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Objective: Treatment for anorexia nervosa (AN) remains challenging; there are no approved psychopharmacological interventions and psychotherapeutic strategies have variable efficacy. The investigation of evidence‐based treatments has so far been compounded by an underdeveloped understanding into the neurobiological changes associated with the acute stages of AN. There is converging evidence of deficiencies in neuroplasticity in AN. Method: This paper provides an overview of neuroimaging, neuropsychological, molecular and qualitative findings relating to neuroplasticity in AN, translating these findings to the identification of novel biological and psychotherapeutic strategies. Results: Novel psychopharmacological approaches that may ameliorate deficiencies in neuroplasticity include medications such as ketamine, psilocybin and human recombinant leptin. Anti‐inflammatory medications and brain‐derived neurotrophic factor mimetics may emerge as potential treatments following further research. Psychotherapeutic strategies that may target neuroplastic deficiencies, as well as having wider effects on identity, include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions (e.g. music and arts therapies) and yoga/mindfulness‐based interventions. Conclusions: Treatments specifically targeted towards mitigating the neurobiological sequalae of AN are warranted, and emerging neurobiological and neuropsychological research utilising longitudinal designs and large sample sizes, as well as initial feasibility studies, are necessitated to bolster translational efforts. Highlights: There is converging evidence from neuroimaging, neuropsychological, molecular and qualitative research suggestive of altered neuroplasticity during the acute stages of anorexia nervosa (AN), which is also a transdiagnostic feature across psychiatric disorders.Novel pharmacological treatments that are used for the treatment of other conditions in humans, and could be applied to target neuroplasticity in AN, include ketamine, psilocybin, human recombinant leptin and anti‐inflammatory medications.Psychotherapeutic strategies that may target neuroplastic deficiencies in AN, some of which have already been investigated, include those targeting cognitive problems or biases (e.g. imagery rescripting, memory specificity training, cognitive remediation therapy (CRT)), fear (e.g. exposure‐based therapies), stress (e.g. yoga/mindfulness‐based interventions) and identity (e.g. narrative therapies, cultural interventions such as arts and music‐based therapies). [ABSTRACT FROM AUTHOR]

Background: Physical sequelae of anorexia nervosa (AN) include a marked reduction in whole brain volume and subcortical structures such as the hippocampus. Previous research has indicated aberrant levels of inflammatory markers and growth factors in AN, which in other populations have been shown to influence hippocampal integrity. Methods: Here we investigated the influence of concentrations of two pro-inflammatory cytokines (tumor necrosis factor-alpha [TNF- α ] and interleukin-6 [IL-6]) and brain-derived neurotrophic factor (BDNF) on the whole hippocampal volume, as well as the volumes of three regions (the hippocampal body, head, and tail) and 18 subfields bilaterally. Investigations occurred both cross-sectionally between acutely underweight adolescent/young adult females with AN (acAN; n = 82) and people recovered from AN (recAN; n = 20), each independently pairwise age-matched with healthy controls (HC), and longitudinally in acAN after partial renourishment (n = 58). Hippocampal subfield volumes were quantified using FreeSurfer. Concentrations of molecular factors were analyzed in linear models with hippocampal (subfield) volumes as the dependent variable. Results: Cross-sectionally, there was no evidence for an association between IL-6, TNF- α , or BDNF and between-group differences in hippocampal subfield volumes. Longitudinally, increasing concentrations of BDNF were positively associated with longitudinal increases in bilateral global hippocampal volumes after controlling for age, age2, estimated total intracranial volume, and increases in body mass index (BMI). Conclusions: These findings suggest that increases in BDNF may contribute to global hippocampal recovery over and above increases in BMI during renourishment. Investigations into treatments targeted toward increasing BDNF in AN may be warranted. [ABSTRACT FROM AUTHOR]

Objective: This study examined the effect of cognitive bias modification for interpretation (CBM‐I) training in Korean women with eating disorders (EDs). Method: Sixty‐three women with EDs participated in the study. Participants were randomly assigned to the intervention group where they received six sessions of CBM‐I training (n = 31) in addition to treatment‐as‐usual or were put on a waiting list (n = 32). Participants' interpretation and attention biases, emotion regulation, affect, and ED psychopathology were assessed at baseline, end‐of‐intervention (4 weeks), and follow‐up (8 weeks). Results: Participants who completed the CBM‐I training displayed greater reductions in negative interpretation bias (Δη2 = 0.107) and emotion dysregulation (Δη2 = 0.085) with medium to large effect sizes compared to the control group, which were maintained from baseline to follow‐up. Disengagement from negative faces and a focus on positive faces was found in the intervention group with a moderate effect size at the end‐of‐intervention (Δη2 = 0.090). Both intervention and control groups showed improvements in ED psychopathology. Baseline neuroticism was positively correlated with CBM‐I effect. Discussion: The results suggest that modifying interpretation bias towards ambiguous social stimuli might be an effective adjuvant treatment to reduce negative expectations of social situations and improve emotion regulation in women with bulimia nervosa and anorexia nervosa. Highlights: Cognitive bias modification for interpretation (CBM‐I) training decreased negative interpretation bias towards ambiguous social situations with large effect sizes in women with anorexia nervosa (AN) and bulimia nervosa.The training also reduced attention bias towards negative face stimuli, difficulties in emotion regulation, and negative affect with moderate effect sizes.Participants with higher levels of baseline neuroticism experienced the training effect to a greater extent. [ABSTRACT FROM AUTHOR]

Objective: "Supporting Carers of Children and Adolescents with Eating Disorders in Austria" (SUCCEAT), a skills training for parents, delivered via workshops (WS) or online modules (ONL), has been proven to be effective in terms of parental distress, caregiver skills, and adolescents' outcome. This study examined the adherence to and the acceptability and feasibility of SUCCEAT. Method: One‐hundred parents (86% mothers) of adolescents with anorexia nervosa participated in the 8‐week training. Parents were assigned to the WS (n = 50) or ONL (n = 50) format using a quasi‐randomised design. Adherence, acceptability, and feasibility were assessed using self‐report questionnaires. Results: Adherence to the sessions was high (66%–98%) for both groups. The usage of the material was comparable between the groups. However, in the WS group, participants actively approached the coaches (71.8% vs. 48.9% often/very often) or other parents (63% vs. 4.4% often/very often) more often. Perceived helpfulness was high in both groups, overall satisfaction and practicability were higher in the WS group. Conclusions: Good adherence, acceptability, and feasibility were confirmed for both formats of SUCCEAT, with minimal advantages of the WS regarding satisfaction and contact with other parents and coaches. Thus, both formats can be recommended for implementation in clinical routine. Highlights: Adherence, acceptability, and feasibility were high for both SUCCEAT formats (workshop or online).Although SUCCEAT was perceived as similar helpful in both formats, satisfaction was slightly higher in the workshop group.Both formats can be recommended for implementation into clinical routine. [ABSTRACT FROM AUTHOR]

Background: Despite several decades of treatment research for anorexia nervosa (AN), many of the same questions remain: how to boost enrollment, engage participants, prevent attrition, and meet the needs of a diverse patient population within the rigorous framework of a randomized controlled trial (RCT). Methods: In this research forum, we highlight some of the challenges and opportunities observed over the course of TRIANGLE, the largest RCT for severe AN treatment in the UK to date. We discuss strategies for addressing common challenges and avoiding common pitfalls and propose solutions to future researchers seeking to conduct treatment research in AN. Results: Our experience underscores the value of involving people with lived experience at every stage of intervention research. We offer additional recommendations for treatment researchers, including, (1) early qualitative research to identify patient barriers and obstacles, (2) clear, systematic collaboration with clinical sites for patient recruitment and passive data collection, (3) careful consideration of assessment metrics, including repeated measurement of quality of life, (4) adopting a flexible, patient‐centered approach to clinical trial research, and (5) considering the unique needs and obstacles that might impact carer participation in research and their ability to provide support to their loved ones. Discussion: We hope that these lessons learned will prove fruitful for the next generation of researchers embarking on treatment research for AN. Public Significance: Using the TRIANGLE trial as an illustrative case study, we highlight the value of lived experience and codesign for developing and testing interventions for AN. We offer several lessons learned over the course of the trial, pertaining to trial enrollment, retention and engagement, measurement of outcomes, and research adaptations for real‐world settings, and hope that these recommendations facilitate future treatment research for AN. [ABSTRACT FROM AUTHOR]

ObjectiveAlthough low weight is a key factor contributing to the high mortality in anorexia nervosa (AN), it is unclear how AN patients sustain low weight compared with bulimia nervosa (BN) patients with similar psychopathology. Studies of genes involved in appetite and weight regulation in eating disorders have yielded variable findings, in part due to small sample size and clinical heterogeneity. This study: (1) assessed the role of leptin, melanocortin, and neurotrophin genetic variants in conferring risk for AN and BN; and (2) explored the involvement of these genes in body mass index (BMI) variations within AN and BN.MethodOur sample consisted of 745 individuals with AN without a history of BN, 245 individuals with BN without a history of AN, and 321 controls. We genotyped 20 markers with known or putative function among genes selected from leptin, melanocortin, and neurotrophin systems.ResultsThere were no significant differences in allele frequencies among individuals with AN, BN, and controls. AGRP rs13338499 polymorphism was associated with lowest illness-related BMI in those with AN (p = 0.0013), and NTRK2 rs1042571 was associated with highest BMI in those with BN (p = 0.0018).DiscussionTo our knowledge, this is the first study to address the issue of clinical heterogeneity in eating disorder genetic research and to explore the role of known or putatively functional markers in genes regulating appetite and weight in individuals with AN and BN. If replicated, our results may serve as an important first step toward gaining a better understanding of weight regulation in eating disorders.

Animal studies indicate that gonadal hormones at puberty have an effect on the development of masculine and feminine traits. However, it is unknown whether similar processes occur in humans. We examined whether women with anorexia nervosa (AN), who often experience primary amenorrhea, exhibit attenuated feminization in their psychological characteristics in adulthood due to the decrease/absence of gonadal hormones at puberty. Women with AN were compared on a number of psychological characteristics using general linear models on the basis of the presence/absence of primary amenorrhea. Although women with primary amenorrhea exhibited lower anxiety scores than those without primary amenorrhea, in general, results did not provide evidence of attenuated feminization in women with AN with primary amenorrhea. Future research should utilize novel techniques and direct hormone measurement to explore the effects of pubertal gonadal hormones on masculine and feminine traits.

Objectives: The current study aimed to investigate the impact of oxytocin on emotion recognition, trust, body image, affect, and anxiety and whether eating disorder (ED) symptoms moderated any of these relationships. Method: Participants (n = 149) were female university students, who were randomly allocated to receive in a double-blind nature, a single dose of oxytocin intranasal spray (n = 76) or a placebo (saline) intranasal spray (n = 73). Participants were asked to complete an experimental measure of emotion recognition and an investor task aimed to assess trust. Results: The oxytocin group exhibited better overall performance on the emotion recognition task (especially with recognising positive emotions), and a decline in state positive affect than the control group at post-intervention. However, these effects were not moderated by ED symptom severity, nor were effects found for state anxiety, negative affect, body image and recognising negative emotions in the emotion recognition task. Conclusion: The current findings contribute to the growing literature on oxytocin, emotion recognition and positive affect and suggest that ED pathology does not moderate these relationships. Future research would benefit from examining the efficacy of an oxytocin intervention using a within-subjects, cross-over design, in those with sub-clinical and clinical EDs, as well as healthy controls. [ABSTRACT FROM AUTHOR]

Marchetti and Sawrikar (International Journal of Eating Disorders, 2023) used the framework of the Common‐Sense Model of the Self‐Regulation to explore the perceptions and experiences of parents caring for individuals with anorexia nervosa (AN) from a systematic review of the literature. The studies they reviewed delved into the subjective experiences of parents and considered the influence of emotional and cognitive representations of AN which were predominantly negative. Parents play a key role in all stages of the management of an eating disorder and so our commentary sets the findings into the wider context of eating disorder services. It is important that we continue to forge a collaborative approach with parents that addresses their needs and insights to improve our knowledge about, and services for people with eating disorders. [ABSTRACT FROM AUTHOR]

Objective: Research on carers in the context of eating disorders (EDs) has predominantly focused on parents and offspring, overlooking the adverse effects EDs have on the lives of siblings. This study aims to shift the paradigm by reviewing the literature in this area. To the authors' knowledge, this is the first review of the literature that broadly captured the lived experiences of siblings without being limited by specific search terms such as coping strategies and levels of psychopathology. Method: Six databases (ERIC, MEDLINE, PsycInfo, Pubmed, Scopus, and Web of Science) were searched using predetermined search strings. Quantitative, qualitative, and mixed methods studies were included as long as they were focused on siblings' experiences of having a brother or sister with an ED. No publication date restrictions were applied, and thorough quality assessments were initially carried out before a qualitative analysis of the data was conducted. Results: Twenty‐one studies were eligible for inclusion, thematic synthesis yielded six core themes, and 17 subthemes related to the inter‐ and intrapersonal impacts of the ED on siblings' lives. These themes and sub‐themes include fragmentation in family relationships, parentification, and competition and jealousy. Conclusion: It is of utmost importance to gain a better understanding of siblings' experiences and needs in relation to EDs. The findings are discussed in relation to the existing literature and theoretical and clinical implications, for example, tailored approaches accounting for siblings' experiences. Highlights: Eating disorders (EDs) impact many areas of siblings' lives causing immense, inescapable disruption leading siblings to feel less important than their sibling with the ED. This can be due to receiving less attention from their parents, other people continuously asking about their SED and not them, and significant life events being overshadowed by the ED and their SED.The lacking professional support is in direct contrast to their wish to receive more help from professionals.It is essential for professionals to take a proactive approach to identify siblings' needs and offer them more tailored support. [ABSTRACT FROM AUTHOR]