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Objective: To investigate the knowledge, attitudes, and current practices of adolescent primary care providers regarding the epidemiology, clinical features, and diagnosis of atypical anorexia nervosa (AN) compared to AN. Methods: An online survey was sent to the Pediatric and Family Medicine clinicians who provide medical care to adolescents. Statistical analyses compared differences in responses to questions about atypical AN versus AN. Results: Relative to AN, participants (n = 67) were significantly less familiar with atypical AN, less likely to consider a diagnosis of atypical AN, less comfortable identifying atypical AN, less likely to counsel patients with atypical AN on health risks, less likely to refer patients with atypical AN to a specialist, and less likely to correctly identify atypical AN. Clinicians with more years in medical practice reported a significantly larger gap in familiarity between AN and atypical AN than clinicians with less than 5 years of practice. Conclusions: Providers who care for adolescents appear to be less familiar with and less likely to identify atypical AN compared to AN. This knowledge gap may be more pronounced among clinicians with more years practicing medicine due to the novelty of atypical AN as a diagnosis. Lack of knowledge surrounding atypical AN risk factors may result in delayed diagnosis and associated poor health outcomes. Future research should investigate strategies that improve knowledge and screening of atypical AN in medical and other settings. Public Significance: Pediatric and Family Medicine clinicians are less familiar with atypical anorexia nervosa (AN) and less likely to diagnose a patient with atypical AN relative to AN. Insufficient knowledge about atypical AN may place these individuals at increased risk for worsening restrictive eating and the physical and psychological consequences of malnutrition. [ABSTRACT FROM AUTHOR]

Objective: Little is known about how individuals with atypical anorexia nervosa (AN) respond to eating disorder (ED) treatment in a partial hospitalization program (PHP), nor how certain factors such as trauma, childhood abuse, psychiatric comorbidity, and suicidal thoughts and behaviors might contribute to poor treatment outcomes. Thus, the current study (1) compares prevalence of these factors between individuals with AN and atypical AN upon admission to an ED PHP, (2) compares PHP treatment response between groups, and (3) investigates whether experiencing these factors impacts treatment outcomes. Method: We conducted a retrospective chart review of young adults admitted to a PHP with AN (n = 95) and atypical AN (n = 59). Histories of psychiatric comorbidities and adverse childhood experiences were obtained from initial psychiatric evaluations. ED symptoms were assessed at intake and discharge with the Eating Disorder Examination‐Questionnaire (EDE‐Q). Results: No significant differences were found at intake in ED symptom severity or prevalence of lifetime trauma, childhood abuse, number of psychiatric diagnoses, or suicidal thoughts and behavior. Symptomatology at discharge also did not differ between groups. Emotional abuse was significantly related to discharge shape and weight overvaluation. No other intake characteristics were significantly related to discharge symptomatology. Discussion: To our knowledge, this is the first study to compare the prevalence of comorbidities for both AN and atypical AN, as well as differential treatment outcomes for these individuals in a PHP. Results add to growing literature suggesting that, other than weight, AN and atypical AN have few properties that reliably distinguish them from one another. Public Significance: This study adds to a growing body of literature that raises questions about whether anorexia nervosa (AN) and atypical AN are truly different diagnoses. Our findings suggest these two groups present to treatment in a partial hospitalization program (PHP) with similar ED symptoms, as well as prevalence of lifetime trauma, childhood abuse, suicidal thoughts and behavior, and number of psychiatric comorbidities, and demonstrate similar treatment trajectories in PHP. [ABSTRACT FROM AUTHOR]

This study examined the feasibility and preliminary effectiveness of a cognitive‐behavioral, family‐centered partial hospitalization program (PHP) for adolescents with anorexia nervosa (AN) and atypical AN (AAN), and described the outpatient services received following discharge. Participants (N = 31) completed anthropometric and self‐report assessments at admission, discharge, and six and twelve months after discharge from the PHP. Descriptive statistics explored markers of feasibility. Paired samples t‐tests evaluated changes in weight and eating disorder (ED) symptomatology from admission to discharge, admission to six‐month follow‐up, and admission to twelve‐month follow‐up. Descriptive statistics and effect sizes compared symptoms at each timepoint between participants with AN and AAN. Results indicated that we were successful at recruiting greater than 50% of adolescents approached for this study. We collected follow‐up data from more than 70% of participants at discharge, but did not meet this retention benchmark at six‐month and twelve‐month follow‐ups. The entire sample demonstrated significant improvements in weight and ED symptomatology from admission to discharge, and generally maintained these improvements at six‐ and twelve‐month follow‐up. While descriptive statistics suggested that participants with AN and AAN received similar outpatient services following discharge from the PHP, those with AN experienced greater improvement in self‐reported ED symptomatology than those with AAN at six‐ and twelve‐month follow‐up. These findings provide preliminary support for the efficacy of PHPs in treating adolescents with AN and AAN. Further research with larger sample sizes should investigate whether adolescents with AAN experience poorer outcomes than those with AN following discharge from a PHP. Key points: Satisfactory benchmarks for recruitment at PHP admission and retention at PHP discharge were met, but these benchmarks were not met at the two follow‐up timepoints. Future studies should utilize improved retention strategies.Preliminary results indicate that adolescents with AN and AAN experienced significant improvements from admission to discharge, further supporting the effectiveness of PHPs for people with AN and AAN.The sample also experienced significant weight increases and ED symptom reductions on all self‐report measures changes from admission to six‐month and twelve‐month follow‐up, suggesting that the treatment gains made in the PHP were generally maintained over time.Descriptively, trends suggest that adolescents with AN and AAN may continue to experience similar increases in %MBMI in the year after discharge from a PHP, but different trajectories of self‐reported ED symptoms, as adolescents with AAN tended to report higher scores on measures of ED symptomatology at follow‐up relative to discharge.This study provides support for the feasibility of a larger study evaluating the effectiveness of a cognitive‐behavioral, family‐centered PHP for adolescents with AN and AAN. Future versions of the study with larger sample sizes should aim to statistically compare differences between outcomes in the AN and AAN groups. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the factorial, divergent, and criterion‐related validity of the Youth‐Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (Y‐NIAS) in a paediatric clinical sample at initial evaluation for an eating disorder (ED). Method: Participants included 310 patients (82.9% female, 77.4% White, Age M = 14.65) from a tertiary ED clinic. Confirmatory factor analysis (CFA) evaluated the three‐factor of the Y‐NIAS. One‐way analysis of variance compared Y‐NIAS scores across diagnoses. A receiver operating curve analysis assessed the ability of each subscale to identify ARFID presentations from the full sample. Two logistic regressions assessed the criterion‐related validity of the obtained Y‐NIAS cut‐scores. Results: CFA supported the original three‐factor structure of the Y‐NIAS. Clinically‐elevated scores were observed in all diagnostic groups except for binge‐eating disorder. Subscales were unable to discriminate ARFID cases from other ED diagnoses. Cut scores were identified for picky eating subscale (10) and Fear subscale (9), but not for Appetite subscale. In combination with the ED Examination Questionnaire (EDE‐Q), classification accuracy was moderate for ARFID (62.7%) and other EDs (89.4%). Discussion: The Y‐NIAS demonstrated excellent factorial validity and internal consistency. Findings were mixed regarding the utility of the Y‐NIAS for identifying clinically‐significant ARFID presentations from other ED diagnoses. Key points: The Y‐NIAS demonstrated acceptable factorial validity, internal consistency, and discriminant validity with a measure of weight/shape‐driven disordered eating.Mean scores on the Y‐NIAS subscales did not significantly differ between those diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID) and those diagnosed with other eating disorders.Cut scores for the picky eating (PE) and Fear subscales with high sensitivity and acceptable specificity were identified, but positive predictive value (PPV) was low.Despite limited ability to discriminate ARFID from other eating disorders, the Y‐NIAS was able to identify clinically‐elevated scores in all diagnostic groups with restrictive eating disorders, indicating that it may have the potential to serve as a transdiagnostic ED screener. [ABSTRACT FROM AUTHOR]

Objective: There is a lack of reliable and valid parent-report measures assessing eating disorder (ED) pathology in children and adolescents. This study aimed to develop and provide preliminary validation of a new parent-report measure, the 12-item Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P). Method: The EDE-QS-P was completed by 296 parents seeking treatment for their child at an ED clinic. Children (ages 6–18, N = 296) completed the Eating Disorder Examination-Questionnaire (EDE-Q), the seven-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the nine-item Patient Health Questionnaire (PHQ-9). Results: After removing item 10, the 11-item version of the EDE-QS-P showed borderline adequate fit to the one factor solution and strong internal consistency (α = 0.91). This measure also demonstrated strong convergent validity with child scores on the EDE-Q (r =.69), and moderate convergent validity with child scores on the GAD-7 (r =.37) and PHQ-9 (r =.46). The EDE-QS-P was able to differentiate children with EDs characterized by body image disturbances (e.g. anorexia nervosa) from those with avoidant/restrictive food intake disorder, who do not experience shape or weight concerns. Discussion: The 11-item EDE-QS-P may be a promising parent-report measure of ED pathology in children and adolescents. [ABSTRACT FROM AUTHOR]

Little is known about patients' perceptions toward open and blind weighing for eating disorders. Upon admission to a partial hospitalization program, 35 child/adolescent patients, 55 adult patients, and 36 parents of child/adolescent patients completed questionnaires assessing attitudes toward open and blind weighing. Participants perceived blind weighing as more effective in the short term. No differences emerged on measures assessing preference, credibility, or long-term effectiveness. Relative to adults, parents preferred blind weighing, and child/adolescents perceived blind weighing as more credible. On a forced-choice question, a majority of adults, about half of children/adolescents, and a minority of parents preferred open weighing over blind weighing. There was a positive association between past treatment experience and current attitudes about weighing. Results suggest that individuals enter treatment with variable attitudes about weighing procedures for eating disorders, and may develop more favorable attitudes toward the practice they receive in treatment. [ABSTRACT FROM AUTHOR]

Little is known about which specific weight management skills bariatric patients find most and least valuable. Participants completed a measure assessing their usage of weight management skills at a follow-up appointment one or more years after undergoing bariatric surgery. Decreased usage of skills was associated with unsuccessful weight outcome, defined as losing less than 50% of excess weight, as well as weight regain. Weighing regularly was the skill selected most often by successful participants as helpful, and was chosen by a significantly smaller percentage of unsuccessful participants and those who regained a clinically significant amount of weight. A majority of both successful and unsuccessful participants indicated that they had discontinued food journaling. Weighing regularly may be perceived as a more useful method of self-monitoring. [ABSTRACT FROM AUTHOR]

Purpose: To explore the psychological impact of weight labels.Design: A double-blind experiment that randomly informed participants that they were "normal weight" or "overweight."Setting: Public university in Honolulu, Hawai'i.Participants: Normal-weight and overweight female undergraduates (N = 113).Measures: The Body Image States Scale, Stunkard Rating Scale, Weight Bias Internalization Scale, Positive and Negative Affect Schedule, General Health question from the 12-item Short Form Health Survey, modified version of the Weight Loss Methods Scale, and a manipulation check.Analysis: A 2 × 2 between-subjects analysis of variance explored the main effects of the assigned weight label and actual weight and interactions between assigned weight label and actual weight.Results: Significant main effects of the assigned weight label emerged on measures of body dissatisfaction, F(1, 109) = 12.40, p = .001, [Formula: see text] = 0.10, internalized weight stigma, F(1, 108) = 4.35, p = .039, [Formula: see text] = .04, and negative affect, F(1, 108) = 9.22, p = .003, [Formula: see text] = .08. Significant assigned weight label × actual weight interactions were found on measures of perceived body image, F(1, 109) = 6.29, p = .014, [Formula: see text] = .06, and perceived health, F(1, 109) = 4.18, p = .043, [Formula: see text] = .04.Conclusion: A weight label of "overweight" may have negative psychological consequences, particularly for overweight women. [ABSTRACT FROM AUTHOR]

The Fear of Food Measure (FOFM) was developed to assess eating-related anxiety and evaluate outcomes of food exposure treatment. The FOFM scores in adult community and clinical samples have demonstrated good factor structure, reliability, and validity, but the FOFM has yet to be evaluated in adolescents, despite eating disorders (EDs) being extremely prevalent during adolescence. The current research evaluated the psychometric properties of the FOFM in three independent child and adolescent samples ages 11–18: patients at two separate intensive treatment programs for EDs (N = 688, N = 151) and students in an all-girl high school (N = 310). The revised adolescent version of FOFM (FOFM-A) consists of 10 items and three subscales: Anxiety About Eating, Food Anxiety Rules, and Social Eating Anxiety. We also found support for the use of a global FOFM-A score in an adolescent population. The FOFM-A scores evidenced good internal consistency as well as convergent, discriminant, and incremental validity across all samples. FOFM-A subscales strongly correlated with other measures of ED symptoms and moderately to strongly correlated with measures of anxiety and depression. Adolescents diagnosed with EDs scored significantly higher on all subscales of FOFM-A compared to a community high school sample without ED diagnoses. We identified that a total FOFM-A cutoff score of 1.93 best differentiates between those with and without ED diagnoses. The FOFM-A may be useful in the assessment and treatment of eating-related anxiety and avoidance in adolescents. Public Significance Statement: The study provides evidence for reliability and validity of the scores of the Fear of Food Measure adapted to adolescents (FOFM-A). The FOFM-A can be used to access eating-related anxiety in adolescents with and without an ED diagnosis and help assess outcomes of exposure-informed treatment programs. [ABSTRACT FROM AUTHOR]