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Purpose: Researchers have theorized that interactions between appetitive and circadian disruptions result in increased eating disorder (ED) symptoms and insomnia. However, it is unclear how specific insomnia symptoms present among people with EDs and if the latent structure of insomnia in this population is similar to that of people with insomnia disorder., Methods: We conducted a secondary analysis of data collected on ED and insomnia symptoms using a subset of students (N = 547; 79.52% female) with probable EDs at a large Midwestern American university. Item response theory (IRT) for polytomous items was performed to identify item difficulty, discrimination, and information parameters for the Insomnia Severity Index (ISI). IRT parameters were compared to those established in a 2011 study of people diagnosed with insomnia disorder by Morin and colleagues., Results: Clinically significant insomnia symptoms were common among students with ED pathology and symptom endorsement for each ISI item ranged from 40.77 to 86.65%. ISI items assessing insomnia-related impairment and distress showed better discriminative capacities and had higher item information than items assessing sleep behavior alterations (i.e., difficulties falling asleep, difficulties maintaining sleep, waking too early). Item discrimination was largely similar among the ED sample compared to previous IRT analyses in an insomnia disorder sample., Conclusion: Insomnia symptoms are common among university students with probable EDs and similar to those reported by people with insomnia disorder. When considering insomnia assessment, items assessing sleep behaviors alone are likely inadequate to provide information about insomnia severity among people with EDs., Level V: Evidence obtained from a cross-sectional descriptive study., (© 2024. The Author(s).)

Objective: Evidence suggests that interpersonal stress plays a role in maintaining binge eating and purging (e.g., self-induced vomiting, misuse of laxatives). Stress is especially likely to promote engagement in maladaptive behaviour if the behaviour is habitual; therefore, individuals whose binge eating and/or purging are habitual may be particularly likely to engage in these behaviours in the context of interpersonal stress. We aimed to investigate this hypothesis in a sample of women with binge eating and/or purging using ecological momentary assessment (EMA)., Method: Women (N = 81) with binge-eating and/or purging symptoms completed a self-report measure assessing habit strength of binge eating and purging followed by a 14-day EMA protocol assessing daily perceived interpersonal stress and binge-eating and purging episodes., Results: Habit strength of purging moderated the within-person effect of interpersonal stress on purging frequency, such that higher daily stress was associated with greater same-day purging frequency when purging was more habitual. Contrary to expectations, the interactive effect of habit strength of binge eating and daily interpersonal stress on same-day binge-eating frequency was non-significant., Conclusions: Findings suggest that individuals with habitual purging may be vulnerable to engaging in purging when they are experiencing high levels of interpersonal stress., (© 2024 The Author(s). European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Binge eating appears to be associated with impulsivity, especially in response to negative affect (i.e., negative urgency). However, negative urgency is typically assessed via self-report, which captures only some aspects of urgency and may be subject to bias. Few studies have examined impulsivity following experimental manipulations of affect in binge-eating samples., Method: In the present study, individuals who engage in regular binge eating completed a behavioural impulsivity (go/no-go) task with high- and low-calorie food stimuli, once following negative affect induction and once following neutral affect induction., Results: Greater behavioural impulsivity to high-calorie food cues while in a negative (and not a neutral) affective state was associated with more frequent binge-eating behaviour. Further, this behavioural measure of negative urgency uniquely accounted for variance in binge-eating frequency when controlling for self-reported negative urgency, suggesting that behavioural measures may be a useful complement to self-report measures., Discussion: These findings provide novel and compelling evidence for the relationship between negative urgency and binge eating, highlighting negative urgency as a potentially important target for intervention., (© 2024 Eating Disorders Association and John Wiley & Sons Ltd.)

Background: Loss of control eating is more likely to occur in the evening and is uniquely associated with distress. No studies have examined the effect of treatment on within-day timing of loss of control eating severity. We examined whether time of day differentially predicted loss of control eating severity at baseline (i.e. pretreatment), end-of-treatment, and 6-month follow-up for individuals with binge-eating disorder (BED), hypothesizing that loss of control eating severity would increase throughout the day pretreatment and that this pattern would be less pronounced following treatment. We explored differential treatment effects of cognitive-behavioral guided self-help (CBTgsh) and Integrative Cognitive-Affective Therapy (ICAT)., Methods: Individuals with BED ( N = 112) were randomized to receive CBTgsh or ICAT and completed a 1-week ecological momentary assessment protocol at baseline, end-of-treatment, and 6-month follow-up to assess loss of control eating severity. We used multilevel models to assess within-day slope trajectories of loss of control eating severity across assessment periods and treatment type., Results: Within-day increases in loss of control eating severity were reduced at end-of-treatment and 6-month follow-up relative to baseline. Evening acceleration of loss of control eating severity was greater at 6-month follow-up relative to end-of-treatment. Within-day increases in loss of control severity did not differ between treatments at end-of-treatment; however, evening loss of control severity intensified for individuals who received CBTgsh relative to those who received ICAT at 6-month follow-up., Conclusions: Findings suggest that treatment reduces evening-shifted loss of control eating severity, and that this effect may be more durable following ICAT relative to CBTgsh.

Objective: Sleep disturbance is common among individuals with eating disorders (EDs), with approximately 50% of patients with EDs reporting sleep disturbance. Sleep problems may promote, exacerbate, or maintain ED symptoms through a variety of hypothesized mechanisms, such as impaired executive function, increased negative affect, and disruptions to appetitive rhythms. Although research investigating the role of sleep in EDs is growing, the current literature suffers from methodological limitations and inconsistencies, which reduce our ability to translate findings to improve clinical practice. The purpose of this forum is to propose a coordinated approach to more seamlessly integrate sleep research into ED research with particular emphasis on best practices in the definition and assessment of sleep characteristics., Methods: In this article, we will describe the current status of sleep-related research and relevant gaps within ED research practices, define key sleep characteristics, and review common assessment strategies for these sleep characteristics. Throughout the forum, we also discuss study design considerations and recommendations for future research aiming to integrate sleep research into ED research., Results/discussion: Given the potential role of sleep in ED maintenance and treatment, it is important to build upon preliminary findings using a rigorous and systematic approach. Moving forward as a field necessitates a common lens through which future research on sleep and EDs may be conducted, communicated, and evaluated., (© 2024 Wiley Periodicals LLC.)

Objective: This study investigated whether sleep reactivity (i.e., a propensity to experience sleep disturbances when stressed) relates to eating disorder behavioral symptoms indirectly through dysphoric mood in a sample of college students. Participants: One hundred and ninety-eight college students (51.5% female). Methods: Participants completed self-report measures of dysphoric mood, eating disorder behavioral symptoms, and sleep reactivity. Results: Higher sleep reactivity was associated with greater binge-eating symptoms indirectly through higher dysphoric mood. Higher sleep reactivity was associated with greater purging symptoms; however, this association was not explained by dysphoric mood. Conclusions: Findings support the relevance of sleep reactivity to binge eating and purging and suggest that sleep reactivity relates to binge-eating symptoms indirectly through dysphoric mood. If replicated in prospective data, targeting stress-induced sleep and mood disturbances in college students may reduce risk for binge eating.

The Hierarchical Taxonomy of Internalizing Dimensions for Eating Disorders model positions eating disorder (ED) symptoms on an internalizing dimension alongside anxiety and mood symptoms. Symptom dimensions falling under the internalizing subfactors of distress (e.g., social anxiety) and fear/avoidance (e.g., panic, compulsions, checking) may differentially guide treatment. We examined relations between fear of negative evaluation and intolerance of uncertainty (core features of social anxiety and obsessive-compulsive disorder, respectively) and ED-related impairment and potential diagnostic differences. We hypothesized that: (a) fear of negative evaluation and intolerance of uncertainty would be related to ED-related impairment, (b) the relation between fear of negative evaluation and impairment would be strongest among individuals with "binge-eating syndromes" (i.e., bulimia nervosa [BN], binge-eating disorder [BED]), and (c) the relation between intolerance of uncertainty and impairment would be strongest among individuals with "weight-phobic syndromes" (i.e., anorexia nervosa [AN], BN, atypical AN). Participants (N = 236) included children/adolescents and adults evaluated for outpatient ED treatment. Participants completed questionnaires and semi-structured diagnostic interviews. Greater fear of negative evaluation and greater intolerance of uncertainty were related to greater clinical impairment, and the strength of these relations depended on ED diagnosis. Fear of negative evaluation was related to impairment among individuals with AN and atypical AN, and intolerance of uncertainty was related to impairment for individuals with AN, BN, and atypical AN. We identified fear of negative evaluation and intolerance of uncertainty as correlates of clinical impairment, highlighting the potential utility of developing treatments to target these internalizing constructs, especially for individuals with weight-phobic syndromes., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

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., (© 2024 Wiley Periodicals LLC.)

This study investigated concurrent and prospective associations between measures of reversal learning and attentional set-shifting and eating disorder symptoms at baseline, 3 months, and 6 months among individuals with anorexia nervosa restricting subtype (AN-R, n = 26), AN binge eating/purging subtype (AN-BP, n = 22), bulimia nervosa (BN, n = 35), and healthy controls (n = 27), and explored whether these associations differed by diagnosis. At baseline, participants completed diagnostic interviews, height/weight measurements, and measures of set-shifting (the Intradimensional/Extradimensional shift task) and reversal learning (a probabilistic reversal learning task). At 3- and 6-month follow-up, participants with eating disorders completed assessments of weight and eating disorder symptoms. A one-way analysis of variance found no evidence that baseline reversal learning and attentional set-shifting differed across diagnostic groups. Multilevel modeling analyses indicated that perseverative errors (an index of reversal learning) predicted an increase in purging over time for individuals with AN-BP and BN. Set-shifting errors differentially predicted frequency of loss of control eating for individuals with AN-BP and BN; however, set-shifting was not related to loss of control eating when examined separately in AN-BP and BN. These findings suggest that disentangling facets of cognitive flexibility may help understand change in eating disorder symptoms., Competing Interests: Declaration of competing interest None of the authors report any conflicts of interest with this work., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Loss of control (LOC) is a hallmark feature of binge eating that is associated with significant distress and impairment. Despite the central role diurnal rhythms may play in the development and maintenance of LOC eating, diurnal patterns of LOC remain understudied and poorly characterised. We assessed the diurnal timing of LOC in a sample of females with bulimia nervosa and binge-eating disorder who participated in a study assessing the impact of bright light exposure on binge eating, hypothesising that higher ratings of LOC would be more likely to occur later in the day. Participants (N = 34) completed a 22-day protocol during which they provided LOC ratings six times daily. Kernel density estimates describing LOC ratings across times of day were compared using permutation tests of equality. Results demonstrated an evening shift in LOC, wherein higher LOC was more likely to occur later in the day and lower LOC was more likely to occur earlier in the day. This study is the first to clearly depict the phenomenon that the likelihood of experiencing higher LOC increases throughout the day, pointing to the potential role diurnal rhythms, such as disrupted appetitive rhythms or mood variations, may play in maintaining binge eating., (© 2023 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Circadian rhythm disruptions are associated with binge eating, can be causal of negative mood, and may be corrected with bright light exposure. A subtype of individuals with binge-spectrum eating disorders are characterized by combined high dietary restraint and negative affect. These individuals have higher eating disorder psychopathology and poorer treatment response. We aimed to test the targeted effects of morning bright light exposure on individuals with binge-spectrum eating disorders, hypothesizing significant reductions in binge eating for those characterized by high dietary restraint and negative affect., Methods: Participants (N = 34 females with binge-eating disorder and bulimia nervosa) used a morning bright light and normal light for 10 consecutive days each, in randomized order. They completed the Change in Eating Disorder Symptoms (CHEDS) scale at baseline, day 12 (when they switched lamps), and day 22. We conducted moderation analyses, clustering data by person, controlling for order, and examining the effect of light condition on binge eating according to baseline restraint and negative affect., Results: At high levels of combined dietary restraint and negative affect, participants experienced a reduction in binge eating and food preoccupation following exposure to morning bright light. There were no changes in restrictive eating, body preoccupation, body dissatisfaction, or body checking following exposure to morning bright light for these individuals., Discussion: These findings suggest that morning bright light may be a useful adjunct to empirically supported eating disorder treatments that target binge eating, especially for individuals characterized by the difficult to treat restraint/negative affect subtype., Public Significance: At high levels of combined dietary restraint and negative affect, participants with binge-spectrum eating disorders experienced a reduction in binge eating and food preoccupation following exposure to morning bright light. These findings suggest that morning bright light may be a useful adjunct to empirically supported eating disorder treatments that target binge eating, especially for individuals characterized by the difficult-to-treat restraint/negative affect subtype., (© 2023 Wiley Periodicals LLC.)

Emotion regulation and coping strategies are often conceptualized in eating disorder (ED) research as inherently adaptive or maladaptive, and successful regulation is often defined as greater overall use of adaptive strategies. However, recent empirical work outside of the field of EDs challenges this categorical conceptualization of strategies, demonstrating that adaptiveness is determined by the ability to flexibly implement and adjust strategies based on contextual demands (i.e., regulatory flexibility). Despite evidence that emotion regulation and coping strategies are best conceptualized in terms of flexibility in the broader literature, few ED studies have adopted this model. We review the current conceptual framework of emotion regulation and coping strategies used in ED research and present regulatory flexibility as an alternative approach to conceptualizing these strategies. The lack of research on regulatory flexibility among individuals with EDs limits our understanding of the role of emotion regulation and coping difficulties in ED risk and maintenance. Adopting a regulatory flexibility model of strategies in EDs may extend knowledge of the role of emotion regulation difficulties in the development and maintenance of EDs. We highlight the potential utility of investigating regulatory flexibility and present recommendations for future research on regulatory flexibility in EDs. PUBLIC SIGNIFICANCE STATEMENT: Research on emotion regulation and coping strategy usage in eating disorders often view regulatory strategies as inherently adaptive or maladaptive. However, recent studies support defining strategies in terms of flexibility. Adopting a regulatory flexibility model of strategies in eating disorders research may advance knowledge of the role of emotion regulation difficulties in the development and maintenance of eating disorders, ultimately enhancing prevention and treatment efforts., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

We aimed to evaluate whether the content of eating/body image-related beliefs in individuals with anorexia nervosa (AN) was associated with important aspects of eating disorder (ED) psychopathology. Females with AN completed assessments within 96 hours of admission to an inpatient medical stabilization program. Study staff administered the Brown Assessment of Beliefs Scale and participants completed self-report measures. We derived belief content domains using an inductive approach and examined associations between beliefs and clinical variables. The following belief categories emerged (% with a belief in that category): body image beliefs (64%), food beliefs (30%), body function beliefs (20%), rejection of illness beliefs (12%), morality beliefs (10%), and control beliefs (6%). No one belief domain was significantly associated with greater delusional intensity. However, findings indicate that greater delusionality was generally associated with worse ED psychopathology.

Binge eating demonstrates an evening diurnal shift among individuals with eating disorders. Disruptions to diurnal appetitive rhythms may be somewhat chronic and set the stage for additional disruptions to prompt binge eating. Despite known diurnal shifts in binge eating and related constructs (e.g., mood) and detailed characterizations of binge-eating episodes, no findings to date describe the naturalistic diurnal timing and composition of energy and nutrient intake on days with and without loss of control eating. We aimed to characterize eating behaviors (i.e., meal timing, energy intake, and macronutrient composition) across seven days in individuals with binge-spectrum eating disorders, assessing differences between eating episodes and days with and without loss of control eating. Undergraduate students (N = 51; 76.5% female) who endorsed past 28-day loss of control eating completed a 7-day naturalistic ecological momentary assessment protocol. Participants completed daily food diaries and reported instances of loss of control eating across the 7-day period. Results indicated that episodes of loss of control were more likely to occur later in the day, but overall meal timing did not differ across days with and without loss of control. Similarly, greater caloric consumption was more likely for episodes with loss of control, but overall caloric consumption did not differ between days with and without loss of control. Analysis of nutritional content demonstrated differences between both episodes and days with and without loss of control for carbohydrates and total fats, but not for protein. Findings provide support for the hypothesized role disruptions in diurnal appetitive rhythms play in maintaining binge eating via consistent irregularities, underscoring the importance of examining treatment adjuncts that intervene on the regulation of meal timing to enhance eating disorder treatment outcomes., Competing Interests: Declaration of competing interest None, (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Appalachia is uniquely impacted by healthcare disparities. Outpatient dropout rates remain a significant barrier for individuals necessitating specialty eating disorder (ED) treatment. We explored factors impacting patient continuation in specialty outpatient care for EDs. Participants ( N =138; 89.9% female) were patients with EDs attending specialty outpatient treatment in a geographically isolated, under-resourced Appalachian community. Patient dropout rate was 26.8%. Dropout rates did not significantly differ across any sociocultural factors except patient age and BMI; patients who discontinued were older and had higher BMIs at intake, perhaps due to longer duration of illness or treatment-related misconceptions. Implications and future directions are discussed., Competing Interests: No conflicts of interest to disclose.

Purpose: Earlier work on engaging in physical exercise when experiencing negative affect demonstrated robust associations with eating disorder (ED) behaviors and attitudes; however, measurement of the behavior was primitive, relying on one yes/no question that cannot capture much variability. We report on the development of a self-report measure, the Reactive Exercise Scale (RES), that disentangles the tendency to engage in exercise in response to negative mood cues from the tendency to engage in exercise in response to eating and body image cues, which themselves may be associated with negative mood. The measure also assesses exercising in response to positive mood cues., Methods: Exploratory factor analysis (EFA) guided item and factor selection. Confirmatory factor analysis (CFA) in an independent sample tested a 3-factor solution-exercising in response to negative mood cues, eating and body image cues, and positive mood cues. Correlations with exercise attitudes, eating disorder and body image attitudes, mood, and personality were used to evaluate construct validity., Results: Results supported the 3-factor structure and indicated that exercising in response to negative mood cues may not uniquely relate to most aspects of ED psychopathology when accounting for eating and body image cues, which themselves are associated with negative mood., Conclusion: The RES captures the tendency to exercise in response to negative mood, positive mood, and eating and body image cues. Together, these constructs allow researchers to examine the unique relations of negative mood cued exercise with ED constructs, while accounting for appearance-related motives for which exercise may also be used., Level of Evidence: Level III: evidence obtained from well-designed cohort or case-control analytic studies., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orientations and their intersections by recruiting a diverse sample of Amazon MTurk workers (MTurkers; N = 1782)., Method: We created a comprehensive, quantitative assessment of racial/ethnic identification, gender identification, sex assigned at birth, current sexual identification, and sexual orientation called the Demographic Assessment of Racial, Sexual, and Gender Identities (DARSGI). We calculated normative data for each demographic category response option., Results: Our sample was comprised of 68% underrepresented racial/ethnic identities, 42% underrepresented gender identities, 13% underrepresented sexes, and 49% underrepresented sexual orientations. We reported means and standard deviations for each demographic category response option and, where possible, mean estimates by percentile across intersectional groups. EDE-Q Global Score for a subset of identities and intersections in the current study were higher than previously reported norms for those identities/intersections., Discussion: This is the most thorough reporting of norms for the EDE-Q and CIA among racial/ethnic, sexual, and gender identities, and sexual orientations and the first reporting on multiple intersections, filling some of the gaps for commonly used measures of eating-disorder psychopathology. These norms may be used to contextualize eating-disorder psychopathology reported by underrepresented individuals. The data from the current study may help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups., Public Significance: We provide the most thorough reporting on racial/ethnic, sexual, and gender identities, and sexual orientations for the Eating Disorder Examination - Questionnaire and Clinical Impairment Assessment, and the first reporting on intersections, which fills some of the gaps for commonly used measures of eating-disorder psychopathology. These norms help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups., (© 2022 Wiley Periodicals LLC.)

Caloric consumption occurs in rhythms, typically during daytime, waking hours, marked by peaks at mealtimes. These rhythms are disrupted in individuals with eating disorders; mealtime peaks are blunted and delayed relative to sleep/waketimes. Individuals with eating disorders also tend to experience an overall phase delay in appetite; they lack hunger earlier in the day and experience atypically high hunger later in the day, the latter of which may culminate in binge-eating episodes. This disruptive appetitive behavior-early in the day restrictive eating and later in the day binge eating-may be partially accounted for by circadian disruptions, which play a role in coordinating appetitive rhythms. Moreover, restrictive eating and binge eating themselves may further disrupt circadian synchronization, as meal timing serves as one of many external signals to the central circadian pacemaker. Here, we introduce the biobehavioral circadian model of restrictive eating and binge eating, which posits a central role for circadian disruption in the development and maintenance of restrictive eating and binge eating, highlighting modifiable pathways unacknowledged in existing explanatory models. Evidence supporting this model would implicate the need for biobehavioral circadian regulation interventions to augment existing eating disorder treatments for individuals experiencing circadian rhythm disruption. PUBLIC SIGNIFICANCE: Existing treatments for eating disorders that involve binge eating and restrictive eating mandate a regular pattern of eating; this is largely responsible for early behavioral change. This intervention may work partly by regulating circadian rhythm and diurnal appetitive disruptions. Supplementing existing treatments with additional elements specifically designed to regulate circadian rhythm and diurnal appetitive rhythms may increase the effectiveness of treatments, which presently do not benefit all who receive them., (© 2022 Wiley Periodicals LLC.)

Background: The professional advancement of Family Medicine faculty requires contributions in the form of clinical service, teaching, and scholarly activity. While teaching and clinical work are part of the everyday routine of faculty members, a research culture can be challenging to build., Methods: Our department started a Scholarly Works and Activities Group (SWAG). The group's aim is to promote a collegial, collaborative research culture in the department. Meetings occur monthly, and faculty have the opportunity to discuss scholarly projects with peers, as well as promotion/tenure goals. Minutes from each meeting are sent to all faculty members in the department. The aim of this retrospective study was to determine if SWAG meetings impacted faculty scholarly activity. Data were collected on presentations, publications, and collaborations from Curriculum Vitae (CVs), and were compared between 5 years prior to the intervention and the 5 years since., Results: Results indicated increased scholarly activity in the time period during the SWAG group meetings. Faculty presentations increased by 34% while faculty publications more than doubled (221% increase), with publications constituting a small Cohen's d effect size. Interestingly, faculty collaboration did not increase. Two faculty members were promoted during the 5 years study period, and the total number of faculty who published went from three to eight., Conclusions: Implementation of a monthly SWAG meeting led to an increase in faculty peer reviewed publications. Furthermore, two faculty members were promoted during the time of the intervention. A monthly faculty meeting, even when brief, can help promote and build a research culture.

Frequent weighing to assess shape and weight is common in eating disorders, as is going to great lengths to avoid knowledge of weight. However, few tools exist to measure these different weighing tendencies. This study reports on the development of a self-report measure of weighing tendencies using exploratory and confirmatory factor analysis (EFA; CFA). An EFA using 10 items identified 2 factors and indicated all items should be retained. Two CFAs in two independent samples indicated that a 2-factor, 6-item version fit reasonably well. The factors indicate the tendency to approach weighing and to avoid weighing. Additional evidence of convergent and discriminant validity is presented, covering a number of eating behaviors and relevant behavioral constructs. Findings suggest that individuals characterized by approach weighing tendencies may weight-check to reduce the anxiety and distress of not knowing their weights, and those characterized by avoidance may reduce the anxiety and distress of knowing their weights by avoiding weight-related information. This may have important clinical implications, as the feared stimulus for one group is uncertainty about their weights, whereas for the other, it is awareness of their weights, suggesting different treatment targets. Overall, the AAWQ appears to be a promising tool that may aid in examining weighing tendencies, in turn having the potential to aid in eating disorder cognitive-behavioral clinical case formulation and treatment planning.

We examined the naturalistic relations between motivation to change and change in four specific eating disorder (ED) behaviors-binge eating (BE), purging, fasting, and driven exercise-in a community-based sample of individuals with EDs over two consecutive 6-week periods. We conducted cross-lagged generalized estimating equations using the transtheoretical model's four stages of change to predict changes in the ED behaviors 6 weeks later. Individuals reported lower pre-contemplation for behaviors typically associated with more distress (e.g., BE, purging) than they did for behaviors associated with less distress (e.g., fasting and driven exercise). Action predicted decreases in BE and purging frequencies but not fasting or driven exercise frequencies. Naturalistic relations between ED behavior severity/frequency and motivation to change these features can be detected over 6-week intervals; that is, attempts at change in individuals' natural environments can be successful over relatively brief periods of time, especially when individuals experience the motivation to change these features. The process of motivation to change ED behaviors is not linear, and our study highlights the movement between stages of change among individuals with EDs. Future research is needed to examine how much of the observed changes are sustained.

Delayed eating rhythms, relative to the sleep/wake period, commonly manifest as a lack of hunger in the morning (morning anorexia) and elevated hunger in the late evening (evening hyperphagia). These intake patterns are associated with adverse mental and physical health outcomes. We aimed to evaluate whether the timing of light exposure, an important environmental signal for circadian synchronization, explains the link between sleep/waketime preferences and delayed diurnal appetite. We also aimed to test whether disruptions in sleep quality, reflecting suboptimal circadian synchronization, identify individuals for whom sleep/waketime preference is associated with delayed diurnal appetite. Participants (N = 150) completed a measure of their sleep/waketime preferences and wore a device to capture their sleep efficiency and naturalistic light exposure for 48 consecutive hours. The timing of light exposure mediated the link between sleep/waketime preferences and evening hyperphagia, but not morning anorexia, such that a later peak in light exposure mitigated some of the risk for evening hyperphagia that was associated with later sleep/waketime preferences. Sleep efficiency moderated the association between sleep/waketime preference and morning anorexia, but not evening hyperphagia. Earlier sleep/waketime preference was associated with less morning anorexia among individuals with high sleep efficiency, but morning anorexia was consistently elevated among individuals with poor sleep efficiency. These results on the relation between sleep/waketime preference and two aspects of delayed diurnal appetite suggest that morning anorexia depends on sleep efficiency and evening hyperphagia may be influenced by the timing of daily light exposure. Future research should assess over longer periods, covering weekdays and weekends, and incorporate momentary reports of meals/snacks and appetite., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Dietary restraint refers to the intention to restrict caloric intake, whereas dietary restriction refers to the actual intentional and sustained restriction of caloric intake for weight-control purposes. Findings regarding the relation between dietary restraint and restriction to date are inconsistent. Our study sought to clarify this complex relationship using a novel laboratory task. Participants (N = 103; 56.3% female) completed a Paced Visual Serial Addition Task (PVSAT). Participants were provided a choice between ending each of eight PVSAT rounds at any time and drinking a high-calorie Kool-Aid® mixture or correctly completing 10 consecutive computations to access to a zero-calorie mixture for each round. We measured participants' dietary restraint using the Three-Factor Eating Questionnaire - Restraint Subscale and measured persistence and dietary restriction using the PVSAT. Results indicated a positive association between persistence and restriction. Female participants demonstrated higher eating disorder psychopathology, dietary restraint, and dietary restriction compared to male participants. Restraint was positively associated with restriction the more individuals persisted, indicating that persistence is a potentially important modifier of the relation between dietary restraint and restriction. Our findings highlight the complexity of the relation between dietary restraint and restriction; that is, measures of dietary restraint alone may not reliably predict short-term dietary restriction during laboratory consumption tasks; however, other factors, such as persistence, may play critical roles., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Online, anonymous data collection is common and increasingly available to researchers studying eating disorders (ED), particularly since the development of online crowdsourcing platforms. Crowdsourcing for participant recruitment may also be one effective strategy to address ED research disruptions caused by the COVID-19 pandemic. We aimed to: (a) develop a rigorous method for assessing self-reported athropometrics; (b) determine if individuals with EDs self-select into MTurk studies assessing eating behaviors; and (c) characterize ED-related psychopathology in an MTurk sample. We recruited 400 US adults to complete an MTurk study assessing ED features. Results did not indicate the presence of a self-selection bias among individuals with EDs; however, 40% of the sample met criteria for a current ED diagnosis, with all diagnoses represented except ARFID, and 18.1% reported currently being in ED treatment. The sample was characterized by higher scores on measures of ED psychopathology compared to extant non-clinical norms. Approximately 66% of the overall sample and 73% of participants with EDs indicated that they have participated in more MTurk studies since the COVID-19 pandemic began. Finally, we identified an alternative approach to assessing self-reported height and weight that appears to reduce error, which we strongly recommend researchers conducting online surveys use. Our findings suggest that individuals with EDs appear to be overrepresented on MTurk and highlight the utility of crowdsourcing using MTurk as an ED data collection alternative during and after the COVID-19 pandemic., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Guilt increases prior to objective binge-eating episodes (OBE) and decreases following OBE, suggesting that OBE may function to regulate negative affective states. Rapid eating, a common feature of OBE, may be an observable indication of difficulty regulating eating. Heart rate variability (HRV), a measure of parasympathetic activity, is an indicator of top-down inhibitory control and indicates emotion regulation attempts. We aimed to test the effect of guilt on consumption rate and change in HRV among individuals with (+) and without (-) OBE., Method: Participants (N = 86) underwent a mood induction (randomized to either a neutral mood or a guilt condition) and were then provided with 32 ounces (0.95 L) of Boost® meal replacement shake (960 kcal) and instructed to consume until they felt satisfied. Guilt was measured at baseline, prior to consumption, and following consumption. HRV was measured throughout., Results: Participants in the guilt condition reported higher guilt prior to consumption than individuals in the neutral mood condition, primarily driven by individuals with low HRV. Guilt decreased following consumption among individuals with low HRV in the guilt condition. The OBE+ individuals did not consume more or at an overall faster rate than OBE- individuals. Guilt prior to consumption did not lead to faster initial rates among OBE+ individuals; although, OBE+ individuals who experienced an increase in HRV from prior to during consumption demonstrated faster initial rates and greater changes in rate over time., Discussion: When experiencing negative emotions, individuals with OBE may experience increases in parasympathetic functioning while eating, reinforcing OBE as a facilitator of emotion regulation., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Negative affect increases in the hours prior to binge eating (BE), suggesting individuals may use BE to attempt to alleviate experiences of aversive self-awareness, such as shame and guilt. Guilt involves feeling bad about ones behavior and may elicit reparative actions; shame involves feeling bad about oneself and is generally associated with maladaptive behavior. Distinguishing how shame and guilt differentially relate to specific eating disorder (ED) behaviors may inform our understanding of emotional antecedents of ED behaviors and lead to refined treatment and prevention targets. We aimed to distinguish shame and guilt as they relate to BE and self-induced vomiting (SIV). We hypothesized that: (a) shame-proneness and state shame would be uniquely associated with BE, as BE may be used to escape from experiences of shame, and (b) guilt-proneness and state guilt would be positively associated with SIV among individuals who binge eat, as SIV may be used as a reparative action for BE. Participants (N = 347) completed self-report measures assessing guilt, shame, and ED behaviors. Shame-proneness and state shame were uniquely associated with BE and the urge to binge eat, while guilt-proneness and state guilt were not. Contrary to our hypothesis, guilt-proneness and state guilt were not associated with SIV among those who binge eat or endorsed urges to binge eat. These findings suggest that shame and guilt are differentially related to ED behaviors and identify shame specifically as an emotion that may elicit BE. Future research is needed to identify temporal relations between shame and ED behaviors., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Outcome states, such as remission and recovery, include specific duration criteria for which individuals must be asymptomatic. Ideally, duration criteria provide predictive validity to outcome states by reducing symptom-return risk. However, available research is insufficient for deriving specific recommendations for remission or recovery duration criteria for eating disorders., Method: We intensively modeled the relation between duration criteria length and rates of remission, recovery, and subsequent symptom return in longitudinal data from a treatment-seeking sample of women with anorexia nervosa (AN) and bulimia nervosa (BN). We hypothesized that the length of the duration criterion would be inversely associated with both rates of remission and recovery and with subsequent rates of symptom return., Results: Generalized estimating equations supported our hypotheses for all investigated eating-disorder features except for symptom return when using the Psychiatric Status Rating for AN., Discussion: We recommend that 6 months be used for remission definitions applied to binge eating, purging, and BN symptom composite measures, whereas no duration criteria be used for low weight and AN symptom composites. We further recommend that 6 months be used for recovery definitions applied to BN symptom composites and AN symptom composites, whereas 18 months be used for individual symptoms of binge eating, purging, and low weight. The adoption of these duration criteria into comprehensive definitions of remission and recovery will increase their predictive validity, which in turn, maximizes their utility., (© 2020 Wiley Periodicals, Inc.)

Objective: To evaluate how subjective control over intake is influenced by objective aspects of consumption, negative affect, and recent binge eating., Method: 105 participants with or without current binge eating (BE) consumed a meal replacement shake following a 12-hour overnight fast in a 2 × 2 design: participants were instructed to either consume the entire shake (no control) or decide on their own how much to consume (affirmative control). They were allotted either 5 (fast) or 15 (slow) minutes to complete the task. Participants reported on subjective control and negative affect following consumption., Results: Compared to the slow condition, participants in the fast condition reported higher negative affect after eating. Individuals without a history of BE reported lower subjective control in the no control compared to the affirmative control condition; however, this pattern was reversed among those with BE, such that individuals reported higher subjective control following consumption in the no control condition. In addition, subjective control was positively associated with negative affect in the no control condition whereas it was negatively associated with negative affect in the affirmative control condition., Discussion: Eating rate influences affect, and subjective control over eating may be the result of an interaction of objective control with affect. Thus, distress may drive perceptions of control. This should be directly tested in future studies and has implications for how we understand BE., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The insights and activities that regularly occur in clinical settings are an underutilized wellspring of potential scientific advances. Single-case experimental designs (SCEDs) include a collection of methods for testing hypotheses in one individual (or a small number of individuals) at a time that are particularly well suited to clinical settings. Their strengths include their potential for maximizing both internal and external validity by way of tight experimental control over threats to internal validity and flexibility in application and inclusion criteria. Despite these advantages, the eating disorder field has not made use of SCEDs to a similar extent as other research areas, providing an opportunity for expansion. Recent advances in organizing SCED standards have resulted in the publication of two sets of reporting guidelines relevant to eating disorders research. These guidelines are integrated and summarized alongside descriptions of domains for evaluating their methodological rigor. Example research questions of potential interest to the eating disorder field are illustrated with SCEDs, and several issues to consider when using SCEDs in eating disorders research are described. It is recommended that researchers aiming to use SCEDs refer to this paper and the resources cited herein when designing and reporting their work. Finally, it is hoped that individuals with access to clinical samples use this paper as a source of inspiration for testing their unique clinical insights., (© 2018 Wiley Periodicals, Inc.)