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Objective: Power posing involves the adoption of an expansive bodily posture. This study examined whether power posing could benefit individuals with anorexia nervosa (AN) and women with normal weight in regards to interoceptive ability and affective states. Method: Participants included 50 inpatients and outpatients with AN as well as 51 normal‐weight women. Interoceptive accuracy (IAcc), measured by the heartbeat tracking task and interoceptive sensibility (IS), measured by confidence ratings, were assessed at baseline, after a single power posing session and after 1 week of daily training. Also, the short‐term effects of power posing on subjective feelings of dominance, pleasantness, and arousal were investigated. Results: Both groups increased in their IAcc after one power posing session. Also, there was a significant main effect of time on feelings of dominance and pleasantness in the short‐term. Women with AN displayed lower levels of IS, dominance, and pleasantness as well as higher levels of arousal than women without AN. Discussion: These findings suggest that power posing has the potential to increase IAcc, subjective feelings of power and pleasant affect in the short‐term. Further research should investigate which mechanisms foster the effectiveness of this intervention to tailor it to the needs of women with AN. Highlights: Feelings of powerlessness are prominent in AN but few concrete interventions exist that directly address this concern.Power posing has the potential to increase interoceptive accuracy, subjective feelings of power and pleasant affect in the short‐term.Women with AN display lower levels of interoceptive sensibility than women without AN. [ABSTRACT FROM AUTHOR]

Objective: Inpatient treatment effectively increases body weight and decreases eating disorder symptoms in adolescents with anorexia nervosa (AN). However, there is a high risk of relapse within the first year after discharge, which calls for investigating long‐term treatment success and its moderators. Method: Female adolescent inpatients with AN (N = 142) were assessed, of which 85% participated at 1‐year follow‐up. Dependent variables were body mass index percentiles, eating disorder symptoms, depressive symptoms, compulsive exercise and life satisfaction. Results: On average, body weight increased and eating disorder symptoms and depressive symptoms decreased from admission to discharge and remained stable at follow‐up. Compulsive exercise decreased and life satisfaction increased from admission to discharge and even improved further at follow‐up. Age, duration of illness, previous inpatient treatments, length of stay and readmission after discharge moderated changes in several outcome variables. Conclusions: This study confirms the high effectiveness of inpatient treatment for adolescents with AN and demonstrates that treatment effects remain stable or even improve further within the first year after discharge. However, subgroups of patients (e.g., those with an older age, longer duration of illness, and previous inpatient treatments) require special attention during inpatient treatment and aftercare to prevent relapse. Highlights: Inpatient treatment of anorexia nervosa in adolescents is highly effectiveOn average, improvements in body weight and eating disorder symptoms remain stable in the first year after discharge, although this may be due to outpatient psychotherapy after dischargeSeveral variables moderate these treatment effects, indicating that there are substantial individual differences in treatment response with subgroups of patients showing further improvements or worsening of symptoms after discharge [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT‐E) in a real‐world outpatient setting. Method: Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT‐E. BMI and Eating Disorder Examination Questionnaire (EDE‐Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20‐ and 60‐week follow‐ups for treatment completers. Results: Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating‐disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow‐ups. About half of the patients who completed treatment had a BMI ≥18.5 at the end of treatment and follow‐ups. Discussion: CBT‐E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real‐world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment. Method: Seventeen adolescents 12–18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5‐day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi‐structured interviews that were audio‐recorded and transcribed. Results were analyzed deductively using qualitative techniques. Results: Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group‐based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology. Discussion Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment. [ABSTRACT FROM AUTHOR]

Dissociation is a debilitating condition often present as comorbidity in patients with eating disorders, but to date only sparse findings are available on this topic. Additionally, very little data exist on the classification of dissociation, namely, psychoform and somatoform, in anorexia nervosa (AN). This review aimed to provide an updated view on the literature about dissociation in AN, with a focus on AN subtypes (i.e., restricter and binge‐purging) as well as dissociation type (i.e., psychoform and somatoform), when available. We screened 304 studies, and after title and abstract selection and full‐text reading, 29 of them were included in this review. Most of the studies investigated psychoform dissociation, whereas just four publications considered somatoform dissociation. Dissociation resulted to be present in AN more than in healthy controls and in individuals with other psychiatric disorders, and it was related mostly to the binge‐purging subtype of AN. Moreover, dissociation was linked to traumatic events, self‐harm and negative treatment outcomes, especially in patients affected by the binge‐purging subtype of AN. However, results on these matters are scarce and partially discordant. The methodological assessment we performed revealed an overall fair quality of the included studies, although several flaws emerged as well. The present review reported on one hand the relevance of dissociation in AN, but on the other hand the need to stimulate the scientific debate on (a) a deeper investigation of somatoform dissociation in AN and (b) the relationship between dissociation and both clinical severity and treatment response/resistance in AN. [ABSTRACT FROM AUTHOR]

Despite the high percentage of adults living with anorexia nervosa (AN) over the life course, there is limited understanding of what it means to be living with AN in midlife when the majority of research has focused on adolescents and young adults. As such, clinical practice for individuals in midlife is informed by a severe and enduring AN (SE-AN) framework, which assumes that recovery is not necessarily feasible past young adulthood. This study used constructivist grounded theory methodology to understand the experiences of adults in midlife living with AN. In-depth analyses of 19 participant narratives in midlife show that individuals face barriers to seeking help or remaining in recovery; however, midlife can also act as a significant catalyst toward recovery. Subsequently, there is merit in revisiting the utility of the SE-AN framework in the context of life course theory and exploring resilience-informed approaches in supporting recovery from AN. [ABSTRACT FROM AUTHOR]

Research suggests that individuals with anorexia nervosa (AN) have certain temperamental traits (e.g. perfectionism, anxiety, harm avoidance), which often onset prior to the eating disorder (ED), and may persist following recovery. Although these traits are often represented as vulnerabilities to developing an ED, there is reason to believe that within certain contexts, these traits may serve as assets. We propose that traits can be harnessed within or outside of treatment to promote long-term success, and possibly relate to recovery. To do so, the current paper will: (1) outline literature on traits viewed as strengths; (2) review precedents for strengths-based interventions drawing from other areas of research; (3) propose a framework for future research to assess these strengths in AN; and (4) discuss the implications of the proposed research for the destigmatization of EDs. This last word calls for a shift to a dual consideration of traits as vulnerabilities and strengths. [ABSTRACT FROM AUTHOR]

Trust has been seen as a lynchpin of therapeutic relationships. Yet due to perceptions that anorexia is one of the most difficult illnesses to treat and that patients are "treatment resistant", achieving trust between patient and treatment provider may be challenging. This article draws on qualitative data from 14 semi-structured interviews with women who have experience of inpatient treatment for anorexia in order to analyse how trust and distrust figured in treatment contexts. In so doing, the article draws upon feminist approaches which are critical of conceptions of the "devious" "anorexic" and of the clinical discourses within which these constructions are produced. Our analysis suggests a lack of trust shown toward patients in inpatient contexts – particularly a disqualification of "voice" – which has a number of consequences for participants' subjectivities, including the erosion of self-esteem; demotivation; dropping out/termination of treatment; and triggering experiences of trauma. As such, our analysis raises serious questions about what participants described as routine treatment practices in inpatient treatment for anorexia, and about the serious consequences of constructing "anorexics" as manipulative and untrustworthy. [ABSTRACT FROM AUTHOR]

Background: The present study reports a case series where three adolescent patients with anorexia nervosa (AN) (two cases with typical AN and one case atypical AN) received nasogastric tube feeding under restraint in line with new dietetic clinical guidelines. Methods: Three cases were chosen out of 61 admitted patients over the period of 1 year who were fed via a nasogastric tube under restraint in a specialist eating disorders unit for children and adolescents. These cases were chosen to highlight a range of clinical scenarios that clinicians may encounter. They also represent clinical scenarios where decisions to feed patients under restraint were rendered more complex by additional concerns. Results: Despite the complexity of the cases, all patients tolerated the feeds well and were discharged home eating solid food. Conclusions: The decision to feed a patient against their will is never an easy one. Sadly, there have been some recent high‐profile deaths of adult patients on medical wards where treatment opinion was not considered, and the patient received no or minimal nutrition when awaiting specialist treatment. Dietetic guidelines have been published to help inform clinicians for whom feeding under restraint may be out of the scope of their daily practice. This case series highlights clinical scenarios that illustrate the utility of the guidelines, which we hope will support clinicians when making, potentially lifesaving decisions in children and young people. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa (AN) is a mental disorder potentially leading to severe malnutrition and life‐threatening complications, with high mortality rates and dropouts from treatment. In the most severe cases, treatment refusal associated with acute nutritional disorders may require compulsory admission in specialised units. The aim of this study was to investigate clinical and nutritional parameters associated with the use of compulsory treatment for severely ill AN patients requiring intensive nutritional care. Methods: This retrospective, single‐centre study performed in a unit of specialised nutritional care compared severely undernourished inpatients, compulsorily admitted for AN, with a population of sex‐ and age‐matched voluntarily admitted patients. Socio‐demographic and clinical variables were collected for univariate comparison and logistic regression. Results: Compulsory treatment in AN was mainly associated with lower socio‐economic status (p < 0.01), history of lower weight (p < 0.05), more frequently prescribed psychotropic medication (p = 0.02), more previous admissions for AN, longer hospitalisations (p < 0.01) and binge eating/purging subtype (p = 0.02). Binge eating/purging subtype and the number of past admissions showed the strongest odds of compulsory treatment in multivariate analysis. Conclusion: The knowledge of factors associated with compulsory treatment may help practitioners of all fields to better evaluate its pertinence and indications in AN. HIGHLIGHTS: Severely undernourished patients with anorexia nervosa may require compulsory admission in specialised units in the case of treatment refusalSocio‐economic status, binge eating/purging subtype, more frequently prescribed psychotropic medication, history of lower weight and longer hospitalisations distinguished between compulsorily and voluntarily admitted patients for anorexia nervosaBinge eating/purging subtype and the number of previous admissions were the strongest predictors of compulsory treatment for extremely undernourished patients with anorexia nervosa [ABSTRACT FROM AUTHOR]

Objective: This study aimed to conduct a systematic review of research that has evaluated the outcomes of exercise‐based interventions in anorexia nervosa (AN) patients. Method: We searched for studies in the MEDLINE, Embase, Web of Science, PsycInfo, Scopus and SPORTDiscus databases. We followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines throughout the selection process, and used Cochrane tools to assess the risk of bias in the primary studies. In cases where sufficient information was available, outcomes were pooled using meta‐analytic techniques. Results: Ten studies were included in the review. Results showed similar changes in body mass index in both experimental and control conditions (difference in mean changes of −0.53, 95% CI −1.52 to 0.46). We found no differences in depression or anxiety as a result of implementing exercise programmes. Studies using resistance or strength exercise programmes reported an increase in lower and upper body strength and in skeletal muscle mass in the intervention groups. Conclusion: The incorporation of a supervised physical exercise programme to the usual treatment may be appropriate for AN patients. Exercise interventions should only be performed when they are safe for AN patients and should be focused on resistance/strength or flexibility exercises. The results from this systematic review should be interpreted with caution because the studies reviewed showed serious methodological problems. HIGHLIGHTS: This systematic review highlights the paucity of data to make decisions about the relevance of structured and supervised exercise as a treatment in patients with anorexia nervosa (AN)Supervised physical exercise interventions were not associated with weight loss in patients with ANPhysical exercise interventions focused on resistance/strength or flexibility have no additional effect on anthropometry, but they might improve vital signs, muscle function and strength, and eating disorder symptomatologyPhysical exercise programmes have not shown significant effects on psychological variables such as anxiety and depression [ABSTRACT FROM AUTHOR]

Objective: This study describes the implementation of family‐based treatment (FBT) in an eating disorder program in Asia as well as clinical outcomes of Asian adolescents with anorexia nervosa (AN) treated with FBT. Method: This retrospective consecutive cohort study of 147 Asian adolescents with AN was compared between those in FBT (n = 65) versus treatment as usual (TAU) (n = 82). Variables associated with weight restoration were analyzed between groups. Results: Participants' mean age was 14.2 (SD = 1.5) years and 93% were female. Mean presenting %mBMI was 74.0 (SD = 7.8) and average illness duration was 7.7 (SD = 6.1) months. The two groups' baseline characteristics were not significantly different. Weight restoration rates in the FBT group were significantly higher than the TAU group at 6‐, 12‐, and 24‐month time points. A linear mixed model showed the mean %mBMI was significantly higher at 0, 6, 12, and 24 months in the FBT group. The median time to weight restoration for patients on FBT was shorter (FBT: 7.0 months, TAU: 19.0 months; 95% CI [14.5, 23.5] χ2 = 15.84, p <.001). Within the FBT group, those that completed ≥9 FBT sessions had significantly higher rates of weight restoration at 12 months. Across all participants, those with a lower starting %mBMI were less likely to achieve weight restoration by 12 months. Conclusion: FBT can be effectively implemented in a multidisciplinary eating disorder program managing Asian adolescents with AN with improved rates of weight restoration. Further research is needed to understand the predictors and moderators of remission using FBT in Asian adolescents with AN. [ABSTRACT FROM AUTHOR]

Residential treatment is a necessary element of treatment in some cases of anorexia nervosa, where it is used prior to transitioning to complete the treatment in a less intensive setting. This study tests how effective residential treatment is at helping adolescent and adult patients to reduce their eating pathology to levels that can be managed in outpatient settings. Ninety-eight patients with anorexia nervosa started treatment in a routine residential setting (83 completers). The adolescent and adult groups showed comparable levels of benefit, showing gains in weight and reductions in eating pathology, compatible with transitioning to less intensive treatment. Change was particularly substantial over the first 6 weeks. This effectiveness study has shown that an appropriate period of residential treatment can be used to prepare patients to be able to benefit from a less intensive treatment, regardless of age group. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa (AN) is a disorder characterized by a profound fear of weight gain, resulting in significant weight loss, as well as behavioral symptoms that interfere with weight normalization. In concert, weight gain remains a proximal goal of treatment, and patient weighing is a critical component of treatment. However, divergent approaches exist in how patient weighing is undertaken in clinical practice. The aim of this study is to investigate the impact of a brief course of open weighing (sharing weight data with patients) versus blind weighing (not sharing weight data with patients) on distress around being weighed and AN symptom severity. Method: 216 patients with AN and atypical AN will be randomized to receive 4 weeks of open or blind weighing practices across residential, intensive outpatient, and outpatient treatment settings, within the context of manualized empirically supported treatment. Following 4 weeks of open or blind weighing, all patients will be enrolled into open weighing practices. Primary outcomes of interest will be patient‐reported distress around being weighed at week 5 and eating disorder symptom severity at week 5. Secondary outcomes will assess weight prediction error, intolerance of uncertainty, and the fear of food. Discussion: No best practice guidelines exist in determining optimal practices around weighing patients with AN. This multisite randomized controlled trial will provide the first known data on the impact of open versus blind weighing practices upon weight‐related distress and AN symptom severity. [ABSTRACT FROM AUTHOR]

Objective: This study uses data from a multisite randomized clinical trial to study the role of perfectionism in family‐based treatment (FBT) for adolescent anorexia nervosa (AN). The main aim is to examine the role of baseline perfectionism in treatment response. Method: Adolescents (N = 158; ages 12–18; 89.2% female) and their families were randomized to receive either FBT or systemic family treatment for AN. Eating disorder (ED) pathology, obsessive–compulsive symptoms, and perfectionism were assessed at baseline, end of treatment, and 6‐ and 12‐month follow‐up. Linear regression analyses were used to test whether perfectionism and obsessive–compulsive symptoms at baseline predict ED pathology at all timepoints. An independent samples t test was used to test whether there was a significant difference in the change in perfectionism in either treatment group. Results: Baseline maladaptive perfectionism significantly predicted ED pathology but not ideal body weight at all timepoints. The model that included obsessive–compulsive symptoms also predicted ED pathology at all timepoints except 12‐month follow‐up. Perfectionism scores did not change during treatment regardless of treatment type. Discussion Baseline perfectionism predicted treatment response in this study. Interventions might target perfectionism to improve treatment response in AN. [ABSTRACT FROM AUTHOR]

Background Treating patients with anorexia nervosa (AN) remains a major challenge. The choice between an inpatient or an outpatient care setting is an essential issue for the patients and for their relatives with major health economic implications. However, health services‐related studies are lacking. The present study was a descriptive exploration of time‐trends in treatment modes of patients with free and equal access to health services. Methods: The study was based on a nationwide cohort of patients diagnosed for the first time with AN, each followed for 5 years in the registers covering the years 1994–2018. The per patient number of hospital admissions, cumulated number of days of hospitalization and number of outpatient visits during the first 5 years after initial diagnosis were considered. Results: The cohort of patients with AN with at least 5 years of follow‐up amounted to N = 7,505. A clear trend was observed in the per patient five‐year cumulated number of inpatient days, decreasing by 6% per year after adjustment for age at diagnosis, parental mental diagnosis, and family income. The five‐year number of hospital admissions after initial diagnosis decreased by 2% per year, while no trend was observed for outpatient visits. Conclusions: The per patient number of hospitalizations and cumulated days of hospitalization during 5 years after diagnosis were reduced for patients initially diagnosed with AN while there was no change in the number of outpatient visits. The factors contributing to these changes of treatment modes over time are in need of further study. [ABSTRACT FROM AUTHOR]

Eating disorders are serious and life threatening illnesses that typically present during adolescence. The current recommended treatment for adolescents diagnosed with anorexia nervosa and bulimia nervosa is Family-Based Therapy. Family-Based Therapy is a manualized treatment that empowers parents to temporarily take control of the eating disorder symptoms. However, literature often discusses the role of parents in treatment, yet the reality is that mothers are often tasked with the difficult role of interrupting symptoms for their adolescent, while fathers remain absent or, at best, a support to the mother. By removing the gender from literature, we are failing to examine ways to better support mothers and engage fathers in family-based treatment. Through the use of case studies and limited literature, this paper will examine how these mothering and fathering expectations surface in treatment, how they may be perpetuated by professionals, and the impact that these gendered expectations may have on mothers and fathers. [ABSTRACT FROM AUTHOR]

The transition to parenthood is perceived as a stressful life event, when parents experience an immense change of their psychological focus and a reorientation of roles and responsibilities in the family system. This process may be even more challenging in the presence of a parental eating disorder history. This paper reviews the impact of parental eating disorders on the parents, the couple relationship, and their child during the perinatal period. A parental eating disorder is associated with more negative expectations of parental efficacy as well as specific difficulties in couple communication over the child's feeding, shape, and weight. Providers who better understand the effects of an eating disorder on parental functioning can more effectively intervene early on. We also present couple‐ or parent‐based, empirically supported interventions for adults with eating disorders and their partners in the prenatal and postnatal periods: Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and Uniting couples In the Treatment of Eating disorders (UNITE) both enhance recovery from the eating disorder through a couple‐based intervention; the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) incorporates the support of partners, when appropriate; Parent‐Based Prevention (PBP) focuses on improving parental functioning and reducing risk of negative parental and child outcomes. Finally, we discuss the clinical implications of addressing parental eating disorders and encourage more research on these families. [ABSTRACT FROM AUTHOR]

Manual restraint, a type of physical restraint, is a common practice in inpatient mental health settings linked to adverse physical and psychological staff and patient outcomes. However, little is known about the use of manual restraint for compulsory nasogastric feeding of patients with anorexia nervosa within inpatient eating disorder settings. The present phenomenological study aimed to explore nursing assistants' experiences of administering manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa. The study followed COREQ guidelines. Eight semi‐structured interviews were conducted with eight nursing assistants from one UK inpatient child and adolescent eating disorder service. Interviews were transcribed verbatim and analysed using thematic analysis. Three themes were extracted: An unpleasant practice, importance of coping, and becoming desensitized and sensitized. Nursing assistants commonly experienced emotional distress, physical exhaustion, physical injury and physical aggression as a result of their manual restraint use. Nursing assistants appeared to cope with their distress by talking with colleagues and young persons who were further in their recovery, and by detaching themselves during manual restraint incidents. The findings highlight that the use of manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa in the UK is a highly distressing practice for nursing assistants. It is therefore important that sufficient supervision, support, and training are made available to staff working in these settings. [ABSTRACT FROM AUTHOR]

Delivering Art Psychotherapy online has become a necessary part of practice for many in 2020 due to the Covid-19 Pandemic. Art Psychotherapy practice and theory needs to be considered in light of this new way of working in addition to the impact on clients themselves. This paper considers an experience of delivering online group Art Psychotherapy to adolescents attending an NHS day service programme for Anorexia Nervosa. A case vignette of three group sessions is provided to illustrate the process. The experiences and reflections of three clients are reported. The approach to the art therapy described is psychoanalytical as it focuses on importance of the relationship between the internal and external world and mentalization based as it aims to increase capacity to perceive and understand self and others. It is argued that there are additional considerations for this client group when working online including body image concerns and experience of gaze. Consideration of the unique requirements of this client group are important when devising protocol for ways of delivering art therapy online. Further research could consider, on a larger scale, the perspectives of clients with eating disorders on having art therapy delivered online. This paper describes the set up and delivery of an online Art Psychotherapy group for adolescents with Anorexia Nervosa as part of an NHS day service. The group ran for seven weeks and was attended by three clients. I outline the theoretical framework of my approach to delivering this intervention. Theories of containment, gaze and joint attention are highlighted as being particularly relevant for working with this client group online. I describe the experiences of the clients who attended as well as my process as the art therapist. I note the main themes arising from this group as an intensified experience of gaze, body image concerns and a desire for control over what might be seen or shown. I reflect on my experience of feeling deskilled and having to alter my process to adjust to working online. I conclude that when working with this client group online these are important considerations to bear in mind. Future research is needed to gather perspectives from clients with eating disorders regarding their experience of art therapy being delivered online. [ABSTRACT FROM AUTHOR]

Background: Anorexia nervosa (AN) is a serious mental illness with high rates of relapse and mortality. Psychiatric comorbidities are common but their impact on the prognosis is largely unknown. Objective: The aim was to investigate the influence of psychiatric comorbidity on weight gain during treatment of AN. Methods: A systematic search was performed in PubMed/MEDLINE, EMBASE and PsycINFO. Studies evaluating psychiatric comorbidity as a predictor for treatment outcome (weight gain) were included, however, comorbid alcohol/drug addiction was excluded from this review. Results: Four thousand five hundred and twenty six publications were identified from which 15 were included. The majority of the included studies had a prospective open naturalistic study design, a short‐term follow‐up period, and were based on small populations of primarily adolescent and adult women. Four studies indicate depression, and two obsessiveness as negative prognostic factors, whilst one study indicated moderate depression and yet another, neuroticism, as positive predictors for weight gain. Discussion The systematic scoping review found a large number of publications whereof only a few directly described the influence of psychiatric comorbidity on weight gain in AN. Overall, studies were heterogeneous in design, purpose and outcome making comparisons difficult. Findings were divergent but depression had a negative influence on weight gain in four studies. [ABSTRACT FROM AUTHOR]

Objective: This study assessed longer‐term outcomes from a randomised controlled feasibility trial of 20 sessions of real versus sham high‐frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex in adults with severe, enduring anorexia nervosa (SE‐AN). Methods: Thirty participants who completed the original study protocol were invited to take part in an open follow‐up (18‐months post‐randomisation), assessing body mass index (BMI), eating disorder (ED) symptoms and other psychopathology. Results: Twenty‐four participants (12 each originally allocated to real/sham) completed the 18‐month follow‐up. Ten of 12 participants who originally received sham treatment had real rTMS at some stage during the follow‐up. A medium between‐group effect size was seen for BMI change from baseline to 18‐months, favouring those originally allocated to real rTMS. In this group at 18‐months, five participants were weight recovered (BMI ≥18.5 kg/m2), compared with one participant in the original sham group. Both groups showed further improvement in ED symptoms during the follow‐up. Effects on mood were largely maintained at follow‐up, with catch‐up effects in the original sham group. Conclusions: Findings suggest that rTMS treatment effects on mood are durable and that BMI and ED symptom improvements need time to emerge. Large‐scale trials are needed. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta‐analysis examine the contribution of duration to treatment outcome for eating disorders. Method: Studies (n = 31) were identified that examined associations (r) between duration and 45 different outcomes. We were unable to extract r for seven studies (9 outcomes) and extracted r for 36 outcomes across 24 studies (2,349 participants). Indicators of treatment outcome were heterogeneous and thus a series of different meta‐analyses, aimed at increasing homogeneity, were conducted. Results: First, we examined the average effect size for one primary eating disorder related outcome from each of the 24 studies. There was no association between duration and treatment outcome (r =.05, 95% CI: −.03:.13), with high heterogeneity. Second, we conducted three sub‐group analyses to explore possible sources of heterogeneity (diagnosis: anorexia nervosa versus bulimia nervosa; nature of the outcome: binary versus continuous; or type of outcome: binary indicator of recovery, eating disorder psychopathology, weight gain). There was no significant moderation or associations between duration and outcome (ranging from.02–.08), with low to medium heterogeneity. Third, two stand‐alone analyses examined outcomes related to weight gain (n = 8) and eating disorder psychopathology (n = 5), with nonsignificant rs of.23/−.06, respectively. High levels of heterogeneity were present. Discussion Duration did not influence treatment outcome across any of our meta‐analyses. Increasing homogeneity and power will allow more stable estimates of the impact of duration on outcome to be calculated; to this end, future treatment studies should include outcome related to weight gain (anorexia nervosa) and improvements in eating disorder psychopathology. [ABSTRACT FROM AUTHOR]

Background: Outpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa. Methods: Participants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months. Results: Adherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks. Conclusions: Augmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance. [ABSTRACT FROM AUTHOR]

Objective: Inpatient treatment for patients with anorexia nervosa (AN) is recommended in extreme or severe cases after failure of outpatient treatment and is highly effective. However, a number of patients show symptom increase and relapse after discharge. The aim of this study is to evaluate the efficacy of a therapist‐guided smartphone‐based aftercare intervention for inpatients with AN to support symptom stabilization. Method: A total of 186 female patients with a DSM‐5 diagnosis of AN (307.1) will be randomized either to receive a 16‐week smartphone‐based aftercare intervention with therapist feedback as add‐on to treatment as usual (TAU) or TAU alone. Data will be assessed at discharge (= baseline, T0), after 16 weeks (= end of the aftercare intervention, T1) and after 10 months (= 6‐month follow‐up, T2). Primary outcome will be overall eating disorder symptomatology (Eating Disorder Examination Global score). Secondary outcome measures will include body mass index, depression, motivation to change, self‐efficacy, patient satisfaction with and adherence to the smartphone‐based aftercare intervention as well as rehospitalization rate. Discussion: This study will be the first randomized controlled trial to examine a therapist‐guided smartphone‐based aftercare intervention for inpatients with AN. Results may reveal whether and to which extent this novel intervention can support symptom stabilization after inpatient treatment. [ABSTRACT FROM AUTHOR]

This study examined parents' experiences of family-based interventions for the treatment of adolescents with anorexia nervosa (AN). Nine parents whose child's weight had reached the healthy weight range post-treatment were interviewed about their experiences of parenting a child with AN in either manualised family-based therapy (FBT) (n = 6) or non-manualised family systematic interventions (n = 3). The interviews were analysed using interpretative phenomenological analysis. Findings draw attention to the impact of AN on the whole family, the gatekeeping role of health professionals in accessing support and treatment, the value of externalisation, the prime importance of the therapeutic alliance between parents and clinicians, and the importance of tailoring treatment to the unique circumstances, values, and culture of each family. IMPLICATIONS Practitioners should be alert to the feelings of shock, guilt, and responsibility felt by parents of a child with anorexia nervosa and recognise the challenges faced by parents in accessing treatment and responding to their child's behaviour, alongside the demands of family, work, and other social roles. The quality of the parent–practitioner therapeutic relationship influences parental perceptions of support and of the effectiveness of treatment. Regardless of the treatment model, parents respond well to therapists who express empathy, pay attention to building trust, respect, and activate the family's unique circumstances and values, offer support, explain the nature and purpose of the treatment, and provide feedback. From the parent perspective, practitioners are more effective if they clarify parents' value and belief systems and use these to engage parents with the treatment process. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive behavioral therapy (CBT‐E) in adolescent and adult patients with anorexia nervosa. Methods: A total of 150 consecutive patients (74 adolescents and 81 adults) were admitted to a 20‐week intensive CBT‐E program (13 weeks of inpatient followed by 7 weeks of day‐hospital treatment). All patients had responded poorly to previous outpatient treatments and were assessed at admission, end of treatment (EOT), and 20‐ and 60‐week follow‐ups. Results: About 70% of eligible patients began the program, and more than 85% completed it. Body mass index (BMI) in adults and BMI‐for‐age percentile in adolescents improved significantly from baseline to EOT, remained stable until 20‐week follow‐up, and slightly decreased from 20‐week follow‐up to 60‐week follow‐up, while remaining in the lower normal range. Eating disorder psychopathology, general psychopathology, and clinical impairment scores decreased significantly at EOT and showed only a slight increase from EOT to follow‐ups. No difference was found between adolescent and adult patients in treatment acceptance, dropout, or any outcome measure. Discussion: These findings indicate that intensive CBT‐E seems to be an effective treatment for severely ill adolescent and adult patients with anorexia nervosa. [ABSTRACT FROM AUTHOR]

Background: Although the primary target of treatment for anorexia nervosa (AN) is weight gain, established psychological interventions focus on maintaining factors of AN, and do not specifically address eating behaviours. We have previously reported results of a case series investigating in-vivo food exposure in AN, demonstrating the feasibility and acceptability of this treatment together with evidence of significant clinical change (Cardi, Leppanen, Mataix-Cols, Campbell, & Treasure, 2019). The current study examined the neural circuitry of food-related anxiety.Methods: We examined neural reactivity (fMRI) to food images pre- and post-food exposure therapy (n=16), and compared it to a group of healthy control participants (HC n=21) who were scanned on two occasions.Results: Prior to treatment, the AN group (compared to HC) showed less reactivity in the anterior cingulate cortex (ACC). Following exposure treatment, patients (compared to HC), show increased activity in the dorsolateral prefrontal cortex, decreased activity in the superior parietal lobe and no differences in the ACC. The level of activation of the insula (pre-treatment) predicted the degree of post-treatment reduction in self-reported food anxiety in AN. Changes in food-related anxiety were also associated with changes in neural activation in a cluster located in the middle temporal gyrus/lateral parietal cortex.Limitations: The primary limitations of this work are the small sample size and lack of patient comparison group.Conclusions: Exposure to food in AN may be associated with changes in neural circuitries implicated in emotion regulation and attentional processes. However, these findings need replication in larger and controlled studies. [ABSTRACT FROM AUTHOR]

There is a need for a new perspective on treatment for adolescents and adults with extreme recurring anorexia, underlying prenatal and perinatal trauma, early childhood trauma (or Adverse Childhood Experiences), and complex multi-problems. Current evidence-based therapies are successful with 66% of patients suffering from anorexia with a BMI higher than 17.5. An approach is suggested that regards the eating disorder as a coping strategy for underlying emotional pain. We advocate this approach, which is based on principles like those from CBT, the Self-Determination Theory, and trauma therapy: Past Reality Integration (PRI). The following initial results of a PRI pilot study with 13 clients appear promising. [ABSTRACT FROM AUTHOR]

The purpose of this study was to conduct a longer-term (i.e., 9-month) follow-up of students identified with possible anorexia nervosa (AN) as part of the Healthy Body Image Program, an online platform for screening and delivering tailored feedback and interventions, offered at 36 US universities. Participants were 61 individuals who screened positive for AN and who completed the follow-up. Regarding results, some indices of ED pathology and psychiatric comorbidity decreased over time, while others did not. Participants most commonly endorsed feeling ashamed, nervous, validated, and sad in response to receiving the referral. One-third (33%) reported already being in treatment at the time they received the referral, 26% initiated treatment since that time, and 41% did not initiate treatment. The most common reasons for seeking treatment were emotional distress, concern with eating, and health concerns. The strongest treatment barriers were believing one should be able to help themselves, believing the problem was not serious enough to warrant treatment, and not having time. Findings highlight the high level of pathology in students identified with possible AN, even nine months after they were first identified and provided resources, and the relatively low rates of treatment utilization given the seriousness of these illnesses. [ABSTRACT FROM AUTHOR]

Background: We explored the utility of "staging" anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12‐month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment. Method: We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: "early stage" (illness duration <3 years; n = 60) and "severe and enduring" stage (SE‐AN; n = 41) indicated by distress (Depression Anxiety and Stress Scales, DASS ≥60) and illness duration (≥7 years). Results: At 12 months, patients reported large improvements in body mass index, small to moderate improvements in ED symptoms, mood, and work/social adjustment, and 23.6% met criteria for recovery. However, patients classified as SE‐AN reported higher rates of accessing intensive services, higher ED symptomatology, and poorer work/social adjustment at baseline, and lower rates of improvement in work/social adjustment at 12 months compared to "early stage" respondents. Discussion: Although present findings suggest overall symptomatic improvements, exploratory results highlight marked differences in course and service use between people at different stages of AN, suggesting a need to consider staging for clinical decision‐making. Further research differentiating between clinical subtypes of AN and adoption of a more personalized approach may ensure that services and care pathways better fit patient needs. [ABSTRACT FROM AUTHOR]

Several objectives underlie the current article. First, to review historical diagnostic issues and clinical strategies for treating SE‐AN. Second, to provide an overview of recent evidence informed strategies and clinical innovations for the treatment of SE‐AN. Third, based on the authors' collective clinical and research experience, we offer eight observations that we believe capture the current clinical experience of patients with SE‐AN. Some of these observations represent empirically testable hypotheses, but all are designed to generate a meaningful discussion about the treatment of this group of individuals with eating disorders. Finally, we hope to call clinicians, scientists, professional organizations, advocates, and policy makers to action to attend to critical issues related to the care of individuals with SE‐AN. We believe that an international discussion could clarify areas of need for these patients and identify opportunities for clinical innovation that would enhance the lives of individuals with SE‐AN and their families. [ABSTRACT FROM AUTHOR]

Objective: This study assesses the impact of a clinical refeeding guideline on weight restoration, length of stay, rate of refeeding complications, and rehospitalizations.Method: This retrospective study included patient records of 107 participants aged 13-55 years with a diagnosis of AN, admitted for at least 7 days for renutrition before and after introduction of the refeeding guideline. Weight evolution graphs were rated by 2 clinical experts independently. Binary logistic regression models were erected to identify clinical outcomes associated independently with the guideline as well as to control for potential confounding by sociodemographic and clinical characteristics at admission.Results: The proportion of patients achieving optimal weight gain after the first 2 weeks increased significantly from 6.3% pre-guideline to 41.8% post guideline (adjusted odds ratio [AOR] = 37.6; 95% confidence interval [CI], 2.77-510.3; P = 0.006). Average length of hospitalization was reduced from 96.7 (SD 48.3) days pre-guideline to 62.2 (SD 45.5) days post guideline (AOR = 0.99; 95% CI, 0.97-1.01; P = 0.18). None of the patients developed a full refeeding syndrome. There was no significant change in the rate of rehospitalization: 48.5% pre-guideline to 43.2% post guideline (OR = 0.81; 95% CI, 0.36-1.84; P = 0.62).Discussion: The clinical guideline proved highly effective in bolstering weight gain via intensive refeeding procedures while also being safe. Harmonizing clinical practices improves quality of care for patients with anorexia and, interestingly, may decrease costs by cutting average length of stay by a third without increasing the rehospitalization rate. [ABSTRACT FROM AUTHOR]

The necessity to employ distance‐based methods to deliver on‐going eating disorder care due to the novel coronavirus (COVID‐19) pandemic represents a dramatic and urgent shift in treatment delivery. Yet, TeleHealth treatments for eating disorders in youth have not been adequately researched or rigorously tested. Based on clinical experience within our clinic and research programs, we aim to highlight the common challenges clinicians may encounter in providing family‐based treatment (FBT) via TeleHealth for children and adolescents with anorexia nervosa and bulimia nervosa. We also discuss possible solutions and offer practical considerations for providers delivering FBT in this format. Additional research in TeleHealth treatment for eating disorders in youth may lead to improved access, efficiency, and effectiveness of FBT delivered via videoconferencing. [ABSTRACT FROM AUTHOR]

Background: Guideline-recommended therapies are moderately successful in the treatment of obsessive-compulsive disorder (OCD) and anorexia nervosa (AN), leaving room for improvement. Cognitive inflexibility, a common trait in both disorders, is likely to prevent patients from engaging in treatment and from fully benefiting from existing therapies. Cognitive remediation therapy (CRT) is a practical augmentation intervention aimed at ameliorating this impairing cognitive style prior to disorder-specific therapy.Objective: To compare the effectiveness of CRT and a control treatment that was not aimed at enhancing flexibility, named specialized attention therapy (SAT), as add-ons to treatment as usual (TAU).Methods: In a randomized controlled multicenter clinical trial, 71 adult patients with OCD and 61 with AN were randomized to ten twice-weekly sessions with either CRT or SAT, followed by TAU. Patients were evaluated at baseline, post-CRT/SAT, and after 6 and 12 months, with outcomes being quantified using the Yale-Brown Obsessive Compulsive Scale for OCD and the Eating Disorder Examination Questionnaire for AN.Results: Across study groups, most importantly CRT+TAU was not superior to control treatment (SAT)+TAU in reducing OCD and AN pathology. Contrary to expectations, SAT+TAU may have been more effective than CRT+TAU in patients being treated for OCD.Conclusions: CRT did not enhance the effect of TAU for OCD and AN more than SAT. Unexpectedly, SAT, the control condition, may have had an augmentation effect on TAU in OCD patients. Although this latter finding may have been due to chance, the effect of SAT delivered as a pretreatment add-on intervention for adults with OCD and AN merits future efforts at replication. [ABSTRACT FROM AUTHOR]

Objective: The value of weight suppression (WS) in predicting the course of anorexia nervosa (AN) is uncertain. The objective of this study was to determine, using data from a previously published study, whether patients who remain weight suppressed following restoration to a minimally normal weight are at greater risk for relapse. Method: Following weight restoration, 93 women with AN were randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy for 1 year. WS (highest adult weight minus current weight), body mass index (BMI), and their interaction were assessed as predictors of change in weight over the first 28 days, of successful weight maintenance at 6 and 12 months, and of time to relapse. Results: Neither WS nor its interaction with BMI predicted successful weight maintenance at 6 and 12 months, time to relapse, or weight change over the first 28 days following discharge. Discussion This study found that WS does not substantially impact the likelihood of successful weight maintenance or time to relapse following restoration to a minimally normal weight in AN. [ABSTRACT FROM AUTHOR]

Objective: Previous research has found increasing evidence for difficulties in emotion recognition ability (ERA) and social cognition in anorexia nervosa (AN), and recent models consider these factors to contribute to the development and maintenance of the disorder. However, there is a lack of experimental studies testing this hypothesis. Therefore, the present proof‐of‐concept study examined whether ERA can be improved by a single session of a computerized training in AN, and whether this has short‐term effects on eating disorder symptoms. Method: Forty inpatients (22.20 ± 7.15 years) with AN were randomly assigned to receive a single session of computerized training of ERA (TERA) or a sham training (training the recognition of different types of clouds). ERA, self‐reported eating disorder symptoms, and body mass index (BMI) were assessed within 3 days before and after training. Results: After training, both groups showed improved ERA, reduced self‐reported eating disorder symptoms, and an increased BMI. As compared to patients in the control group, patients who received TERA showed greater improvements in ERA and self‐reported eating disorder symptoms. Discussion: ERA can be effectively trained in patients with AN. Moreover, short‐term improvements in self‐reported eating disorder symptoms provide tentative support for the hypothesis that difficulties in ERA contribute to the maintenance of AN, and that specific trainings of ERA hold promise as an additional component in AN treatment. Future studies are needed to replicate these findings in larger samples, and to investigate long‐term effects and transfer into real‐world settings. [ABSTRACT FROM AUTHOR]

Objective: Rates of psychiatric comorbidity are elevated in adolescents with anorexia nervosa, but little is known about how psychiatric comorbidity changes following family‐based treatment (FBT). Methods: Adolescents with anorexia nervosa (N = 107) enrolled in a randomized controlled trial comparing two forms of FBT completed the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline and end of treatment. Analyses tested whether baseline comorbid diagnoses predicted the presence of comorbid diagnoses at end of treatment and if baseline eating disorder psychopathology impacted this association. Results: Rates of comorbid diagnoses decreased from 54% at baseline to 26% at end of treatment. Logistic regression analyses indicated that individuals with multiple comorbid diagnoses at baseline were more likely to meet criteria for a comorbid condition at end of treatment (b = 2.00, p <.05). Individuals with reported psychotropic medication use were less likely to meet criteria for a comorbid condition at end of treatment (b = −1.63, p =.04). Diagnostic rates for major depressive disorder, generalized anxiety disorder, and panic disorder/agoraphobia decreased following FBT. Conclusions: Findings suggest that FBT for adolescent anorexia nervosa may aid in the resolution of some co‐occurring psychiatric diagnoses. Continued research is needed to understand factors contributing to comorbid symptom improvement throughout treatment. [ABSTRACT FROM AUTHOR]

Objective: Birth outcomes of women with anorexia nervosa are poorly understood. We hypothesized that hospitalization for anorexia nervosa before or during pregnancy is associated with an elevated risk of adverse maternal and infant birth outcomes. Method: We performed a retrospective cohort study of 2,134,945 pregnancies in Quebec, Canada, from 1989 to 2016. The main exposure measure was anorexia nervosa requiring hospital treatment before or during pregnancy. Outcome measures included stillbirth, preterm birth, low birth weight, small‐for‐gestational age birth, preeclampsia, gestational diabetes, cesarean delivery, and other pregnancy disorders. We computed risk ratios and 95% confidence intervals (CI) for the association between anorexia nervosa and birth outcomes adjusted for maternal characteristics. Results: Compared with no hospitalization, anorexia nervosa hospitalization was associated with 1.99 times the risk of stillbirth (95% CI 1.20–3.30), 1.32 times the risk of preterm birth (95% CI 1.13–1.55), 1.69 times the risk of low birth weight (95% CI 1.44–1.99), and 1.52 times the risk of small‐for‐gestational age birth (95% CI 1.35–1.72). The associations with low birth weight and small‐for‐gestational age birth were more prominent in women hospitalized for anorexia nervosa during pregnancy or within 2 years of delivery. Hospitalization for anorexia nervosa was associated with certain maternal outcomes, including precipitate labor, acute liver failure, and admission to an intensive care unit. Discussion: Hospitalization for anorexia nervosa before or during pregnancy is associated with adverse infant and maternal outcomes. Infants are primarily at risk of stillbirth, preterm birth, low birth weight, and small‐for‐gestational age birth. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess and compare eating disorder feature networks in adult and adolescent patients with anorexia nervosa. Methods: Patients seeking treatment for anorexia nervosa in inpatient and outpatient settings were consecutively recruited from January 2008 to September 2019. Body mass index was measured, and each patient completed the Eating Disorder Examination Questionnaire. Results: The sample comprised 547 adolescent and 724 adult patients with anorexia nervosa. Network analysis showed that in both adults and adolescents, the most central and highly interconnected nodes in the network were related to shape overvaluation and desiring weight loss. The network comparison test identified similar global strength and network invariance, confirming the similarity of the two network structures. Discussion: The network structures in adult and adolescent patients with anorexia nervosa are similar, and lend weight to the cognitive behavioral theory that overvaluation of shape and weight is the core feature of anorexia nervosa psychopathology. [ABSTRACT FROM AUTHOR]

Objective: Peer mentorship has been shown to be helpful for other mental health conditions, but it has been understudied for patients with eating disorders. The goal of the present study was to evaluate the feasibility and efficacy of peer mentorship for individuals with eating disorders by conducting a randomized controlled trial (RCT). Trial Design: Parallel three‐arm pilot RCT with 1:1:1 allocation to peer mentorship, social support mentorship (active comparison intervention), and waiting list. Method: Sixty outpatients with anorexia nervosa (AN), bulimia nervosa (BN), or binge‐eating disorder (BED) were randomly assigned to a condition. Outcome measures, including eating disorder symptoms and general psychopathology, were completed at baseline, mid‐, and postintervention. Results: Session attendance and acceptability ratings were higher in peer mentorship than social support mentorship. More participants in social support mentorship (39%) dropped out compared to peer mentorship (5%). In intent‐to‐treat analysis, peer mentorship showed greater reductions in body dissatisfaction and anxiety compared with both control groups. Compared with social support mentorship, peer mentorship had greater reductions in depression. Compared with waiting list, peer mentorship had greater reduction in binge eating days/week in patients with BN/BED and restriction days/week in patients with AN. Peer mentorship did not impact body mass index or reentry into higher level of care. Discussion This pilot RCT provides preliminary evidence that peer mentorship is effective for some cognitive and behavioral symptoms of eating disorders as an adjunct to outpatient treatment. Additional studies are needed to evaluate the efficacy of peer mentorship in absence of treatment. [ABSTRACT FROM AUTHOR]

Objective: In the general population, body weight is—on average—higher in the winter than in the summer. In patients with anorexia nervosa (AN), however, the opposite pattern has been reported. Yet, only a handful of studies exist to date that suffer from small sample sizes and inconsistent results. Therefore, the current study examined seasonal effects on body weight in a large sample of patients with AN to dissolve previous inconsistencies. Method: Clinical records of N = 606 inpatients (95.4% female) who received AN treatment at the Schoen Clinic Roseneck (Prien am Chiemsee, Germany) between 2014 and 2019 were analyzed. Results: Patients with restrictive type AN had lower body mass index at admission in the winter than in the summer. This difference was not found for patients with binge/purge type AN and patients with atypical AN. Discussion: Individuals with restrictive type AN show seasonal variations in body weight that are opposite to seasonal variations in body weight in individuals without AN. These seasonal effects are specific to the restrictive subtype and cannot be found for the binge/purge or atypical subtypes. Future studies that replicate this effect in other cultures or latitudes and that examine the mediating mechanisms are needed. [ABSTRACT FROM AUTHOR]

Objective: Gastrointestinal (GI) symptoms appear frequently in patients with anorexia nervosa (AN), but the associations between psychopathological, GI, and eating disorder (ED) symptoms remain unclear. This study aimed to determine the relationships of GI complaints with psychopathological measures, ED symptoms, and body mass index (BMI) in patients with AN. Method: Thirty outpatients with AN aged >16 years were included. Psychopathological measures (Symptom Checklist‐90‐Revised, Beck Depression Inventory‐II, and Beck Anxiety Inventory), ED symptoms (Eating Disorder Examination Questionnaire), ED‐associated impairment (Clinical Impairment Assessment Questionnaire), GI complaints (Irritable Bowel Syndrome Severity Scoring System [IBS‐SSS]), and BMI were assessed prior to starting treatment, and correlation and multiple regression analyses were applied to data from 19 patients. Results: IBS‐symptoms were significantly correlated only with ED symptoms (r = 0.583, p =.009) and somatization (r = 0.666, p =.002). Multiple regression analysis revealed that somatization significantly predicted worse IBS symptoms (beta = 0.5, p =.04), while ED symptoms did not. Discussion Higher IBS‐SSS scores were associated with higher severities of other somatic complaints. GI complaints and somatization should be addressed in treatments for AN in order to prevent these factors impeding the establishment of healthy eating patterns. Clinical trial registration: ClinicalTrials.gov Identifier: NCT02745067. [ABSTRACT FROM AUTHOR]

Objective: The Canadian Eating Disorder Priority Setting Partnership was established to identify and prioritize the top 10 research priorities for females, 15 years or older, with anorexia nervosa, by incorporating equal input from those with lived experience, families, and healthcare professionals. Method: This project, which closely followed the James Lind Alliance guidelines, solicited research priorities from the Canadian eating disorder community by means of a five‐step process including use of a survey, response collation, literature checking, interim ranking survey, and in‐person prioritization workshop. Results: The initial survey elicited 897 priorities from 147 individuals, with almost equal representation from all three stakeholder groups. From this, 603 responses aligned with the project objectives and were collapsed into 71 broader indicative questions. Based on available systematic reviews, 18 indicative questions were removed as they were considered answered by existing literature while 8 indicative questions were added from the recommendations of the reviews. In total, 61 indicative questions were ranked in an interim ranking survey, where 21 questions were prioritized as important by at least 20% of respondents. As a final step, 28 individuals from across Canada attended the prioritization workshop to coestablish the top 10 research priorities. Discussion: Top priorities were related to treatment gaps and the need for more surveillance data. This systematic methodology allowed for a transparent and collaborative approach to identifying current priorities from both the service user and provider perspective. Wide dissemination is anticipated to promote work that is of high relevance to patients, families, and clinicians. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to identify the comparison with the different methods of acupressure treatment in breast cancer patients undergoing chemotherapy. Methods: This study was a single group pretest-posttest design. Thirty patients age 30- 65 scheduled for chemotherapy were included. The data were collected through self- reported questionnaires on nausea, vomiting, and anorexia and analyzed using descriptive statistics and the Wilcoxon signed ranked test. Results: The relieving effect of nausea and vomiting (Z=-2.54, p=.011) was significant in P6 acupressure by wrist bands. Conclusion: Patients undergoing chemotherapy have relieving effects on nausea and vomiting after P6 acupressure by wrist band. This study demonstrates the stimulation of the P6 acupressure by wrist band for reducing nausea and vomiting for breast cancer patients undergoing chemotherapy. [ABSTRACT FROM AUTHOR]

Objective: Improved treatment outcome in family‐based treatment (FBT) for anorexia nervosa (AN) is predicted by weight gain occurring early in the course of treatment (i.e., about 4 lbs by week 4). Although prior work suggests that early weight gain in higher levels of care (e.g., partial hospitalization programs [PHP]) predicts weight restoration at discharge, no study has examined the specific rate of gain within FBT‐informed PHP programs that best predicts treatment response. Method: This study examined rate of weight gain in pounds and percent expected body weight (EBW) that predicts positive outcome in 70 patients (M age = 15.49 years, SD = 2.56) with AN who were enrolled in a family‐based PHP. Results: Receiver operator characteristic analyses demonstrated that changes in %EBW during weeks 2–5 were more useful than changes in weight in predicting positive outcome. Gaining at least 8.9 pounds or over 8% of EBW in the first 4 weeks of treatment significantly predicted positive outcome. Discussion Findings suggest that positive outcome in an FBT‐informed PHP is predicted by rapid weight gain in the initial weeks of treatment. Research is needed to identify specific family and patient characteristics that facilitate weight gain and to develop corresponding interventions to improve outcome. [ABSTRACT FROM AUTHOR]

This study illuminates how 25 in-patients who were treated for anorexia nervosa in a highly specialized clinic for eating disturbances in Sweden experienced the treatment program. The program included structured eating, medication, restrictions in physical activity and supportive dialogues. Patients were also offered semi-standardized NADA ear acupuncture as a complement to relieve stress, anxiety and tension. In total, 46 interviews were analysed qualitatively using latent content analysis. The results showed how participants strived with their slow transition towards recovery. The novelty of integrating acupuncture in psychiatric treatment makes this study interesting. Acupuncture was experienced to relieve anxiety and somatic symptoms through the whole process. Further research is needed to evaluate the effect of acupuncture on the patient's subjective sense of well-being when used as an adjunct to usual care. [ABSTRACT FROM AUTHOR]

A 16-year-old was brought to a pediatrician's office by her parents for evaluation. She was visiting the doctor reluctantly and said that she had no health concerns. However, her parents reported that for 5 months she had been eating a highly restrictive diet consisting mainly of vegetables and small amounts of chicken or turkey, had declined to increase her food intake, and was progressively losing weight. On examination, her body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) was 17.5 (weight, 108 lb [49 kg], and height, 5 ft 7 in. [170 cm]). Her blood pressure while sitting was 100/78 mm Hg, which decreased to 78/60 mm Hg after she stood for 3 minutes. Her resting pulse was 46 beats per minute. Her skin was dry, and her hair was thinning at her scalp. An examination of her oral cavity revealed extensive erosion of the dental enamel. How would you further evaluate and treat this patient? [ABSTRACT FROM AUTHOR]