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Background: Clinical, epidemiological, and genetic findings support an overlap between eating disorders, obsessive-compulsive disorder (OCD), and anxiety symptoms. However, little research has examined the role of genetics in the expression of underlying phenotypes. We investigated whether the anorexia nervosa (AN), OCD, or AN/OCD transdiagnostic polygenic scores (PGS) predict eating disorder, OCD, and anxiety symptoms in a large developmental cohort in a sex-specific manner. Methods: Using summary statistics from Psychiatric Genomics Consortium AN and OCD genome-wide association studies, we conducted an AN/OCD transdiagnostic genome-wide association meta-analysis. We then calculated AN, OCD, and AN/OCD PGS in participants from the Avon Longitudinal Study of Parents and Children to predict eating disorder, OCD, and anxiety symptoms, stratified by sex (combined N = 3212–5369 per phenotype). Results: The PGS prediction of eating disorder, OCD, and anxiety phenotypes differed between sexes, although effect sizes were small. AN and AN/OCD PGS played a more prominent role in predicting eating disorder and anxiety risk than OCD PGS, especially in girls. AN/OCD PGS provided a small boost over AN PGS in the prediction of some anxiety symptoms. All three PGS predicted higher compulsive exercise across different developmental timepoints [ β = 0.03 (s.e. = 0.01) for AN and AN/OCD PGS at age 14; β = 0.05 (s.e. = 0.02) for OCD PGS at age 16] in girls. Conclusions: Compulsive exercise may have a transdiagnostic genetic etiology, and AN genetic risk may play a role in the presence of anxiety symptoms. Converging with prior twin literature, our results also suggest that some of the contribution of genetic risk may be sex-specific. [ABSTRACT FROM AUTHOR]

Objective: Treatments for adults with eating disorders (EDs) only work in about 50% of individuals, and for some diagnoses (e.g., anorexia nervosa; atypical anorexia nervosa), there are no existing evidence-based treatments. Part of the reason that treatments may only work in a subset of individuals is because of the high heterogeneity present in the EDs, even within diagnoses. Manualized treatments delivered in a standard format may not always address the most relevant symptoms for a specific individual. Method: The current open series trial recruited participants with transdiagnostic ED diagnoses (N = 79) to investigate the feasibility, acceptability, and initial clinical efficacy of a 10-session network-informed personalized treatment for eating disorders. This treatment uses idiographic (i.e., one-person) network models of ecological momentary assessment symptom data to match participants to evidence-based modules of treatment. Results: We found that network-informed personalized treatment was highly feasible with low dropout rates, was rated as highly acceptable, and had strong initial clinical efficacy. ED severity decreased from pre- to posttreatment and at 1-year follow-up with a large effect size. ED cognitions, behaviors, clinical impairment, worry, and depression also decreased from pre- to posttreatment. Conclusions: These data suggest that network-informed personalized treatment has high acceptability and feasibility and can decrease ED and related pathology, possibly serving as a feasible alternative to existing treatments. Future randomized controlled trials comparing network-informed personalized treatment for ED to existing gold standard treatments are needed. Additionally, more research is needed on this type of personalized treatment both in the EDs, as well as in additional forms of psychopathology, such as depression. What is the public health significance of this article?: This study shows that network-informed personalized treatment for eating disorders is feasible, acceptable, and decreases eating disorder symptom severity and depression and worry. This type of personalized treatment may be a feasible alternative to existing evidence-based treatments for eating disorders. [ABSTRACT FROM AUTHOR]

Objective: Data suggest that obsessive–compulsive (OC) symptoms are commonly observed in adolescents with eating disorders and predict poorer treatment response. Further, emerging data among adults suggest that changes in OC symptoms relate to changes in eating disorder symptoms across treatment. Given evidence that early invention decreases risk for protracted illness, evaluating processes that may relate to treatment response will be useful in increasing the effectiveness of existing interventions. Therefore, the current investigation explored changes in general and eating disorder‐specific OC symptoms throughout family‐based treatment (FBT) and cognitive behavioral therapy (CBT) for bulimia nervosa (BN), as well as associations among these changes and eating disorder outcomes at follow‐up. Method: Participants (N = 110) received 18 sessions of FBT or CBT and completed measurements of general and eating disorder‐specific OC symptoms at baseline, end‐of‐treatment, and 6‐ and 12‐month follow‐up. Results: Multilevel models indicated that across both treatments, there was no change in general OC symptoms, whereas all eating disorder‐related OC symptoms decreased over treatment and follow‐up. Exploratory analyses indicated that lower severity in discharge eating‐disorder‐specific OC symptoms contributed to lower eating pathology at follow‐up. Discussion: Together, findings support the efficacy of both FBT and CBT in helping to reduce eating disorder‐specific OC symptoms and suggest that adjunctive intervention may be required for ameliorating general OC symptoms in this population. Public significance: BN is associated with significant increases in mortality and societal cost, and there is a pressing need for innovations within available treatments for young people with this disorder. In the current study, we explore the extent to which existing evidence‐based treatments for adolescent BN are effective in targeting obsessive–compulsive symptoms, a known predictor of treatment response and common co‐morbidity in this population. [ABSTRACT FROM AUTHOR]

Objective: Cross‐sectional associations between eating disorders (EDs) and deficits in neuropsychological functioning have been well documented; however, limited research has examined whether neuropsychological functioning is prospectively associated with EDs. The current study investigated prospective associations between neuropsychological functioning in childhood (ages 8 and 10) and ED behaviours and disorders in adolescence (at ages 14, 16, and 18 years) in a population‐based sample. Method: Participants (N = 4,803) were children enrolled in the Avon Longitudinal Study of Parents and Children, a population‐based, prospective study of women and their children. Regression methods tested associations between facets of neuropsychological functioning (attention, working memory, and inhibition) and eating disorder symptoms and diagnoses. Results: Better scores on working memory tasks in childhood were associated with decreased risk of fasting but increased risk of excessive exercise during adolescence. Better inhibitory control was associated with decreased risk for disordered eating at age 14, and attentional difficulties were associated with increased risk for binge eating disorder during adolescence among boys but not girls. Conclusions: Neuropsychological functioning may enhance risk for disordered eating behaviours in specific ways. Overall, effect sizes were small, and results did not support global associations between neuropsychological differences and ED risk in this sample. [ABSTRACT FROM AUTHOR]

Objective: Exercise dependence is a set of cognitive and behavioral symptoms that constitute a reliance on exercise and is related to eating disorder (ED) symptoms. There are seven components of exercise dependence: tolerance, withdrawal, continuance, lack of control, reduction in other activities, time, and intention effects. Exercising in response to negative affect (NA) is a key feature of dysfunctional exercise in the EDs. However, it is unknown which specific components of exercise dependence relate to ED symptoms, above and beyond NA. Method: The current study (N = 168 individuals with EDs) investigated which components of exercise dependence relate to ED symptoms both cross‐sectionally and prospectively. Results: In cross‐sectional data, we found that withdrawal, tolerance, and time were associated with ED symptoms, above and beyond NA. Prospectively over 1 month, when adjusting for baseline ED symptoms and NA, we found that lack of control, withdrawal, and time positively predicted ED symptoms. Discussion: These findings inform future research on how exercise dependence relates to ED symptoms, showing that withdrawal and time are uniquely associated with ED symptoms both cross‐sectionally and over time. [ABSTRACT FROM AUTHOR]

Sensor technology has made huge technological advances in the past decade. Many sensor technologies (e.g., wearable wristbands) have been integrated into health research with the ability to substantially improve health outcomes and reduce health care costs. Despite the rapid technological developments in sensor technology, little research has examined sensor technology in eating disorders (EDs). The overarching aim of the current article is to briefly review the literature on sensor technology and health outcomes, including EDs, and discuss several potential ideas for the application of sensor technology in the treatment, assessment, and diagnosis of EDs. We will also present data from a feasibility case study with an ED participant and healthy control providing a brief example of how wearable sensor technology might be implemented in ED research. Overall, we will discuss how sensor technology could be used to improve treatment and assessment of EDs and represents an idea in need of more research in the ED field. [ABSTRACT FROM AUTHOR]

Eating disorders and social anxiety are highly comorbid. Understanding this comorbidity may improve treatment outcomes, as social anxiety can impair the ability to benefit from eating disorder treatment. The primary model of social anxiety and eating disorder comorbidity includes social appearance anxiety, high standards, and maladaptive perfectionism. In the current study, we tested for ethnic invariance between Asians (n = 82) and European Americans (n = 182) in a cross-sectional and prospective comorbidity model of social anxiety and eating disorder symptoms. Differences were found across ethnicity in eating disorder and social anxiety symptom comorbidity. Maladaptive perfectionism predicted social anxiety and eating disorder symptoms in European Americans, whereas social appearance anxiety predicted social anxiety and eating disorder symptoms in Asians. Our findings suggest that interventions for social anxiety and eating disorders in Asian populations may be improved by assessing and targeting social appearance anxiety, while maladaptive perfectionism should be targeted among European Americans. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa (AN) and obsessive–compulsive disorder (OCD) are highly comorbid. However, the factors that account for this comorbidity are poorly understood. We examined the core dimensions of AN and OCD and psychological and personality factors shared by both disorders. Method: In path analyses (N = 732 women with either current AN or recovered from AN), we examined which factors were uniquely and independently associated with the core dimensions of AN and OCD. We also examined recovery from AN as a moderator. Results: When individuals with AN reported greater concern over mistakes, they endorsed more severity in both AN and OCD core dimensions. These unique associations existed above and beyond all other transdiagnostic personality and psychological factors and regardless of AN recovery status. Conclusions: Concern over mistakes partially accounts for severity in the core dimensions of both AN and OCD. Concern over mistakes may represent an important target in the aetiology of AN and OCD. [ABSTRACT FROM AUTHOR]

Background: Alcohol involvement has familial associations with bulimic symptoms (i.e., binge eating, inappropriate compensatory behaviors), with several studies indicating a genetic overlap between the two. It is unclear whether overlapping familial risk with alcohol involvement extends to other eating disorder symptoms. Understanding the genetic overlap between alcohol involvement and other eating disorder symptoms may aid in more targeted interventions for comorbid alcohol use‐eating disorder symptoms. Thus, we investigated associations between alcohol involvement and 2 core eating disorder symptoms: drive for thinness and body dissatisfaction in adolescent female and male twins. Methods: We assessed 3 levels of alcohol involvement: alcohol use in the last month, having ever been intoxicated, and alcohol intoxication frequency via self‐report. The Eating Disorder Inventory‐II assessed drive for thinness and body dissatisfaction. Sex‐specific biometrical twin modeling examined the genetic overlap between alcohol involvement and eating disorder symptoms. Results: Phenotypic associations between alcohol involvement, drive for thinness, and body dissatisfaction were significantly greater in girls compared with boys. A majority of the associations between alcohol involvement, drive for thinness, and body dissatisfaction in girls, but not boys, met our threshold for twin modeling (phenotypic r > 0.20). Moderate genetic correlations were observed between the 3 aspects of alcohol involvement and drive for thinness. Moderate genetic correlations were observed between alcohol use and intoxication frequency and body dissatisfaction. Conclusions: Together with the literature on alcohol involvement and bulimic symptoms, these findings suggest a generalized association between alcohol involvement and eating disorder symptoms in girls, whereas this association may be symptom specific in boys. Genetic correlations indicate that the amount and direction of this genetic overlap differs across specific symptoms. When intervening on comorbid alcohol involvement and eating disorder symptoms, it may be important to target‐specific eating disorder symptoms. It is unclear whether alcohol involvement (AI) has familial associations with eating disorder symptoms beyond symptoms of bulimia nervosa. We investigated associations between alcohol involvement and drive for thinness (DT) and body dissatisfaction (BD) in adolescent twins using sex‐specific biometrical twin modeling. Moderate genetic correlations were observed between AI and DT. Findings suggest the amount and direction of the genetic overlap between AI and eating disorder symptoms differs across specific symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Despite the high mortality and significant societal and personal costs associated with eating disorders (EDs) there are few evidence‐based treatments. Part of the difficulty developing and implementing evidence‐based treatments in EDs is due to the extremely high heterogeneity (e.g., variability in treatment outcome, symptom presentation etc) present. Methods: To begin to identify specific symptom heterogeneity within persons, the current study used novel within and between group and intra‐individual network analyses to create longitudinal and within‐person networks of ED cognitions and behaviors (N = 66 individuals diagnosed with an ED). This article provides a proof of concept study for how to use between and within‐person network analyses both for the EDs and other forms of psychopathology. Results: We found that cognitions focused on desiring thinness played a likely maintaining role in ED pathology, across network type and across time. Furthermore, we showed that three individuals with the same diagnosis (anorexia nervosa) differed in which symptoms maintained the disorder. We use these participants to exemplify how to use intra‐individual network analysis to personalize treatment focused on the primary maintaining symptoms. Finally, we found that amount of time (e.g., 4 hr vs. simultaneously) impacts how symptoms maintain each other. Conclusions: These findings have implications for the development of novel personalized evidence‐based treatments for EDs, as well as implications for how the field understands how psychopathology maintains itself. These data represent a first‐step towards using intra‐individual network analyses in the ED field, as well as for hypotheses generation in future research. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders (EDs) and social anxiety disorder (SAD) are highly co‐occurring. This comorbidity is extremely relevant, given that individuals with comorbid ED‐SAD are less likely to seek and/or benefit from ED treatment. Method: We used network analysis to conceptualize ED‐SAD comorbidity in a sample of 2,215 participants with a primary diagnosis of ED, SAD, or no known diagnosis. We used novel network analyses methods to select symptoms for our models, identify potential illness pathways (i.e., bridge symptoms) between disorders and underlying vulnerabilities (e.g., perfectionism, social appearance anxiety), and to compare across sample types (e.g., clinical vs. nonclinical). We also tested several novel network analyses methods aimed at the following methodological concerns: (a) topological concerns (i.e., which items should be included in NA models), (b) how to use empirical indices to quantify bridge symptoms and (c) what differences in networks across samples mean. Results: We found that difficulty with drinking beverages and eating in public were bridge symptoms between ED and SAD. We also found that feeling nervous about one's appearance was a bridge symptom. Conclusions: We identified public eating and drinking as bridge symptoms between EDs and SAD. Future research is needed to test if interventions focused on public eating and drinking might decrease symptoms of both EDs and SAD. Researchers can use this study (code provided) as an exemplar for how to use network analysis, as well as to use network analysis to conceptualize ED comorbidity and compare network structure and density across samples. [ABSTRACT FROM AUTHOR]