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Background: Gambling disorder (GD) and bulimic spectrum eating disorders (BSDs) not only share numerous psychopathological, neurobiological, and comorbidity features but also are distinguished by the presence of inappropriate behaviours related to impulsivity and compulsivity. This study aimed to emphasise the differences and similarities in the main impulsivity and compulsivity features between GD and BSD patients, and to analyse the potential influence of sex in these domains., Methods: Using self-reported and neurocognitive measures, we assessed different impulsive-compulsive components in a sample of 218 female and male patients (59 with BSD and 159 with GD) and 150 healthy controls., Results: We observed that GD and BSDs exhibited elevated levels of impulsivity and compulsivity in all the dimensions compared to healthy controls. Moreover, these disorders showed differences in several personality traits, such as high novelty seeking in GD, and low persistence and high harm avoidance in BSDs. In addition, patients with BSDs also displayed a trend towards greater impulsive choice than GD patients. Regarding sex effects, GD women presented higher overall impulsivity and compulsivity than GD men. Nevertheless, no sex differences were found in BSDs., Conclusions: Clinical interventions should consider these deficits to enhance their effectiveness, including adjunctive treatment to target these difficulties. Our findings also provide support to the relevance of sex in GD, which should also be considered in clinical interventions.

Objective: This study assessed gender-related differences in executive functions (decision-making, inhibitory control and cognitive flexibility), personality traits and psychopathological symptoms in binge-spectrum eating disorders (EDs). Secondly, we aimed to separately explore the predictive value of gender and executive functions in treatment outcome., Method: A battery of self-reported and neurocognitive measures were answered by a sample of 85 patients (64 females) diagnosed with a binge-spectrum ED (41 BN; 44 binge eating disorder)., Results: Data showed gender-related differences in executive functioning, displaying women lower inhibitory control and lower cognitive flexibility than men. Regarding personality traits and psychopathology symptoms, women presented higher reward dependence and cooperativeness, as well as more drive for thinness, body dissatisfaction, bulimia, and somatisation symptoms than men. Finally, worse executive functioning, particularly having lower ability in concept formation seems to predict worse treatment outcomes and dropout in these patients., Conclusions: We described gender specific neuropsychological, personality and psychopathological impairments in patients with binge-spectrum EDs. Moreover, difficulties in executive functioning might have an impact on treatment response, since patients with a lower ability in concept formation are less likely to benefit from treatment. The present results can help improving current treatment approaches by tackling gender and individual differences., (© 2022 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

MONTELEONE, A.M., F. Pellegrino, G. Croatto, M. Carfagno, A. Hilbert, J. Treasure, T. Wade, C. Bulik, S. Zipfel, P. Hay, U. Schmidt, G. Castellini, A. Favaro, F. Fernandez-Aranda, J. Il Shin, U. Voderholzer, V. Ricca, D. Moretti, D. Busatta, G. Abbate-Daga, F. Ciullini, G. Cascino, F. Monaco, C.U. Correll and M. Solmi. Treatment of Eating Disorders: a systematic meta-review of meta-analyses and network meta-analyses. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2022.- Treatment efficacy for eating disorders (EDs) is modest and guidelines differ. We summarized findings/quality of (network) meta-analyses (N)MA of randomized controlled trials (RCTs) in EDs. Systematic meta-review ((N)MA of RCTs, ED, active/inactive control), using (anorexia or bulimia or eating disorder) AND (meta-analy*) in PubMed/PsycINFO/Cochrane database up to December 15th, 2020. Standardized mean difference, odds/risk ratio vs control were summarized at end of treatment and follow-up. Interventions involving family (family-based therapy, FBT) outperformed active control in adults/adolescents with anorexia nervosa (AN), and in adolescents with bulimia nervosa (BN). In adults with BN, individual cognitive behavioural therapy (CBT)-ED had the broadest efficacy versus active control; also, antidepressants outperformed active. In mixed age groups with binge-eating disorder (BED), psychotherapy, and lisdexamfetamine outperformed active control. Antidepressants, stimulants outperformed placebo, despite lower acceptability, as did CBT-ED versus waitlist/no treatment. Family-based therapy is effective in AN and BN (adolescents). CBT-ED has the largest efficacy in BN (adults), followed by antidepressants, as well as psychotherapy in BED (mixed). Medications have short-term efficacy in BED (adults)., Competing Interests: Conflicts of interest CMB reports: Shire (grant recipient, Scientific Advisory Board member); Idorsia (consultant); Lundbeckfonden (grant recipient); Pearson (author, royalty recipient); Equip Health Inc. (clinical advisory board). PH receives/has received sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry and royalties/honoraria from Hogrefe and Huber, McGraw Hill Education, and Blackwell Scientific Publications, Biomed Central and PlosMedicine and she has received research grants from the NHMRC and ARC. She is Chair of the National Eating Disorders Collaboration Steering Committee in Australia (2019-) and was Member of the ICD-11 Working Group for Eating Disorders (2012–2018) and was Chair Clinical Practice Guidelines Project Working Group (Eating Disorders) of RANZCP (2012–2015). She has prepared a report under contract for Takeda (formerly Shire) Pharmaceuticals in regards to Binge Eating Disorder (July 2017) and is a consultant to Takeda Pharmacueticals. All views in this paper are her own. SZ is involved in editorial duties by Elsevier, Wiley, Thieme and Frontiers; he received several grants from the German Federal Ministry of Education and Research (e.g. 01GV0624). FFA received consultancy honoraria from Novo Nordisk and editorial honoraria as EIC from Wiley, and he received several national and international Grants (FIS-ISCIII and EU-H2020). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. AH received: royalties for books on the treatment of binge-eating disorder and obesity with Hogrefe; honoraria for workshops and lectures on binge-eating disorder and obesity and their treatment; honoraria as associate editor of the International Journal of Eating Disorders and Psychotherapeut; honoraria as a reviewer from Mercator Research Center Ruhr, Oxford University Press, and the German Society for Nutrition; and honoraria as a consultant for WeightWatchers and Zweites Deutsches Fernsehen. CUC has been a consultant and/or advisor to or has received honoraria from AbbVie, Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sequirus Sumitomo Dainippon, Sunovion, Supernus, Takeda, Teva and Viatris. He has provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a stock option holder of LB Pharma. MS has received honoraria/has been a consultant for Angelini, Lundbeck, unrelated to this work. Other authors have nothing to declare and report no financial relationships with commercial interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and Aims: Mental disorders with high levels of impulsivity such as bulimic spectrum eating disorders (BSED) and gambling disorder (GD) are associated with high risk of suicidal behavior. The aim of the present study was to identify the common and differential vulnerability factors behind suicide attempts in a sample of patients with BSED compared to patients with GD., Methods: A total of 6,077 adults who sought treatment and met criteria either for BSED (n = 2,391) or GD (n = 3,686) were assessed at a specialized hospital unit. Personality traits, psychopathological symptomatology, lifetime history of suicide attempts and socio-demographic variables were evaluated., Results: The prevalence of suicide attempts was higher for BSED patients (26.2%) compared to GD patients (7.1%) being anorexia nervosa (Binge/Purge type) and bulimia nervosa the most affected subtypes. In the predictive model, the transdiagnostic vulnerability factors with the highest contribution to the risk of suicidal behavior both in BSED and GD were unemployment, early age of onset of the disorder, worse psychopathological state, and self-transcendence personality trait. However, specific risk factors for suicidal acts were identified in each disorder: longer duration of the disorder, lower education levels and reward dependence were exclusively associated with BSED while female gender, older age, and higher harm avoidance were associated with GD., Discussion: Patients with GD and BSED share certain vulnerability factors although certain factors are exclusive to each disorder., Conclusions: Interventions need to pay special attention to both common and specific vulnerability factors to mitigate the risk of suicidal acts in these disorders.

Objective: Impulsivity and difficulties in regulating emotions are considered to be transdiagnostic characteristics of patients with eating disorders (EDs). The study aimed to investigate trait impulsivity and inhibitory components of impulsivity, related or unrelated to emotions in patients with EDs., Method: A total of 17 patients with anorexia nervosa (AN), 16 patients with bulimic-spectrum EDs (BSD) and 20 healthy control (HC) participants completed an impulsivity scale (UPPS-P) before performing an emotional inhibitory control task during electroencephalography (EEG) acquisition., Results: Higher trait impulsivity in EDs than HC (with higher scores among BSD patients) was observed. However, no differences in behavioural measures or neural indexes [event-related potential (ERP)] of emotional and non-emotional inhibitory control were observed between patients and HC., Conclusion: The present results highlighted negative urgency, an impulsive personality trait related to emotions, as a common feature of AN and BSD. Lack of perseverance, a trait which is less related to emotions, specifically characterises patients with BSD. On the other hand, behavioural and ERP data did not show altered inhibitory control in EDs, for either general or emotional-related response inhibition., (© 2020 John Wiley & Sons, Ltd and Eating Disorders Association.)

Eating behavior style (emotional, restrictive, or external) has been proposed as an explanation for the differences in response to food-related cues between people who overeat and those who do not, and has been also considered a target for the treatment of eating disorders (EDs) characterized by lack of control over eating and weight-related (overweight/obesity) conditions. The aim of this study was to analyze the relationship between eating behavior style and psychophysiological responses (self-reported food craving and anxiety) to food-related virtual reality (VR) environments in outpatients with bulimia nervosa (BN) and binge eating disorder (BED) and to compare them with healthy participants. Fifty-eight outpatients and 135 healthy participants were exposed to palatable foods in four experimental everyday real-life VR environments (kitchen, dining room, bedroom and café). During exposure, cue-elicited food craving and anxiety were assessed. Participants also completed standardized instruments for the study purposes. ED patients reported significantly higher levels of craving and anxiety when exposed to the virtual food than healthy controls. Eating behavior styles showed strong associations with cue-elicited food craving and anxiety. In the healthy group, external eating was the only predictor of cue-elicited craving and anxiety. In participants with BN and BED, external and emotional eating were the best predictors of cue-elicited craving and anxiety, respectively., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Food addiction (FA) refers to a condition characterized by addiction in relation to some high-fat and high-sugar carbohydrate that leads to clinically significant impairment or distress on several areas of functioning. The Yale Food Addiction Scale 2.0 (YFAS 2.0) has been recently updated to measure FA according to the DSM-5 criteria for substance-related and addictive disorders. This study aimed at validating the Italian version of YFAS 2.0., Methods: A sample of 574 Italian university students was involved in this research. Confirmatory Factor Analysis (CFA) and Kuder-Richardson's alpha for dichotomous data were run to evaluate scale structure and reliability. Correlations between YFAS 2.0 and eating psychopathology, binge eating, sleep, and mood symptoms were evaluated., Results: Analogously to the original version, a single factor structure emerged at the CFA. The alpha coefficient was 0.87. Moreover, sound, from moderate to high, correlations were found with other measures., Conclusions: The Italian version of the YFAS 2.0 has demonstrated in a sample of university students to be a useful tool to investigate food addictions. Level of evidence Level V, descriptive study.

High-sugar/high-fat foods are related to binge-eating behaviour and especially people with low inhibitory control may encounter elevated difficulties to resist their intake. Incentive sensitization to food-related cues might lead to increased motivated attention towards these stimuli and to cue-induced craving. To investigate the combined influence of olfactory and visual stimuli on craving, inhibitory control and motivated attention, 20 healthy controls and 19 individuals with binge-eating viewed chocolate and neutral pictures, primed by chocolate or neutral odours. Subjective craving and electroencephalogram activity were recorded during the task. N2 and Late Positive Potential (LPP) amplitudes were analysed. Patients reported higher craving than controls. Subjective craving, N2 and LPP amplitudes were higher for chocolate versus neutral pictures. Patients showed a higher relative increase in N2 amplitudes to chocolate versus neutral pictures than controls. Chocolate images induced significant increases in craving, motivated attention and measures of cognitive control. Chocolate odour might potentiate the craving response to visual stimuli, especially in patients with binge-eating., Competing Interests: The authors declare no competing financial interests.

Facial expressions are critical in forming social bonds and in signalling one's emotional state to others. In eating disorder patients, impairments in facial emotion recognition have been associated with eating psychopathology severity. Little research however has been carried out on how bulimic spectrum disorder (BSD) patients spontaneously express emotions. Our aim was to investigate emotion expression in BSD patients and to explore the influence of personality traits. Our study comprised 28 BSD women and 15 healthy controls. Facial expressions were recorded while participants played a serious video game. Expressions of anger and joy were used as outcome measures. Overall, BSD participants displayed less facial expressiveness than controls. Among BSD women, expressions of joy were positively associated with reward dependence, novelty seeking and self-directedness, whereas expressions of anger were associated with lower self-directedness. Our findings suggest that specific personality traits are associated with altered emotion facial expression in patients with BSD. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association., (Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.)

Background: Binge eating behavior constitutes a central feature of both bulimia nervosa (BN) and binge eating disorder (BED). Cue exposure therapy (CET) has been proposed as an effective intervention., Objective: To determine which situations and specific cues trigger higher levels of binge craving and to use the results in the development of virtual reality scenarios in which CET could be applied with BN and BED patients., Method: Participants were 101 outpatients, 50 with BED and 51 with BN, according to DSM-5 criteria, and 63 healthy undergraduate students who completed a self-administered questionnaire to assess binge craving., Results: The likelihood of binge craving in the clinical group was greater when alone at home, during the afternoon/early evening and in the late evening/at night, at weekends, and at dinner time or between meals. Higher levels of craving were produced in the kitchen, bedroom, dining room, and bakery situations. With regard to the specific cues reported, the presence of and access to high calorie food and snacks was the most commonly reported cue. Although some gender differences regarding triggering factors were obtained, no statistical differences were observed between ED subtypes. BN and BED patients showed significantly higher levels of binge craving than controls in all the contexts except when feeling positive affect; in this situation, levels of craving were low in both groups., Conclusions: This information regarding trigger contexts and specific cues can be used to create valid and reliable virtual environments for CET. Indeed, the data from this study may serve to develop a wide range of situations with different levels of binge craving, in which the therapeutic aim is to extinguish conditioned responses and facilitate the generalization of craving extinction., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: Technology assisted guided self-help has been proven to be effective in the treatment of bulimia nervosa (BN). The aim of this study was to determine predictors of good long-term outcome as well as drop-out, in order to identify patients for whom these interventions are most suitable., Methods: One hundred and fifty six patients with BN were assigned to either 7 months internet-based guided self-help (INT-GSH) or to conventional guided bibliotherapy (BIB-GSH), both guided by e-mail support. Evaluations were taken at baseline, after 4, 7, and 18 months. As potential predictors, psychiatric comorbidity, personality features, and eating disorder psychopathology were considered., Results: Higher motivation, lower frequency of binge eating, and lower body dissatisfaction at baseline predicted good outcome after the end of treatment. Lower frequency of binge eating predicted good outcome at long-term follow-up. Factors prediciting drop-out were higher depression and lower self-directedness at baseline., Conclusion: Technology assisted self-help can be recommended for patients with a high motivation to change, lower binge-eating frequency and lower depression scores., (Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.)

The objective of this study was to identify frequent situations and specific cues that produce the craving to binge in Spanish and Italian samples of patients with eating disorders (ED). There were two main aims: to assess transcultural differences in the contexts and cues that elicit food craving; and to develop valid, reliable VR environments for effective cue-exposure therapy (CET) for patients from both countries. Twenty-six Spanish and 75 Italian ED patients completed an ad hoc questionnaire to assess contexts and cues that trigger the craving to binge. No differences between groups were found. All patients reported experiencing higher levels of craving in the afternoon/early evening and in the late evening/night, between meals, when alone, and more frequently at the end of the week. Being in the dining room, the kitchen, the bedroom, the bakery and the supermarket were the specific situations that produced the highest levels of craving to binge. We used the questionnaire results to develop a virtual reality application for CET.

Objective: We examined prevalence of substance use disorders (SUD) in women with: (1) anorexia nervosa (AN) restricting type (RAN); (2) AN with purging only (PAN); (3) AN with binge eating only (BAN); and (4) lifetime AN and bulimia nervosa (ANBN). Secondary analyses examined SUD related to lifetime purging behavior and lifetime binge eating., Method: Participants (N = 731) were drawn from the International Price Foundation Genetic Studies., Results: The prevalence of SUD differed across AN subtypes, with more in the ANBN group reporting SUD than those in the RAN and PAN groups. Individuals who purged were more likely to report substance use than those who did not purge. Prevalence of SUD differed across lifetime binge eating status., Discussion: SUD are common in AN and are associated with bulimic symptomatology. Results underscore the heterogeneity in AN, highlighting the importance of screening for SUD across AN subtypes.

Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are complex psychiatric disorders where different genetic and environmental factors are involved. Several lines of evidence support that brain-derived neurotrophic factor (BDNF) plays an essential role in eating behaviour and that alterations on this neurotrophic system participates in the susceptibility to both AN and BN. Accordingly, intraventricular administration of BDNF in rats determines food starvation and body weight loss, while BDNF or its specific receptor NTRK2 knockout mice develop obesity and hyperphagia. Case-control studies also suggest a BDNF contribution in the aetiology of ED: we have previously reported a strong association between the Met66 variant within the BDNF gene, restricting AN (ANR) and minimum body mass index (minBMI) in a Spanish sample, and a positive association between the Val66Met and -270C/T BDNF SNPs and ED in six different European populations. To replicate these results, avoiding population stratification effects, we recruited 453 ED trios from eight European centres and performed a family-based association study. Both haplotype relative risk (HRR) and haplotype-based haplotype relative risk (HHRR) methods showed a positive association between the Met66 allele and ANR. Consistently, we also observed an effect of the Met66 variant on low minBMI and a preferential transmission of the -270C/Met66 haplotype to the affected ANR offspring. These results support the involvement of BDNF in eating behaviour and further suggest its participation in the genetic susceptibility to ED, mainly ANR and low minBMI.

Several genes with an essential role in the regulation of eating behavior and body weight are considered candidates involved in the etiology of eating disorders (ED), but no relevant susceptibility genes with a major effect on anorexia nervosa (AN) or bulimia nervosa (BN) have been identified. Brain-derived neurotrophic factor (BDNF) has been implicated in the regulation of food intake and body weight in rodents. We previously reported a strong association of the Met66 allele of the Val66Met BDNF variant with restricting AN (ANR) and low minimum body mass index in Spanish patients. Another single nucleotide polymorphism located in the promoter region of the BDNF gene (-270C>T) showed lack of association with any ED phenotype. In order to replicate these findings in a larger sample, we performed a case-control study in 1142 Caucasian patients with ED consecutively recruited in six different centers from five European countries (France, Germany, Italy, Spain and UK) participating in the 'Factors in Healthy Eating' project. We have found that the Met66 variant is strongly associated to all ED subtypes (AN, ANR, binge-eating/purging AN and BN), and that the -270C BDNF variant has an effect on BN and late age at onset of weight loss. These are the first two variants associated with the pathophysiology of ED in different populations and support a role for BDNF in the susceptibility to aberrant eating behaviors.

Objectives: This study attempts to understand the effects of a parental history of alcohol abuse on the psychopathology and symptoms of bulimia nervosa (BN)., Method: The study involved 121 female BN patients consecutively admitted to the Eating Disorders Unit of the University Hospital of Bellvitge. The sample was divided post hoc into two subgroups on the basis of the presence (PAA, n=25) or not of parental abuse of alcohol (NPAA, n=96). All of the patients fulfilled the DSM-IV criteria for BN., Evaluation: The assessment measures were the Eating Attitudes Test (EAT-40), the Eating Disorders Inventory (EDI), the Bulimic Investigatory Test Edinburgh (BITE), the Body Shape Questionnaire (BSQ) and Beck Depression Inventory (BDI), as well as clinical and psychopathological variables., Results and Conclusions: Only 7.4% of the patients reported current alcohol abuse and this correlated positively with the presence of other impulsive behaviours (p<0.001). Furthermore, PAA was observed in 20.7% of cases. When the PAA and NPAA subgroups were compared, no significant differences were found in the symptomatological or psychopathological variables, but the PAA group showed more frequent parental obesity (p<0.001) and its members lived less frequently with their parents (p<0.001). The results of this study suggest that there is little correlation between parental abuse of alcohol and the severity of BN.

Objective: Orlistat (tetrahydrolipstatin) is an intestinal lipase inhibitor that was approved recently for the management and treatment of obesity. This is the first report of the misuse of orlistat in two normal-weight purging bulimia nervosa (BN) patients. METHOD AND RESULTS We report two diagnosed cases of BN in two Spanish women who used orlistat as a purging mechanism after binge episodes. In both cases, the onset of the eating disorder was in adolescence. From the beginning, a restrictive diet, binging, and purging behavior (vomiting and using laxatives) were present. Both patients misused this substance as their only purging mechanism after every binge episode., Conclusion: BN patients have used many substances and bizarre behaviors as purging mechanisms. Nevertheless, to the authors' knowledge, these are the first reported cases of orlistat misuse as the only purging mechanism in two BN patients., (Copyright 2001 by John Wiley & Sons, Inc.)

We report a case of binge eating disorder (BED) in a 19-year-old Spanish woman, whose onset followed a nowadays uncommon parasitic intestinal disease (Taenia solium by cysticercosis). The patient exhibited bizarre and frequent hyperphagia episodes and extreme loss of weight, common symptoms of this condition. The patient continued to have frequent binge episodes and inappropriate eating patterns, gaining weight consequently over a normal range, despite successful treatment of the condition. No purging behavior was detected. A classical conditioning behavioral model, was useful for the understanding and formulation of this case. To the authors' knowledge, this is the first reported case where a parasitic infestation triggered the onset of BED., (Copyright 2001 by John Wiley & Sons, Inc.)

The purpose of the present study was to assess body perception in eating disorders and its meaning in therapy. A total of 44 patients, 25 bulimia nervosa and 19 anorexia nervosa, admitted at a specialized in-patient treatment center participated in the present study. Body size estimation procedures (video-distortion and image-marking techniques) and self-report questionnaires were used for the assessment. No significant differences were found in actual body size estimation between the two eating disorder groups, either before or after therapy. It emerged after therapy that the outcome was not related to body size estimation. These findings suggest that there is no evidence for a serious impairment of body perception (size estimation) in eating-disordered patients, but rather for a disturbance in the emotional aspect of body image, as expressed in negative body attitudes. Body size perception does not appear to be a predictor of treatment outcome in eating disorders.

Background: Despite a wide range of proposed risk factors and theoretical models, prediction of eating disorder (ED) onset remains poor. This study undertook the first comparison of two machine learning (ML) approaches [penalised logistic regression (LASSO), and prediction rule ensembles (PREs)] to conventional logistic regression (LR) models to enhance prediction of ED onset and differential ED diagnoses from a range of putative risk factors. Method: Data were part of a European Project and comprised 1402 participants, 642 ED patients [52% with anorexia nervosa (AN) and 40% with bulimia nervosa (BN)] and 760 controls. The Cross-Cultural Risk Factor Questionnaire, which assesses retrospectively a range of sociocultural and psychological ED risk factors occurring before the age of 12 years (46 predictors in total), was used. Results: All three statistical approaches had satisfactory model accuracy, with an average area under the curve (AUC) of 86% for predicting ED onset and 70% for predicting AN v. BN. Predictive performance was greatest for the two regression methods (LR and LASSO), although the PRE technique relied on fewer predictors with comparable accuracy. The individual risk factors differed depending on the outcome classification (EDs v. non-EDs and AN v. BN). Conclusions: Even though the conventional LR performed comparably to the ML approaches in terms of predictive accuracy, the ML methods produced more parsimonious predictive models. ML approaches offer a viable way to modify screening practices for ED risk that balance accuracy against participant burden. [ABSTRACT FROM AUTHOR]

Eating disorders are severe mental disorders with a high mortality rate - suicidality - and a high incidence in adolescence and early adulthood, especially in women. The course of these disorders is uncertain and treatment outcomes are limited, with successful outcomes in 50-75% of cases. For bulimia nervosa (BN) and binge eating disorder (BED), several factors, such as duration of the disorder, eating and general psychopathology, dysfunctional personality traits and cognitive impairment, have been found to be associated with treatment adherence and response. In anorexia nervosa (AN) and atypical ED (OSFED), treatment response is poorer, with higher dropout rates and longer duration and chronicity. In this presentation, we will describe recent prospective observational studies in large samples of EDs analysing clinical, personality and cognitive predictors of treatment response in eating disorders, as well as potential associated neurobiomarkers. Optimisation of health care resources and transitions, as well as early and effective personalised treatments, can change the trajectory of EDs. Disclosure of Interest: F. Fernandez-Aranda Grant / Research support from: We thank CERCA Programme/Generalitat de Catalunya for institutional support. We also want to thank the Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) and ISCIII (CIBERobn is its initiative). This research was supported by grants from Instituto de Salud Carlos III (ISCIII) (FIS PI20/00132) and co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe.Additional support was received from the Delegación del Gobierno para el Plan Nacional sobre Drogas (2021I031) and Ministerio de Ciencia e Innovación (grant PID2021-124887OB-I00), but also AGAUR-Generalitat de Catalunya (2021-SGR-00824), European Union's Horizon 2020 research and innovation program under Grant agreement no. 847879 (PRIME/H2020, Prevention and Remediation of Insulin Multimorbidity in Europe) and the European Union's Horizon Europe research and innovation program under grant agreement No 101080219 (eprObes)., Consultant of: FFA received consultancy and speakers honoraria from Novo Nordisk. [ABSTRACT FROM AUTHOR]

Extreme eating and weight conditions (EWC) are a construct that emerges as a dimensional and theoretical model that identifies individuals who exhibit inappropriate eating behaviours and abrupt weight fluctuations. According to this spectrum of EWC, one extreme can be represented by individuals with anorexia nervosa (AN), characterised by excessive food restriction and an extremely low body mass index (BMI), whereas the other end of this continuum is represented by individuals with obesity (OB), characterised by a BMI above 30. In addition to AN and OB, some eating disorders (EDs), namely bulimia nervosa and binge eating disorder, are also part of this continuum, given the high risk of falling into one of the extremes, especially that of higher BMI. Studies have described similar changes at the psychological and neurobiological levels associated with their abnormal eating patterns, delineating vulnerability pathways related to the neurobiological basis. Based on previous literature, individuals suffering from EWC would show dysfunctional brain activity in regions associated with emotional reward processing and cognitive control compared to healthy controls (HC). Similarly, neuroendocrine alterations in EWC are expected to influence clinical symptomatology. It will also be discussed how impairments in executive function and differential brain activity observed in individuals with EWC may negatively impact their clinical course and treatment outcome. Disclosure of Interest: F. Fernandez-Aranda: None Declared, S. Jimenez- Murcia Grant / Research support from: We thank CERCA Programme/Generalitat de Catalunya for institutional support. This research was supported by grants from Instituto de Salud Carlos III (ISCIII) (FIS PI20/00132) and co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe. CIBERObn is an initiative of ISCIII. Additional support was received from the Delegación del Gobierno para el Plan Nacional sobre Drogas (2021I031) and Ministerio de Ciencia e Innovación (grant PID2021-124887OB-I00). Additional funding was received by AGAUR-Generalitat de Catalunya (2021-SGR- 00824), European Union's Horizon 2020 research and innovation program under Grant agreement no. 847879 (PRIME/H2020, Prevention and Remediation of Insulin Multimorbidity in Europe) and the European Union's Horizon Europe research and innovation program under grant agreement No 101080219 (eprObes)., Consultant of: FFA and SJM received consultancy and speakers honoraria from Novo Nordisk. [ABSTRACT FROM AUTHOR]

Objective The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical sample of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years). Method All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety-six patients were classified as LAO and 759 as TAO. Assessment Measures included the Eating Attitude Test-40 (EAT-40), Eating Disorders Inventory-2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL-90-R), and the Temperament and Character Inventory-Revised (TCI-R), as well as other clinical and psychopathological indices. Results LAO individuals reported significantly fewer weekly vomiting episodes, fewer self-harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI-2 drive for thinness, and the TCI-R harm avoidance scales than TAO individuals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group. Conclusion LAO eating disorder patients in this sample presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment. [ABSTRACT FROM AUTHOR]

Using a sister-pair design, we aimed to investigate the role of maternal anxiety in pregnancy and parental overprotection as risk factors for anorexia nervosa (AN) and bulimia nervosa (BN). We were also interested in investigating anxious personality traits in patients with AN and BN compared to their healthy sisters, and their possible association to overprotection. One-hundred-and-fifty-seven females (AN = 94; BN = 63) and their healthy sisters from four European centres were recruited. Data on temperament and childhood characteristics were obtained from cases and their sisters using the Temperament and Character Interview Revised (TCI-R) and the Oxford Risk Factor Interview (ORFI); maternal anxiety and overprotection were obtained from retrospective parental report. Both AN and BN women displayed significantly higher levels of separation anxiety in childhood in comparison to their sisters, but only women with AN showed anxious temperamental traits. Mothers of women with AN reported higher levels of anxiety during the index pregnancy ( p < .01), compared to when pregnant with the healthy daughter. The age in months at which women with AN were first left with another adult for a night was also higher compared to their sisters (respectively medians: 12 (range 1-120), 9 (range 1-96), p < .05). This was not the case for women with BN. Maternal overprotection was not associated with index daughter temperament. This finding is suggestive of an association between AN and maternal stress and anxiety in utero and later overprotective care, whilst BN was not associated with maternal anxiety or overprotection. [ABSTRACT FROM AUTHOR]

Association studies and rodent models suggest a major role for BDNF (brain-derived neurotrophic factor) in feeding regulation. Altered BDNF blood levels have been associated with eating disorders (ED) and their related psychopathological traits. Since the influence of BDNF on self-reported eating disorder inventory scores (EDI) has not been tested, we investigated the correlation of EDI scales with BDNF plasma levels. BDNF levels were measured by (ELISA), and the EDI questionnaire was administered in a total of 81 ED patients. The relationship between BDNF levels and EDI scores was calculated using a general linear model. After correcting for multiple testing, BDNF plasma levels negatively correlated with the EDI total score ( R2 = 0.26; p = 4.09 × 10−4), interoceptive awareness ( R2 = 0.26; p = 1.96 × 10−4), and maturity fears ( R2 = 0.13; p = 6.92 × 10−4). When subdividing according to the main diagnoses, interoceptive awareness presented significant correlations with BDNF blood levels in both the anorexia nervosa ( R2 = 0.33, p = 0.0026) and bulimia nervosa groups ( R2 = 0.10; p = 0.008). Our data suggest that BDNF levels may influence the severity of the ED by modulating the associated psychopathology, in particular through the impairment of interoceptive awareness. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to understand the clinical impact of the motivational stage of change on the psychopathology and symptomatology of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). Method The participants were 218 eating disorder (ED) patients (58 AN, 95 BN and 65 EDNOS), consecutively admitted to our hospital. All patients fulfilled DSM-IV criteria for these disorders. Assessment Assessment measures included the Eating Disorders Inventory (EDI), Bulimic Investigation Test Edinburgh (BITE), Beck Depression Inventory (BDI), four analogue scales of motivational stage, as well as a number of other clinical and psychopathological indices. Results Our results indicated higher motivation for change in BN than in AN and EDNOS patients (p < 0.05). For all groups, motivation to change was predicted by chronological age (p < 0.05). However, a longer duration of illness was only predictive of the motivational levels in EDNOS (p < 0.05) patients. Conclusions Compared to BN, AN and EDNOS patients are most resistant to change and the younger these patients are, the less likely they are to be motivated to change their disturbed eating behaviour. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Murine models and association studies in eating disorder (ED) patients have shown a role for the brain-derived neurotrophic factor (BDNF) in eating behavior. Some studies have shown association of BDNF −270C/T single-nucleotide polymorphism (SNP) with bulimia nervosa (BN), while BDNF Val66Met variant has been shown to be associated with both BN and anorexia nervosa (AN). To further test the role of this neurotrophin in humans, we screened 36 SNPs in the BDNF gene and tested for their association with ED and plasma BDNF levels as a quantitative trait. We performed a family-based association study in 106 ED nuclear families and analyzed BDNF blood levels in 110 ED patients and in 50 sib pairs discordant for ED. The rs7124442T/rs11030102C/rs11030119G haplotype was found associated with high BDNF levels (mean BDNF TCG haplotype carriers = 43.6 ng/ml vs. mean others 23.0 ng/ml, P = 0.016) and BN ( Z = 2.64; P recessive = 0.008), and the rs7934165A/270T haplotype was associated with AN ( Z =−2.64; P additive = 0.008). The comparison of BDNF levels in 50 ED discordant sib pairs showed elevated plasma BDNF levels for the ED group (mean controls = 41.0 vs. mean ED = 52.7; P = 0.004). Our data strongly suggest that altered BDNF levels modulated by BDNF gene variability are associated with the susceptibility to ED, providing physiological evidence that BDNF plays a role in the development of AN and BN, and strongly arguing for its involvement in eating behavior and body weight regulation. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to determine whether or not there are gender differences in personality, clinical features and associated traits in people with an eating disorder (ED) Method The participants consisted of 40 ED patients (20 males and 20 females) consecutively admitted to our hospital. The two groups were matched in terms of age, diagnosis and duration of illness. All patients fulfilled DSM-IV-R criteria for those pathologies. Assessment Assessment measures included the Eating Disorders Inventory-2 (EDI-2), the Symptom Check List (SCL-90-R) and the Temperament and Character Inventory-R (TCI-R), as well as a number of other clinical and psychopathological indices. Results In terms of personality traits, the males demonstrated less harm avoidance (p < 0.025) compared to females. Males showed significantly lower scores on drive for thinness (p < 0.007), impulse regulation (p < 0.043) and body dissatisfaction (p < 0.01). There were no gender differences on other symptomatological and psychopathological measures. The male group gave a history of premorbid overweight or obesity more frequently (45% vs 15%, p < 0.038) Conclusions The results of this study indicate that there were few gender differences in personality and psychological traits. However, higher premorbid obesity and overweight are more common antecedent factors in males. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Introduction: The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) introduced severity indices for Eating Disorders (ED). Objectives: This study assessed in a male ED sample the DSM-5 severity indices for Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) and compared them to an alternative transdiagnostic drive for thinness (DT) severity category and a combined DSM-5/DT severity categorization Methods: 178males with EDs were classified using: a.) a DT categorisation based on the EDI-2 DT subscale; b.) the DSM-5 severity categories for AN, BN and BED and c.) a combination of the DT and the DSM-5 severity categorisation. These severity classifications were then compared based on psychopathology and personality. Results: For the DSM-5 severity indices, the "mild" category was most prevalent for AN and BN, and the "moderate to extreme" group for BED. For the EDI-2 DT severity classification, the "mild" category was overrepresented in all subtypes. For the combined DSM-5/DT categorization, the "mild combined" severity group was the most prevalent for AN, while for BN and BED the "severe/extreme" combined group was most prevalent. Clinically significant findings were strongest for the DT categorization followed by the combined DSM-5/DT approach. Almost non-significant findings were revealed for the DSM-5 severity categories for all ED subtypes. These findings were most pronounced for AN and BN and almost non-existent for BED. Conclusions: Our findings provide support for DTas an alternative transdiagnostic severity category for EDs in males that may be more meaningful than the DSM-5 severity indices for AN and BN, but not BED. [ABSTRACT FROM AUTHOR]

Introduction: The DSM-5 introduced severity indicies for the first time. Objectives: We conducted a systematic review and synthesis the frequency of each DSM-5 severity categories (i.e., mild, moderate, severe and extreme severe) for Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorders (BED), and to evaluate studies that assess the clinical utility of these severity specifiers for all eating disorders (ED) subtypes. Methods: Five databases (EMBASE, MEDLINE, PsycARTICLES, PsycINFO, and ProQuest) were used to identify for both academic and grey literature published from 2013 until July 8, 2020. Twentyfive studies were retrieved for the systematic review based on the inclusion and exclusion criteria, and up to six studies were qualified for meta-analysis Results: We found limited support for the current DSM-5 severity ratings for all ED indices, as the majority of ED severity groups were not significantly distinguishable in overall ED psychopathology (mean effect size ranged from .02 to .5). The value of the DSM-5 severity ratings was further devalued as 56.91% to 80.52% of individuals with AN, BN, and BED were categorized into mild and moderate groups. However, there was significant heterogeneity between the studies (p< .001), and some of these heterogeneities were explained by differences in study settings and measurement of eating disorder psychopathology. Conclusions: Overall, the current study provided little support for the DSM-5 severity ratings for EDs, thus it is suggested that further exploration in alternative severity classification approach is needed. [ABSTRACT FROM AUTHOR]

Introduction: Impulsive personality traits and inhibitory control deficits, have been suggested in eating disorders (EDs), especially in bulimic-spectrum ones (BE). Emotions have a central role in the characterization of certain types of impulsivity, suggesting a distinction between emotional and non-emotional components. Emotional impulsive traits, such as negative urgency, have been associated with BE, but also with restrictive anorexia nervosa (AN). However, no studies explored emotional-related inhibitory control among EDs. Combining behavioural and event-related potentials (ERPs) measures allows exploring emotional and nonemotional inhibitory control in EDs. Objectives: The study aimed to assess different aspect of emotional and non-emotional impulsivity in 17 patients with binge BE and 16 AN, compared with 20 healthy controls (HC). Methods: Trait impulsivity was assessed using the UPPS-P scale; inhibitory control was measured by go/no-go task with emotional and neutral images, using behavioural responses and ERPs analysis. Results: Higher negative urgency in both EDs groups compared to HC, with BE showing higher negative urgency than AN. Patients with BE also showed the highest score in lack of perseverance compared to both AN and HC. In the go/no-go task both groups showed lower accuracy and higher amplitudes of the N2 and P3 components in no-go trials. However, emotional stimuli did not affect behavioural or ERP data, in nor patients or controls. Conclusions: Negative urgency as emotional impulsive trait characterize both patients with BE and AN, whereas non-emotional impulsive traits are present only in BE. By contrast, the present findings do not support evidences for emotional or non-emotional inhibitory control deficits in patients with EDs. [ABSTRACT FROM AUTHOR]

Introduction: Difficulties in emotion regulation and craving regulation have been linked to eating symptomatology in patients with anorexia nervosa (AN), contributing to the maintenance of their eating disorder. However, little is known about the neurocognitive correlates of AN. Objectives: This study aimed to assess emotion and food craving regulation by means of behavioural measures and event-related potentials (ERPs). Methods: Twenty patients with AN and twenty healthy controls (HC) completed a computerized task during EEG recording, where they were instructed to down-regulate negative emotions or food craving. The P300 and Late Positive Potential (LPP) ERPs were analysed. Participants also completed self-report measures of emotional regulation and food addiction. Results: The AN group, in comparison to the HC group, exhibited greater food addiction, greater use of maladaptive strategies, and emotional dysregulation. As for ERP results, LPP amplitudes were significantly smaller during down-regulation of food craving among both groups. Independent of task condition, individuals with AN showed smaller P300 amplitudes compared to HC. Among HCs, the self-reported use of re-appraisal strategies positively correlated with LPP amplitudes during emotional regulation task, while suppressive strategies negatively correlated with LPP amplitudes. Conclusions: Despite the enhanced self-reported psychopathology among AN, both groups indicated neurophysiological evidence of food craving regulation as evidenced by blunted LPP amplitudes in the relevant task condition. Further research is required to delineate the mechanisms associated with reduced overall P300 amplitudes among individuals with AN, which may index neurocognitive alterations, possibly as a secondary effect of malnutrition. [ABSTRACT FROM AUTHOR]