs $154, $752), higher health care costs (mean difference = $399, 95% CIs $102, $695), and higher productivity costs (mean difference = $59, 95% CIs $29, $90) for adolescents with UWCBs compared to their peers with no UWCBs. Subgroup analysis revealed that higher costs were associated with fasting and purging behaviors., Discussion: UWCBs were associated with increased economic costs during adolescence. Our finding suggests there should be a policy focus on tackling UWCBs to reduce the economic burden on the healthcare system and society., Public Significance: The study contributes to existing knowledge by investigating the direct healthcare costs and productivity losses associated with unhealthy weight control behaviors in Australian adolescents (14-18 years old) using a dataset that follows Australian adolescents over time. We found that engaging in unhealthy weight control behaviors such as fasting, using weight loss supplements, and purging was linked to higher costs among adolescents, suggesting policies should focus on addressing these behaviors., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Family-based treatment (FBT) for youth with anorexia nervosa (AN), has not been compared to inpatient, multimodal treatment (IMT)., Method: Prospective, non-randomized pilot feasibility study of adolescents with AN receiving FBT (n = 31), and as a reference point for exploratory outcome comparisons IMT (n = 31), matched for baseline age and percent median BMI (%mBMI). Feasibility of FBT in youth fulfilling criteria for IMT was assessed via study recruitment and retention rates; acceptability via drop-out and caregiver strain; safety via adverse events; preliminary treatment effectiveness between groups was assessed via a change in %mBMI, AN psychopathology (Eating Disorder Examination-Questionnaire, EDE-Q), and hospital days, over 12 months with intent-to-treat, mixed models repeated measures analyses covering post-intervention usual care until 12 months., Results: Taking into account that 8 FBT patients (25.8%) crossed over to IMT due to lack of weight gain or psychiatric concerns, FBT and IMT were similarly feasible, acceptable, and safe, apart from more physical antagonism toward others in FBT (p = .010). FBT lasted longer (median [interquartile range, IQR]; 33.6 [17.4, 49.9] vs. 17.3 [14.4, 24] weeks, p < .001), but required fewer hospital days than IMT (median, [IQR], FBT = 1 [0, 16] vs. IMT = 123 [101, 180], p < .001). Baseline comorbidity-adjusted changes over 12 months did not differ between groups in %mBMI (FBT = 12.6 ± 11.9 vs. IMT = 13.7 ± 9.1; p = .702) and EDE-Q global score (median, [IQR]; FBT = -1.2 [-2.3, 0.2] vs. IMT = -1.3 [-2.8, -0.4]; p = .733)., Discussion: Implementing FBT in this pilot study was feasible, acceptable, and safe for youth eligible for IMT according to German S3 guidelines. Non-inferiority of FBT versus IMT requires confirmation in a sufficiently large multicenter RCT., Public Significance: This pilot study with 62 adolescent patients with anorexia nervosa demonstrated that for 2/3rd of patients eligible for a long hospitalization in the German health care system, outpatient, Family-based treatment (FBT) was a safe and feasible treatment alternative. Over 12 months, FBT lead to similar weight gain and reduction in eating disorder cognitions as inpatient treatment with fewer hospital days. This pilot study needs to be followed up by a larger, multicenter trial., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: An extensive number of predictors has been examined across the literature to improve knowledge of relapse in anorexia nervosa (AN). These studies provide various recovery and relapse definitions, follow-up durations and relapse rates. The current study summarizes these values and predictors of relapse in AN in a review and meta-analysis., Method: The study was executed according to PRISMA guidelines. Different databases were searched and studies in which participants did not receive an official clinical diagnosis were excluded. A quality analysis was performed using the National Institute of Health's Study Quality Assessment Tool. Random-effects meta-analyses were conducted to summarize data., Results: Definitions of relapse and recovery were diverse. During an average follow-up period of 31 months an average relapse rate of 37% was found. Predictive variables from 28 studies were grouped in six categories: age and sex, symptoms and behaviors, AN subtype and duration, weight or weight change, comorbidity, and personality. The studies were characterized by non-significant and contradictory results. Meta-analyses were performed for the predictors age, AN duration, pre-treatment BMI, post-treatment BMI and depression. These yielded significant effects for post-treatment BMI and depression: higher pre-treatment depression (SMD = .40 CI [.21-.59] and lower post-treatment BMI (SMD = -.35 CI [-.63 to -.07]) increased relapse chances in AN., Discussion: Our results emphasized a lack of sufficiently powered studies, consistent results, and robust findings. Solely post-treatment BMI and pre-treatment depression predicted relapse. Future research should use uniform definitions, larger samples and better designs, to improve our understanding of relapse in AN., Public Significance: Knowledge about predictors is important to understand high relapse rates. Our study performed a review and meta-analysis of relapse predictors in AN. Related to the heterogeneity in studies examining predictors, an overview of relapse and recovery definitions, follow-up durations and relapse rates for AN was provided. Significant effects were found for post-treatment BMI and pre-treatment depression. More studies with uniform definitions are needed to improve clinical implications., (© 2023 Wiley Periodicals LLC.)