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This article explores the family consultations during the inpatient treatment of children and adolescents with anorexia nervosa. There were three study goals: to explore the therapeutic team's interventions, to study the team's perception of parental reactions toward the interventions, and to compare two groups of parents. Medical records of 32 were analyzed using Consensual Qualitative Research. There were eight categories of interventions discussed. Parents with better cooperation were more concentrated on their personal experiences (p = 0.005), whereas parents with poorer cooperation had more work on marital conflict (p = 0.004). Bereavement also appeared to be a particularly important theme. [ABSTRACT FROM AUTHOR]

Objective: Motivation to change is an important predictor for treatment outcomes in individuals with anorexia nervosa (AN), however, the existence and clinical relevance of distinct motivational dimensions are understudied. This study aimed to structurally validate the AN Stage of Change Questionnaire (ANSOCQ) in the Italian adult AN population to identify separate motivational dimensions and their association with clinical variables and outcomes. Method: Inpatients and outpatients with AN (N = 300) completed the ANSOCQ and measures assessing eating and depressive psychopathology. Unique Variable Analysis and Exploratory Graph Analysis were employed to identify dimensions in the network structure of ANSOCQ. Cross‐sectional associations with clinical variables were assessed in the whole sample. Predictive value on weight and psychopathology was assessed in inpatients. Results: Two dimensions were identified, one comprising items relative to weight gain, and the second items regarding attitudes towards eating, body, and emotional problems. Feelings associated with eating resulted as most central in the network. Higher scores in the first dimension and ANSOCQ total predicted weight gain during hospitalisation. No significant predictors emerged for changes in eating psychopathology. Discussion: These findings confirm the robust psychometric properties of ANSOCQ and provide support for the use of its subdimensions in clinical practice. Highlights: Motivation to change is an important predictor of clinical improvement in individuals with anorexia nervosa (AN). The AN Stages of Change is a reliable tool for assessing motivation, and valuable clinical information can be obtained from its structure.In this study, we utilise an innovative method based on network analysis to assess motivational dimensions and their associations with weight gain and psychopathology in the Italian population.Two main dimensions emerged, one pertaining to weight gain and significantly associated to inpatient weight increase, and the second regarding attitudes towards eating, body, and emotional problems. The application of network analysis to motivation to change introduces a novel and potentially valuable model for future investigations. [ABSTRACT FROM AUTHOR]

Objective: An increasing demand for inpatient treatment for adolescents with anorexia nervosa (AN) during and after the Covid‐19 pandemic contrasts with limited capacity and long waiting times. The current pilot study evaluated an outpatient group therapy (GT) as early intervention for adolescents with AN prior to inpatient treatment. Methods: Seventeen female adolescents who participated at the GT (intervention group, INT) were compared to 16 adolescents without GT (treatment‐as‐usual, TAU). BMI, eating disorder psychopathology and motivation of change (MoC) were assessed at three timepoints. Results: Comparing pre‐ versus post‐ group participation, we identified a significant increase of MoC and a trend towards a decreased AN‐specific psychopathology. Comparing INT with TAU adolescents, we found a significant lower AN psychopathology at inpatient admission for the INT group and a trend for different BMI courses: While the BMI of the TAU group decreased during waiting time, the INT group did not show a decrease during GT resulting in a higher BMI at admission. Conclusions: Results of the current pilot study suggest positive effects of an early outpatient intervention in a group setting for adolescents with AN prior to inpatient treatment. Further research with larger sample sizes is necessary to validate the current pilot results. Highlights: Outpatient group therapy (GT) for adolescents with anorexia nervosa (AN) prior to inpatient treatment represents an early intervention and may improve the starting conditions of inpatient treatment.Motivation to change improves while participating in an outpatient GT prior to inpatient treatment for adolescents with AN.Adolescents with AN participating in GT show less weight loss from first outpatient contact to inpatient admission compared to TAU adolescents. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate longitudinal changes in set‐shifting and central coherence in a predominantly adolescent cohort with anorexia nervosa (AN) and to explore whether these factors predict long‐term eating disorder outcomes. Method: Ninety‐two female patients with AN (mean age: 16.2, range: 13–21 years) completed neurocognitive tests (Rey Complex Figure Test, Adapted Version of the Wisconsin Card Sorting Test) before and after 12 months of psychotherapeutic treatment (n = 45 Maudsley AN Treatment, MANTRa; n = 47 standard psychotherapy; groups not randomised). Eating disorder severity was assessed at baseline, after 6, 12 and 18 months. Results: Central coherence (indicated by an increase in the Rey Figure Style Index) and set‐shifting (indicated by a reduction in the percentage of perseverative errors) significantly improved over the course of treatment, with similar outcomes across groups. Lower central coherence was associated with higher eating disorder severity. Individuals with lower baseline set‐shifting ability tended to have worse eating disorder outcomes in the long‐term. However, this trend did not reach statistical significance in a multilevel linear mixed model. Conclusions: Neurocognitive difficulties in adolescents and young adults with AN can improve after treatment. Interventions specifically addressing flexibility in thinking and behaviour may contribute to treatment success. Highlights: Central coherence and set‐shifting significantly improved over the course of treatment, with similar outcomes across groups (MANTRa treatment vs. standard psychotherapy).Lower central coherence was associated with higher eating disorder severity.There was a trend towards lower set‐shifting being associated with worse eating disorder outcomes in the long‐term, indicating that interventions addressing cognitive flexibility may contribute to treatment success. [ABSTRACT FROM AUTHOR]

Purpose: The transition period from eating disorder inpatient (IP) care to outpatient care can be difficult for patients and is often characterised by high relapse rates. This study aims to co-develop a novel treatment pathway to support patients during this critical period. Design/methodology/approach: This was a mixed-methods case study using co-production methodology and a nested qualitative component. The authors co-developed an initial proposed pathway structure with clinicians and people with lived experience of an eating disorder, based on a review of the literature. They then conducted interviews with clinicians and patients (n = 8) to refine the pathway; these were analysed using framework analysis. Findings: A four-component pathway structure was developed. Six main themes emerged from this qualitative analysis: autonomy, the need for holistic patient care, difficult experiences, service provision, relationships and feedback on the discharge pathway. Practical implications: This study highlighted the importance of centring patient autonomy during treatment, as well as ensuring treatments are holistic in nature. This may reduce the high levels of relapse associated with discharge from IP treatment and improve the quality and effectiveness of eating disorder treatment delivered. Originality/value: Co-production approaches were used to develop the IP discharge pathway with members of a Lived Experience Advisory Panel alongside clinicians. To the best of the authors' knowledge, this study was also the first intervention development study aimed at providing targeted support for patients dealing with the adverse effects of hospitalisation and difficulties transitioning to outpatient care. [ABSTRACT FROM AUTHOR]

Early weight gain is a primary goal in the treatment of anorexia nervosa (AN) and associated with more favorable discharge weights and clinical outcomes. Activity urges, that is, a motivational state to engage in activity, have been suspected to delay early weight gain, but their prognostic role remains barely explored. Here, we investigated whether acute (state‐like) activity urges at treatment onset would predict within‐person weight gain in patients with AN during the initial 2 weeks of inpatient treatment. Adults with AN from an inpatient unit (N = 53) completed an activity urges measure at treatment onset, and weight changes were monitored for the duration of their treatment. Regression analyses, controlling for admission body mass index and other patient variables (i.e., patient age and AN subtype), found that higher state activity urges were associated with lower initial weight gain. Mediation analyses showed that differences in early weight changes further linked higher activity urges at admission to lower discharge weights. An activity urge cutoff value of 2.76 for distinguishing between cases with optimal and suboptimal initial weight gain is proposed. We discuss potential mechanisms of the link between activity urges and early weight gain and the implications of activity urges as a prognostic factor for improving weight restoration during AN treatment. [ABSTRACT FROM AUTHOR]

Objective: Assessment of the longer‐term outcome of anorexia nervosa (AN) in female adolescent inpatients (N = 132). Method: A follow‐up (mean 8.2 years) after treatment was conducted. A subsample of 39 patients with at least 10 years of follow‐up (mean 14 years) was defined. Results: Over the 8‐year follow‐up period, the body mass index (BMI) increased from 14.33 (1.65) to 19.04 kg/m2 (2.97; t[112] = 17.33, p < 0.001, d = 1.63), and BMI percentiles increased from 0.50 (1.14) to 24.96 (26.81; t[112] = 9.83, p < 0.001, d = 0.92). Remission was found in 32.5% (8‐year total sample) and 48.6% (14‐year subsample). In the 8‐year total sample, 15.1% still had AN or had relapsed (8.1% in the 14‐year subsample). A cross‐over from AN to binge‐eating disorder was rare. The main cross‐over occurred from AN to an eating disorder not otherwise specified (37.5% and 27.0%, respectively). The standardized mortality ratio was 21.7. Discussion: In the long run, eating disorder diagnoses decreased significantly. Although a considerable proportion of patients recovered from their eating disorder, the number of recovered patients remained limited, with long‐term negative consequences in a large proportion of patients. Standardized mortality was excessive, calling for ever‐better therapies. Additional studies are needed to show if improved therapies lead to a better long‐term outcome. [ABSTRACT FROM AUTHOR]

Background: Determining an accurate treatment goal weight (TGW) is critical for treating eating disorders requiring weight restoration. This is challenging in adolescents since body mass index (BMI) normally increases over time. Median BMI (mBMI) is often used to determine TGW, though use of historical growth trajectories is increasingly common. Using the appropriate method to set TGW may be particularly important in treating individuals with anorexia nervosa (AN) whose prior growth was substantially above or below the median, and in atypical anorexia (AAN) where prior growth is, by definition, above the median. Objectives: (1) Compare differences between TGWs based on mBMI and historical BMI percentile (hBMI) in patients with AN and AAN. (2) Determine whether either TGW method better predicted scores on the Eating Disorder Examination (EDE), heart rate, and menstrual status during treatment. Method: Retrospective chart review of 197 adolescents with AN or AAN completing a partial hospitalization program (PHP). Results: For AN, the within‐person variation between methods varied up to 11.3 kg, though the average TGW was similar if derived from the mBMI or hBMI. In AAN, the average hBMI TGW was higher than mBMI TGW, and within‐person variation was up to 19.3 kg. Associations between hBMI TGW and mBMI with heart rate, menstrual status, and EDE scores varied. Discussion: Within‐person differences in TGWs derived from hBMI versus mBMI can be large, with prominent differences in AAN, where hBMI TGW is significantly higher. [ABSTRACT FROM AUTHOR]

Background: Temperament Based Therapy with Support (TBT‐S) is an emerging intervention based on empirically supported neurobiological models. Due to its novelty, only a handful of studies to date have examined TBT‐S, and none of these previous studies have provided a qualitative evaluation of how TBT‐S is perceived by the target population. Therefore, the aim of the current study was to provide an increased understanding of how TBT‐S is experienced by patients with an eating disorder and their supports. Method: Forty‐six patients with an eating disorder and 63 supports consented to be included in the study. The participants provided written responses to six open‐ended questions during the post‐treatment assessment, detailing their treatment experiences and offering additional feedback. Thematic analysis (TA) was used to analyze their written responses, aiming for a combination of latent and semantic themes. Results: The results reveal a substantial overlap between patients' and supports' experiences with TBT‐S. In both groups, identified themes suggest increased knowledge and hopefulness as key benefits of the intervention. While both patients and support persons considered TBT‐S to be worthwhile, patients also reported finding the intervention quite challenging. Additionally, both groups emphasized the neurobiological rationale as an essential component of TBT‐S. Conclusions: The qualitative evaluations from this study offer new insights into how TBT‐S is experienced by the target population. The findings provide an opportunity to incorporate participant suggestions for improving the treatment, and serve as an important building block for future studies aimed at assessing the effectiveness of TBT‐S as an augmentation to treatment‐as‐usual. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) are a group of serious, potentially life-threatening illnesses that typically have their onset during adolescence and can be associated with severe medical and psychosocial complications. The impact of EDs on caregivers and other family members can also be significant. Health care providers (HCPs) play an important role in the screening and management of adolescents and young adults with EDs. This position statement assists community-based HCPs with recognizing, diagnosing, and treating EDs in the paediatric population. Screening modalities, indications for hospitalization, medical complications, and monitoring of young people with EDs are summarized. Current evidence supports the use of family-based treatment (FBT) as the first-line psychological therapeutic modality for adolescents with restrictive EDs. While the provision of FBT may be beyond the scope of practice for some community physicians, this statement reviews its core tenets. When an ED is diagnosed, early application of these principles in the community setting by HCPs may slow disease progression and provide guidance to families. [ABSTRACT FROM AUTHOR]

Eating disorders represent a disabling, deadly and costly condition, whose principal treatment is constituted by weigh restoration and psychotherapy. Partial or total refuse of treatment is very common, leading some authors to question their decision-making capacity (DMC) to consent to treatment. However, very few studies have investigated treatment DMC, leading to contrasting results. Forty-five women were enrolled at the Psychiatric and Eating Disorders Unit of the University Hospital Policlinico Umberto I of Rome. Psychiatric symptoms severity (Brief Psychiatric Rating Scale Expanded, BPRS-E), treatment DMC (MacArthur Competence Assessment Tool for Treatment, MacCAT-T), depressive symptoms (Hamilton Depression Rating Scale, HAM-D), anxiety symptoms (Hamilton Anxiety Rating Scale, HAM-A), symptoms and psychological characteristics of eating disorders (Eating Disorder Inventory, EDI-3) and Metacognitive beliefs (Metacognitions Questionnaire 30, MCQ-30) were assessed. Sixty-seven percent of the total sample showed low treatment DMC; specifically, 70.4% of patients affected by Anorexia Nervosa, 72.7% of patients affected by Bulimia Nervosa, and 42.9% of patients affected by Binge Eating Disorder. Specific psychopathological symptoms enhance or hamper patients' decisional capacities. Clinicians should be aware of the risk of impaired DMC in this vulnerable group of patients and pay attention at those factors suggesting the need of an in-depth evaluation. [ABSTRACT FROM AUTHOR]

Multi‐family therapy for children and adolescents with anorexia nervosa (MFT‐AN) draws on the same principles as family therapy for AN (FT‐AN), but is delivered in a more intensive format to help families overcome a sense of isolation and stigmatisation and to maximise their own resources. In Japan, the main treatment for AN is inpatient care, and family‐based treatment that is based on the practice at the Maudsley Hospital in the 1980s has started to be introduced at an inpatient level in Japan. MFT‐AN could offer more opportunities to practice managing AN symptoms and reduce the family's anxiety. It may also act as a step‐down intervention during transition from inpatient to outpatient care or a step‐up in intensity if outpatient treatment is stalling. This article reports on MFT‐AN's theoretical underpinnings, the current Japanese eating disorder treatment context, and the way MFT‐AN may be adapted for the unique Japanese socio‐cultural context. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders (EDs) represent a major public health burden. Increasingly, studies suggest mental health (MH) fields are failing to improve the effectiveness of treatments and that alternative models of care must be considered. Precision mental health (PMH) seeks to tailor treatment to individual needs and relies on a comprehensive understanding of the neurobiological and physiological underpinnings of mental illness. Methods: In this narrative review, published literature with focus on biological application of PMH strategies for EDs is reviewed and summarised. Results: A total of 39 articles were retained for the review covering a variety of themes with relevance to PMH. Many studies of biological markers with PMH applicability focused on anorexia nervosa. Although a variety of potential PMH research applications were identified, the review failed to identify any evidence of implementation into routine ED practice. Conclusions: Despite the theoretical merit of biological application of PMH in ED treatment, clinical applications for standard practice are lacking. There is a need to invest further in studies that seek to identify biological markers and investigate neurobiological underpinnings of disease in hopes of targeting and developing treatments that can be better tailored to the individualised needs of patients. Highlights: Despite the theoretical merit of biological application of precision mental health (PMH) in eating disorder (ED) treatments, clinical applications for standard practice are lacking.The majority of identified studies with PMH application in EDs involved patients with anorexia nervosa.There is a need to invest further in studies that seek to identify biological markers and investigate neurobiological underpinnings of disease in hopes of targeting and developing PMH treatments that can be better tailored to the individualised needs of patients. [ABSTRACT FROM AUTHOR]

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]

The incidence of eating disorders in children, mainly of anorexia nervosa, is dramatically increased in the last years. A timely identification of the disease is associated with higher rates of recovery. Aim of the work is to underline signs and symptoms that can be used to an early detection of anorexia nervosa in the pediatric age. A scoping review has been conducted by The Italian Pediatric Society Adolescent Study Group according to the PRISMA Extension guidelines for Scoping Reviews, using the search term "anorexia nervosa" and the following filters "review", "systematic review", "age 0–18", "last 4 years". The strategy search produced 657 studies, of which 52 were included in this revision. Screening and red flags were discussed in 23 reports, genetics in 12, neurological pathways in 11, environmental factors in 10, and gut microbiota in 7. An accurate physiological and pathological anamnesis, physical and psychological examination, including the body perception, should be taken in account as well as the presence of co-morbidities, including chronic functional abdominal pain and autoimmune/autoinflammatory diseases. Evidence suggests the role of familiar predisposition as well as of neurological morphology and pathway in anorexia nervosa development. Gut microbiota has also been included among possible risk factor for developing anorexia nervosa due to a complex direct and indirect interactions between gut and brain. The Italian Pediatric Society Adolescent Study Group suggests performing an accurate familial and personal anamnesis, including psychological evaluation as well as a physical exam including auxological parameters as a screening tool during pediatric checks to better explore the risk of developing anorexia nervosa. [ABSTRACT FROM AUTHOR]

Whether anorexic patients should be able to refuse treatment when this refusal potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of "terminal anorexia" suggests criteria when a move to palliative care or even physician-assisted suicide might be justified. The author argues that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision-making capacity. It should therefore be rejected. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to report the effectiveness of family based treatment and pharmacotherapy on an adolescent boy with anorexia nervosa and intellectual disability. Design/methodology/approach: The authors reported the case of a 16-year-old boy with AN and ID and referred him to a family therapist and psychiatrist in Tehran. Findings: The patient experienced fatigue, weakness, dissatisfaction, suicidal thoughts and self-harm signs over the past one year. He also had behaviors such as abstinence from eating and voluntary vomiting. He was diagnosed with AN and MDD. Originality/value: The results suggest that these interventions can be effective but should be used with special consideration. Combining family therapy and pharmacotherapy might offer a chance to alleviate anorexia symptoms in people with ID. [ABSTRACT FROM AUTHOR]

Objective: Cognitive remediation therapy (CRT) can be used as an adjunct treatment for adolescents with severe and complex anorexia nervosa (AN) requiring inpatient treatment. However, there has been only one study on CRT for adolescents with AN in Japan. This study explored group CRT as an adjunct to inpatient treatment for Japanese adolescents with severe and complex AN requiring inpatient care. Methods: Thirty-one adolescents with AN underwent group CRT. Neuropsychological (set-shifting and central coherence) and psychological assessments (motivation, self-esteem, and depressive symptoms) were measured before and after the intervention. Weight and AN symptoms were measured before and after the intervention and at follow-up, and the adolescents completed post-intervention and follow-up questionnaires. Results: Set-shifting led to medium to large effect size improvements. Medium effect size improvements in central coherence and depressive symptoms were also observed. The feedback from the adolescents was mainly positive, and the treatment completion rate was high. The patients also reported that the skills learned through group CRT could be applied in daily life. Conclusion: Group CRT may be beneficial for adolescents with severe and complex AN who require inpatient care. Plain language summary: Why was this study done? Cognitive remediation therapy (CRT) can be used as an adjunct treatment for adolescents with severe and complex anorexia nervosa (AN) requiring inpatient treatment. However, there has been only one study on CRT for adolescents with AN in Japan. This study explored group CRT as an additional inpatient treatment for adolescents with severe and complex AN requiring inpatient care in Japan. What did the researchers do? A total of 31 adolescents with AN underwent group CRT. Cognitive function and psychological parameters (motivation, self-efficacy, and depressive symptoms) were measured before and after group CRT. Body mass index and AN symptoms were evaluated before and after group CRT and at follow-up. The adolescents completed post-therapy and follow-up questionnaires. What did the researchers find? Cognitive function and depressive symptoms improved after group CRT. The feedback from the adolescents was mostly positive, and 29 of the 31 adolescents completed group CRT. Many adolescents also reported that they used the skills learned through group CRT in their daily lives. What do the findings mean? Group CRT may be beneficial for adolescents with severe and complex AN who require inpatient care. [ABSTRACT FROM AUTHOR]

Introduction: Different non-pharmacological interventions have been studied to manage symptoms derived from chemotherapy, but their effectiveness is unknown. Objective: To describe non-pharmacological interventions for managing symptoms secondary to antineoplastic chemotherapy in adults. Materials and Methods: Systematic review of analytical experimental and observational studies (2021 to 2023). The studies were selected, and data was extracted in parallel. Discrepancies were resolved with a third reviewer. The risk of bias was assessed using the Risk of Bias (RoB) tool and The Newcastle-Ottawa Scale (NOS). The literature was synthesized descriptively based on prioritized outcomes. Results: The prioritized outcomes were neutropenia, pain, neuropathy, nausea, vomiting, alopecia, anorexia, and sleep disorders. Out of 7520 references found, 62 were included for analysis. Acupressure showed a possible effect in controlling symptoms such as nausea and vomiting. The intervention with cold on the scalp showed differences in the stages of alopecia severity. Other interventions showed heterogeneity. Discussion: Non-pharmacological interventions have been widely described in observational and experimental studies in the control of side effects of chemotherapy; however, there is homogeneity and a high risk of bias. Conclusion: Acupressure, muscle massage, music therapy, foot baths, and other interventions have been studied for nausea, vomiting, sleep disorders, neutropenia, alopecia, anorexia, pain, and neuropathy as secondary symptoms prioritized by patients. It is necessary to standardize both the interventions and how measure the outcomes. [ABSTRACT FROM AUTHOR]

Youth with anorexia nervosa (AN) have been reported to have high levels of comorbid autism spectrum disorder (ASD) and ASD-like traits suggesting a potential shared underlying neurodevelopmental or genetic link between the disorders. Youth with comorbid AN and ASD symptomatology generally require more intensive treatment and have worse psychological outcomes following treatment. To date, no Canadian national guidelines exist for the treatment of this comorbidity. An informal survey of tertiary paediatric eating disorder programs across Canada revealed that centres do not routinely screen for ASD at intake and few offer any treatment modifications for youth with AN and suspected/diagnosed comorbid ASD. This represents a significant care gap for this clinical sub-population and an important area for future study and healthcare provider training. [ABSTRACT FROM AUTHOR]

Objective: Patients with anorexia nervosa (AN) are often anxious, display inflexible behavior and disrupted reward processing. Emerging evidence suggests that gut dysbiosis in patients contributes to the disease phenotype and progression. Methods: In a preclinical study, we explored whether AN‐derived microbiota impacts cognitive flexibility, anxiety, and dopamine signaling using fecal microbiota transplantation (FMT) in tyrosine hydroxylase‐cre rats. We performed probabilistic reversal learning task (PRLT) at the baseline, after antibiotic treatment, and following FMT from patients with AN and controls. We assessed flexible behavior, task engagement, and ventral tegmental area (VTA) dopamine signaling during and in the absence of reward. Furthermore, anxiety‐like behavior was evaluated with open field (OF) and elevated plus maze (EPM) tests. Results: Neither antibiotic‐induced dysbiosis nor AN FMT led to significant alterations in the number of reversals or lever press strategies after reinforced or nonreinforced lever presses (win and lose‐stay) in the PRLT. However, the number of initiated trials decreased after antibiotic treatment while remaining unchanged after FMT. No significant differences were observed in VTA dopamine activity, anxiety measures in the OF and EPM tests. Microbiome analysis revealed limited overlap between the microbiota of the donors and recipients. Discussion: No evidence was found that the microbiota of patients compared to controls, nor a depleted microbiome impacts cognitive flexibility. Nonetheless, antibiotic‐induced dysbiosis resulted in reduced task engagement during the PRLT. The relatively low efficiency of the FMT is a limitation of our study and highlights the need for improved protocols to draw robust conclusions in future studies. Public Significance: While our study did not reveal direct impacts of AN‐associated gut microbiota on cognitive flexibility or anxiety behaviors in our preclinical model, we observed a decrease in task engagement after antibiotic‐induced dysbiosis, underscoring that the presence of a gut microbiome matters. Our findings underscore the need for further refinement in FMT protocols to better elucidate the complex interplay between gut microbiota and behaviors characteristic of anorexia nervosa. [ABSTRACT FROM AUTHOR]

The article focuses on anorexia nervosa (AN) and its high mortality rate, emphasizing body distortions as a core issue. Topics include the role of interoception in self-perception, disruptions in sensory integration in AN, and the Re-Embodiment Project aimed at developing effective treatments. It also discuses the role of Interoception and Embodiment.

Background: Chemotherapy‐induced anorexia is a common occurrence in patients undergoing treatment for advanced lung cancer. However, the relationship between chemotherapy‐induced anorexia and weight loss during platinum‐based chemotherapy combined with immune checkpoint inhibitors is unclear. This study explored the relationship between chemotherapy‐induced anorexia and therapeutic outcomes in patients with stage IV non‐small‐cell lung cancer undergoing platinum‐based chemotherapy combined with immune checkpoint inhibitors. Methods: The study retrospectively reviewed the medical records of 106 patients with stage IV non‐small‐cell lung cancer treated with platinum‐based chemotherapy and immune checkpoint inhibitors between January 2019 and October 2022. The incidence of weight loss and its association with treatment efficacy was assessed in the chemotherapy‐induced anorexia group. Chemotherapy‐induced anorexia, nausea, and vomiting were evaluated using Common Terminology Criteria for Adverse Events v 5.0. Progression‐free and overall survival were used to measure treatment efficacy. Results: Chemotherapy‐induced anorexia was observed in 13.2% of patients. These patients exhibited significant weight loss at 6 and 9 weeks after treatment initiation compared to those in the non‐chemotherapy‐induced anorexia group. Progression‐free and overall survival were shorter in the chemotherapy‐induced anorexia group than in the non‐chemotherapy‐induced anorexia group, but the difference was not statistically significant. Conclusions: Chemotherapy‐induced anorexia was associated with significant weight loss and reduced treatment efficacy in patients with stage IV non‐small‐cell lung cancer. These results highlight the importance of implementing robust supportive care for chemotherapy‐induced anorexia to mitigate weight loss and uphold treatment effectiveness during platinum‐based chemotherapy combined with immune checkpoint inhibitors. [ABSTRACT FROM AUTHOR]

Introduction: Anorexia nervosa (AN) is characterised by limited remission rates and emotional dimensions are often neglected. Cognitive remediation and emotional skills training (CREST) protocol aims to address cognitive and emotional factors. This study evaluates the feasibility and effectiveness of a modified rolling‐group CREST protocol in an inpatient setting. Methods: Quasi‐experimental design evaluated CREST protocol in a rehabilitation programme. A total of 116 females diagnosed with AN were included, of whom 63 were included in the CREST protocol and 53 in the standard rehabilitation treatment. Various standardized measures were employed to assess psychopathology. Data collection occurred longitudinally, before and after CREST implementation. Results: No significant differences emerged between groups regarding changes in specific eating psychopathology. CREST group exhibited significant improvements in emotion regulation (p = 0.002) and social skills (p = 0.014), besides a reduction in alexithymia (p < 0.001) and cognitive rigidity (p = 0.013). Empathic features remained stable. Participants reported positive perceptions of the CREST intervention. Discussion: The study highlights the potential benefits of integrating emotional training within multidisciplinary intensive treatment for AN. Results emphasise the importance of treatment protocol with more affective and hot‐cognition‐related interventions, beyond weight‐related psychopathology. Implementing a rolling‐group CREST protocol in an inpatient setting showed promise in enhancing the emotional abilities of AN patients. Highlights: The Cognitive remediation and emotional skills training (CREST) group exhibited exceptional adherence, with no dropouts observed, indicating strong engagement and acceptability of the programme among participants.Participants in the CREST group experienced significant reductions in Difficulties in Emotion Regulation Scale (DERS) scores, suggesting enhanced emotional regulation skills compared to the treatment as usual ,TAU group.The CREST intervention led to a notable decrease in alexithymia scores, indicating improved emotional awareness and expression among participants. [ABSTRACT FROM AUTHOR]

Objective: Little is known about factors associated with treatment trajectory following brief paediatric admissions for children and young people (CYP) admitted for medical complications of their eating disorder (ED). This project aimed to identify possible factors and ways to improve the usefulness of paediatric admissions. Method: Retrospective NHS data was analysed to explore differences between paediatric admissions followed by community‐based care or inpatient psychiatric care. Twelve parents were interviewed to seek feedback about paediatric admissions. Results: Patients who received subsequent inpatient psychiatric care were unwell for longer, had longer paediatric admissions and more crisis team input, were more likely to have had previous admissions, and had higher parent‐reported anxiety and depression. However, the groups did not significantly differ in ED severity. The interviews identified recommendations for improving paediatric admissions, which included improving understanding of EDs, enhancing communication channels, and providing psychological support to parents. Conclusions: Factors linked with illness severity (but not illness severity itself) appear to be associated with the difference between CYP either returning to community‐based care or requiring more intensive psychiatric input. These factors may help clinicians understand who requires subsequent inpatient care, allowing clinicians to target more intensive support earlier and facilitate smoother transitions between services. Highlights: Children and adolescents appeared less likely to require intensive inpatient psychiatric care within 3 months following discharge from a paediatric ward if they had shorter stays in paediatric hospitals, shorter known duration of their eating disorder, less crisis team input, fewer previous paediatric and psychiatric admissions, and lower parent‐rated anxiety and depression.Paediatric admissions are a valuable component of the treatment pathway, and they could be improved further by improving understanding of eating disorders among staff, enhancing communication between services and with families, and providing psychological support to parents.For some families, paediatric admissions seemed to instigate recovery by helping them to both access necessary treatment and realise the severity of their child's health. [ABSTRACT FROM AUTHOR]

Several psychotherapeutic interventions are recommended for Eating Disorders (EDs), chiefly individual cognitive-behavioral therapy and family-based treatments. Manualized individual psychodynamic treatments are recommended for adults with Anorexia Nervosa (AN). Evaluation of psychodynamic group treatments in treating EDs requires further assessment, and recent reviews focused only marginally on this topic. To fill this gap, a narrative review through APA PsychInfo, PubMed and Scopus was carried out. Psychodynamic group treatments appear to improve some ED symptoms at the end of the treatment; however, most of the studies cited were not manualized and lacked control groups and follow-ups. The differences in therapeutic methods and the criteria used to measure remission across the studies included, as well as the incorporation of diverse interventions (including psychodynamic group therapy and elements of BT/CBT or psychoeducation), create difficulties when it comes to forming conclusive judgments about the effectiveness of psychodynamic group therapies for Eating Disorders. The need for more rigorous research and Randomized Controlled Trials (RCTs) is evident. [ABSTRACT FROM AUTHOR]

Medically compromised people with anorexia nervosa are cared for in inpatient settings where clinicians closely monitor health and safety. Clinicians are in a position of power, with the capacity to impose mandated weight gain to achieve medical stabilisation. Consumers are in a vulnerable position, compelled to temporarily relinquish autonomy and to accept coercive practices that often diminish the quality of the therapeutic relationship. Clinicians' position of power in mental healthcare has a dual potential for both healing and harm, and limited attention has been given to consumers' views of clinicians' power. The aim of this qualitative descriptive study was to investigate the consumer perspective of clinicians' power in the inpatient care of anorexia nervosa, establishing insight into the beneficence and maleficence of the power asymmetry. Ten women with anorexia nervosa in the community participated in semi‐structured interviews online. The COREQ checklist was used to ensure accuracy and completeness of reporting. Thematic analysis revealed that abuses of power were common in the course of inpatient AN care, however life‐saving measures were regarded as defensible. The perception of clinicians' power was determined by the strength of interpersonal relationships and clinicians' clinical competence. To mitigate the potential for harmful experiences, clinicians' use of power must be exercised with close consideration for consumer perspectives, with the integration of person‐centred care and trauma‐informed care principles. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to compare treatment trajectories in anorexia nervosa (AN) and atypical AN. Method: Adolescents and adults with AN (n = 319) or atypical AN (n = 67) in a partial hospitalization program (PHP) completed diagnostic interviews and self‐report questionnaires measuring eating disorder (ED), depression, and anxiety symptoms throughout treatment. Results: Premorbid weight loss did not differ between diagnoses. Individuals with atypical AN had more comorbid diagnoses, but groups did not differ on specific diagnoses. ED psychopathology and comorbid symptoms of depression/anxiety did not differ at admission between groups nor did rate of change in ED psychopathology and comorbid symptoms of depression/anxiety from admission to 1‐month. From admission to discharge, individuals with atypical AN had a faster reduction in ED psychopathology and comorbid symptoms of depression and anxiety (ps < 0.05; rs = 0.01–0.32); however, there were no group differences in ED psychopathology or depression symptoms at discharge (ps>.50; ds =.01–.30). Individuals with atypical AN had lower anxiety at discharge compared to individuals with AN (p = 0.05; d =.4). Length of stay did not differ between groups (p = 0.11; d =.21). Discussion: Groups had similar ED treatment trajectories, suggesting more similarities than differences. PHP may also be effective for AAN. Public Significance: This study supports previous research that individuals with AN and atypical AN have more similarities than differences. Results from this study indicate that individuals with AN and atypical AN have similar treatment outcomes for both ED psychopathology and depressive symptoms; however, individuals with atypical AN have lower anxiety symptoms at discharge compared to individuals with AN. AN and atypical AN also have more symptom similarity at admission and throughout treatment, which challenges their current designation as distinct disorders. [ABSTRACT FROM AUTHOR]

Objective: This study used machine learning methods to analyze data on treatment outcomes from individuals with anorexia nervosa admitted to a specialized eating disorders treatment program. Methods: Of 368 individuals with anorexia nervosa (209 adolescents and 159 adults), 160 individuals had data available for a 6‐month follow‐up analysis. Participants were treated in a 6‐day‐per‐week partial‐hospital program. Participants were assessed for eating disorder‐specific and non‐specific psychopathology. The analyses used established machine learning procedures combined in an ensemble model from support vector machine learning, random forest prediction, and the elastic net regularized regression with an exploration (training; 75%) and confirmation (test; 25%) split of the data. Results: The models predicting body mass index (BMI) at 6‐month follow‐up explained a 28.6% variance in the training set (n = 120). The model had good performance in predicting 6‐month BMI in the test dataset (n = 40), with predicted BMI significantly correlating with actual BMI (r =.51, p = 0.01). The change in BMI from admission to discharge was the most important predictor, strongly correlating with reported BMI at 6‐month follow‐up (r =.55). Behavioral variables were much less predictive of BMI outcome. Results were similar for z‐transformed BMI in the adolescent‐only group. Length of stay was most predictive of weight gain in treatment (r =.56) but did not predict longer‐term BMI. Conclusions: This study, using an agnostic ensemble machine learning approach in the largest to‐date sample of individuals with anorexia nervosa, suggests that achieving weight gain goals in treatment predicts longer‐term weight‐related outcomes. Other potential predictors, personality, mood, or eating disorder‐specific symptoms were relatively much less predictive. Public Significance: The results from this study indicate that the amount of weight gained during treatment predicts BMI 6 months after discharge from a high level of care. This suggests that patients require sufficient time in a higher level of care treatment to meet their specific weight goals and be able to maintain normal weight. [ABSTRACT FROM AUTHOR]

Objective: Family‐based treatment (FBT) is an efficacious treatment for adolescent anorexia nervosa (AN). A parent‐only guided self‐help version of FBT (GSH‐FBT) demonstrated preliminary efficacy in pilot investigations. To address challenges in access to care, we adapted GSH‐FBT into a parent‐only multi‐family group format (MF‐GSH‐FBT) delivered via videoconferencing. Method: This report details the feasibility and acceptability of a parent‐only group‐based multi‐family GSH‐FBT (MF‐GSH‐FBT) for adolescent AN delivered virtually. The MF‐GSH‐FBT intervention consisted of 12 weekly 60‐min sessions facilitated by a clinician in addition to online FBT video content and recommended readings. Adolescents and parents completed assessments at baseline and post‐treatment. Parents reported their child's weight each week. Results: A total of 13 adolescents (15.57 + 1.63 years; 92% female; 23% Hispanic) with AN and their parents enrolled and initiated treatment. Four consecutive cohorts of groups of 3–4 families were completed from April 2022 to April 2023. Across cohorts, parents attended 85% of sessions. Most parents rated the treatment sessions as helpful (79%; agree/strongly agree) and felt supported by the other group members (84%). All parents (100%) reported MF‐GSH‐FBT helped their child, and most (90%) reported their child had improved by end‐of‐treatment. On average, adolescents gained 3.53 kg (SD: 3.76) from pre‐ to post‐treatment, with percent estimated mean body weight increasing 5% on average. Parental self‐efficacy also increased from baseline to end‐of‐treatment. Discussion: MF‐GSH‐FBT for AN appears feasible and acceptable to parents participating in this pilot study. Challenges with recruitment and adolescent data collection remain questions for future investigation. Public significance: This study describes initial pilot testing of a virtual guided self‐help family‐based treatment for adolescents with anorexia nervosa delivered in a multi‐family group format. This treatment aims to enhance access to family‐based treatment for anorexia nervosa whilst providing additional support to parents. [ABSTRACT FROM AUTHOR]

Parenting a child with anorexia nervosa (AN) is highly stressful, and the struggles around eating have a large impact on family functioning. Parents get involved in conflicts with their child and/or accommodate to the eating disorder symptoms. Non‐violent resistance (NVR) offers an additional treatment option for these families. NVR aims at helping parents effectively deal with their child's (self‐)destructive behaviour and their own helplessness, by non‐violent and non‐escalating means. In our pilot, we examined whether NVR was helpful in reducing stress and improve parent–child interaction. In six parents, it was found that parenting stress was significantly reduced at post‐assessment and at 3‐month follow‐up. For parent–child interaction, a non‐significant trend was found for improvement. Change in body mass index of the adolescents was not associated with the decrease in parenting stress. Although preliminary, the results of this pilot suggest that NVR can be a feasible treatment alternative for families of adolescents with AN. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive‐behavioral therapy (CBT‐E) in patients aged between 12 and 18 years with anorexia nervosa with a duration of illness <3 versus ≥3 years. Methods: One hundred and fifty‐nine consecutively treated patients (n = 122 with illness duration <3 years and n = 37 ≥ 3 years) were enrolled in a 20‐week intensive CBT‐E program. All patients underwent assessment at admission, end of treatment (EOT), and 20‐week follow‐up. The following measures were used: body mass index (BMI)‐for‐age percentile and percentage of expected body weight (EBW), Eating Disorder Examination Questionnaire, Brief Symptom Inventory, and Clinical Impairment Assessment. Results: Approximately 81% of eligible patients began the program, with over 80% successfully completing it. Patients with a longer or shorter duration of illness did not show significantly different treatment outcomes. In detail, BMI‐for‐age percentile and percentage of EBW outcomes were significantly improved from baseline to EOT, remaining stable until 20‐week follow‐up in both groups. Similarly, in both groups, scores for eating disorder psychopathology, general psychopathology, and clinical impairment decreased significantly at EOT and remained stable from EOT to follow‐up. Furthermore, a substantial percentage of adolescents in both groups achieved a good BMI outcome at EOT and 20‐week follow‐up, with approximately 60% maintaining a full response at the latter time point. Discussion: These findings suggest that intensive CBT‐E appears to be an effective treatment for severely ill adolescent patients with anorexia nervosa, regardless of whether the duration of illness is shorter or longer than 3 years. Public Significance: Existing treatment outcome studies in adolescents, whether randomized controlled trials or longitudinal investigations, typically involve patients with less than 3 years of illness, while data on the treatment outcomes for adolescents with anorexia nervosa with an illness duration of 3 years or over is very limited. Our findings suggest that adolescents with anorexia nervosa, irrespective of the duration of their illness, can derive similar benefits from intensively CBT‐E. [ABSTRACT FROM AUTHOR]

Anorexia nervosa (AN) has a multifaceted and complex pathology, yet major gaps remain in our understanding of factors involved in AN pathology. MicroRNAs (miRNAs) play a regulatory role in translating genes into proteins and help understand and treat diseases. An extensive literature review on miRNAs with AN and comorbidities has uncovered a significant lack in miRNA research. To demonstrate the importance of understanding miRNA deregulation, we surveyed the literature on depression and obesity providing examples of relevant miRNAs. For AN, no miRNA sequencing or array studies have been found, unlike other psychiatric disorders. For depression and obesity, screenings and mechanistic studies were conducted, leading to clinical studies to improve understanding of their regulatory influences. MiRNAs are promising targets for studying AN due to their role as signaling molecules, involvement in psychiatric‐metabolic axes, and potential as biomarkers. These characteristics offer valuable insights into the disease's etiology and potential new treatment options. The first miRNA‐based treatment for rare metabolic disorders has been approved by the FDA and it is expected that these advancements will increase in the next decade. MiRNA research in AN is essential to examine its role in the development, manifestation, and progression of the disease. Public Significance: The current understanding of the development and treatment of AN is insufficient. miRNAs are short regulatory sequences that influence the translation of genes into proteins. They are the subject of research in various diseases, including both metabolic and psychiatric disorders. Studying miRNAs in AN may elucidate their causal and regulatory role, uncover potential biomarkers, and allow for future targeted treatments. [ABSTRACT FROM AUTHOR]

Objective: The development of novel treatments for anorexia nervosa (AN) requires a detailed understanding of the biological underpinnings of specific, commonly occurring symptoms, including compulsive exercise. There is considerable bio‐behavioral overlap between AN and obsessive‐compulsive disorder (OCD), therefore it is plausible that similar mechanisms underlie compulsive behavior in both populations. While the association between these conditions is widely acknowledged, defining the shared mechanisms for compulsive behavior in AN and OCD requires a novel approach. Methods: We present an argument that a better understanding of the neurobiological mechanisms that underpin compulsive exercise in AN can be achieved in two critical ways. First, by applying a framework of the neuronal control of OCD to exercise behavior in AN, and second, by taking better advantage of the activity‐based anorexia (ABA) rodent model to directly test this framework in the context of feeding pathology. Results: A cross‐disciplinary approach that spans preclinical, neuroimaging, and clinical research as well as compulsive neurocircuitry and behavior can advance our understanding of when, why, and how compulsive exercise develops in the context of AN and provide targets for novel treatment strategies. Discussion: In this article, we (i) link the expression of compulsive behavior in AN and OCD via a transition between goal‐directed and habitual behavior, (ii) present disrupted cortico‐striatal circuitry as a key substrate for the development of compulsive behavior in both conditions, and (iii) highlight the utility of the ABA rodent model to better understand the mechanisms of compulsive behavior relevant to AN. Public Significance: Individuals with AN who exercise compulsively are at risk of worse health outcomes and have poorer responses to standard treatments. However, when, why, and how compulsive exercise develops in AN remains inadequately understood. Identifying whether the neural circuitry underlying compulsive behavior in OCD also controls hyperactivity in the activity‐based anorexia model will aid in the development of novel eating disorder treatment strategies for this high‐risk population. [ABSTRACT FROM AUTHOR]

Background & Aims: Changes in stomach size may impact eating behaviour. A recent study showed gastric dilatation in restrictive eating disorders using computed tomography scans. This study aimed to describe stomach size in the standing position in women with anorexia nervosa (AN). Methods: Women treated for AN at our institution were retrospectively included if they had undergone upper gastrointestinal radiography (UGR) after the diagnosis of AN. Two control groups (CG1 and CG2) were included, both comprising female patients: CG1 patients were not obese and underwent UGR for digestive symptoms of other aetiologies, and CG2 comprised obese individuals who had UGR before bariatric surgery. A UGR‐based Stomach Size Index (SSI), calculated as the ratio of the length of the stomach to the distance between the upper end of the stomach and the top of the iliac crests, was measured in all three groups. Gastromegaly was defined as SSI >1.00. Results: 45 patients suffering from AN (28 with restrictive and 17 with binge/purge subtype), 10 CG1 and 20 CG2 subjects were included in this study. Stomach Size Index was significantly higher in AN (1.27 ± 0.24) than in CG1 (0.80 ± 0.11) and CG2 (0.68 ± 0.09); p < 0.001, but was not significantly different between patients with the restrictive and binge/purge subtypes. Gastromegaly was present in 82.2% of patients with AN and not present in the control groups. In patients with AN, gastromegaly was present in 12/15 patients without digestive symptoms (80.0%) and in 25/30 patients with digestive complaints (83.3%) at time of UGR (p = 0.99). In the AN group, no significant relationship was found between SSI and body mass index. Conclusion: Gastromegaly is frequent in AN and could influence AN recovery. This anatomical modification could partially explain the alterations of gastric motility previously reported in AN. Highlights: A gastromegaly can be detected by using a simple Stomach Size Index (SSI) calculated from upper gastrointestinal radiography (UGR)Gastromegaly is frequent in anorexia nervosa (AN)Gastromegaly is in not only present in patients with AN‐B/P but also in those with active food restriction (AN‐R) without any superior mesenteric artery syndrome (SMAS) [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]

Copyright of Miscelánea: A Journal of English & American Studies is the property of Miscelanea: A Journal of English & American Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Patients with advanced cancer often experience a reduced ability to eat, which may result in tensions between patients and family members. Often with advanced cancer diagnoses, patients' appetites decline markedly, while family members focus on nutritional intake with the hope that this will postpone death. This hope might cause tensions between the patient and family; the family may expect healthcare professionals to encourage the patient to eat more, whereas the patient needs to be supported in their reduced ability to eat. When these tensions arise, healthcare professionals can experience challenges in providing good palliative care. To address these challenges in the provision of palliative care, healthcare professionals may adopt a care ethics approach. Similar to palliative care's focus on patient and family members' relationships, a care ethics approach emphasizes interdependency and social relationships. Using Joan Tronto's care ethics approach, we conducted a normative analysis of what caring for patients with reduced ability to eat and their family members should look like. Tronto's approach includes five phases of care: caring about, taking care of, care giving, care-receiving, and caring with. Based on our analysis and empirical studies on patients with advanced cancer and family members, concerns with their lack of appetite, we assert that healthcare professionals must be mindful of the potential of tensions related to appetite and be adept in dealing with these tensions. We urge that education is needed for healthcare professionals regarding the psychosocial impact of reduced ability to eat on both patients and family members and interprofessional collaboration is of the essence. [ABSTRACT FROM AUTHOR]

Objective: The therapeutic alliance is broadly linked with positive outcomes. However, nearly all research in this area involves in‐person therapy, whereas teletherapy has grown increasing common since the COVID‐19 pandemic. There is now a pressing need to establish whether the nature and importance of the therapeutic alliance is impacted by teletherapy. This study examined therapeutic alliance in families of youth with anorexia nervosa who were participating in a randomized controlled trial that transitioned from in‐person to telehealth visits during the COVID‐19 pandemic. Method: We analysed data from 53 adolescents and their parents (20 began in‐person, 33 began with telehealth). Both parents, youth and therapist completed the Working Alliance Inventory–Short Revised after 4 weeks of treatment. Results: We found no significant differences across telehealth and in‐person treatment for paternal or therapist reported data. However, both adolescents and mothers reported higher bond and goal‐related alliance for in‐person sessions compared to telehealth. Conclusions: Findings regarding alliance across telehealth and in‐person sessions were mixed, with some preference among mothers and youth for in‐person treatment. Future studies should determine whether possible adaptations can improve working alliance during family‐based treatment for anorexia nervosa via telehealth. [ABSTRACT FROM AUTHOR]

Objective: Inefficiencies in executive functioning (EF), more specifically cognitive flexibility and an overly detailed processing style, are frequently observed in individuals with Anorexia Nervosa (AN) and have been identified as potential targets in treatment. Cognitive Remediation Therapy (CRT) is an adjunctive treatment approach specifically designed to have a positive impact on EF. Mainly evaluated in adults, CRT has been criticized for its perceived ineffectiveness in promoting weight restoration or directly reducing eating disorder symptoms. Method: We argue that we need to refocus our conceptual framework for using CRT as an adjunctive treatment and specifically explore its potential benefit in adolescents. Results: Adolescence is a critical window for EF development during which CRT has the potential to have the most impact. While it may not specifically ameliorate eating disorder symptoms and directly improve weight gain, CRT may mitigate the impact of malnutrition on adolescent brain development, reduce attrition rates in treatment, and improve cognitive flexibility and (indirectly) other maintaining factors, thereby improving global functioning. Discussion: More research needs to be done to understand the development of EF in adolescents with AN and how best to employ CRT as an adjunctive treatment to support development and target maintaining factors. The current article broadly reviews findings on executive functioning inefficiencies in adolescents with AN and discusses the purpose and role of CRT in treating AN. Finally, we highlight key critiques of using CRT and pose questions for future research. Public Significance: Treatments targeting executive functioning in adolescents with AN are limited. We need to better understand how CRT can benefit adolescents in treatment. Increasing treatment options, including adjunctive treatments, is necessary to reduce the long‐term impact of AN. [ABSTRACT FROM AUTHOR]

Treatments for anorexia nervosa (AN) remain ineffective for many patients. Processes that can account for differential treatment outcomes remain mostly unknown. We propose that the field test the role of associative learning in current psychological treatments. We hold that this line of research could yield actionable information for understanding non‐response and improving long‐term outcomes. To make this argument, we define associative learning and outline its proposed role in understanding psychiatric disorders and their treatment. We then briefly review data exploring associative learning in AN. We argue that associative learning processes are implicitly implicated in existing treatments; by this rationale, baseline differences in learning may interfere with treatment response. Finally, we outline future research to test our hypotheses. Altogether, future research aimed at better understanding how associative learning may contribute to AN symptom persistence has the potential to inform novel directions in intervention research. Public Significance: There is a pressing need to improve outcomes in treatments for anorexia nervosa (AN). We propose that individual differences in associative learning—the ability to form and update associations between cues, contexts, behaviors, and outcomes—may account for differential response to existing treatments. Undertaking this research could provide an understanding of how current treatments work and inform new approaches for those who may be at risk of poor outcomes. [ABSTRACT FROM AUTHOR]

Objective: Novel treatments for adults with anorexia nervosa (AN) are sorely needed. Although psychological interventions have been developed for AN, none have been identified as superior to one another or nonspecific treatments. Common comorbidities (e.g., mood and anxiety disorders) are rarely targeted in AN treatments, possibly impairing long‐term clinical improvement. AN is associated with reward processing dysfunctions paralleling those identified in affective disorders; however, few treatments directly target these processes. Method: We adapted Positive Affect Treatment, a neuroscience‐informed behavioral treatment developed for affective disorders, to the treatment of AN (PAT‐AN). Adults with AN (N = 20) were randomized to 20 weeks of PAT‐AN or waitlist to investigate the feasibility, acceptability, preliminary efficacy, and target engagement (on reward mechanisms) of PAT‐AN. Results: PAT‐AN demonstrated strong retention (100%) and acceptability ratings (M = 5.67–5.95 on a 7‐point scale). BMI (p =.006) and eating disorder symptoms (p <.001) improved over PAT‐AN sessions. The PAT‐AN group showed medium to large pre‐to‐post‐treatment improvements in BMI, eating disorder symptoms and impairment, depressive and anxiety symptoms, and some reward indices (ds =.56–.87); changes were largely sustained at 3‐month follow‐up. Waitlist showed negligible changes (ds <.20) on nearly all measures. Discussion: PAT‐AN holds promise as an innovative treatment with capability to simultaneously improve eating disorder symptoms, affective symptoms, and underlying reward mechanisms. Findings should be interpreted cautiously due to small sample size and permitted concurrent enrollment in other treatments. Future, larger‐scale research is warranted to establish the efficacy of PAT‐AN. Public Significance: This study provided a preliminary evaluation of Positive Affect Treatment for anorexia nervosa (PAT‐AN), a novel, neuroscience‐informed treatment aimed at increasing rewarding life experiences outside of one's eating disorder. Initial results suggest that PAT‐AN is considered acceptable and may alleviate eating disorder, depressive, and anxiety symptoms. Therefore, this study presents promising data on a treatment that may hold potential for improving the lives of individuals with this disorder. [ABSTRACT FROM AUTHOR]

Objective: We present the protocol of a feasibility randomised controlled trial (RCT) of intermittent theta burst stimulation (iTBS) for young people with anorexia nervosa (AN). Effective first‐line psychological therapies exist for young people with AN, but little is known about how to treat those who do not respond. Non‐invasive neuromodulation, such as iTBS, could address unmet treatment needs by targeting neurocircuitry associated with the development and/or maintenance of AN. Design: Sixty‐six young people (aged 13–30 years) with persistent AN will be randomly allocated to receive 20 sessions of real or sham iTBS over the left dorsolateral prefrontal cortex in addition to their usual treatment. Outcomes will be measured at baseline, post‐treatment (1‐month post‐randomisation) and 4‐months post‐randomisation (when unblinding will occur). Additional open follow‐ups will be conducted at 12‐ and 24‐months post‐randomisation. The primary feasibility outcome is the proportion of participants retained in the study at 4‐months. Secondary outcomes include AN symptomatology, other psychopathology, quality of life, service utilisation, neurocognitive processes, and neuroimaging measures. Discussion: Findings will inform the development of a future large‐scale RCT. They will also provide exploratory data on treatment efficacy, and neural and neurocognitive predictors and correlates of treatment response to iTBS in AN. HIGHLIGHTS: This paper presents a study protocol of a triple‐blind feasibility randomised controlled trial (RCT) with an open longer‐term follow‐up, using intermittent theta burst stimulation (iTBS) for young people with AN.It provides a clinical and scientific rationale for conducting a neuromodulation RCT in eating disorders.It is hoped that the findings will inform the development of a future large‐scale RCT investigating the clinical efficacy of iTBS for AN. [ABSTRACT FROM AUTHOR]

Introduction: In young adults with anorexia nervosa (AN), the process of transition from a child and adolescent mental health service (CAMHS) to an adult mental health service (AMHS) has been recognized as critical, and many patients fear falling through the gap between the two types of service. As reports about the transition process in emerging adults with AN are scarce, the present study aimed to explore the problems and experiences of this age group. Method: We screened our registry for patients with AN who had been treated as inpatients during childhood and/or adolescence and come of age during the last 3 years. Thirty‐two female patients [mean age 20.3 (1.2) y.] agreed to participate in a semistructured personal or telephone interview assessing their demographic and clinical data, whether they had finalised the transition, and their wishes and experiences regarding the transition process. Results: Only approximately one‐third of the participants had already undergone the transition. Nearly 60% of the former patients were still cared for by a CAMHS, and only 12.5% had stopped treatment for AN. Approximately 60% were exclusively or additionally cared for by their general practitioner. More than 50% of the participants still lived with their parents. Approximately 90% of the participants who remained in a CAMHS expressed concerns about transitioning, mostly about losing their trusted therapist and the assumption of personal responsibility. Conclusion: Patients with AN often delay the transition from a CAMHS to an AMHS, which they experience as intimidating and overwhelming. Thus, patients should be better prepared for the transition, which should be linked to "developmental readiness" and not to chronological age. Because many patients still live with their family of origin, parents and their family physician should be closely involved in the transition process. Highlights: Patients with anorexia nervosa (AN) often experience the transition from child‐oriented services to adult‐oriented services as challenging and thus try to delay the process.The majority of patients with AN want to continue their treatment with their trusted well‐known psychotherapist.More specialised and individualised treatments for emerging adults with AN are urgently needed. [ABSTRACT FROM AUTHOR]

Objective: The relative merits of inpatient or day‐treatment for adults with anorexia nervosa (AN) are unknown. The DAISIES trial aimed to establish the non‐inferiority of a stepped‐care day patient treatment (DPT) approach versus inpatient treatment as usual (IP‐TAU) for improving body mass index (BMI) at 12 months in adults with AN. The trial was terminated due to poor recruitment. This paper presents outcomes and investigates the reasons behind the trial's failure. Method: Fifteen patients with AN (of 53 approached) participated and were followed‐up to 6 or 12 months. Summary statistics were calculated due to low sample size, and qualitative data concerning treatment experiences were analysed using thematic analysis. Results: At baseline, participants in both trial arms rated stepped‐care DPT as more acceptable. At 12 months, participants' BMIs had increased in both trial arms. Qualitative analysis highlighted valued and challenging aspects of care across settings. Only 6/12 sites opened for recruitment. Among patients approached, the most common reason for declining participation was their treatment preference (n = 12/38). Conclusions: No conclusions can be drawn concerning the effectiveness of IP‐TAU and stepped‐care DPT, but the latter was perceived more positively. Patient‐related, service‐related and systemic factors (COVID‐19) contributed to the trial's failure. Lessons learnt can inform future studies. Highlights: Patient‐related (e.g., treatment preferences) and service‐related (e.g., reduced service capacity) alongside wider systemic (e.g., increased emergency admissions due to COVID‐19) factors seem to have contributed to the failure of the DAISIES trial.Patients and carers identified valued aspects for both inpatient (e.g., weight gain) and day‐patient (e.g., greater link to home environment) treatment settings, but day‐patient treatment was perceived as a more holistic and collaborative approach, and thus as more positive.Although randomised controlled studies investigating intensive treatments for severe anorexia nervosa are important and necessary, alternative study designs should be explored to overcome implementation challenges. [ABSTRACT FROM AUTHOR]

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Objective: Anorexia nervosa (AN) and atypical AN are conceptualized as distinct illnesses, despite similar characteristics and sequelae. Whereas DSM‐5 differentiates youth with AN and atypical AN by the presence of clinical 'underweight' (i.e., 5th BMI percentile for age‐and‐sex (BMI%)), we hypothesized that using this weight cut‐off to discern diagnoses creates a skewed distribution for premorbid weight. Method: Participants included hospitalized youth with AN (n = 165, 43.1%) and atypical AN (n = 218, 56.9%). Frequency analyses and chi‐square tests assessed the distribution of premorbid BMI z‐scores (BMIz) for diagnosis. Non‐parametric Spearman correlations and Stepwise Linear regressions examined relationships between premorbid BMIz, admission BMIz, and weight loss in kg. Results: Premorbid BMIz distributions differed significantly for diagnosis (p <.001), with an underrepresentation of 'overweight/obesity' (i.e., BMI% ≥ 85th) in AN. Despite commensurate weight loss in AN and atypical AN, patients with premorbid 'overweight/obesity' were 8.31 times more likely to have atypical AN than patients with premorbid BMI% < 85th. Premorbid BMIz explained 57% and 39% of the variance in admission BMIz and weight loss, respectively. Discussion: Findings support a homogenous model of AN and atypical AN, with weight loss predicted by premorbid BMI in both illnesses. Accordingly, premorbid BMI and weight loss (versus presenting BMI) may better denote the presence of an AN‐like phenotype across the weight spectrum. Findings also suggest that differentiating diagnoses with BMI% < 5th requires that youth with higher BMIs lose disproportionately more weight for an AN diagnosis. This is problematic given unique treatment barriers experienced in atypical AN. Public significance: Anorexia nervosa (AN) and atypical AN are considered distinct conditions in youth, with differential diagnosis hinging upon a presenting weight status of 'underweight' (i.e., BMI percentile for age‐and‐sex (BMI%) < 5th). In our study, youth with premorbid 'overweight/obesity' (BMI% ≥ 85th) disproportionately remained above this threshold, despite similar weight loss. Coupled with prior evidence for commensurate characteristics and sequelae in both diagnoses, we propose that DSM‐5 differentiation of AN and atypical AN inadvertently reinforces weight stigma and may contribute to treatment disparities in atypical AN. [ABSTRACT FROM AUTHOR]

In this special issue, international researchers investigate how atypical anorexia nervosa (atypical AN) differs from anorexia nervosa (AN) and other eating disorders with respect to demographics, psychological and physiological morbidity, as well as treatment course and outcome. Manuscripts in this special issue report that atypical AN is associated with substantial medical and psychological morbidity, and the majority of studies find few differences between atypical AN and AN. While much remains to be learned about the long‐term course and treatment response of individuals with atypical AN to psychological and pharmacological interventions, the evidence supports conceptualization of atypical AN as part of a spectrum‐based restrictive eating disorder. These findings together with the potentially stigmatizing use of the term "atypical" suggest it may be time to revise the existing definition of atypical AN. [ABSTRACT FROM AUTHOR]

Objective: There is a lack of consensus in defining "significant weight loss" when diagnosing atypical anorexia nervosa (atypical AN) and no guidelines exist for setting target weight (TW). The current study aimed to identify community providers' practices related to the diagnosis of atypical AN and the determination of TW. A secondary aim was to evaluate whether professional discipline impacted "significant weight loss" definitions. Method: A variety of providers (N = 141; 96.4% female) completed an online survey pertaining to diagnostic and treatment practices with atypical AN. Descriptive statistics were computed to characterize provider‐based practices and Fisher's exact tests were used to test for differences in diagnostic practices by professional discipline. Thematic analysis was used to examine open‐ended questions. Results: Most (63.97%) providers diagnosed atypical AN in the absence of any weight loss if other AN criteria were met, but doctoral‐level psychologists and medical professionals were less likely to do so compared to nutritional or other mental health professionals. Most providers found weight gain was only sometimes necessary for atypical AN recovery. Qualitative responses revealed providers found atypical AN to be a stigmatizing label that was not taken seriously. Providers preferred to use an individualized approach focused on behaviors, rather than weight when diagnosing and treating atypical AN. Discussion: Lack of diagnostic clarity and concrete treatment guidelines for atypical AN may result in substantial deviations from the DSM‐5‐TR criteria in real‐world practice. Clinically useful diagnostic definitions for restrictive eating disorders and evidence‐based treatment guidelines for TW and/or other relevant recovery metrics are needed. Public Significance: The current study found variability in how community providers diagnose and determine target recovery weight for atypical anorexia nervosa (atypical AN). Many providers viewed the diagnosis of atypical AN as stigmatizing and preferred to focus on behaviors, rather than weight. This study underscores the importance of creating a clinically useful diagnostic definition and guidelines for recovery for atypical AN backed by empirical evidence that providers may implement in practice. [ABSTRACT FROM AUTHOR]