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Characterized primarily by a low body-mass index, anorexia nervosa is a complex and serious illness1, affecting 0.9-4% of women and 0.3% of men2-4, with twin-based heritability estimates of 50-60%5. Mortality rates are higher than those in other psychiatric disorders6, and outcomes are unacceptably poor7. Here we combine data from the Anorexia Nervosa Genetics Initiative (ANGI)8,9 and the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED) and conduct a genome-wide association study of 16,992 cases of anorexia nervosa and 55,525 controls, identifying eight significant loci. The genetic architecture of anorexia nervosa mirrors its clinical presentation, showing significant genetic correlations with psychiatric disorders, physical activity, and metabolic (including glycemic), lipid and anthropometric traits, independent of the effects of common variants associated with body-mass index. These results further encourage a reconceptualization of anorexia nervosa as a metabo-psychiatric disorder. Elucidating the metabolic component is a critical direction for future research, and paying attention to both psychiatric and metabolic components may be key to improving outcomes.

Objective: To compare individuals who have experienced binge‐eating disorder (BED) and anorexia nervosa (AN) (BED AN+) to those who have experienced BED and not AN (BED AN–). Method: Participants (N = 898) met criteria for lifetime BED and reported current binge eating. Approximately 14% had a lifetime diagnosis of AN. Analyses compared BED AN+ and BED AN– on sociodemographic variables and clinical history. Results: The presence of lifetime AN was associated with more severe eating disorder symptoms, including earlier onset, more frequent, more chronic, and more types of eating disorder behaviors over the lifetime, as well as a higher lifetime prevalence of bulimia nervosa (BN). Participants with lifetime AN reported being more likely to have received treatments for BED or BN, had significantly lower minimum, current, and maximum BMIs, had more severe general anxiety, and were significantly more likely to be younger and female. In the full sample, the lifetime prevalence of unhealthy weight control behaviors was high and treatment utilization was low, despite an average 15‐year history since symptom onset. Gastrointestinal disorders and comorbid anxiety, depression, and attention‐deficit/hyperactivity disorder symptoms were prevalent. Discussion: Individuals fared poorly on a wide array of domains, yet those with lifetime AN fared considerably more poorly. All patients with BED should be screened for mental health and gastrointestinal comorbidities and offered referral and treatment options. Public Significance: Individuals experiencing binge‐eating disorder have severe symptomology, but those who have experienced binge‐eating disorder and anorexia nervosa fare even more poorly. Our study emphasizes that patients with binge‐eating disorder would benefit from being screened for mental health and gastrointestinal comorbidities, and clinicians should consider history of unhealthy weight control behaviors to inform treatment and relapse prevention. [ABSTRACT FROM AUTHOR]

Enabled by advances in high throughput genomic sequencing and an unprecedented level of global data sharing, molecular genetic research is beginning to unlock the biological basis of eating disorders. This invited review provides an overview of genetic discoveries in eating disorders in the genome-wide era. To date, five genome-wide association studies on eating disorders have been conducted – all on anorexia nervosa (AN). For AN, several risk loci have been detected, and ~11–17% of the heritability has been accounted for by common genetic variants. There is extensive genetic overlap between AN and psychological traits, especially obsessive-compulsive disorder, and intriguingly, with metabolic phenotypes even after adjusting for body mass index (BMI) risk variants. Furthermore, genetic risk variants predisposing to lower BMI may be causal risk factors for AN. Causal genes and biological pathways of eating disorders have yet to be elucidated and will require greater sample sizes and statistical power, and functional follow-up studies. Several studies are underway to recruit individuals with bulimia nervosa and binge-eating disorder to enable further genome-wide studies. Data collections and research labs focused on the genetics of eating disorders have joined together in a global effort with the Psychiatric Genomics Consortium. Molecular genetics research in the genome-wide era is improving knowledge about the biology behind the established heritability of eating disorders. This has the potential to offer new hope for understanding eating disorder etiology and for overcoming the therapeutic challenges that confront the eating disorder field. [ABSTRACT FROM AUTHOR]

Objective: Weight suppression (WS), the difference between highest past non‐pregnancy weight and current weight, predicts negative outcomes in eating disorders, but the impact of WS and related weight constructs are understudied in nonclinical, midlife populations. We examined WS (current weight < highest weight) and weight elevation (WE), the opposite of WS (current weight > lowest weight) and their associations with eating psychopathology in women aged 50+. Method: Participants were a community‐based sample (N = 1,776, Mage = 59) who completed demographic and eating psychopathology questions via online survey. WS, WE, and WS × WE were tested as predictors of outcome variables; BMI and medical conditions that affect weight were controlled for. Results: Individuals that were higher on WS and WE were most likely to engage in current weight loss attempts, dieting in the past 5 years, and extreme lifetime restriction. Individuals with higher WS were more likely to experience binge eating, greater frequency of weight checking, overvaluation of shape and weight, and lifetime fasting. Individuals with higher WE were more likely to report negative life impacts of eating and dieting. Higher WS and WE each predicted higher levels of skipping meals over the lifetime. Discussion: This novel study investigated WS in midlife women and introduced a new conceptualization of weight change (WE) that may be more relevant for aging populations given that women tend to gain weight with age. The findings implicate the utility of investigating both WS and WE as factors associated with eating psychopathology in midlife women. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout. Method Participants ( N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors. Results Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96). Discussion Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:569-577) [ABSTRACT FROM AUTHOR]

Objective: The factor structure of the eating disorder examination (EDE) has never been tested in a clinical pediatric sample, and no normative data exist. Method: The factor structure of an adapted EDE was examined in a clinical sample of 665 females aged 9-17 years with anorexia nervosa spectrum (70%), bulimia nervosa spectrum (12%), purging disorder (3%), and unspecified feeding and eating disorders (15%). Results: The original four-factor model was a good fit in a confirmatory factor analysis as well a higher order model with three dimensions of restraint, eating concern, and combined weight concern/ shape concern. Normative data are reported for clinicians to identify the percentiles in which their patients' score. Discussion: The findings support dimensions of restraint, eating concern, weight concern, and shape concern in a clinical pediatric sample. This supports the factorial validity of the EDE, and the norms may assist clinicians to evaluate symptoms in females under 18 years. [ABSTRACT FROM AUTHOR]

Objective China is undergoing dramatic Westernization, hence may be able to provide unique insights into the role of sociocultural factors in disease. The purpose of this exploratory study was two-fold: to describe the prevalence of screening-detected eating disorders and disordered eating in China at the first occasion of assessment in the large-scale China Health and Nutrition Survey (CHNS) and to explore the associations between dietary practices and disordered eating. Regarding the first objective, participants are provincially representative and in subsequent waves will be followed longitudinally. Method CHNS participants were recruited using multistage, cluster random sampling, beginning in 1989. In this study, participants comprised 259 female adolescents (12-17 years) and 979 women (18-35 years) who participated in the CHNS 2009 survey, which is the first CHNS survey to assess disordered eating. Dietary practice-disordered eating associations were investigated with logistic regression adjusting for age, body mass index, and urbanization. Results Of the participants, 6.3% (95% CI: 4.8, 8.2) of adults and 7.8% (95% CI: 5.0, 12.0) of adolescents had a screening-detected eating disorder. Dietary practices had non-significant associations with disordered eating at the general population level, except for protein consumption among women. There was evidence that skipping meals and a high-fat diet may confer risk. Discussion Screening-detected eating disorders in China are lower in prevalence than in developed countries. Dietary practices had fairly limited associations with disordered eating at the general population level; protein consumption, skipping meals, and a high-fat diet are candidate dietary practice exposures for disordered eating. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective Given the importance of assessing depressive symptoms and suicidal ideation in adolescents with eating disorders (EDs), the aim was to provide normative data on the Children's Depression Inventory (CDI) for female adolescents presenting for treatment of an ED. Method The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry ( N = 1000), a prospective, ongoing registry study comprising consecutive pediatric tertiary ED referrals. Females ( N = 256; 12-17 years) with DSM-5 EDs completed the CDI at intake. Results Results on the CDI revealed a pattern of increasing depressive scores with age and higher scores among patients with anorexic spectrum disorders. The prevalence of suicidal ideation was high and had the same pattern as CDI scores. The mean score on the CDI in the sample was higher than community samples and clinical samples of adolescents with post-traumatic stress disorder, obsessive compulsive disorder, and other clinical disorders. Discussion Females adolescents with EDs are at high-risk of depression and suicidal ideation. These data provide information about variation in CDI scores to guide clinicians in interpretation of scores. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:666-670) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To provide normative data on the Multidimensional Anxiety Scale for Children (MASC) for female adolescents presenting for eating disorder (ED) treatment. Method This study is part of the Helping to Outline Paediatric Eating Disorders Project registry ( N ∼ 1,000), a prospective ongoing registry study comprising consecutive pediatric tertiary ED referrals. Female adolescents ( N = 278; 13-17 years) with EDs completed the MASC at intake. Results Summary data including percentiles are given for the MASC total and subscales. MASC scores were higher than community norms as expected and increased with age ( p <.001) and an anorexic spectrum diagnosis ( p < .001). Discussion The norms reported will aid clinicians in the understanding and interpretation of individual MASC scores among female adolescents with EDs and could assist future research to better understand the role of anxiety in the onset and maintenance of EDs. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:471-474) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program. Method This study compared cognitive, behavioral, and physical and medical features of children (≤12 years) and adolescents (13-18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades ( N = 656; 8-18 years; 94% female). Results Significant differences were found between the groups. Children were more commonly male ( p < .001), had lower eating pathology scores ( p < .001), were less likely to binge eat ( p = .02), purge ( p < .001) or exercise for shape and weight control ( p < .001), and lost weight at a faster rate than adolescents ( p = .009), whereas adolescents were more likely to present with bulimia nervosa spectrum disorders ( p = .004). Children and adolescents did not differ significantly on mean body mass index z-score, percentage of body weight lost, or indicators of medical compromise ( p > .05). Discussion The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:47-53) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study examined whether rapid response to enhanced cognitive behavioral therapy (CBT-E) was associated with superior treatment outcomes in a transdiagnostic sample of patients with an eating disorder. Method Participants were 105 patients with a primary eating disorder diagnosis who received individual CBT-E at a community-based outpatient clinic. Patients completed measures of eating disorder and related pathology at baseline and post-treatment. The Eating Disorder Examination-Questionnaire (EDE-Q) was administered at baseline and again, on average, 4.6 weeks after commencing treatment to assess rapid response to CBT-E. Patients achieving reliable change on the EDE-Q at this point were classified as rapid responders. Results No baseline differences distinguished rapid and nonrapid responders. Rapid responders had significantly lower scores on EDE-Q global at post-treatment, were more likely to achieve full remission, and required significantly fewer treatment sessions than nonrapid responders. One-quarter of the nonrapid responders went on to achieve full remission. There were no group differences on measures of anxiety and depression symptoms at the end of treatment. Discussion Early change in treatment is encouraged to achieve the best possible prognosis in CBT-E. Those who did not achieve rapid response still had an overall significant improvement in symptoms from pretreatment to post-treatment, but a lower rate of full remission. Nonrapid responders are an important group of patients to study because they offer researchers an opportunity to improve clinical decision-making and treatment outcomes for patients who are at risk of suboptimal response. © 2013 Wiley Periodicals, Inc.(Int J Eat Disord 2013; 46:764-770) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The aim of this study was to examine parent-youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample. Method The sample comprised 619 parent-youth dyads of youth (8-18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports. Results On the whole, parent-youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48-0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07-0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents. Discussion Results support the utility of parent-youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:617-625) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective In light of prior inconsistent findings, this study revisits the relationship between weight suppression and treatment outcome in bulimia nervosa. Aside from differences in methodology, we propose that moderator effects may assist the field in interpreting previous inconsistency. In this study, we considered moderators that might place individuals at risk of broad cognitive and biobehavioral mechanisms implicated in weight (dys)regulation and binge eating, and that within the context of a history of weight suppression, might be associated with especially poor outcomes. Method Participants were 117 female outpatients aged 16-54 years ( M = 25.5) with bulimic disorders treated with enhanced cognitive behavioral therapy. Results Logistic regression indicated that higher pretreatment weight suppression did not predict drop-out or poor treatment outcome (nonabstinence from binging and purging). Moderators of parental history of overweight, childhood body shape, pretreatment body mass index, and the difference between highest and lowest ever adult body weight were analyzed, but no moderator effects were apparent. Discussion This study, along with other negative studies, calls into question the association between weight suppression and treatment outcome. We maintain that moderators may account for inconsistencies, but no candidates were identified in this study. Moderator models could assist us to refine conceptualizations of why some patients high in weight suppression may be vulnerable to poor treatment adherence and outcome and to establish clinical interventions that enhance prognosis. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:586-593) [ABSTRACT FROM AUTHOR]

Objectives: To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., 'subjective bulimia nervosa,' SBN), has comparable clinical severity to established eating disorders, particularly BN. Method: Treatment-seeking adults with BN ( N = 112), SBN ( N = 28), anorexia nervosa restricting type (AN-R) ( N = 45), and AN-binge/purge type (AN-B/P) ( N = 24) were compared. Results: Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P. Discussion: Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) [ABSTRACT FROM AUTHOR]