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Integrating across motivational models suggests that different self-damaging behaviors (SDBs) are enacted for similar reasons. However, it remains unclear whether some motives are more relevant to certain SDBs than others. To answer this question, the present study compared the salience of 8 potentially shared motives across 3 exemplar SDBs, selected to represent different points along the internalizing and externalizing spectra: binge drinking, disordered eating (binge eating, purging, fasting), and nonsuicidal self-injury (NSSI). Seven hundred and four first-year university students (73% female, Msubage/sub = 17.97) completed monthly surveys assessing their engagement in and motives for SDBs. Motives were conceptualized as either interpersonal (bonding with others, conforming with others, communicating strength, communicating distress, reducing demands) or intrapersonal (reducing negative emotions, enhancing positive emotions, punishing oneself). Multilevel models compared endorsement of each motive across SDBs. Results revealed that SDBs were motivated by similar goals, albeit to different degrees. Although some exceptions emerged, interpersonal motives were most salient to binge drinking, followed by disordered eating, and then NSSI. In contrast, intrapersonal motives were most salient to NSSI, followed by disordered eating, and then binge drinking. Motivational differences were also found within disordered eating. For example, punishing oneself was more relevant to purging and fasting than binge eating, whereas relieving negative emotions was more relevant to binge eating and purging than fasting. Similar to dimensional models that position SDBs on internalizing or externalizing spectra, the salience of motives for binge drinking and NSSI may fall on distinct spectra (i.e., interpersonal and intrapersonal, respectively), with motives for disordered eating exhibiting elements consistent with both spectra. This study supports a common motivational framework for investigating and potentially treating a variety of topographically distinct SDBs.

Only a small proportion of eligible individuals undergo bariatric surgery. The purpose was to examine attrition to surgery and whether psychiatric symptoms and eating behaviors differentially predicted attrition among men and women.Data was collected from a retrospective chart review of 313 patients who underwent a pre-surgical psychosocial evaluation.The overall attrition rate was 33.5%; 42.6% of men and 31.7% of women experienced attrition. In the multivariate analysis of the entire sample, White patients (OR = 2.33, CI: 1.33, 4.08) and those without a history of binge eating (OR = 2.71, CI: 1.23, 5.97) were more likely to undergo surgery. In a multivariate analysis of women only, race and binge eating independently predicted attrition; however, no factors significantly predicted attrition among men.Factors identified at the pre-surgical psychosocial evaluation can identify patients at risk for attrition, and these factors may differ for men and women.

Despite frequently co-occurring, the temporal relationship between depression and eating disorder symptoms remains poorly understood. This exploratory study sought to investigate the reciprocal relationship between depressive symptoms and (1) shape and weight dissatisfaction, (2) shape and weight overvaluation, (3) preoccupation with shape or weight, (4) preoccupation with food, (5) dietary restraint and (6) binge eating in early adolescence. Adolescents (N = 1393) aged between 11.4 and 13.9 years (M = 12.50, SD = 0.38) completed the Centre for Epidemiological Depression Scale-Revised and Eating Disorder Examination Questionnaire-Adolescent version at the beginning of secondary school (T1) and 12-months later (T2). Cross-lagged models were created to assess the reciprocal relationship between depressive symptoms and ED symptoms. Depressive symptoms at T1 predicted shape and weight dissatisfaction, shape and weight overvaluation, preoccupation with shape or weight, preoccupation with food, dietary restraint and binge eating at T2. Shape and weight dissatisfaction and binge eating were the only ED symptoms at T1 to predict depressive symptoms at T2. Findings suggest young adolescents who experience depressive symptoms in their first year of secondary school are at-risk of developing ED symptoms over the subsequent 12-month period.

Objective: To study the occurrence of alexithymia in obese adolescents. Methods: Cross-sectional study with 102 obese adolescents. Sociodemographic, clinical, and psychometric data (alexithymia and binge eating) were analyzed The Brazilian version of the Toronto Alexithymia Scale and Binge Eating Scale were used for psychometric data collection. Statistical analysis was performed using the Kolmogorov-Smirnov test, Student's t-test, ANOVA, chi-square, linear regression, and logistic regression. The study was approved by Research Ethics Committee. Results: A 22% occurrence of alexithymia was observed. Considering the category “possible alexithymia”, half of the participants presented some alexithymic behavior. Adolescents with alexithymia had higher binge eating scores (alexithymia 16,2 versus possible alexithymia 11,7 versus no alexithymia 8,5; ANOVA p < 0,0005) and three times more binge eating behavior than adolescents with no alexithymia or possible alexithymia (alexithymia 36.4% versus 17.2% possible alexithymia versus 11.8% no alexithymia; chi-square = 6,2, p = 0.04). In simple linear regression, alexithymia scores were positively associated with binge eating scores (r2 = 0,4; p = 0,002). Binary logistic regression showed a three times higher probability of an adolescent with severe obesity to meet the criteria for alexithymia. Conclusion: There was a 22% occurrence of alexithymia in obese adolescents. It was positively associated with obesity severity and higher binge eating scores, suggesting a relationship between severe obesity, alexithymia, and binge eating behavior.

PURPOSE: Dysfunctional exercise is a common, debilitating symptom across eating disorders (ED). We examined the cross-sectional and longitudinal associations between experiences of exercise and ED behaviors and cognitions in an adolescent, population-based sample. METHODS: Adolescents (n = 4,054) self-reported whether they exercised to control shape and weight (exercise for weight loss; EWL), and, if so, whether they exercised even when or injured, and whether exercise interfered with life functioning (driven exercise) at age 14 years, allowing delineation of three exercise-based groups: No-EWL, EWL, and driven exercise. Participants also reported ED cognitions at age 14 years along with other ED behaviors (fasting, purging, binge eating) at ages 14 and 16 years. Sex-stratified regression approaches were employed to examine relationships between these exercise categories at age 14 and ED behaviors and cognitions at ages 14 and 16. RESULTS: Cross-sectionally, those in the driven exercise group, as compared to the no-EWL group, consistently reported higher levels of ED cognitions and behaviors, with those in the EWL group also reporting higher levels of some ED cognitions and behaviors relative to the no-EWL group. Those in the EWL and driven exercise groups at age 14 also demonstrated a higher prospective likelihood of fasting (boys and girls) and purging (girls only) at age 16, relative to those in the no-EWL group at age 14. CONCLUSIONS: Results inform our understanding of EWL and driven exercise and the developmental timing of ED behaviors in adolescence and point towards the potential utility of targeted prevention for young people who report EWL.

The prevalence of eating disorders (EDs) in young children remains relatively unknown. Here, we aimed to assess the prevalence of anorexia nervosa (AN), bulimia nervosa (BN), binge ED (BED), and their subclinical derivatives, among 10- to 11-year-old children in the United States.Cross-sectional data from the year 1 sample of the nationwide Adolescent Cognitive Brain Development study were extracted, and unadjusted prevalence of EDs was reported, as per DSM-5 criteria.Among 10- to 11-year-old children in the United States, no cases of AN were reported. The prevalence of BN was negligible, whereas the prevalence of BED was 1.1%. The prevalence of subclinical AN, BN, and BED was 6%, 0.2%, and 0.5%, respectively.BED is the most prevalent ED subtype among preadolescent children in the United States, although subclinical markers for all ED subtypes are evident in this age range.

The food insecurity-obesity paradox suggests that people lacking access to adequately nutritious foods are more susceptible to disordered eating. However, the mechanisms underlying the relationship between food insecurity and binge eating are not well understood.This study sought to assess the role of eating behaviors (i.e., cognitive restraint, disinhibition, and hunger) as mediators between food insecurity and binge eating among a sample of preoperative bariatric candidates.University hospital in the Appalachian region of the United States.A total of 369 adults seeking bariatric surgery were included in this cross-sectional study. Patients completed validated measures of food insecurity and eating behaviors as part of a routine psychological evaluation prior to bariatric surgery.Food insecurity was significantly related to binge eating symptoms (r[369] = .14, P.01) and hunger (r[369] = .11, P.05). Hunger mediated the relationship between food insecurity and binge eating (b = 1.23, standard error = .62, 95% confidence interval .08-2.54). Food insecurity was not associated with restraint (r[369] = .06, P = .27) or disinhibition (r[369] = .02, P = .69).Food insecurity presents a unique pathway to binge eating that has several implications for intervention prior to bariatric surgery. Identification of food insecurity and the subsequent effects on eating behaviors is crucial to understanding the factors relevant to disordered eating prior to bariatric surgery.

Depression, anxiety, and binge eating are common psychiatric symptoms among people with obesity. Although many studies seek to understand the mechanisms of association between these psychiatric symptoms, there is no still consensus about the longitudinal association.155 patients (124 women) were recruited from a university-based bariatric center and evaluated over three waves (T0-T1-T2). In the last period the sample comprised 126 (104 women) participants. Trained clinicians assessed psychiatric symptoms by telephone interview using measurement scales. Partial Least Squares (PLS) was applied to investigate the path effects between anxiety, depression and binge eating symptoms over time.The results of path coefficients (β) showed that the effect of anxiety on depression was constantly significant in all periods T0 (β = 0.74), T1 (β = 0.71), and T2 (β = 0.67). Anxiety had an effect on binge eating in T0 (β = 0.39) and T2 (β = 0.26) but not in T1. Binge eating affected depressive symptoms only in T2 (β = 0.22). Two carry-over-effects were significant binge eating in T0-T1 (β = 0.41) and T1-T2 (β = 0.19).Telephone interviews, social isolation due to the pandemic and the social desirability may have contributed to collection and information biases.Anxiety has significant path effects on depression and binge eating. Binge eating was shown to be the most unstable symptom over time. The time factor seems to contribute to path effects between the psychiatric symptoms. The results draw attention to the fact that psychiatric symptoms must be evaluated and treated in association with each other, and investigated over time.

Background Pre-surgical psychopathology does not consistently predict post-surgical outcomes in patients who undergo metabolic and bariatric (MBS) surgery. Individuals with elevated pre-MBS psychopathology may be less likely to undergo surgery, which may create a floor effect due to the limited range of scores on measures of psychopathology included in post-surgical analyses, thereby decreasing power to detect clinically significant differences between groups. Objectives We compared rates of clinically significant pre-MBS psychopathology across domains of functioning in patients who did and did not undergo MBS: surgical completers (SC, n = 286) and non-surgical completers (NSC, n = 125). Setting Academic Medical Center, United States Methods Participants (N = 411) were a racially diverse sample of MBS candidates who completed a pre-surgical psychosocial evaluation including measures of disordered eating, alcohol and tobacco use, pain catastrophizing, anxiety, and depressive symptomatology. Results Compared to SC, NSC had larger scale score variance on measures of psychopathology and were more likely to be African-American, to report clinically significant scores on measures of binge eating, depression, anxiety, and pain catastrophizing, and to use tobacco. Conclusions Results support the presence of a restriction of range effect, but do not demonstrate a floor effect. These data suggest that current outcome data for MBS patients may not generalize to those who report clinically significant psychopathology at the pre-MBS psychosocial evaluation, and warrant caution when using the current literature to inform clinical decision-making for this group. Findings also suggest a need for interventions that will better engage African-American patients.

Eating disorders (EDs) and post-traumatic stress disorder (PTSD) commonly co-occur, but the mechanisms driving this co-occurrence are not well understood. The current study explored the relationships between symptoms of ED and PTSD in a sample of male and female undergraduate students in order to identify pathways that may maintain the comorbidity. Network analysis was conducted in a sample of 344 first year undergraduates to visualize partial correlations between each symptom in the comorbidity. Core symptoms, bridge symptoms, and direct pathways between ED and PTSD symptoms were identified. The PTSD symptoms negative emotions (strength = 1.13) and negative beliefs (strength = 1.11) were the strongest symptoms in the network. The strongest bridge nodes were the ED symptoms restriction (bridge strength = 3.32) and binge eating (bridge strength = 2.63). The strongest edges between ED and PTSD nodes were between binge eating and concentration (part r = .16), restriction and sleep (part r = .14), and binge eating and positive emotions (part r = .11). Findings suggest that PTSD symptoms related to negative alterations in cognitions and mood may be highly influential in the ED-PTSD network due to their relatedness to all other symptoms. The pathway between binge eating and inability to experience positive emotions suggest that the comorbidity may be partially maintained through an affect regulation function of binge eating. (Word count: 219)

Distress tolerance (DT) has received increased attention in recent years due to its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology.A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, and BPD symptomatology. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender.DT shared significant, negative, medium correlations with PSU (r = -.18,), DEB (r = -.20), and BPD symptomatology (r = -.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships.The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures.The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.

Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12–20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.

Behavioral models are central to behavioral neuroscience. To study the neural mechanisms of maladaptive behaviors (including binge eating and drug addiction), it is essential to develop and utilize appropriate animal models that specifically focus on dysregulated reward seeking. Both food and cocaine are typically consumed in a regulated manner by rodents, motivated by reward and homeostatic mechanisms. However, both food and cocaine seeking can become dysregulated, resulting in binge-like consumption and compulsive patterns of intake. The speakers in this symposium for the 2021 International Behavioral Neuroscience Meeting utilize behavioral models of dysregulated reward-seeking to investigate the neural mechanisms of binge-like consumption, enhanced cue-driven reward seeking, excessive motivation, and continued use despite negative consequences. In this review, we outline examples of maladaptive patterns of intake and explore recent animal models that drive behavior to become dysregulated, including stress exposure and intermittent access to rewards. Lastly, we explore select behavioral and neural mechanisms underlying dysregulated reward-seeking for both food and drugs.

Binge eating involves consuming excessive amounts of food within a discrete period of time and is associated with significant impairments in binge-eating disorder and bulimia nervosa. While research on clinical binge eating has provided valuable aetiological insights, animal models allow for closer examination of environmental, biological, and developmental risk factors. Numerous animal models of binge eating exist and differ widely in operational definitions of bingeing, animal characteristics and methodological parameters. The current review aimed to synthesise the available published evidence on these models. A systematic review of binge definitions in 170 articles found most studies displayed good face validity. Meta-analyses on 150 articles confirmed that the amount of food or drink consumed by animals under binge conditions was larger than that of non-binge conditions across many protocols. The meta-regression revealed species, strain, and sex moderated binge effect size, with the largest effect observed in studies with female animals and mice. Risk of bias assessment identified that improved reporting of allocation, baseline characteristics and outcome assessment is required in future studies.

Background affective temperaments have been so far understudied in the field of obesity. Therefore, we aimed to assess affective temperaments in outpatients with obesity reporting symptoms of binge eating (BE) and multiple weight cycling (MWC) and to investigate the likelihood of an association between affective temperaments and risk of both conditions. Methods A total of 300 individuals with obesity seeking treatment at the Obesity Unit of an academic hospital were asked to complete self-report measures of affective temperaments, BE, depressive and anxiety symptoms, and quality of life. Results Even in the absence of full-blown mental disorders, symptoms of anxiety and depression emerged in the sample; 197 individuals (65.6%) reported BE and 162 (54%) MWC. The most frequent affective temperament was the depressive one. Depression symptoms and cyclothymic scores (directly), and age and hyperthymic score (inversely) were significantly associated with BE risk, while being an active smoker (directly) and hyperthymic score (inversely) were significantly associated with MWC risk, after controlling for confounders in a multiple logistic regression. Limitations sample size was small, the study was limited to a single center, no formal definition of weight cycling exists and MWC was self-reported. Conclusions A substantial number of outpatients with obesity reported BE and MWC notwithstanding the absence of a formal psychiatric diagnosis. Cyclothymic scores were positively associated with BE while the hyperthymic temperament showed a protective effect on both BE and MWC. These findings suggest the need for multidisciplinary treatments for people with obesity enhancing research on temperament-based psychological interventions.

Accumulating evidence suggests that the presence of shape/weight overvaluation in binge-eating disorder (BED) is associated with more severe psychopathology and impairment. To further inform the role of the overvaluation construct in BED, we examined whether those with and without shape/weight overvaluation differ on four core processes that underpin the contextual behaviour therapies: distress tolerance, self-compassion, mindfulness, and experiential avoidance. These four processes were investigated as each are considered important change mechanisms in contextual behavioural therapies and are either compatible or incompatible with the emotion dysregulation known to precipitate binge eating. Participants were categorized into one of four study groups: probable BED with overvaluation (n = 60); probable BED without overvaluation (n = 108); obese control (n = 59); healthy control (n = 123). Analyses of covariance showed that the probable BED with overvaluation group reported lower levels of self-compassion and distress tolerance, and higher levels of experiential avoidance than the three other groups. The probable BED without overvaluation group did not differ to control groups on these processes, except experiential avoidance levels. Findings highlight potentially important intervention targets and constructs among a subgroup of individuals with BED.

Purpose Male weight concerns tend to focus on shape and muscularity as opposed to a desire for thinness and remain underdetected by conventional eating disorder assessments. We aimed to describe the longitudinal course of weight concerns and disordered eating behaviors among males across adolescence and young adulthood. Methods We used prospective assessments of 4,489 U S. males, aged 11 to 18 years at baseline of analyses, in the Growing Up Today Study. We assigned mutually exclusive classifications of behaviors consistent with bulimia nervosa (BN), binge eating disorder (BED), purging disorder (PD); high levels of concern with thinness and/or muscularity; and use of muscle-enhancing products. We estimated the probability of maintenance, resolution, or transition to different weight concerns and/or disordered eating behaviors across consecutive survey waves. Results Less than 1% of participants met full or partial criteria for BN, PD, or BED at baseline. One-quarter (25.4%, n = 1,137) of males reported high weight concerns during follow-up; nearly all these cases (93.7%, n = 1,065) had high muscularity concerns. The most common transition in concerns or behaviors involved the addition of muscularity concerns to a preoccupation with thinness. Eleven percent of participants used muscle-building products during follow-up. Multi-year product use (23.0% [standard deviation 1.0%] of males who used products) was more common than maintenance of bulimic behaviors (3.0% [.7%] of BN/PD, 10.5% [1.2%] of BED cases). Conclusions Integrating muscularity concerns and product use into health promotion and screening tools may improve prevention and early detection of harmful body image and weight control among adolescent and young adult males.

Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one’s own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.

Nonsuicidal self-injury (NSSI) and binge eating frequently co-occur. These behaviors are often used to alleviate distress. Previous studies examining this co-occurrence have used a variable-centered approach. The current study used a person-centered approach (mixture modeling) to examine how individuals cluster in groups based on their past-month NSSI, past-month objective and subjective binge episodes (OBEs and SBEs, respectively), and endorsement of coping motives for NSSI and eating in two large samples of emerging adults. Validators included self-report measures of emotion regulation, impulsivity, and negative affect. In Study 1, additional validators included lifetime history of mental health treatment and suicide attempts. In Study 2, additional validators included child abuse history. In both Study 1 and Study 2, a three-class solution provided the most interpretable fit with classes characterized as (a) low psychopathology; (b) the presence of OBEs and NSSI, and endorsement of NSSI coping motives; and (c) the presence of SBEs and NSSI, and endorsement of high levels of NSSI coping motives. In both studies, eating motives were equivalent in Classes 2 and 3, but NSSI motives were most strongly endorsed by Class 3. In Study 1, Class 2 endorsed higher rates of lifetime suicide attempts than Class 3. In Study 2, both Class 2 and Class 3 endorsed higher rates of child abuse than Class 1, although they did not differ from each other. The class structure and validator analysis were consistent across samples and measures. Results suggest that binge eating and NSSI tend to cluster together in otherwise healthy emerging adults.

Bulimia nervosa (BN) is characterized by recurrent engagement in eating disorder behaviors despite negative consequences, potentially reflecting aberrant stimulus-response or reward-learning processes. Indeed, frontostriatal circuitry involved in reward learning is altered in persons with BN and preliminary research suggests reward learning is impaired in persons with BN. Additional research on reward learning in BN and its association with eating disorder symptom expression is warranted to further the field's understanding of potential pathophysiological mechanisms of BN. To this end, the probabilistic reward learning task (PRLT) was administered to unmedicated women with BN (n = 15) and demographically matched psychiatrically healthy women (n = 18). Contrary to our hypotheses, results demonstrated that women with BN showed greater reward learning during the PRLT relative to healthy comparison women when covarying for symptoms of depression, social anxiety, and mania. Exploratory analyses showed that binge-eating frequency was inversely associated with reward learning in women with BN; however, results should be interpreted with caution due to the small sample size. Together, results suggest that women with BN do not have deficits in implicit reward learning. Given the preliminary nature of this investigation, larger-scale studies are needed to further examine reward learning in current BN and could compare reward learning using general (e.g., monetary) and disorder-specific (e.g., food) reinforcers. Further work is needed to confirm the inverse association between reward learning and binge eating.

Eating disorders occur in diverse populations, and discrimination may be a specific factor that is related to higher eating disorder psychopathology among marginalized individuals. To evaluate the current evidence on this topic, a meta-analysis was used to quantitatively synthesize the literature on discrimination and eating disorder psychopathology across a heterogeneous range of studies. Searches were conducted in peer-reviewed journals and accessible unpublished dissertations of all years through January 2020. Studies were coded by two authors using a tailored coding form, and zero-order bivariate correlations were used as effect size measures. There were 55 cross-sectional studies extracted for inclusion in the meta-analysis. Results showed a small-to-medium association between discrimination and eating disorder psychopathology that was consistent across domains. Effect sizes were typically higher for weight discrimination. For binge eating and general eating disorder pathology, effects were smaller in studies that had larger proportions of women, and for binge eating only, effects were higher in college samples. These findings could suggest that discrimination represents a contributory factor related to eating disorder psychopathology across types of discrimination and eating disorder psychopathology. Implications are discussed for future research on discrimination and psychopathology including possible mechanisms.

Purpose Eating disorders are prevalent public health problems associated with broad psychosocial impairments and with elevated rates of psychiatric and medical comorbidities. Critical reviews of the treatment literature for eating disorders indicate that although certain specialized psychological treatments and specific medications show efficacy to varying degrees across the different eating disorders, many patients fail to derive sufficient benefit from existing treatments. This article addresses whether combining psychological and pharmacologic interventions confers any additional benefits for treating eating disorders. Methods This study was a critical review of randomized controlled trials (RCTs) testing combined psychological and pharmacologic treatment approaches for eating disorders with a focus on anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED). Findings For AN, 3 of the 4 RCTs reported no significant advantage for combining treatments; the fourth reported a statistically significant, albeit clinically modest, advantage. For BN, 10 of the 12 RCTs reported no significant advantage for combining treatments; 2 RCTs found that combining fluoxetine with specific psychological treatments enhanced outcomes relative to medication only but not relative to the psychological treatments only. For BED, of the 12 RCTs, only 2 (both with antiseizure medications) significantly enhanced both binge-eating and weight outcomes, and only 2 (with orlistat, a weight-loss medication) enhanced weight loss but not binge-eating outcomes. Implications Despite the public health significance of eating disorders, the scope of research performed on the utility of combining treatments is limited. To date, the few RCTs testing combined pharmacologic plus psychological treatments for eating disorders have yielded mostly nonsignificant findings. Future RCTs should focus on testing additive benefits of medications with relevant mechanisms of action to available effective psychological interventions. In addition, future RCTs that test additive effects should use adaptive designs, which could inform treatment algorithms to enhance outcomes among both responders and nonresponders to initial interventions.

Purpose Of the 3 major eating disorders, anorexia nervosa, bulimia nervosa, and binge eating disorder (BED), BED is the most common and exists in the practices of most primary care and psychiatric clinicians. However, BED often goes unrecognized and thus untreated. Methods Reviewed in this commentary are the basic elements in the diagnosis of BED, demographic and clinical characteristics, screening options, the importance of comorbidities, pathophysiology, and available treatments. Findings Psychological treatments, including cognitive-behavioral therapy, interpersonal therapy, and behavioral weight loss, have been recommended as first-line options and are supported by several different meta-analytic reviews. Lisdexamfetamine is currently the only medication approved by the US Food and Drug Administration for the treatment of BED. Effect sizes for lisdexamfetamine versus placebo for response, remission, and avoidance of relapse in BED are robust, but its use may be limited by tolerability. This is also the case for topiramate, an anticonvulsant that has been used “off-label” to treat BED. Implications Additional medication choices approved by the US Food and Drug Administration for the treatment of BED are needed. Moving forward, opportunities to leverage modern technology to broaden access to treatment are highly desirable.

We aim to investigate the association between the presence of eating disorders and both Internet addiction (IA) and Facebook addiction (FA) in women suffering from eating disorders.A total of 124 women completed three instruments: the Internet Addiction Test (IAT), the Bergen Facebook Addiction Scale (BFAS) and a sociodemographic questionnaire.The proportion of FA was 37.9%. The distribution of risk of IA was 21.8%. When the risk of Internet or Facebook addiction was compared with respect to eating disorders, no significant differences were found between groups (P = 0.146 and P = 0.086, respectively). Age and Body Mass Index (BMI) were predictors of BFAS scores; the standardized beta coefficient (β) for age was -0.463 (P ≤ 0.001), while for BMI it was 3.44; (P = 0.001) being a positive predictor of BFAS scores. For IAT scores, β age (negatively) = -0.415; (P 0.001) and β for weight (positively) 3.657; (P 0.001) were identified.The presence of an eating disorder does not seem to be a factor that characterizes the risk of Internet or Facebook addiction in our sample. As information regarding the potential association between Internet and Facebook addiction and the presence of eating disorders is limited, we encourage further studies on this topic.

Background & objectives Polycystic ovary syndrome (PCOS) is the most common endocrinal disorder, and the greatest cause of infertility in women. Despite availability of individual data on impact of multiple endocrinal, reproductive and even metabolic factors in PCOS individuals, the data on the co-existence of BED and depression in PCOS patients with its relationship on the quality of life in Saudi Arabian females is not found. Hence this study is aimed to elucidate the implication of PCOS on eating behaviour, induction of depression and general health quality in Saudi Arabian population of Riyadh. Materials and methods This is a cross-sectional study carried out in multiple health facilities of Riyadh from January to March 2019. The study samples (494) were recruited by convenience sampling and administered validated questionnaire by trained research participants. The data obtained was analysed by binary logistic regression using SPSS-IBM 25. Results Of the total 494 women participated in the study, 23.48% (116) were PCOS individuals. The odds of developing abnormal health related quality of (HRQ) in patients with PCOS was significantly (P = 0.000, OR = 3.472) high when compared to non-PCOS participants. The odds of showing high binge eating disorder (BED, P = 0.007, OR = 2.856) and depression (P = 0.000, OR = 2.497) scores in PCOS participants were significantly more than patients who were not having PCOS. Out of the three parameters studied, abnormal health related quality of life possessed a higher influence of PCOS compared to depression and abnormal eating behavior. Interpretation & conclusion In conclusion, the present study shows that women with PCOS are at a significant risk for depressive disorders, disorganized eating behavior and impaired quality of life. Therefore, necessary care and screening is required to minimize the impact of PCOS on already burdened individuals.

There is significant variability in the type and severity of symptoms reported by individuals diagnosed with binge-eating disorder (BED). Using latent class analysis (LCA), the current study aimed to investigate potential sources of heterogeneity among individuals with BED. Participants were 775 treatment-seeking adults with DSM-IV-defined BED. Doctoral research clinicians reliably assessed participants for BED and associated eating-disorder psychopathology using the Structured Clinical Interview for DSM-IV Disorders and the Eating Disorder Examination (EDE) interview, measured weight and height, and participants completed a battery of self-report measures. Based on fit statistics and class interpretability, a 2-class model yielded the best overall fit to the data. The two classes were most distinct with respect to differences in body image concerns, distress about binge-eating, and depressive symptomology. Number of binge episodes were significantly different between classes, though the effect was much smaller. Body mass index was not a significant indicator or covariate in the majority of models. The results show that many of the features currently used to define BED (e.g., binge-eating frequency) are not helpful in explaining heterogeneity among individuals with BED. Instead, body image disturbances, which are not currently included as a part of the diagnostic classification system, appear to differentiate distinct subgroups of individuals with BED. Future research examining subgroups based on body image could be integral to resolving ongoing conflicting evidence related to the etiology and maintenance of BED.

Binge eating disorder (BED) is known as the most common eating disorder with both psychosocial and biological factors involved. In this regard, there is a need to recognize probable disturbances in substances involved in food intake regulation in BED. In this study, we hypothesized that the levels of endocannabinoids, fatty acid amid hydrolase (FAAH) gene polymorphisms, and appetite regulatory substances are different in overweight and obese women with and without BED. A Binge Eating Scale was used to estimate the prevalence of BED in 180 women classified as overweight or obese. The levels of anandamide (AEA), 2-arachidonoylglycerol (2-AG), leptin, insulin, and orexin-A were measured by enzyme-linked immunosorbent assay kits. The subjects were genotyped for polymorphisms of FAAH gene using amplification refractory mutation system-polymerase chain reaction. Data were analyzed using SPSS software. About 41.6% (n = 75) of the subjects were diagnosed with BED. Women with BED exhibited significantly higher levels of AEA, 2-AG, leptin, and insulin compared to non-BED women (P .05). Binary logistic regression analysis also showed that AEA, leptin, and insulin were the predictors of having BED after adjusting for body mass index (P .05). In addition, the frequency of A allele of FAAH gene was higher in women with BED compared to women without BED; however, there were no significant differences between these 2 groups (P = .08). These results supported our hypothesis in the cases of AEA, 2-AG, leptin, and insulin but not orexin and FAAH gene polymorphisms. The findings of the current study provide further evidence concerning the role of these substances in BED.

Background Eating disorders affect 13% of females and contribute to functional impairment and mortality, but few studies have identified risk factors that prospectively correlate with future onset of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Identifying risk factors specific to each eating disorder is critical for advancing etiologic knowledge and designing effective prevention programs. Objectives This study examined whether weight suppression (the difference between a person's highest past weight at their adult height and their current weight) correlates with future onset of AN, BN, BED, and PD. Methods Data from 1165 young women with body image concerns (mean ± SD age: 21.9 ± 6.4 y) who completed annual diagnostic interviews over a 3-y follow-up period were examined. Logistic regression models evaluated the relation of baseline weight suppression to onset risk of each eating disorder controlling for age, dietary restraint, and intervention condition. Results Elevated weight suppression predicted future onset of AN (OR: 1.36; 95% CI: 1.03, 1.80), BN (OR: 1.34; 95% CI: 1.11, 1.62), PD (OR: 1.46; 95% CI: 1.23, 1.74), and any eating disorder (OR: 1.32; 95% CI: 1.12, 1.56), but not BED (OR: 1.10; 95% CI: 0.89, 1.37). Highest past weight correlated with future onset of BN and PD but not onset of AN, BED, or any eating disorder, and baseline current weight was inversely related to future AN onset only, implying that women with the largest difference between their highest past weight and current weight are at greatest risk of eating disorders. Conclusions The results provide novel evidence that weight suppression correlates with future onset of eating disorders characterized by dietary restriction or compensatory weight control behaviors and suggest weight-suppressed women constitute an important risk group to target with selective prevention programs.These trials were registered at clinicaltrials.gov as NCT01126918 and NCT01949649.

Background Inhibitory control refers to a central cognitive capacity involved in the interruption and correction of actions. Dysfunctions in these cognitive control processes have been identified as major maintaining mechanisms in a range of mental disorders such as ADHD, binge eating disorder, obesity, and addiction. Improving inhibitory control by transcranial direct current stimulation (tDCS) could ameliorate symptoms in a broad range of mental disorders. Objective The primary aim of this pre-registered meta-analysis was to investigate whether inhibitory control can be improved by tDCS in healthy and clinical samples. Additionally, several moderator variables were investigated. Methods A comprehensive literature search was performed on PubMed/MEDLINE database, Web of Science, and Scopus. To achieve a homogenous sample, only studies that assessed inhibitory control in the go-/no-go (GNG) or stop-signal task (SST) were included, yielding a total of 75 effect sizes from 45 studies. Results Results of the meta-analysis indicate a small but significant overall effect of tDCS on inhibitory control (g = 0.21) which was moderated by target and return electrode placement as well as by the task. The small effect size was further reduced after correction for publication bias. Conclusion Based on the studies included, our meta-analytic approach substantiates previously observed differences between brain regions, i.e., involvement of the right inferior frontal gyrus (rIFG) vs. the right dorsolateral prefrontal cortex (rDLPFC) in inhibitory control. Results indicate a small moderating effect of tDCS on inhibitory control in single-session studies and highlight the relevance of technical and behavioral parameters.

BACKGROUND: Binge eating disorder (BED) is the most prevalent eating disorder. We examined the presence of binge eating (BE) and three associated eating behaviors in relation to subcortical regional volumes and cortical thickness from brain scans. METHODS: We processed structural MRI brain scans for 466 individuals from the Nathan Kline Institute Rockland Sample using Freesurfer. We investigated subcortical volumes and cortical thicknesses among those with and without BE and in relation to the scores on dietary restraint, disinhibition, and hunger from the Three-Factor Eating Questionnaire (TFEQ). We conducted a whole-brain analysis and a region of analysis (ROI) using a priori regions associated with BE and with the three eating factors. We also compared scores on the three TFEQ factors for the BE and non-BE. RESULTS: The BE group had higher scores for dietary restraint (p = .013), disinhibition (p = 1.22E-07), and hunger (p = 5.88E-07). In the whole-brain analysis, no regions survived correction for multiple comparisons (FDR corrected p

Background Food Craving (FC) is a construct influenced by cognitive, emotional, physiological and external components, severely altered in Eating Disorders (EDs). Objectives To investigate how FC was measured in EDs. Methods A search was conducted (PubMed, Scopus and PsycINFO databases) for studies that have investigated FC in EDs published in the last thirty years. Results The studies found (n= 37) demonstrated that FC is a predictor of binge eating in individuals with Bulimia Nervosa and Binge Eating Disorder, which are more sensitive to the environment and emotional factors, whereas, in individuals with Anorexia Nervosa, FC levels are lower. Discussion FC is a physiological component of eating behavior, as well as the craving/urge that arises associated with thirst during dehydration, and food restriction is a crucial mechanism for the restriction-binge cycle to hold. Further studies are needed to see if FC increases in response to treatment for Anorexia Nervosa, recognizing that individuals without Anorexia Nervosa have higher FC levels and greater motivational orientation towards food. Conclusions It is necessary to understand the physiological role of FC and also consider the significance of each food in an individual eating context (eating attitudes) and whether it is treated like a “drug” or just as a desired tasty food and future studies should verify possible neural changes involved in FC after nutritional treatment.

Summary Background & aims To compare groups of bariatric patients with preoperative scores of Binge Eating Scale (BES) above and below the clinical cut off value on weight outcomes up to 60 months following surgery. Methods This is a prospective observational study involving 108 Brazilian patients (follow-up rate: 48.1%) operated by Roux-en-Y gastric bypass. In the preoperative period, they were clinically evaluated, and BES was applied. Based on the scores, patients were categorized as high or low according to established cut off 17 for binge eaters. Follow-up weight loss was obtained (3, 6, 12, 24, 36, 48, and 60 months) using data from medical records. The percentage of total weight loss (%TWL) was examined by generalized linear model. Results 41.7% of patients had BES scores higher than 17 at baseline. Weight loss was significant up to 12 months. The greatest weight loss was at 24 months of follow-up, ranging from 2.7 to 110.4 kg (mean 42.9 ± 17.8 kg). In the short postoperative period (3, 24, and 36 months), %TWL was significantly different between groups. At 24 months, patients with higher scores lost more %TWL than those with lower scores (35.1 ± 0.8% vs 31.6 ± 0.7%, p = 0.029). However, this difference was not fount at 60 months postoperatively (mean 28.9 ± 9.6%). In a multivariate analysis, the presence of depression, age, and BES score were not associated with %TWL at 24 and 60 months. Conclusions The results suggest that preoperative BES scores point to a similar weight loss after bariatric surgery. Further studies with long-term follow-up are necessary to evaluate this finding.

Binge eating disorder (BED) is the most common eating disorder in the United States and Europe and is associated with obesity and type 2 diabetes (T2D). Presence and severity of BED have been associated with worse metabolic control and greater BMI in T2D patients. Glucagon Like Peptide-1 (GLP1) receptors are present in central nervous system areas involved in appetite regulation and treatment with GLP-1 receptor agonists modulates appetite and reward-related brain areas in humans. We evaluated the effects of treatment with dulaglutide on eating behavior in T2D outpatients with BED.This was a pilot open label, prospective controlled study. Inclusion criteria were: Age ≤65, HbA1c between 7.5 and 9% on metformin therapy alone, normal renal function and diagnosis of BED. Patients were randomly assigned to receive either Dulaglutide 1,5 mg/sett or Gliclazide 60 mg for 12 weeks. We evaluated baseline binge eating scale score (BES), weight, BMI, percentage fat mass, HbA1c and their changes after treatment. A multivariate linear regression model was used to verify the association between Δ BES from baseline with Δ Hba1c and variation of anthropometric parameters after treatment.After 12 weeks patients treated with dulaglutide had grater reduction of binge eating behaviour (p 0.0001), body weight (p 0,0001), BMI (p 0.0001), percentage fat mass (p 0.0001) and HbA1c (p = 0.009) than patients treated with gliclazide. Reduction in BES was associated with reduction in body weight (p 0.0001) and HbA1c (p = 0.033).Dulaglutide treatment reduces binge eating behaviour in T2D patients with BED.

Many individuals seeking bariatric surgery present with problematic eating behaviors, psychological factors or psychiatric co-morbidities that can adversely affect outcomes. The entire health care team can utilize Motivational Interviewing skills to enhance the patient's motivational level and confidence for having a healthy lifestyle. Therefore, the purpose of this review is to highlight 4 domains of functioning that are important to assess and evaluate: Eating Behaviors (binge eating disorder, food addiction, and night eating syndrome) Mood disorders (depression and anxiety), Addictive Behaviors (alcohol, cannabis, opioid, and behavioral), and motivational level for healthy eating and physical activity. This review is not meant to be all encompassing or a comprehensive review of the literature, as other psychological and psychiatric factors such as limited cognitive functioning, history of being the victim of abuse, positive aspects of being overweight, post-traumatic stress disorder, or lack of social support, are a few specific examples of other psychosocial domains that are also important to assess and evaluate in patients seeking to have weight loss surgery. Rather, these 4 domains were selected to highlight the importance of conducting a comprehensive psychiatric or psychological evaluation in patients seeking to have weight loss surgery and to provide ongoing mental health support and counseling for positive lifestyle changes.

Background Lithium and quetiapine can cause weight gain, but their comparative longer term anthropometric effects are unknown, as are the potential moderating effects of baseline binge-eating (BE) behavior. Methods We assessed 6 month changes in body weight, body mass index (BMI) and waist circumference in 482 adults with DSM-IV bipolar disorders who participated in a comparative effectiveness study of lithium and quetiapine with evidence-based adjunctive treatment (Bipolar CHOICE). Anthropometric measurements were obtained at baseline, and at 2, 4, 6, 8, 12, 16, 20, and 24 weeks. BE behavior was defined as affirmative responses to MINI items M1 and M3 at baseline. Data were analyzed using a mixed model repeated measures approach, adjusted for baseline values of dependent measures. Results On average, body weight and BMI increased over 6 months with lithium and quetiapine. However, those treated with quetiapine experienced greater increases from baseline in body weight (peak change, + 3.6 lbs. vs. + 1.4 lbs.) and BMI (peak change, + 0.6 kg/m2 vs. + 0.3 kg/m2), starting at 2 weeks (group x time, F8,3052= 2.9, p = 0.003 for body weight, F8,3052= 3.0, p = 0.002 for BMI). Significant increases in waist circumference were observed only with quetiapine. The relationship between drug treatment and changes in body weight (group x time x binge eating status, F1,2770= 2.0, p = 0.002), BMI (F1,2767= 2.0, p = 0.002), and waist circumference (women only, F25,1621= 2.9, p Limitations Bipolar CHOICE was not designed to study anthropometric outcomes. Conclusions Greater changes in body weight, BMI, and waist circumference occurred with quetiapine- versus lithium-based treatment over 6 months of treatment. The effects of study drugs on these anthropometric measures were moderated by BE behavior at baseline.

Summary Background Mental health problems are prevalent among adolescents with severe obesity, but long-term mental health outcomes after adolescent bariatric surgery are not well known. We aimed to assess mental health outcomes over 5 years of follow-up after Roux-en-Y gastric bypass surgery in adolescents who participated in the Adolescent Morbid Obesity Surgery (AMOS) study. Methods This was a non-randomised matched-control study in adolescents aged 13–18 years who had a BMI of 40 kg/m2 or higher, or 35 kg/m2 or higher in addition to obesity-related comorbidity; who had previously undergone failed comprehensive conservative treatment; and were of pubertal Tanner stage III or higher, with height growth velocity beyond peak. A contemporary control group, matched for BMI, age, and sex, who underwent conventional obesity treatment, was obtained from the Swedish Childhood Obesity Treatment Register. Data on dispensed psychiatric drugs and specialist treatment for mental disorders were retrieved from national registers with complete coverage. In the surgical group only, questionnaires were used to assess self-esteem (Rosenberg Self-Esteem [RSE] score), mood (Mood Adjective Checklist [MACL]), and eating patterns (Binge Eating Scale [BES] and Three-Factor Eating Questionnaire-R21 [TFEQ]). This study is registered with ClinicalTrials.gov ( NCT00289705 ). Findings Between April 10, 2006, and May 20, 2009, 81 adolescents (53 [65%] female) underwent Roux-en-Y gastric bypass surgery, and 80 control participants received conventional treatment. The proportion of participants prescribed psychiatric drugs did not differ between groups in the years before study inclusion (pre-baseline; absolute risk difference 5% [95% CI −7 to 16], p=0·4263) or after intervention (10% [−6 to 24], p=0·2175). Treatment for mental and behavioural disorders did not differ between groups before baseline (2% [−10 to 14], p=0·7135); however, adolescents in the surgical group had more specialised psychiatric treatment in the 5 years after obesity treatment than did the control group (15% [1 to 28], p=0·0410). There were few patients who discontinued psychiatric treatment post-surgery (three [4%] receiving psychiatric drug treatment and six [7%] receiving specialised care for a mental disorder before surgery). In the surgical group, self-esteem (RSE score) was improved after 5 years (mixed model mean 21·6 [95% CI 19·9 to 23·4]) relative to baseline (18·9 [17·4 to 20·4], p=0·0059), but overall mood (MACL score) was not (2·8 [2·7 to 2·9] at 5 years vs 2·7 [2·6 to 2·8] at baseline, p=0·0737). Binge eating was improved at 5 years (9·3 [7·4 to 11·2]) relative to baseline (15·0 [13·5 to 16·5], p Interpretation Mental health problems persist in adolescents 5 years after bariatric surgery despite substantial weight loss. Although bariatric surgery can improve many aspects of health, alleviation of mental health problems should not be expected, and a multidisciplinary bariatric team should offer long-term mental health support after surgery. Funding Swedish Research Council, VINNOVA, Vastra Gotalandsregionen, ALF VG-region, Region Stockholm, Swedish Child Diabetes Foundation, Swedish Heart and Lung Foundation, Tore Nilsson's Foundation, SUS Foundations and Donations, Capio Research Foundation, and Mary von Sydow's Foundation.

Binge eating episodes are persistent and are essential features of numerous eating disorders (EDs). Susceptibility to EDs is largely presumed to be associated with early life stress. In fact, converging evidence from preclinical animal studies have implicated stress as a driver of binge eating. Still, literature examination indicates that vulnerability to EDs may depend on factors such as severity, time, and the type of stressor. Therefore, we aimed at exploring the link between chronic psychosocial stress and 'binge-like' sucrose intake in adolescent mice. To this aim, intruders' experimental mice were exposed to the chronic subordinate colony (CSC) housing, in the presence of a resident aggressive mouse for 2 weeks. At the end of the stress period, mice were tested for anxiety-like behavior then assessed for 'binge-like' intake of sucrose using a long-term drinking in the dark (DID) method that successfully replicates binge eating in humans. As expected, and compared to single housed colony controls (SHC), CSC exposure elicited an anxiogenic-like response in the open field (OF) and elevated-plus maze (EPM) tests and reduced weight gain. Most importantly, we report here for the first time, that mice exposed to chronic psychosocial stress displayed a 'binge-like' consumption of sucrose. However, neither quinine (bitter) nor saccharin (sweet) intakes were affected by CSC exposure. Finally, using Pearson's correlation, results showed a strong correlation between anxiety-like behavior parameters and sucrose intake. Overall these findings support the validity of our chronic psychosocial stress to model binge EDs and establish the long-term consequences of stress on 'binge-like' eating in male mice. These data suggest that chronic psychosocial stress is a risk factor for developing anxiety-associated EDs.

Obesity is associated with difficulties due to stigma and loneliness. These impact negatively on individuals’ quality of life and behaviour change efforts. Increased sensitivity to others’ negative feedback might play a role in the maintenance of these difficulties and could be addressed in psychological interventions. We conducted a systematic review of interpersonal difficulties in individuals with obesity, across the lifespan. We investigated early interpersonal adversity (i.e. frequency of teasing/bullying), perceived interpersonal stress and quality of social life, based on a rejection sensitivity model. The databases PubMed, Web of Knowledge and AGRIS, Embase, Medline and PsychINFO were searched for published peer-reviewed journal articles (1980-June 2018). Thirty-two studies met inclusion criteria. Results from the meta-analyses (n = 16 studies) indicated that overweight/obese individuals reported more frequent experiences of teasing/bullying, greater interpersonal stress and poorer quality of social life than healthy weight individuals. Findings in the systematic review aligned to this evidence. Psychological interventions targeting increased sensitivity to negative interpersonal feedback could improve interpersonal functioning and, in turn, eating behaviours in individuals with obesity.

Bulimia nervosa (BN) is associated with functional abnormalities in frontostriatal and frontolimbic circuits. Although structural alterations in the frontal portions of these circuits have been observed, this is the first study of subcortical surface morphometry and the largest study of subcortical volume in BN.Anatomical magnetic resonance scans were acquired from 62 female participants with full and subthreshold BN (mean age ± SD, 18.7 ± 4.0 years) and 65 group-matched healthy control participants (mean age ± SD, 19.3 ± 5.7 years). General linear models were used to compare groups and assess the significance of group-by-age interactions on the shape and total volume of 15 subcortical structures (p.05, familywise error corrected). Associations with illness severity and duration were assessed in the BN group.Subcortical volumes did not differ across groups, but vertexwise analyses revealed inward shape deformations on the anterior surface of the pallidum in BN relative to control participants that were associated with binge-eating frequency and illness duration. Inward deformations on the ventrolateral thalamus and dorsal amygdala were more pronounced with advancing age in the BN group, and inward deformations on the caudate, putamen, and amygdala were associated with self-induced vomiting frequency.Our findings point to localized deformations on the surface of subcortical structures in areas that comprise both reward and cognitive control circuits. These deformations were more pronounced among older BN participants and among those with the most severe symptoms. Such precise localization of alterations in subcortical morphometry may ultimately aid in efforts to identify markers of risk and BN persistence.

Binge eating disorder (BED) is the most prevalent eating disorder in the adult population. It is characterized by recurrent episodes of uncontrollable overconsumption of palatable food (PF). BED is connected to several comorbidities such as obesity, major depression, and substance use disorder, and was linked to heightened levels of impulsivity. The neurobiological basis of BED is however still vaguely known. Binge eating (BE) occurs without homeostatic needs, and therefore, relates to hedonic consumption of PF. A major brain structure in the control of hedonic feeding, and part of the network regulating impulsive action, is the nucleus accumbens shell (NAcSh). The present study in rats assessed the influence of trait impulsivity on the development of BE-like feeding and the role of the orexigenic neuropeptide orexin (OX) and the anorexigenic neuropeptide cocaine- and amphetamine-regulated transcript (CART) within the NAcSh in a BE-model. The rats were initially ranked for their trait impulsivity based on a screening in the 5-choice serial reaction time task. They were subsequently introduced into a limited access-model to establish BE-like feeding with pure vegetable fat to examine a correlation between trait impulsivity and the development of BE-like feeding. The effect of bilateral infusions of the OX 1-receptor (OX1R) antagonist SB-334867 (SB) and CART-antibodies (CART-ABs) into the NAcSh was examined in relation to trait impulsivity. Further, accumbal OX1R density was evaluated by immunohistochemical staining in rats with normal and BE-like feeding behavior. We found that all animals developed stable BE-like PF intake, independent of trait impulsivity and without differences in the dynamics. The blockade of accumbal OX1Rs effectively reduced PF intake only in the control group that had daily access to PF, with impulsivity trait as a decisive factor, pointing towards alterations in orexinergic transmission in the NAcSh of rats bingeing on pure fat. This was corroborated by a lower density of OX1Rs in the NAcSh of rats with BE-like feeding behavior, precisely, in low-impulsive bingeing rats. Regardless of impulsivity trait, antagonizing CART in the NAcSh did not affect PF intake of control or bingeing animals. This suggests that endogenous accumbal CART does not influence consummatory behavior in ad libitum-fed rats with access to fat, under both normal and BE-like feeding patterns.

The orbitofrontal cortex (OFC) has been repeatedly found to play an important role in food reward processing and binge eating (BE) episodes. However, most studies have focused mainly on reward-related neural alterations in clinical binge eating patients, with little consideration of preclinical individuals with BE that are more likely to develop from non-clinical individuals to clinical patients in the future. This study aimed to examine whether preclinical binge eaters exhibited OFC-related resting-state functional connectivity (rsFC) in the context of food reward.Binge eaters (BE group, n = 28) and healthy controls (HCs, n = 28) matched for age and body mass index (BMI) underwent rs-fMRI scans and completed self-reported assessment of BE symptoms. Food reward sensitivity was measured using the modified food incentive delay task. Analysis of covariance was used to assess the between-group differences in the medial and lateral OFC (a priori selected regions of interest) connectivity patterns in the context of food reward, while controlling for age, sex, and BMI.Lower unhealthy food (UF) reward sensitivity was significantly associated with stronger inverse OFC-putamen connectivity for HCs, while the BE group showed no association between UF reward sensitivity and the OFC-putamen connectivity. Higher healthy food (HF) reward sensitivity in the BE group was significantly correlated with stronger positive OFC-middle frontal gyrus and OFC-inferior parietal gyrus connectivity, while the opposite was found for HCs.Binge eaters showed less functional synchrony within reward regions contributing to the UF reward sensitivity, but enhanced neural interactions between reward and inhibitory control regions correlated with the HF reward sensitivity. These novel findings may demonstrate the potential orbitofrontal neural dissociation of unhealthy and healthy food reward sensitivity in normal-weight binge eaters.

Obesity and Binge-Eating Disorder (BED) are prevalent conditions that are associated with increased risk of morbidity and mortality. There is evidence that the use of pharmacotherapy alongside behavioural treatments can improve quality of life and reduce disease risk for patients with these disorders. However, there are few approved drug therapies for obesity, and these are limited by poor efficacy and/or side effects and only one drug has been approved for the treatment of BED. There is considerable potential to use experimental medicine models to identify new drug treatments for obesity and BED, with greater efficacy and an improved side effect profile, at an early stage of development. Here, we present a model developed in our laboratory that incorporates both behavioural and neuroimaging measures which can be used to facilitate drug development for obesity and BED. The results from validation studies conducted to date using our model suggest that it is sensitive to the effects of agents with behavioural, neurophysiological and neuropharmacological mechanisms of action known to be associated with weight loss and reductions in binge eating. Future studies using the model will be valuable to evaluate the potential efficacy and side-effects of new candidate drugs at an early stage in the development pipeline for both obesity and BED.

Individuals with binge eating disorder (BED) show preferred attention allocation towards their own (vs. another) body, and towards self-disliked (vs. self-liked) body parts. It remains unclear whether these gaze patterns are a consequence of underlying eating pathology or increased weight. In this study, women with BED (N = 73), overweight (N = 38) and healthy weight (N = 42) female control groups (CG) performed two eye-tracking paradigms using pictures of their own and a control-body. In task 1 (processing their own vs. a control-body), the BED group displayed a stronger preference for the own body during more automatic processing relative to the overweight CG, whereas the healthy weight CG showed a balanced attention distribution between both bodies. In task 2, all groups showed a bias towards the most unattractive relative to the most attractive part of their own body. This was strongest in the BED and overweight groups, but only the BED group showed a negative bias towards the control-body. Results indicate a stronger self-focused and deficit-oriented bias in the BED group but also some abnormalities in overweight individuals. Future studies should test whether these biases are modifiable, and whether their modification improves body image.

Eating disorders are severe psychiatric illnesses with a typical age of onset in adolescence. Brain research in youth and young adults may help us identify specific neurobiology that contributes to onset and maintenance of those disorders. This article provides a state-of-the-art review of our current understanding of the neurobiology of anorexia nervosa and bulimia nervosa. This includes brain structure and function studies to understand food restriction, binge-eating or purging behaviors, cognitive and emotional factors, as well as interoception. Binge-eating disorder and avoidant restrictive food intake disorder are also discussed, but the literature is still very small.

Binge eating disorder onset often occurs during adolescence, yet the diagnosis and treatment of the disorder in this age group has been inadequately studied. Criteria and challenges in making the diagnosis in children and adolescents are reviewed, as well as prevalence rates, current treatment options, and complications.

Psychotropic medications are commonly used in the treatment of eating disorders in children and adolescents. This article reviews the evidence base on psychotropic medications, including all randomized trials, uncontrolled trials, and case reports for the treatment of anorexia nervosa, bulimia nervosa, other specified feeding and eating disorders, binge-eating disorder, and avoidant/restrictive food intake disorder. Despite advances in the number of medication-based studies completed in young patients with eating disorders over the last 2 decades, significantly more work needs to be done in terms of identifying what role, if any, psychotropic medications can have on treatment outcomes.

Puberty is a critical risk period for eating disorders (EDs). ED incidence increases across the pubertal period and becomes female predominant, and genetic influences on disordered eating significantly increase. Surges of ovarian hormones, particularly estrogen, may drive this increasing genetic effect for EDs in pubertal girls and contribute to differential phenotypic presentations beyond puberty. In this article, we explain phenotypic associations between puberty and disordered eating and present evidence showing underlying genetic and hormonal influence. Potential benefits of communicating roles of genetic influence to people with or at risk for EDs are also discussed.

The Yale Food Addiction Scale 2.0 (YFAS) assesses addiction-like eating of palatable foods based on the 11 diagnostic criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study was the first to investigate the factor structure, psychometric properties, and clinical significance of the YFAS 2.0 in individuals with binge-eating disorder (BED) symptomatology. Data were analysed from 220 community-based participants who met criteria for "probable BED" based on self-report symptom frequency. Classification of food addiction (FA) was met by 42.3% of the sample. The YFAS 2.0 exhibited a unidimensional structure, adequate internal consistency, and convergent and incremental validity. YFAS 2.0 scores contributed the largest percentage of unique variance in psychological distress and impairment over other BED features (overvaluation of weight and shape, binge eating, BMI), highlighting the clinical significance of the FA construct in BED. Support for the validity and reliability of the YFAS 2.0 in individuals with BED-like symptoms was found. Findings also suggest that the presence of FA may represent a more disturbed group of BED characterised by greater general and eating disorder-specific psychopathology. Our findings overall highlight the potential need to screen and assess addictive-like eating behaviours during interventions for BED.

The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momentary assessment phase in which participants self-reported state body dissatisfaction, disordered eating behavior, drive for thinness, and appearance comparisons at 10 semi-random intervals daily. Higher trait body image flexibility predicted lower average scores, less frequent reporting of high state body dissatisfaction, and less variability in their state body dissatisfaction ratings. Individuals with higher trait body image flexibility were also less likely to engage in a range of behaviors and cognitions previously shown to produce body dissatisfaction, including upward appearance comparisons, drive for thinness, binge eating, and dieting. However, few of these state-based relationships involving body dissatisfaction and these related behaviors and cognitions were moderated by trait body image flexibility. Overall, this pattern of findings suggests that body image flexible individuals may have less negative body image because they are less inclined to engage in behaviors and cognitions in their daily lives that encourage negative body image.

Objective Although bariatric surgery is a durable treatment for patients with severe obesity, it does not directly address behavioural and psychological factors that potentially contribute to weight regain post-surgery. Psychological interventions, such as cognitive behavioural therapy (CBT), can be challenging to access due to physical limitations and practical barriers. Telephone-based CBT (Tele-CBT) can improve eating psychopathology and psychological distress before and after surgery. Given the frequent occurrence/recurrence of problematic eating-related and psychological issues many patients face 1-year post-surgery, this open-trial pilot study aimed to evaluate the effectiveness of Tele-CBT delivered 1-year post-surgery as an adjunctive treatment to the usual standard of bariatric care. Methods Patients (n = 43) received six 1-h Tele-CBT sessions delivered weekly beginning at 1-year post-surgery. Patients completed questionnaire packages before and after the intervention to assess changes in binge eating (BES), emotional eating (EES), depression (PHQ-9), and anxiety (GAD-7). Results Thirty-two patients completed Tele-CBT yielding a 74.4% completion rate. Participants reported significant improvements on the Binge Eating Scale (t(31) = 3.794, p = 0.001), Emotional Eating Scale (t(31) = 3.508, p = 0.001), Patient Health Questionnaire-9 Item Scale (z = −2.371, p = 0.018), and Generalised Anxiety Disorder-7 Item Scale (z = −3.546, p Discussion The results demonstrate that Tele-CBT delivered 1-year post-surgery may improve binge eating, emotional eating, depression, and anxiety. Additional research is warranted to examine whether these changes translate into long-term improvements in bariatric surgery outcomes.