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Background: Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality.Methods: We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score.Results: A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates.Conclusions: These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN. [ABSTRACT FROM AUTHOR]

Anorexia nervosa (AN) is found associated with increased mortality. Frequent comorbidities of AN include substance use disorders (SUD), affective disorders (AD) and personality disorders (PD). We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders in the observation window between January 2007 and March 2016 for 1970 people with AN, using data from the case register of the South London and Maudsley (SLaM) NHS Foundation Trust, an almost monopoly-secondary mental healthcare service provider in southeast London. We retrieved data from its Clinical Records Interactive Search (CRIS) system as data source. Mortality was ascertained through nationwide tracing by the UK Office for National Statistics (ONS) linked to CRIS database on a monthly basis. A total of 43 people with AN died during the observation period. Standardized Mortality Ratio (SMR) with England and Wales population in 2012 as standard population for our study cohort was 5.21 (95% CI 3.77, 7.02). In univariate analyses, the comorbidity of SUD or PD was found to significantly increase the relative risks of mortality (HRs = 3.10, 95% CI 1.21, 7.92; and 2.58, 95% CI 1.23, 5.40, respectively). After adjustment for demographic and socioeconomic covariates as confounders, moderately but not significantly elevated risks were identified for SUD (adjusted HR = 1.39, 95% CI 0.53, 3.65) and PD (adjusted HR = 1.58, 95% CI 0.70, 3.56). These results suggest an elevated mortality in people with AN, which might be, at least partially, explained by the existence of the comorbidities SUD or PD. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Interpersonal difficulties among individuals with anorexia nervosa (AN) may stem in part due to misperceiving social cues. The current study investigated social functioning by comparing interpersonal self-efficacy, perceptions of dominance/submission (i.e., agency) and coldness/warmth (i.e., communion), and hypothetical behavioral reactions among individuals with and without AN. Method Seventy-seven women (AN/Other Specified Feeding or Eating Disorder OSFED-AN n = 41, nonclinical comparison group n = 36) completed questionnaires assessing mood symptoms and interpersonal self-efficacy, followed by an experimental video-rating task in which they received critical feedback from job supervisors varying in degrees of agency and communion. Results AN respondents perceived more coldness overall, even after adjusting for differences in depression and anxiety symptoms, and tended to respond with coldness even to videos that they perceived as being warm. However, perceptual accuracies for agency were similar across groups. Interpersonal self-efficacy moderated the relationship between diagnostic status and behavioral responses: among those who felt competent being cold-submissive, AN respondents selected cold-submissive responses more frequently than did the nonclinical comparison group. Discussion Among those with AN symptoms, there may be a tendency toward social perceptual inaccuracies regarding communion and non-complementary cold behavioral responses. Results suggest that improving social perceptions may be a fruitful intervention target for enhancing interpersonal functioning among individuals with AN. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:499-506). [ABSTRACT FROM AUTHOR]

Objectives Forming part of a process evaluation of a large randomised controlled trial (the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related conditions, MOSAIC) comparing two outpatient therapies for Anorexia Nervosa (AN), the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM), this study adopted a qualitative approach to examine therapist experiences of treatment delivery. Method Twenty MOSAIC therapists completed semi-structured interviews. Interviews were recorded, transcribed and analysed thematically. Results Themes of positive aspects, challenges and therapeutic fit emerged. MANTRA was seen as structured and flexible but could feel demanding on therapist time and skill. The slow pace and narrower focus of SSCM gave patients space to talk, but the lack of psychological tools and nutritional emphasis could create frustration. Views on the therapeutic relationship and patient-therapy fit differed across treatments. Discussion Findings provide testable hypotheses about what works for whom, ideas for therapist training, treatment development and delivery. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The neural correlates of body checking perceptions in eating disorders have not yet been identified. This functional Magnetic Resonance Imaging study examined the neuroanatomy involved in altered perception and identification with body checking in female with anorexia nervosa (AN). Method Brain activation while viewing images depicting normal weight individuals involved in either body checking behavior or a neutral (noneating disorder) body action, was compared between 20 females with AN and 15 matched healthy controls (HC). Results Females with AN reported higher anxiety compared to HC during the body checking task. The level of anxiety positively correlated with body shape concern scores. People with AN had less activation in the medial prefrontal cortex (PFC) and right fusiform gyrus compared to HC in response to body checking compared to neutral action images. Body shape concern scores correlated negatively with medial PFC activation in AN group. Discussion This preliminary study with modest power suggests that AN patients have reduced activation in cortical areas associated with self-reference, body action perception, and social cognition in females with AN. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:653-662) [ABSTRACT FROM AUTHOR]

Objective The aim of this pilot study was to test the acceptability and benefit of a guided self-help intervention incorporating a mobile component in eating disorders (EDs). Method Eighteen people with Anorexia Nervosa and eleven people with Bulimia Nervosa were included in the study for 3 weeks and self-report and behavioural assessments were made before and after the intervention which included 10 video clips, a manual, and limited guidance. Results The most reported positive comment associated with the use of the vodcasts was the increased awareness about the illness. Adherence was good (29/31 subjects completed). A medium sized increase in Body Mass Index was found in participants with Anorexia Nervosa, and significantly lowered EDs and mood symptoms (effect size range = 0.72/1.35), and improvement in cognitive flexibility were reported post-intervention. Discussion A guided self-help intervention incorporating a mobile component was both acceptable and associated with symptom change in people with EDs. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objectives Emotional processing difficulties are potential risk markers for eating disorders that are also present after recovery. The aim of this study was to examine these traits in twins with eating disorders. Methods The Reading the Mind in the Eyes test, Emotional Stroop task and the Difficulties in Emotion Regulation Scale were administered to 112 twins with and without eating disorders (DSM IV-TR eating disorder criteria). Generalised estimating equations compared twins with eating disorders against unaffected co-twins and control twins, and within-pair correlations were calculated for clinical monozygotic ( n = 50) and dizygotic twins ( n = 20). Results Emotion recognition difficulties, attentional biases to social threat and difficulties in emotion regulation were greater in twins with eating disorders, and some were present in their unaffected twin siblings. Evidence for a possible genetic basis was highest for emotion recognition and attentional biases to social stimuli. Conclusion Emotion recognition difficulties and sensitivity to social threat appear to be endophenotypes associated with eating disorders. However, the limited statistical power means that these findings are tentative and require further replication. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to investigate eating disorder diagnostic status and related symptoms in early pregnancy. Methods Pregnant women (n=739), attending their first routine antenatal scan, were assessed using an adapted version of the Eating Disorder Diagnostic Scale (EDDS). Prevalence estimates and eating disorder symptoms were assessed during the first 3 months of pregnancy and, retrospectively, in the 6 to 12 months prior to pregnancy. Results During pregnancy 7.5% of women met diagnostic criteria for an eating disorder, compared to prepregnancy prevalence of 9.2%. Approximately one quarter (23.4%) of women reported high weight and shape concern during pregnancy; binge eating was endorsed by 8.8%, and 2.3% of women engaged in regular compensatory behaviours. Conclusions Eating disorders are more common than previously thought in pregnancy. There is a clinical need for increased understanding of eating disorder symptomatology during pregnancy and for appropriate screening tools to be incorporated into antenatal care. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective Evidence suggests that poor emotional processing perpetuates anorexia nervosa (AN); however, emotional processing following recovery and interactions between aspects of processing remain unknown. This study examined beliefs about emotions, emotional tolerance and avoidance and emotion suppression to preserve relationships in recovered AN patients. It also explored whether beliefs about emotion are related to emotional avoidance. Design A cross-sectional between-groups design was employed. Method Currently ill ( n = 40), recovered AN patients ( n = 24) and a sample of healthy controls ( n = 48) completed measures of clinical and demographic background in addition to the Beliefs About Emotions, Distress Tolerance and Silencing the Self emotional processing questionnaires. Results Recovered and healthy control groups were comparable (except for higher externalised self-perception in recovered participants) and both had better emotional processing than current AN patients. Beliefs about emotions correlated with level of emotional avoidance. Conclusions This study demonstrates functional levels of emotional processing following recovery from AN. It substantiates models proposing that maladaptive beliefs about emotions link to emotional avoidance and supports inclusion of these factors as treatment foci. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective This study aims to evaluate a novel and brief skills-based therapy for in-patients with anorexia nervosa, which addressed 'cold' and 'hot' cognition. Method Eighty one adults with anorexia nervosa were recruited from two eating disorder in-patient units. In one unit, patients received 10 sessions of cognitive remediation and emotion skills training (CREST) plus treatment as usual. In the other, patients received treatment as usual only. Primary outcomes were body mass index and neuropsychological performance scores. Results Both groups improved significantly in body mass index and cognitive flexibility. The CREST group also improved on central coherence. Neither group improved significantly on emotion-processing tasks, although the CREST group did show a larger magnitude of change. Conclusion Improvement in 'cold' cognition was achieved in a short period, whereas emotion-processing difficulties might take longer and more therapeutic work to change. Given that effect sizes in the CREST group were larger for the emotion-processing tasks, improved power may benefit future studies. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objectives Similarities have been noted between cognitive profiles of anorexia nervosa (AN) and autism spectrum disorders (ASD). However, there are no direct comparison studies. This study aimed to compare the cognitive profile of AN against published ASD data on tasks measuring empathy, executive function and central coherence. Methods Currently ill AN outpatients ( n = 40) were statistically compared against published ASD scores on Reading the Mind in the Eyes, Voice and Films tasks (assessing empathy), Wisconsin Card Sorting Task (WCST) (assessing executive function) and Embedded Figures Task (EFT) (assessing detail focus aspect of central coherence). Results Cognitive profiles of the groups were statistically similar, except for differences in the relative patterns of empathy scores. Conclusions The cognitive profile in current AN resembles that of ASD with important clinical implications. Replication studies with planned comparisons, examination of the state-or trait-nature of AN profile and clarification of factors underpinning similarities are required in order to broaden understanding of both disorders. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background: An epidemiological study of anorexia nervosa and bulimia nervosa in primary care was performed using the General Practice Research Database (GPRD).Method: The GPRD was screened between 1988 and 1994 for newly diagnosed cases of anorexia nervosa and bulimia nervosa. The validity of the computer diagnosis was established by obtaining clinical details from a random sample of the general practitioners (GPs).Results: Incidence rates for detection of cases by GPs in 1993 was 4.2 per 100,000 population for anorexia nervosa, and 12.2 per 100,000 for bulimia nervosa. The relative risks of females to males was 40:1 for anorexia nervosa and 47:1 for bulimia nervosa. A threefold increase in the recording of bulimia nervosa was found from 1988 to 1993. Eighty per cent of anorexia nervosa cases and 60% of bulimia nervosa cases were referred to secondary care.Conclusion: There is a continuing expansion of service need for bulimia nervosa. The majority of cases of eating disorders are referred to secondary services. There is scope for more effective management of bulimia nervosa in primary care. [ABSTRACT FROM AUTHOR]

Despite intensive medical regimes, suboptimal glycaemic control is common in people with type 1 diabetes. The pooled evidence that psychological treatments are effective in improving glycaemic control is limited. We conducted a multicenter randomised controlled trial comparing two psychological interventions with usual care for adults with type 1 diabetes to improve glycaemic control. Six nurses were trained to deliver diabetes specific motivational enhancement therapy (MET) and cognitive behaviour therapy (CBT) using a standardised manualised training and competency ratings. Trial criteria were adults (18-65 years) with type 1 diabetes (duration ≥ 2 years); local residents of the 9 study hospitals in London and Manchester, United Kingdom; no advanced diabetes complications or severe mental illness; not pregnant or planning pregnancy; at least one A1c in past 12 months plus current A1c ≥ 8.2 and ≤ 15.0%. After baseline assessments, participants were randomised to either 4 sessions of MET followed by 8 sessions of CBT over 6 months or 4 sessions of MET over 2 months or usual diabetes care using computerised proportional minimised randomised blocks and allocation concealment. The main outcome was A1c 12 months from baseline (technicians blind to allocation) adjusted for baseline A1c. Using clinic registers, 2323 adults with type 1 diabetes were screened, of which 1232 did not meet trial criteria, 412 had incomplete assessments, 291 refused, 44 were untraceable and 344 were randomised. GHb was collected in 91.2% (n=316) for the 12 months followup. The sample characteristics were: median age 36 years (interquartile range (IQR) 28-44); duration of diabetes 18 years (IQR 11-25); Ale was 9.4% (IQR 8.8-10.2); 61% female; 80% white; 18% had a depressive disorder. The nurses were competent in MET (Motivational Interviewing Treatment Integrity scale mean empathy score 5.2) and CBT (Cognitive Therapy Rating Scale-Revised mean score 52.4. The adjusted mean 12 month A1c was 0.4% (95% confidence interval (CI) 0.1 to 0.8) lower in the MET+CBT group than in the usual care group which was statistically significant. The adjusted mean 12 month Ale was 0.1% (95% CI -0.2 to 0.5) lower in the MET group than the usual care group but this was not statistically significant. Nurse delivered MET followed by CBT resulted in a clinically significant improvement in glycaemic control. [ABSTRACT FROM AUTHOR]

Background: Anorexia nervosa (AN) is a serious mental illness. One-third of people develop severe, enduring, illness, adversely impacting quality of life with high health system costs. This study assessed the economic case for enhanced care for adults newly diagnosed with AN., Methods: A five-state 312-month-cycle Markov model assessed the economic impact of four enhanced care pathways for adults newly diagnosed with AN in England, Germany, and Spain. Enhancements were halving wait times for any outpatient care, receiving specialist outpatient treatment post-referral, additional transitional support post-referral, and all enhancements combined. Care pathways, estimates of impact, resource use, and costs were drawn from literature. Net monetary benefits (NMBs), impacts on health system costs, and disability-adjusted life years (DALYs) averted were estimated. Parameter uncertainty was addressed in multi-way sensitivity analyses. Costs are presented in 2020 purchasing power parity adjusted Euros., Results: All four enhanced care pathways were superior to usual care, with the combined intervention scenario having the greatest NMBs of €248,575, €259,909, and €258,167 per adult in England, Germany, and Spain, respectively. This represented maximum NMB gains of 9.38% (€21,316), 4.3% (€10,722), and 4.66% (€11,491) in England, Germany and Spain compared to current care. Healthcare costs would reduce by more than 50%., Conclusions: Early and effective treatment can change the trajectory of AN. Reducing the untreated duration of the disorder is crucial. There is a good economic case in different country contexts for measures to reduce waiting times between diagnosis and treatment and increase access to enhanced outpatient treatment.

Background: Obesity and eating disorders commonly co-occur and might share common risk factors. Appetite avidity is an established neurobehavioural risk factor for obesity from early life, but the role of appetite in eating disorder susceptibility is unclear. We aimed to examine longitudinal associations between appetitive traits in early childhood and eating disorder symptoms in adolescence., Methods: In this longitudinal cohort study, we used data from Generation R (based in Rotterdam, the Netherlands) and Gemini (based in England and Wales). Appetitive traits at age 4-5 years were measured using the parent-reported Child Eating Behaviour Questionnaire. At age 12-14 years, adolescents self-reported on overeating eating disorder symptoms (binge eating symptoms, uncontrolled eating, and emotional eating) and restrictive eating disorder symptoms (compensatory behaviours and restrained eating). Missing data on covariates were imputed using Multivariate Imputation via Chained Equations. Ordinal and binary logistic regressions were performed in each cohort separately and adjusted for confounders. Pooled results were obtained by meta-analyses. Sensitivity analyses were performed on complete cases using inverse probability weighting., Findings: The final study sample included 2801 participants from Generation R and 869 participants from Gemini. Pooled findings after meta-analyses showed that higher food responsiveness in early childhood increased the odds of binge eating symptoms (odds ratio [OR] pooled 1·47, 95% CI 1·26-1·72), uncontrolled eating (1·33, 1·21-1·46), emotional eating (1·26, 1·13-1·41), restrained eating (1·16, 1·06-1·27), and compensatory behaviours (1·18, 1·08-1·30) in adolescence. Greater emotional overeating in early childhood increased the odds of compensatory behaviours (1·18, 1·06-1·33). By contrast, greater satiety responsiveness in early childhood decreased the odds of compensatory behaviours in adolescence (0·89, 0·81-0·99) and uncontrolled eating (0·86, 0·78-0·95) in adolescence. Slower eating in early childhood decreased the odds of compensatory behaviours (0·91, 0·84-0·99) and restrained eating (0·90, 0·83-0·98) in adolescence. No other associations were observed., Interpretation: In this study, higher food responsiveness in early childhood was associated with a higher likelihood of self-reported eating disorder symptoms in adolescence, whereas greater satiety sensitivity and slower eating were associated with a lower likelihood of some eating disorder symptoms. Appetitive traits in children might be early neurobehavioural risk factors for, or markers of, subsequent eating disorder symptoms., Funding: MQ Mental Health Research, Rosetrees Trust, ZonMw., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The comorbidity of purging behaviours, such as vomiting, inappropriate use of laxatives, diuretics or slimming medications, has been examined in literature. However, most studies do not include adolescents, individuals who purge in the absence of binge eating, or those purging at subclinical frequency. This study examines the prevalence of purging among 16-year-old girls across three countries and their association with substance use and psychological comorbidity., Methods: Data were obtained by questionnaire in 3 population-based cohorts (Avon Longitudinal Study of Parents and Children (ALSPAC), United Kingdom, n = 1,608; Growing Up Today Study (GUTS), USA, n = 3,504; North Finland Birth Cohort (NFBC85/86), Finland, n = 2,306). Multivariate logistic regressions were employed to estimate associations between purging and outcomes. Four models were fit adjusting for binge eating and potential confounders of these associations., Results: In ALSPAC, 9.7% of girls reported purging in the 12-months prior to assessment, 7.3% in GUTS, and 3.5% in NFBC. In all 3 cohorts, purging was associated with adverse outcomes such as binge drinking (ALSPAC: odds ratio (OR) = 2.0, 95% confidence interval (CI) = 1.4-2.9; GUTS: OR = 2.5, 95% CI = 1.5-4.0; NFBC: OR = 1.7, 95% CI = 1.0-2.8), drug use (ALSPAC: OR = 2.9, 95% CI = 1.8-4.7; GUTS: OR = 4.5, 95% CI = 2.8-7.3; NFBC: OR = 4.1, 95% CI = 2.6-6.6), depressive symptoms in ALSPAC (OR = 2.2, 95% CI = 1.5-3.1) and GUTS(OR = 3.7, 95% CI = 2.2-6.3), and several psychopathology measures including clinical anxiety/depression in NFBC (OR = 11.2, 95% CI = 3.9, 31.7)., Conclusions: Results show a higher prevalence of purging behaviours among girls in the United Kingdom compared to those in the United States and Finland. Our findings support evidence highlighting that purging in adolescence is associated with negative outcomes, independent of its frequency and binge eating., (© 2014 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Objective: The aim of this study was to examine longitudinal patterns of growth trajectories in children of women with eating disorders (ED): anorexia nervosa (AN) and bulimia nervosa (BN)., Design: Prospective longitudinal birth cohort; Avon Longitudinal Study of Parents and Children (ALSPAC)., Setting: South West England, UK., Participants: The sample consisted of women and their children (n=10 190) from ALSPAC. Patterns of growth among children of women reporting a history of AN (n=137), BN (n=165), both AN and BN (n=68) and other psychiatric disorders (n=920) were compared with an unexposed group of children (n=8900)., Main Outcome Measures: Height and weight data, from birth to 10 years, were extracted from health visitor records, parental report from questionnaires and clinic attendances. Growth trajectories were analysed using mixed-effects models and constructed separately for male and female children., Results: Between birth and 10 years, male children of women with BN were taller than children in the unexposed group. Male children of women with a history of AN and BN, and female children of women with AN, were shorter throughout childhood. Between the ages of 2 and 5, higher body mass index (BMI) was observed in male children in all maternal ED groups. Conversely, female children of women with AN had a BMI of -0.35 kg/m(2) lower at 2 years compared with the unexposed group, with catch-up by age 10., Conclusions: Early childhood growth has been found to predict weight gain in adolescence and adulthood, and may be a risk factor for the development of an ED. These findings therefore have public health implications in relation to the prevention of weight-related and eating-related disorders later in life.

Objectives: Markers of prenatal hormone exposure have been associated with the development of eating disorder (ED) behaviors. Our aim was to determine whether 2D:4D ratio, a marker for in utero testosterone exposure, is associated with risk for ED in a large population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC)., Methods: This is the first study to investigate prenatal testosterone exposure in children at high-risk for ED, using 2D:4D as a marker. We compared children whose mothers reported a lifetime ED (anorexia, bulimia, or both; N = 446) to children whose mothers did not (n = 5,367)., Results: Daughters of women with lifetime bulimia nervosa (BN) had lower 2D:4D ratio (B: -0.01, 95% CI: -0.02 to -0.002, P = 0.02), indicating higher prenatal testosterone exposure, than daughters of mothers unaffected by ED. No differences were observed in the male children of women with an ED., Conclusions: Findings suggest that children at high-risk for BN may be exposed to higher levels of testosterone in utero. Fetal exposure to androgen excess is thought to be causal in the development of polycystic ovary syndrome (PCOS), a disorder which is highly comorbid with binge eating and BN. Future research should investigate the potential role of testosterone exposure in utero as a risk factor for BN and binge eating., (Copyright © 2013 Wiley Periodicals, Inc.)

Background: Very few studies have investigated psychopathology in children of mothers with eating disorders (ED). We aimed to determine the effect of maternal ED on childhood psychopathology in a large population-based cohort and investigate relevant risk pathways using structural equation modeling (SEM)., Methods: Data on emotional and behavioral problems at 3½ years were obtained prospectively on 8,622 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Children of exposed women who self-reported lifetime anorexia nervosa (AN, N = 193) or bulimia nervosa (BN, N = 158) in pregnancy were compared with children of unexposed women (N = 8,271) using linear and logistic regression models. SEM was used to determine best-fitting risk models by child gender., Results: There was evidence that girls of AN women were more likely to have emotional, conduct, and hyperactivity disorders [Odds Ratio (OR): 1.7 (95% Confidence Intervals 1.0-3.0); OR: 2.2 (1.2-4.0); OR: 1.8 (1.1-3.1), respectively] and boys of AN women to have emotional disorders compared with unexposed [OR: 2.0(1.2-3.4)]. Girls of women with BN were more likely to show hyperactivity [OR: 1.7 (1.0-3.1)]; and boys to show emotional and conduct disorders compared with unexposed [OR: 2.2 (1.2-3.9); OR: 2.4 (1.4-4.2), respectively]. SEM models showed that pregnancy anxiety and depression mediated the effect of maternal ED on child psychopathology., Conclusions: Maternal ED are associated with different childhood psychopathology outcomes in boys and girls. Pregnancy anxiety and depression and active ED symptoms are important mediators of risk and are preventable; the direct effect of maternal lifetime ED was small., (© 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.)

The main objective of the present study was to analyse the role of the ego-dystonicity and ego-syntonicity of eating disorder intrusive thoughts (EDITs) in the genesis and maintenance of eating disorders (EDs). Participants were 98 female patients with EDs, 56 Spanish and 42 English (27.19±9.59 years; body mass index (BMI): 18.72±2.87). All of them completed the eating attitudes test, the Eating Attitudes Test, the Eating Intrusive Thoughts Inventory, the Ego-Dystonicity Questionnaire-Reduced version, and the Ego-Syntonicity Questionnaire. Patients indicated that their EDITs were rational and also undesirable and immoral, suggesting that EDITs are not fully ego-syntonic or ego-dystonic. Multivariate analysis of variance (MANOVA) indicated no differences in ego-syntonicity and ego-dystonicity across ED subtypes. Path analyses were performed to investigate the mediating role of the EDITs' ego-syntonicity and ego-dystonicity in their interference, dysfunctional appraisals and control strategies. They showed, first, that the more interference an EDIT caused, the more ego-syntonic and the less ego-dystonic it was and, second, that when the EDITs were assessed as ego-syntonic, patients tried to do what they indicated, whereas when they were assessed as ego-dystonic, patients made efforts to neutralise them. Clinical implications for the conceptualisation and treatment of ED are discussed., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

There is limited knowledge about dietary patterns and nutrient/food intake during pregnancy in women with lifetime eating disorders (ED). The objective of the present study was to determine patterns of food and nutrient intake in women with lifetime ED as part of an existing longitudinal population-based cohort: the Avon Longitudinal Study of Parents and Children. Women with singleton pregnancies and no lifetime psychiatric disorders other than ED (n 9723) were compared with women who reported lifetime (ever) ED: (anorexia nervosa (AN, n 151), bulimia nervosa (BN, n 186) or both (AN+BN, n 77)). Women reported usual food consumption using a FFQ at 32 weeks of gestation. Nutrient intakes, frequency of consumption of food groups and overall dietary patterns were examined. Women with lifetime ED were compared with control women using linear regression and logistic regression (as appropriate) after adjustment for relevant covariates, and for multiple comparisons. Women with lifetime ED scored higher on the 'vegetarian' dietary pattern; they had a lower intake of meat, which was compensated by a higher consumption of soya products and pulses compared with the controls. Lifetime AN increased the risk for a high ( ≥ 2500 g/week) caffeine consumption in pregnancy. No deficiencies in mineral and vitamin intake were evident across the groups, although small differences were observed in macronutrient intakes. In conclusion, despite some differences in food group consumption, women with lifetime ED had similar patterns of nutrient intake to healthy controls. Important differences in relation to meat eating and vegetarianism were highlighted, as well as high caffeine consumption. These differences might have an important impact on fetal development.

Background: Maternal eating disorders (ED) have been shown to increase the risk of feeding difficulties in the offspring. Very few studies, however, have investigated whether the effect of a maternal ED on childhood feeding is a direct effect or whether it can be ascribed to other child or maternal factors. We aimed to determine the role of maternal anxiety and depression in mediating the risk for feeding difficulties in infants of women with ED., Methods: A prospective study comparing women with lifetime ED (441) and without any lifetime psychiatric disorder (10,461) and their infants from the Avon Longitudinal Study of Parents and Children (ALSPAC). We investigated the effect of: maternal anxiety and depression in late pregnancy (32 weeks) and the post-partum (8 weeks), child temperament and developmental status on infant feeding difficulties at 1 and 6 months. We also investigated the effect of active pregnancy ED symptoms. We tested 3 models and their fit to the data using structured equation modelling: a direct effect model, a fully mediational model and an integrated (partial meditational) model., Results: The integrated model including a direct effect of maternal lifetime ED on infant feeding and a mediational path via maternal distress (a latent variable combining anxiety and depression) fitted the data best. This also applied to maternal pregnancy ED symptoms. Feeding difficulties in turn increased maternal distress over time., Conclusions: Lifetime ED and active pregnancy ED increase the risk for infant feeding difficulties and do so via maternal distress (i.e., depression and anxiety). This has important implications for prevention and early intervention in relation to infant feeding difficulties, as well as for future research in the field., (© 2010 The Authors. Journal of Child Psychology and Psychiatry © 2010 Association for Child and Adolescent Mental Health.)

Objective: To determine the impact of pregnancy on eating disorders (ED) symptoms using data from a large prospective, community-based cohort study., Methods: Women (12,254) were classified according to whether they had a recent or past history of ED, were obese before pregnancy, or constituted part of the general population control group. We evaluated self-induced vomiting (SIV), laxative use, exercise behavior, and appraisals about weight gain during pregnancy, as well as dieting, and shape and weight concern before and during pregnancy., Results: Women with a recent episode of ED dieted, used laxatives, reported SIV, and exercised more than other groups during pregnancy. They were also more likely to report ED cognitions in pregnancy and their weight and shape concern scores remained high during pregnancy. Women with past ED were also more likely than controls to have some ED behaviors and/or concerns about weight gain during pregnancy., Conclusions: Women with a recent ED continued to have some ED symptoms in pregnancy, albeit fewer compared to before pregnancy. Although at a lower level, women with a past history of ED also had ED symptoms in pregnancy. Screening for ED symptoms during pregnancy may provide a useful opportunity for engagement in treatment and to reduce behaviors that might be detrimental to the foetus.

Objective: A number of sets of clinical guidelines have been developed for the treatment of eating-disordered patients. This study aimed to measure adherence to such guidance among family physicians working in primary care settings., Method: In the wake of the publication of national guidelines for "best practice," family physicians in a large but diverse geographical region of the UK (population of 6.4 million) were approached and asked to complete a two-stage survey., Results: Only 4% of these clinicians report using published guidelines or protocols, and none used the national guidelines that were available. Nor were these clinicians using the spirit of the guidelines, as there was little correspondence between recommended and actual treatment behavior., Conclusion: These findings suggest that specialist eating disorders services should not rely on guidelines to ensure the dissemination of best practice for these patients in primary care. Alternative means of dissemination are needed, and suggestions are made., ((c) 2007 by Wiley Periodicals, Inc.)