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Background: Living in a food-insecure or food insufficient household may increase risk for binge eating and obesity. Because racial disparities in food access, obesity, and access to treatment for disordered eating exist, it is important to examine these relationships in Black populations. Methods: We conducted a secondary analysis of data from the National Survey of American Life (N = 4553), a nationally-representative sample of Black Americans, including African Americans and Afro-Caribbeans. Logistic regression was used to explore the association of food insufficiency with obesity and binge eating. Results: In the total sample of Black Americans, the prevalence of food insufficiency was 10.9% (95% CI 10.0–11.8%). Food insufficiency was not significantly associated with obesity in Black Americans, but when associations were explored in analyses stratified by ethnicity and sex, food insufficiency significantly predicted an increased odds of obesity in Afro-Caribbeans (odds ratio [OR] = 1.47, 95% CI 1.01, 2.13). Individuals experiencing food insufficiency were more likely to report recurrent binge eating in the last 12 months (3% v 2%, P = 0.02) and a lifetime history of binge eating (6% v 3%, P = 0.004) compared to those who were food sufficient. After adjusting for socio-demographic factors, food insufficiency was not significantly associated with recurrent binge eating in Black Americans or in sex- and ethnicity-stratified analyses. Conclusion: The present study reveals a more complex relation between food insufficiency and binge eating than previously thought—although an association existed, it was attenuated by an array of sociodemographic factors. Our results also underscore the importance of considering ethnicity as different patterns emerged between African American and Afro-Caribbean participants. Plain English Summary: Living in a food-insufficient household may increase risk for binge eating and obesity. Because we know very little about this relationship in Black Americans, we conducted a research study to examine the rates of food insufficiency, binge eating, and obesity in a sample of African Americans and Afro-Caribbeans. The prevalence of food insufficiency in the entire sample was 10.9%. In Afro-Caribbeans, individuals with food insufficiency were more likely to have obesity, than those who were food sufficient. We did not see this relationship in African Americans. Individuals with food insufficiency were more likely to report recurrent binge eating in the last 12 months, compared to those with food sufficiency. After adjusting for socio-demographic factors, however, food insufficiency was not significantly associated with recurrent binge eating. [ABSTRACT FROM AUTHOR]

Enabled by advances in high throughput genomic sequencing and an unprecedented level of global data sharing, molecular genetic research is beginning to unlock the biological basis of eating disorders. This invited review provides an overview of genetic discoveries in eating disorders in the genome-wide era. To date, five genome-wide association studies on eating disorders have been conducted – all on anorexia nervosa (AN). For AN, several risk loci have been detected, and ~11–17% of the heritability has been accounted for by common genetic variants. There is extensive genetic overlap between AN and psychological traits, especially obsessive-compulsive disorder, and intriguingly, with metabolic phenotypes even after adjusting for body mass index (BMI) risk variants. Furthermore, genetic risk variants predisposing to lower BMI may be causal risk factors for AN. Causal genes and biological pathways of eating disorders have yet to be elucidated and will require greater sample sizes and statistical power, and functional follow-up studies. Several studies are underway to recruit individuals with bulimia nervosa and binge-eating disorder to enable further genome-wide studies. Data collections and research labs focused on the genetics of eating disorders have joined together in a global effort with the Psychiatric Genomics Consortium. Molecular genetics research in the genome-wide era is improving knowledge about the biology behind the established heritability of eating disorders. This has the potential to offer new hope for understanding eating disorder etiology and for overcoming the therapeutic challenges that confront the eating disorder field. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the early impact of COVID‐19 on people with self‐reported eating disorders. Method: Participants in the United States (US, N = 511) and the Netherlands (NL, N = 510), recruited through ongoing studies and social media, completed an online survey that included both quantitative measures and free‐text responses assessing the impact of COVID‐19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well‐being. Results: Results revealed strong and wide‐ranging effects on eating disorder concerns and illness behaviors that were consistent with eating disorder type. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge‐eating disorder (US 30% of sample; NL 15%) reported increases in their binge‐eating episodes and urges to binge. Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of COVID‐19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations of this treatment modality for this population were raised. Individuals with past histories of eating disorders noted concerns about relapse related to COVID‐19 circumstances. Encouragingly, respondents also noted positive effects including greater connection with family, more time for self‐care, and motivation to recover. Discussions: COVID‐19 is associated with increased anxiety and poses specific disorder‐related challenges for individuals with eating disorders that require attention by healthcare professionals and carers. [ABSTRACT FROM AUTHOR]

Objective: The fetal programming model hypothesizes that developmental programming in utero and in early life induces adaptations that predetermine the adult phenotype. This study investigated whether prenatal/perinatal complications are associated with lifetime eating disorders in women. Method: Participants included 46,373 adult women enrolled in the Norwegian Mother and Child Cohort Study (den norske Mor & barn‐undersøkelsen [MoBa]). MoBa mothers and their mothers (MoBa grandmothers) were the focus of the current study. MoBa mothers with lifetime eating disorders were compared to a referent group. Results: MoBa mothers who weighed more at birth (birth weight, adjusted odds ratio [OR] = 1.14; 95% confidence interval [CI]: 1.10–1.19) or were born large‐for‐gestational‐age (adjusted OR = 1.39; 95% CI: 1.27–1.52) were more likely to develop binge‐eating disorder in later life. MoBa mothers who weighed less at birth were more likely to develop anorexia nervosa (birth weight, adjusted OR = 0.88; 95% CI: 0.81–0.95). Bulimia nervosa and purging disorder (PD) were not significantly predicted by the prenatal and perinatal factors examined. Discussion: Results of this study, which include the first known investigation of prenatal and perinatal factors in binge‐eating disorder and PD, suggest that fetal programming may be relevant to the development of anorexia nervosa and binge‐eating disorder. Future genetically informative research is needed to help disentangle whether these associations are a function of genetic influences or a true environmental fetal programming effect. [ABSTRACT FROM AUTHOR]

Latinos are less likely to seek health care for eating disorders and more likely to drop out of treatment than members of other ethnic groups, highlighting existing challenges to engagement in traditional mental health care. This study explored the role of family in the treatment of adult Latinas with eating disorders through content analysis of family sessions adjunctive to cognitive behavioral therapy. This study yielded insight into the experiences of 10 Latinas with eating disorders (M age = 39.90 years) and 10 relatives (M age = 39.50) from the Promoviendo una Alimentación Saludable trial who were randomly selected to receive six family enhancement sessions. Data from 53 sessions were analyzed using a qualitative content analysis approach. Family intervention might serve as a valuable adjunct to conventional treatment by positively influencing social, family, and emotional support for Latinas with eating disorders. [ABSTRACT FROM AUTHOR]

Objective: Capturing trends in healthcare utilization may help to improve efficiencies in the detection and diagnosis of illness, to plan service delivery, and to forecast future health expenditures. For binge-eating disorder (BED), issues include lengthy delays in detection and diagnosis, missed opportunities for recognition and treatment, and morbidity. The study objective was to compare healthcare utilization and expenditure in people with and without BED.Methods: A case-control design and nationwide registers were used. All individuals diagnosed with BED at eating disorder clinics in Sweden between 2005 and 2009 were included (N = 319, 97% female, M age = 22 years). Ten controls (N = 3190) were matched to each case on age-, sex-, and location of birth. Inpatient, hospital-based outpatient, and prescription medication utilization and expenditure were analyzed up to eight years before and four years after the index date (i.e., date of diagnosis of the BED case).Results: Cases had significantly higher inpatient, hospital-based outpatient, and prescription medication utilization and expenditure compared with controls many years prior to and after diagnosis of BED. Utilization and expenditure for controls was relatively stable over time, but for cases followed an inverted U-shape and peaked at the index year. Care for somatic conditions normalized after the index year, but care for psychiatric conditions remained significantly higher.Conclusion: Individuals with BED had substantially higher healthcare utilization and costs in the years prior to and after diagnosis of BED. Since previous research shows a delay in diagnosis, findings indicate clear opportunities for earlier detection and clinical management. Training of providers in detection, diagnosis, and management may help curtail morbidity. A reduction in healthcare utilization was observed after BED diagnosis. This suggests that earlier diagnosis and treatment could improve long-term health outcomes and reduce the economic burden associated with BED. [ABSTRACT FROM AUTHOR]

Objective The clinical significance of 2 main dimensions of perfectionism (perfectionistic strivings and perfectionistic concerns) was examined via a meta-analysis of studies investigating perfectionism in the psychopathology literature. Method We investigated relationships between psychopathology outcomes (clinical diagnoses of depression, anxiety disorders, obsessive-compulsive disorder, and eating disorders; symptoms of these disorders; and outcomes related to psychopathology, such as deliberate self-harm, suicidal ideation, and general distress) and each perfectionism dimension. The relationships were examined by evaluating (a) differences in the magnitude of association of the 2 perfectionism dimensions with psychopathology outcomes and (b) subscales of 2 common measures of perfectionism. Results A systematic literature search retrieved 284 relevant studies, resulting in 2,047 effect sizes that were analysed with meta-analysis and meta-regression while accounting for data dependencies. Conclusion Findings support the notion of perfectionism as a transdiagnostic factor by demonstrating that both dimensions are associated with various forms of psychopathology. [ABSTRACT FROM AUTHOR]

Previous studies of the relationship between maternal eating disorders and adverse perinatal outcomes have failed to control for familial transmission of perinatal phenotypes, which may confound the reported association. In a unique design afforded by the Norwegian Mother and Child Cohort Study and Medical Birth Registry of Norway, we linked three generations through birth register records and maternal-reported survey data to investigate whether maternal eating disorders increase risk after parsing out the contribution of familial transmission of perinatal phenotypes. The samples were 70,881 pregnancies in grandmother-mother-child triads for analyses concerning eating disorder exposure during pregnancy and 52,348 for analyses concerning lifetime maternal eating disorder exposure. As hypothesized, eating disorders predicted a higher incidence of perinatal complications even after adjusting for grandmaternal perinatal phenotypes. For example, anorexia nervosa immediately prior to pregnancy was associated with smaller birth length (relative risk = 1.62; 95% CI [1.20, 2.14]), bulimia nervosa with induced labor (relative risk = 1.21; 95% CI [1.07, 1.36]), and binge-eating disorder with several delivery complications, larger birth length (relative risk = 1.25; 95% CI [1.17, 1.34]), and large-for-gestational-age (relative risk = 1.04; 95% CI [1.01, 1.06]). Maternal pregravid body mass index and gestational weight mediated most associations. Our results support that exposure to eating disorders increases the risk for negative health outcomes in pregnant women and their babies. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

ABSTRACT Objective We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout. Method Participants ( N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors. Results Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96). Discussion Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:569-577) [ABSTRACT FROM AUTHOR]

Objective To investigate the quality of randomized controlled trials (RCTs) of eating disorder prevention. Method A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library to January 2016. Studies were included if they were RCTs that tested an eating disorder prevention program. We identified 96 studies with a total 15,350 participants (91% female, M age = 17 years) and rated quality with the Quality Rating Scale (QRS; Moncrieff et al., 2001). Results The mean QRS score was 62% ( SD = 13%). Several standards of quality were not frequently fulfilled (i.e., failed to achieve an optimal rating), for example, power calculation (85%), intent-to-treat analysis (54%), blinding of assessor (75%), representative sample (78%), adequate sample size (75%), and appropriate duration of trial including follow-up (67%). QRS was positively and significantly associated with publication year, number of authors, and PubMed-indexation. Discussion Given the majority of eating disorder prevention studies had problems with trial quality, it is recommended that future RCTs follow quality checklists and CONSORT guidelines, that RCTs are registered, and protocols published in advance. In addition, funding bodies are called on to deliver the support needed to ensure that preventions for eating disorders are efficiently and cost-effectively achieved. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To evaluate associations between binge-eating disorder (BED) and somatic illnesses and determine whether medical comorbidities are more common in individuals who present with BED and comorbid obesity. Method Cases ( n = 850) were individuals with a BED diagnosis in the Swedish eating disorders quality registers. Ten community controls were matched to each case on sex, and year, month, and county of birth. Associations of BED status with neurologic, immune, respiratory, gastrointestinal, skin, musculoskeletal, genitourinary, circulatory, and endocrine system diseases were evaluated using conditional logistic regression models. We further examined these associations by adjusting for lifetime psychiatric comorbidity. Amongst individuals with BED, we explored whether comorbid obesity was associated with risk of somatic disorders. Results BED was associated with most classes of diseases evaluated; strongest associations were with diabetes [odds ratio (95% confidence interval) = 5.7 (3.8; 8.7)] and circulatory systems [1.9 (1.3; 2.7)], likely indexing components of metabolic syndrome. Amongst individuals with BED, those with comorbid obesity were more likely to have a lifetime history of respiratory [1.5 (1.1; 2.1)] and gastrointestinal [2.6 (1.7; 4.1)] diseases than those without comorbid obesity. Increased risk of some somatic disease classes in individuals with BED was not simply due to obesity or other lifetime psychiatric comorbidity. Discussion The association of BED with many somatic illnesses highlights the morbidity experienced by individuals with BED. Clinicians treating patients with BED should be vigilant for medical comorbidities. Nonpsychiatric providers may be the first clinical contact for those with BED underscoring the importance of screening in primary care. © 2016 The Authors International Journal of Eating Disorders Published by Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:58-65) [ABSTRACT FROM AUTHOR]

Objective: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F).Method: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up.Results: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up.Conclusions: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention. Method A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention ( N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention ( N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention ( N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted. Results Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up. Discussion The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Perfectionism has a strong association with eating disorders. Research in non-clinical adults has suggested that perfectionism has both direct and indirect effects on eating disorder symptoms, and that compulsive exercise is a potential mediator. The aim of this study was to understand whether perfectionism is associated with eating disorder symptoms, both directly and indirectly through compulsive exercise in underweight adolescents with eating disorders. Participants were 149 female adolescents (M = 14.90 years, age range 13-17) with eating disorders from the Helping to Outline Paediatric Eating Disorders (HOPE) Project, an ongoing, registry study of individuals consecutively referred individuals to a statewide eating disorder service. The majority had a diagnosis of anorexia nervosa restricting type (66 %), followed by unspecified feeding or eating disorder (21 %), and anorexia nervosa binge-eating purging type (13 %). To test the model, path analyses with bootstrapping were conducted. All paths were statistically significant, including the indirect effect from perfectionism to eating disorder pathology via the mediator of compulsive exercise, and the direct effect of perfectionism on eating disorder pathology. Overall, this research provides further evidence that compulsive exercise may be one factor that can explain the relationship between perfectionism and eating disorder symptoms. Future research should seek to determine the relative efficacy of approaches for the treatment of eating disorders in adolescents which target perfectionism and compulsive exercise. [ABSTRACT FROM AUTHOR]

Objective: The factor structure of the eating disorder examination (EDE) has never been tested in a clinical pediatric sample, and no normative data exist. Method: The factor structure of an adapted EDE was examined in a clinical sample of 665 females aged 9-17 years with anorexia nervosa spectrum (70%), bulimia nervosa spectrum (12%), purging disorder (3%), and unspecified feeding and eating disorders (15%). Results: The original four-factor model was a good fit in a confirmatory factor analysis as well a higher order model with three dimensions of restraint, eating concern, and combined weight concern/ shape concern. Normative data are reported for clinicians to identify the percentiles in which their patients' score. Discussion: The findings support dimensions of restraint, eating concern, weight concern, and shape concern in a clinical pediatric sample. This supports the factorial validity of the EDE, and the norms may assist clinicians to evaluate symptoms in females under 18 years. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The aim of this paper was to internally validate previously reported relations (Knoph Berg et al., Aust N Z J Psychiatry, 42, 396-404, 2008) between psychosocial factors and bulimia nervosa (BN) outcomes during pregnancy. Method This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Participants were women enrolled during pregnancy ( N = 69,030). Internal validity was evaluated by way of bootstrapped parameter estimates using the overall sample and a split sample calibration approach. Results Bootstrap bias estimates were below the problematic threshold, and extend earlier findings (Knoph Berg et al., Aust N Z J Psychiatry, 42, 396-404, 2008) by providing support for the validity of the models at the population level of all pregnant women in Norway. Bootstrap risk ratios indicated that prevalence, incidence, and remission of BN during pregnancy were significantly associated with psychosocial factors. The split sample procedure showed that the models developed on the training sample did not predict risks in the validation sample. Discussion This study characterizes associations between psychosocial exposures and BN outcomes among pregnant women in Norway. Women with lifetime and current self-reported psychosocial adversities were at a much higher risk for BN during pregnancy. Psychosocial factors were associated with BN remission during pregnancy, inviting the prospect of enhancing therapeutic interventions. We consider the findings in the context of reproducibility in science. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:654-662) [ABSTRACT FROM AUTHOR]

Objective To examine the prevalence and importance of psychological, behavioural, and situational correlates of impending psychiatric inpatient admissions in children and adolescents with eating disorders. Method The sample consisted of 285 patients (8–17 years, M = 14.4, SD = 1.49) with DSM-5 eating disorders assessed between 2006 and 2013 from the Helping to Outline Pediatric Eating Disorders (HOPE) Project. The sample was split into two groups, those with ( n = 38) and without ( n = 247) impending psychiatric admission; Discriminant function analysis was used to examine correlates. Results The prevalence of impending psychiatric admission was 13.3%. Suicidal ideation provided the greatest discriminating power, followed by eating pathology, depressive symptoms, anxiety, multiple methods of weight control, binge eating, and family functioning. Conclusions Earlier recognition of comorbid symptoms in eating disorders in the community may reduce the number of young people with eating disorders who present needing critical psychiatric care. [ABSTRACT FROM AUTHOR]

Objective China is undergoing dramatic Westernization, hence may be able to provide unique insights into the role of sociocultural factors in disease. The purpose of this exploratory study was two-fold: to describe the prevalence of screening-detected eating disorders and disordered eating in China at the first occasion of assessment in the large-scale China Health and Nutrition Survey (CHNS) and to explore the associations between dietary practices and disordered eating. Regarding the first objective, participants are provincially representative and in subsequent waves will be followed longitudinally. Method CHNS participants were recruited using multistage, cluster random sampling, beginning in 1989. In this study, participants comprised 259 female adolescents (12-17 years) and 979 women (18-35 years) who participated in the CHNS 2009 survey, which is the first CHNS survey to assess disordered eating. Dietary practice-disordered eating associations were investigated with logistic regression adjusting for age, body mass index, and urbanization. Results Of the participants, 6.3% (95% CI: 4.8, 8.2) of adults and 7.8% (95% CI: 5.0, 12.0) of adolescents had a screening-detected eating disorder. Dietary practices had non-significant associations with disordered eating at the general population level, except for protein consumption among women. There was evidence that skipping meals and a high-fat diet may confer risk. Discussion Screening-detected eating disorders in China are lower in prevalence than in developed countries. Dietary practices had fairly limited associations with disordered eating at the general population level; protein consumption, skipping meals, and a high-fat diet are candidate dietary practice exposures for disordered eating. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This review summarizes studies on eating disorders in pregnancy and the postpartum period that have been conducted as part of the broader Norwegian Mother and Child Cohort Study (MoBa). Prior to the 2000s, empirical literature on eating disorders in pregnancy was sparse and consisted mostly of studies in small clinical samples. MoBa has contributed to a new era of research by making population-based and large-sample research possible. To date, MoBa has led to 19 eating disorder studies on diverse questions including the prevalence, course, and risk correlates of eating disorders during pregnancy and the postpartum. The associations between eating disorder exposure and pregnancy, birth and obstetric outcomes, and maternal and offspring health and well-being, have also been areas of focus. The findings indicate that eating disorders in pregnancy are relatively common and appear to confer health risks to mother and her child related to sleep, birth outcomes, maternal nutrition, and child feeding and eating. [ABSTRACT FROM AUTHOR]

Objective Given the importance of assessing depressive symptoms and suicidal ideation in adolescents with eating disorders (EDs), the aim was to provide normative data on the Children's Depression Inventory (CDI) for female adolescents presenting for treatment of an ED. Method The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry ( N = 1000), a prospective, ongoing registry study comprising consecutive pediatric tertiary ED referrals. Females ( N = 256; 12-17 years) with DSM-5 EDs completed the CDI at intake. Results Results on the CDI revealed a pattern of increasing depressive scores with age and higher scores among patients with anorexic spectrum disorders. The prevalence of suicidal ideation was high and had the same pattern as CDI scores. The mean score on the CDI in the sample was higher than community samples and clinical samples of adolescents with post-traumatic stress disorder, obsessive compulsive disorder, and other clinical disorders. Discussion Females adolescents with EDs are at high-risk of depression and suicidal ideation. These data provide information about variation in CDI scores to guide clinicians in interpretation of scores. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:666-670) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To provide normative data on the Multidimensional Anxiety Scale for Children (MASC) for female adolescents presenting for eating disorder (ED) treatment. Method This study is part of the Helping to Outline Paediatric Eating Disorders Project registry ( N ∼ 1,000), a prospective ongoing registry study comprising consecutive pediatric tertiary ED referrals. Female adolescents ( N = 278; 13-17 years) with EDs completed the MASC at intake. Results Summary data including percentiles are given for the MASC total and subscales. MASC scores were higher than community norms as expected and increased with age ( p <.001) and an anorexic spectrum diagnosis ( p < .001). Discussion The norms reported will aid clinicians in the understanding and interpretation of individual MASC scores among female adolescents with EDs and could assist future research to better understand the role of anxiety in the onset and maintenance of EDs. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:471-474) [ABSTRACT FROM AUTHOR]

ABSTRACT Background Eating disorders are common but underdiagnosed illnesses. Help-seeking for co-occurring issues, such as anxiety and depression, are common. Objectives To identify the prevalence of eating problems, using the SCOFF, and eating disorders when screening positive on the SCOFF (i.e., ≥2), among patients seeking help for anxiety and depression at a community-based mental health service. Method Patients ( N = 260) consecutively referred and assessed for anxiety and depression treatment were administered the SCOFF screening questionnaire and a semi-structured standardized diagnostic interview during routine intake. Results 18.5% (48/260) scored ≥2 on the SCOFF, indicating eating problems. Of these, 41% (19/48) met criteria for an eating disorder. Thus, overall, 7.3% (19/260) of the sample met criteria for a DSM-IV eating disorder. Those scoring ≥2 on the SCOFF were more likely to: be female ( p = 0.001), younger ( p = 0.003), and have a history of self-harm ( p < 0.001). Discussion This study confirms that eating disorders are a hidden phenomenon in general outpatient mental health. By using a standardized diagnostic interview to establish diagnosis rather than self- or staff-report, the study builds on limited previous findings. The naturalistic study setting shows that screening for eating disorders can be easily built into routine intake practice, and successfully identifies treatment need. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:422-425) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program. Method This study compared cognitive, behavioral, and physical and medical features of children (≤12 years) and adolescents (13-18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades ( N = 656; 8-18 years; 94% female). Results Significant differences were found between the groups. Children were more commonly male ( p < .001), had lower eating pathology scores ( p < .001), were less likely to binge eat ( p = .02), purge ( p < .001) or exercise for shape and weight control ( p < .001), and lost weight at a faster rate than adolescents ( p = .009), whereas adolescents were more likely to present with bulimia nervosa spectrum disorders ( p = .004). Children and adolescents did not differ significantly on mean body mass index z-score, percentage of body weight lost, or indicators of medical compromise ( p > .05). Discussion The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:47-53) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study examined whether rapid response to enhanced cognitive behavioral therapy (CBT-E) was associated with superior treatment outcomes in a transdiagnostic sample of patients with an eating disorder. Method Participants were 105 patients with a primary eating disorder diagnosis who received individual CBT-E at a community-based outpatient clinic. Patients completed measures of eating disorder and related pathology at baseline and post-treatment. The Eating Disorder Examination-Questionnaire (EDE-Q) was administered at baseline and again, on average, 4.6 weeks after commencing treatment to assess rapid response to CBT-E. Patients achieving reliable change on the EDE-Q at this point were classified as rapid responders. Results No baseline differences distinguished rapid and nonrapid responders. Rapid responders had significantly lower scores on EDE-Q global at post-treatment, were more likely to achieve full remission, and required significantly fewer treatment sessions than nonrapid responders. One-quarter of the nonrapid responders went on to achieve full remission. There were no group differences on measures of anxiety and depression symptoms at the end of treatment. Discussion Early change in treatment is encouraged to achieve the best possible prognosis in CBT-E. Those who did not achieve rapid response still had an overall significant improvement in symptoms from pretreatment to post-treatment, but a lower rate of full remission. Nonrapid responders are an important group of patients to study because they offer researchers an opportunity to improve clinical decision-making and treatment outcomes for patients who are at risk of suboptimal response. © 2013 Wiley Periodicals, Inc.(Int J Eat Disord 2013; 46:764-770) [ABSTRACT FROM AUTHOR]

Background Among adults, personality traits have been implicated in the development and maintenance of eating disorders ( EDs); whether these findings extend to youth is unknown. The aim of this study was to investigate personality traits of adolescents with EDs. Methods A case-control approach was performed by comparing a clinical group of female adolescents with EDs ( n = 23) to a control group of adolescents in the general community ( n = 26) on personality traits of inhibited, self-demeaning, and borderline tendency. Controls were frequency-matched to cases on age and sex, were drawn from a similar geographic catchment area, and observed in the same year as clinical cases. Results The clinical group demonstrated significantly higher scores on self-demeaning ( F(1,47) = 41.39, p < .001, η2 = .075), borderline ( F(1,47) = 24.50, p < .001, η2 = .093), and inhibited ( F(1,47) = 13.33, p = .001, η2 = .014) personality styles. Adjustment for affective symptomatology diminished the strength of these relationships, but personality pathology still demarcated the group with clinical EDs. Conclusions The well-established link between personality pathology and EDs in adults generalised to adolescents. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The aim of this study was to examine parent-youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample. Method The sample comprised 619 parent-youth dyads of youth (8-18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports. Results On the whole, parent-youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48-0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07-0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents. Discussion Results support the utility of parent-youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:617-625) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective In light of prior inconsistent findings, this study revisits the relationship between weight suppression and treatment outcome in bulimia nervosa. Aside from differences in methodology, we propose that moderator effects may assist the field in interpreting previous inconsistency. In this study, we considered moderators that might place individuals at risk of broad cognitive and biobehavioral mechanisms implicated in weight (dys)regulation and binge eating, and that within the context of a history of weight suppression, might be associated with especially poor outcomes. Method Participants were 117 female outpatients aged 16-54 years ( M = 25.5) with bulimic disorders treated with enhanced cognitive behavioral therapy. Results Logistic regression indicated that higher pretreatment weight suppression did not predict drop-out or poor treatment outcome (nonabstinence from binging and purging). Moderators of parental history of overweight, childhood body shape, pretreatment body mass index, and the difference between highest and lowest ever adult body weight were analyzed, but no moderator effects were apparent. Discussion This study, along with other negative studies, calls into question the association between weight suppression and treatment outcome. We maintain that moderators may account for inconsistencies, but no candidates were identified in this study. Moderator models could assist us to refine conceptualizations of why some patients high in weight suppression may be vulnerable to poor treatment adherence and outcome and to establish clinical interventions that enhance prognosis. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:586-593) [ABSTRACT FROM AUTHOR]

Objective Traditionally, drop-out has been investigated subsequent to treatment entry; yet some individuals 'exit early,' attending assessment but failing to commence the treatment offered. Early exit burdens administrative and clinical resources and means that individuals may not receive the care needed for recovery. This study aimed to describe the prevalence and characteristics associated with early exit at a statewide, outpatient eating disorder service. Method From a pool of 972 consecutive referrals of adults and youth (16+ years), two groups were formed; an 'early exit' group of individuals who attended assessment but chose to exit the service prior to treatment entry and a 'non-early exit' group that attended assessment and entered treatment. The groups were compared on sociodemographic, clinical, and administrative features. Results The prevalence of early exit was 18.7%. The early exit group exhibited less pathology compared with the non-early exit group; specifically, a lower presence of Axis I comorbidity ( p = .04) and self-induced vomiting ( p = .04). Discussion The findings, considered in the context of previous research, suggest that there are no measured features to date that are robustly associated with early exit from outpatient eating disorder services. Future research should investigate decision-making processes at assessment, to inform patient-centered approaches that optimize transition to treatment. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:553-559) [ABSTRACT FROM AUTHOR]

Objectives: To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., 'subjective bulimia nervosa,' SBN), has comparable clinical severity to established eating disorders, particularly BN. Method: Treatment-seeking adults with BN ( N = 112), SBN ( N = 28), anorexia nervosa restricting type (AN-R) ( N = 45), and AN-binge/purge type (AN-B/P) ( N = 24) were compared. Results: Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P. Discussion: Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) [ABSTRACT FROM AUTHOR]

Objective To determine whether an outreach community-based training program on eating disorders enhances perceived capacity of rural health and education professionals to respond to and manage eating disorders. Design Survey conducted upon completion of outreach training. Setting Rural Western Australia. Participants Health and education professionals working in rural Western Australia. Main outcome measures Questionnaire responses analysed via descriptive statistics and inferential tests. Results There was a significant increase in perceived ability to identify, support and/or treat people with eating disorders among health and education professionals. Conclusions Outreach training up-skilled rural gatekeepers and introduced systemic health system benefits of increased consultation and liaison, a fine-tuning of referral processes, a reduction in hospital admissions and better uptake of local services by patients discharged from hospital. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to investigate the mediating effect of shape and weight overvaluation and conditional goal-setting on the relationship between perfectionism and eating pathology among women in the general community. Results from structural equation modeling indicated that the full mediation model previously established with a clinical sample (Watson et al., 2011), generalized to the present community sample (n =202). The indirect effect of self-oriented perfectionism on eating disorder pathology was .25 (p <.001) via shape and weight overvaluation, and .10 (p <.01) via conditional goal-setting, supporting the hypothesis that self-oriented perfectionism increased eating disorder psychopathology via each mechanism. Shape and weight overvaluation was the stronger mediator. The findings provide evidence to support existing cognitive-behavioral formulations of eating pathology and clinical perfectionism, and have implications for the prevention of eating pathology. [Copyright &y& Elsevier]

Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well-being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT-E). Patients ( n = 196) admitted to a specialist eating disorders outpatient programme and receiving CBT-E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self-esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post-treatment QOL were baseline QOL and level of depressive symptoms and self-esteem at post-treatment. CBT-E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Abstract: An interactive model implicating high perfectionism, high weight and shape concern, and low self-esteem in the onset and maintenance of bulimic symptoms () has received mixed support. This study aimed to replicate the cross-sectional model in a clinical sample of women with eating disorders, and to investigate whether the model could predict changes in binge eating and purging at the end of treatment. Eating disorder outpatients (n =353) completed measures of perfectionism, weight/shape concern, self-esteem, and bulimic symptoms at pre-treatment and discharge. Contrary to the hypotheses, the three-way interaction did not predict binge eating or purging cross-sectionally or prospectively as a moderator of psychotherapy outcome. It was concluded that the robustness of the interactive model seems questionable and may be impacted by an inadequate conceptualization of the perfectionism construct. [Copyright &y& Elsevier]

Abstract: This study examined the role of perfectionism (self-oriented and socially prescribed), shape and weight overvaluation, dichotomous thinking, and conditional goal setting in eating disorder psychopathology. Perfectionism and shape and weight overvaluation have had longstanding implication in the development and maintenance of eating disorders. A leading evidence-based theory of eating disorders (Fairburn, Cooper & Shafran, 2003) outlines perfectionism as a maintaining mechanism of eating disorder psychopathology and as a proximal risk factor for the development of shape and weight overvaluation. These constructs have been linked to other cognitive processes relevant to eating disorders, specifically, dichotomous thinking and conditional goal setting. Women with DSM-IV eating disorders (N =238) were compared to women in the general community (N =248) and, as hypothesised, scores on measures of these constructs were pronounced in the clinical sample. Hierarchical regression analyses predicting eating disorder psychopathology showed that for both groups, dichotomous thinking and conditional goal setting significantly improved model fit beyond perfectionism and shape and weight overvaluation alone. Self-oriented perfectionism, but not socially prescribed perfectionism, was relevant to eating disorder psychopathology. We discuss the implications for current treatment protocols and early intervention. [Copyright &y& Elsevier]

Objective: To examine mediators of the relationship between perfectionism and eating disorder (ED) psychopathology in a clinical sample. Method: Participants were 201 women with a DSM-IV diagnosed ED consecutively referred to a specialist outpatient treatment clinic. Participants completed measures of perfectionism, ED psychopathology, shape and weight overvaluation, and conditional goal-setting (CGS). Results: Evaluation of a multivariate mediator model using Baron and Kenny’s (1986) four-step mediation methodology showed that shape and weight overvaluation and CGS significantly and uniquely mediated the relation between self-oriented perfectionism (SOP) and restraint, eating concern, shape concern, and weight concern. The mediator model furthered the proportion of explained variance in outcomes beyond the direct effects model by 28–49%. Discussion: The findings support the conclusion that the relationship between SOP and ED psychopathology in women with a clinically diagnosed ED is mediated by shape and weight overvaluation and CGS. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to develop and validate a self-report measure of Conditional Goal Setting (CGS) for use among individuals with eating disorders, the Conditional Goal Setting in Eating Disorders Scale (CGS-EDS). The CGS-EDS assesses the degree to which an individual believes that the achievement of happiness is contingent upon the attainment of body shape and weight goals. Women with a DSM-IV diagnosed eating disorder consecutively referred to a specialist outpatient clinic (N =238) completed the CGS-EDS and self-report measures of theoretically related constructs. Exploratory factor analysis indicated a one-factor solution, which accounted for 65% of the variance. The CGS-EDS correlated positively with theoretically related measures of overvaluation of shape and weight, concern with shape and weight, dichotomous thinking, and depression. The alpha reliability of the scale was .92. The CGS-EDS is a valid and reliable measure of CGS in eating disorders and is relevant to cognitive and behavioral models of maintenance and intervention. [Copyright &y& Elsevier]

Studies have shown that psychiatric patients have significantly impaired quality of life (QOL) in comparison to community samples who are not suffering a mental illness. Despite an increase in research in the mental health field, there still remains little consensus as to the merit of using such questionnaires within a mental health population. There is a concern that QOL is redundant with affective state and symptomatology. We investigated the usefulness of the Quality of Life Enjoyment and Satisfaction Questionnaire-short form (QLESQ-SF) in a depressed outpatient sample receiving time-limited, standardized group cognitive–behavioural therapy. QLESQ-SF ratings were examined at admission and 10-week endpoint in an intention-to-treat (N = 212) and completers (N = 164) sample. QLESQ-SF ratings and symptom ratings (Beck Depression Inventory-II; Beck Anxiety Inventory) improved significantly over time. Hierarchical regression analyses revealed that, although affective state and change in symptomatology were significantly correlated with QOL and change in QOL, a large proportion of variance was unexplained. These results are inconsistent with the theory of measurement redundancy. QOL appears to be a useful measure that provides additional treatment outcome information distinct from affective state and symptomatology. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Gender in cognitive–behavioral therapy (CBT) for outcome for depression has been inadequately examined in previous research. Thirty-five men and 55 women diagnosed with a depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) completed individual CBT at an outpatient community mental health clinic and 56 men and 105 women completed group CBT. Depression severity was measured before treatment and at endpoint using the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) along with secondary outcomes of anxiety (Beck Anxiety Inventory; Beck, Epstein, Brown, & Steer, 1988) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Endicott, Nee, Harrison, & Blumenthal, 1993). Men and women demonstrated equivalent pretreatment and posttreatment illness severity, a comparable gradient of improvement on outcomes, and attainment of clinically meaningful benchmarks. © 2008 Wiley Periodicals, Inc. J Clin Psychol 64:1–15, 2008. [ABSTRACT FROM AUTHOR]

Latinos/as are underrepresented in eating disorders clinical trials. This study compared results of a culturally adapted individual cognitive-behavioral treatment (CBT) for binge-spectrum eating disorders that included or excluded a family enhanced module (CBT + FE), in a proof-of-principle pilot study with a sample of Latina adults and one family member per patient. Twenty-five patients (Mage = 37 yrs) and 25 family members (Mage = 40 yrs) were randomized to CBT (n = 13) or CBT+ FE (n = 12). DSM-IV eating disorder diagnoses were: 48% (n = 12) bulimia nervosa, 28% (n = 7) binge-eating disorder, and 24% (n = 6) eating disorder not otherwise specified. Effect sizes favored CBT + FE on adherence and retention, and scores on treatment satisfaction and therapeutic alliance were high, indicating treatment acceptability. In spite of the hypothesis that family outcomes such as support, familism, cohesion, pride, family cultural conflict, burden, and marital satisfaction (in couples) would be superior in CBT + FE, the preliminary data were inconclusive and results were mixed. The hypothesis that eating disorder outcomes including global eating psychopathology, binge eating, and purging would improve in CBT + FE was not supported. There was some evidence that patients in CBT improved more particularly on binge eating, otherwise the groups had no differences. In conclusion, the results suggest that CBT + FE could enhance treatment adherence and retention, although this did not automatically translate to better family and symptom outcomes. [ABSTRACT FROM AUTHOR]

Objective: To conduct a meta-analysis on randomized, controlled treatment trials of pediatric obsessive-compulsive disorder (OCD). Method: Studies were included if they employed randomized, controlled methodology and treated young people (19 years or under) with OCD. A comprehensive literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons ( N = 1016) and five cognitive-behavioral therapy (CBT) to control comparisons ( N = 161). Results: Random effects modeling yielded statistically significant pooled effect size (ES) estimates for pharmacotherapy (ES = .48, 95% CI = .36 to .61, p < .00001) and CBT (ES = 1.45, 95% CI = .68 to 2.22, p = .002). The results were robust to publication bias. Conclusions: This is the first meta-analysis of treatment RCTs for pediatric OCD. CBT and pharmacotherapy were the only treatments effective beyond control in alleviating OCD symptoms. CBT showed a greater ES than pharmacotherapy. Previous meta-analyses that included uncontrolled trials exaggerated the efficacy of both treatments. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the factor structure, validity, and reliability of the Compulsive Exercise Test (CET) in an adolescent clinical eating disorder population. The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project, a prospective ongoing registry study comprising consecutive pediatric tertiary eating disorder referrals. Adolescents ( N = 104; 12–17 years) with eating disorders completed the CET and other measures. Factor structure, convergent validity, and internal consistency were evaluated. Despite failing to identify a factor structure, the study provided clear evidence of the multidimensionality of the measure. The total score correlated significantly with measures of eating pathology, perfectionism, and frequency of exercise for shape and weight control ( r = 0.32–0.70, p s < 0.05). More research into the multidimensional nature of compulsive exercise in clinical populations is needed. Further, research into compulsive exercise offers promise as an addition to existing cognitive behavioral models and treatments for eating disorders. [ABSTRACT FROM AUTHOR]

Perfectionism is a risk factor for the development and maintenance of eating disorders. The objective of this study was to examine the efficacy of unguided Internet cognitive behaviour therapy for perfectionism (ICBT-P) as a treatment and prevention for perfectionism and symptoms of eating disorders, anxiety, depression and self-esteem in female adolescents. Young women (N = 94, 14–19 years) who self-identified as having difficulties with perfectionism but did not have a clinical eating disorder diagnosis were recruited. Participants were randomly allocated into one of three groups: unguided ICBT-P, unguided ICBT for nonspecific stress management (ICBT-S), or waitlist control. All analyses were intent-to-treat. ICBT-P resulted in the most favorable outcomes at post-treatment and 3- and 6-months follow-up. ICBT-P was superior to control on all outcome measures at 3- and 6-months and superior to ICBT-S on all outcomes over most time points (d s = 0.13–0.94). Clinical significance analysis demonstrated that the treatment prevented symptom increases over 6-month follow-up, with ICBT-P superior to ICBT-S in prevention of clinical perfectionism and depressive symptoms, and ICBT-P superior to waitlist control in prevention of eating disorder symptoms. There was relatively high attrition, although there were no differences in attrition between the groups at 3- and 6-month follow-up and rates were commensurate with other Internet interventions. The findings support unguided ICBT-P as a useful target for preventing eating disorder and associated symptoms in female youth who self-identify as perfectionistic. ACTRN12615001098527. • Perfectionistic female adolescents with no eating disorder diagnosis participated. • Participants were randomized to three conditions. • Unguided Internet cognitive behaviour therapy for perfectionism (ICBT-P). • Unguided Internet stress management (ICBT-S) or waitlist control. • ICBT-P was superior to control on all outcome measures at 3- and 6-months. [ABSTRACT FROM AUTHOR]

Measurement of compulsive exercise is important for the study of eating pathology in individuals who regularly participate in sport and exercise. The current study examined the factor structure, internal consistency and validity of the compulsive exercise test (CET) in regular exercisers. Participants were recruited via the internet and from sport clubs (n = 313 adults; M = 32 years; 57% female). A three-factor model for the CET was supported which included the weight control exercise, avoidance and rule-driven behaviour, and mood improvement subscales (fit statistics for the three-factor model: χ2SB= 4.39; CFI =.95; NNFI =.94, RMSEA =.100, 95% CI:.093—.110, AIC = 656.92). The subscales lack of exercise enjoyment and exercise rigidity were not retained. All factors demonstrated acceptable internal consistency with Cronbach's α =.77 to.91. The weight control exercise and avoidance and rule-driven behaviour subscales were significantly related to eating disorder symptoms. Given the association between CET subscales and eating disorder symptoms, the CET three-factor model may be informative when assessing eating pathology in individuals who regularly exercise. [ABSTRACT FROM AUTHOR]

Background: Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown. Aims: To assess the factor structure and construct validity of the CPQ in female adolescents. Method: The CPQ was administered to 267 females aged 14–19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits. Results: The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit. Conclusions: The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth. [ABSTRACT FROM AUTHOR]

Summary Genome-wide association study (GWAS) analyses, at sufficient sample sizes and power, have successfully revealed biological insights for several complex traits. RICOPILI, an open-sourced Perl-based pipeline was developed to address the challenges of rapidly processing large-scale multi-cohort GWAS studies including quality control (QC), imputation and downstream analyses. The pipeline is computationally efficient with portability to a wide range of high-performance computing environments. RICOPILI was created as the Psychiatric Genomics Consortium pipeline for GWAS and adopted by other users. The pipeline features (i) technical and genomic QC in case-control and trio cohorts, (ii) genome-wide phasing and imputation, (iv) association analysis, (v) meta-analysis, (vi) polygenic risk scoring and (vii) replication analysis. Notably, a major differentiator from other GWAS pipelines, RICOPILI leverages on automated parallelization and cluster job management approaches for rapid production of imputed genome-wide data. A comprehensive meta-analysis of simulated GWAS data has been incorporated demonstrating each step of the pipeline. This includes all the associated visualization plots, to allow ease of data interpretation and manuscript preparation. Simulated GWAS datasets are also packaged with the pipeline for user training tutorials and developer work. Availability and implementation RICOPILI has a flexible architecture to allow for ongoing development and incorporation of newer available algorithms and is adaptable to various HPC environments (QSUB, BSUB, SLURM and others). Specific links for genomic resources are either directly provided in this paper or via tutorials and external links. The central location hosting scripts and tutorials is found at this URL: https://sites.google.com/a/broadinstitute.org/RICOPILI/home Supplementary information Supplementary data are available at Bioinformatics online. [ABSTRACT FROM AUTHOR]

Objective: Clinical perfectionism has been found to be a risk and maintaining factor in eating disorders (EDs), compulsive exercise, and athlete burnout. This study investigated whether an unguided internet cognitive–behavioral treatment (ICBT) for perfectionism would reduce ED pathology, compulsive exercise, and burnout in individuals who engage in regular exercise. Method: Participants were randomly allocated to intervention (n = 38) or waitlist control (n =29). A generalized linear mixed model (GLMM) analysis was conducted pre and post treatment. A follow‐up analysis was conducted with the intervention group at 3 and 6 months. Results: The intervention group experienced a significant reduction in perfectionism (FMPS‐CM: F[1,117] = 17.53, p = < .001, Cohen's d = .82), ED symptomology (EDE‐Q: F[1,55] = 7.27, p = .009,Cohen's d = .53) and compulsive exercise (CET: F[1,116] = 10.33, p < .001,Cohen's d = .63). The changes attained post‐treatment were maintained within the intervention group at 3‐month (FMPS‐CM (t[1,100] = 3.67, p < . 001, Cohen's d = .85) (EDE‐Q (t[1,50] = 2.20, p = .03, Cohen's d = 1.26) and 6‐month follow‐up (FMPS (t[1,100] = 2.74, p = 007, Cohen's d = .70) (EDE‐Q (t[1,50] = 2.18, p = .03, Cohen's d = 1.26). Discussion: The results indicate unguided ICBT for perfectionism can have a significant impact on perfectionism, compulsive exercise, and ED symptomatology. [ABSTRACT FROM AUTHOR]

Background: Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study aimed to identify potential differences in the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, in order to contribute to a better understanding of their diverse needs and experiences. Methods: The study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 years) with bulimia nervosa or binge-eating disorder (BN/BED) enrolled in the Binge Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and their current mental health and gastrointestinal symptoms. Untreated participants (n = 291, 38%) were compared with treated participants (n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives. Results: Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent eating disorder symptoms over their lifetime, and greater body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. A history of anorexia nervosa was positively associated with treatment engagement. Individuals self-reporting a history of inpatient or residential treatment exhibited the most severe illness history, those with outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history. Conclusions: Historically overlooked and marginalized populations self-reported lower treatment access rates, while those who accessed treatment reported more severe eating disorder and comorbid mental health symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not represent individuals with milder symptoms or racial and ethnic diversity, and males. Community-based recruitment is crucial for improving the ability to apply research findings to broader populations and reducing disparities in medical research. Trial Registration ClinicalTrials.gov NCT04162574 (https://clinicaltrials.gov/ct2/show/NCT04162574). Plain English summary: The majority of individuals with eating disorders never enter treatment. However, most clinical research on eating disorders recruits participants from clinics and treatment centers. Therefore, most of our knowledge about eating disorders may not represent the majority of people with eating disorders, particularly those who do not enter treatment. We studied 762 people with bulimia nervosa or binge-eating disorder recruited from the community to a large research study. We compared participants who reported never accessing treatment (38%) to participants who reported having accessed treatment at some point in their lives (62%). Untreated participants were much more likely to identify as male and as a racial or ethnic minority compared with participants who had accessed treatment (who identified mostly as female and White). Participants who had accessed treatment had a more severe illness history and higher levels of body dissatisfaction and mental health symptoms at the time of the study. The present study highlights the importance of recruiting research participants from the community to clinical studies as a way to address medical inequity in marginalized and underrepresented groups. Additionally, caution is advised when generalizing research findings from research samples who have sought treatment to all people with eating disorders. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of the study was to compare the DSM‐IV, DSM‐5, and ICD‐10 eating disorders (ED) nomenclatures to assess their value in the classification of pediatric eating disorders. We investigated the prevalence of the disorders in accordance with each system's diagnostic criteria, diagnostic concordance between the systems, and interrater reliability. Method: Participants were 1062 children and adolescents assessed at intake to a specialist Eating Disorders Program (91.6% female, mean age 14.5 years, SD = 1.75). Measures were collected from routine intake assessments. Results: DSM‐5 categorization led to a lower prevalence of unspecified EDs when compared with DSM‐IV. There was almost complete overlap for specified EDs. Kappa values indicated almost excellent agreement between the two coders on all three diagnostic systems, although there was higher interrater reliability for DSM‐5 and ICD‐10 when compared with DSM‐IV. Discussion: DSM‐5 nomenclature is useful in classifying eating disorders in pediatric clinical samples. [ABSTRACT FROM AUTHOR]

Research suggests that individuals with high liking for sweets are at increased risk for binge eating, which has been minimally investigated in individuals with binge-eating disorder (BED). Forty-one adults (85% female, 83% white) with binge eating concerns completed a sweet taste test and measures of eating disorder behaviors and food cravings. A subset of participants with BED completed an oral glucose tolerance test (OGTT; N=21) and a 24-hour dietary recall (N=26). Regression models were used to compare highest sweet preferers (HSP [N=18]) to other sweet preferers (OSP [N=23]) and were used to assess associations between sweet taste preference and outcome variables. Effect sizes (ηp2) for differences between HSP and OSP ranged from small (≤0.01) to large (≥0.24); group differences were statistically nonsignificant except for 24-hour caloric intake (ηp2=0.16, p=0.04), protein intake (ηp2=0.16, p=0.04), and insulin sensitivity index (ηp2=0.24, p=0.04), which were higher in HSP, and postprandial insulin, which was smaller in HSP (ηp2=0.27, p=0.03). Continuous analyses replicated postprandial insulin response. Compared with OSP, HSP reported numerically higher binge-eating frequency (ηp2=0.04), over-eating frequency (ηp2=0.06), and carbohydrate intake (ηp2=0.14), and they exhibited numerically smaller postprandial glucose AUC (ηp2=0.16). Sweet taste preference may have implications for glucose regulation, binge-eating frequency, and nutrient intake in BED. [ABSTRACT FROM AUTHOR]

Objective: To compare individuals who have experienced binge‐eating disorder (BED) and anorexia nervosa (AN) (BED AN+) to those who have experienced BED and not AN (BED AN–). Method: Participants (N = 898) met criteria for lifetime BED and reported current binge eating. Approximately 14% had a lifetime diagnosis of AN. Analyses compared BED AN+ and BED AN– on sociodemographic variables and clinical history. Results: The presence of lifetime AN was associated with more severe eating disorder symptoms, including earlier onset, more frequent, more chronic, and more types of eating disorder behaviors over the lifetime, as well as a higher lifetime prevalence of bulimia nervosa (BN). Participants with lifetime AN reported being more likely to have received treatments for BED or BN, had significantly lower minimum, current, and maximum BMIs, had more severe general anxiety, and were significantly more likely to be younger and female. In the full sample, the lifetime prevalence of unhealthy weight control behaviors was high and treatment utilization was low, despite an average 15‐year history since symptom onset. Gastrointestinal disorders and comorbid anxiety, depression, and attention‐deficit/hyperactivity disorder symptoms were prevalent. Discussion: Individuals fared poorly on a wide array of domains, yet those with lifetime AN fared considerably more poorly. All patients with BED should be screened for mental health and gastrointestinal comorbidities and offered referral and treatment options. Public Significance: Individuals experiencing binge‐eating disorder have severe symptomology, but those who have experienced binge‐eating disorder and anorexia nervosa fare even more poorly. Our study emphasizes that patients with binge‐eating disorder would benefit from being screened for mental health and gastrointestinal comorbidities, and clinicians should consider history of unhealthy weight control behaviors to inform treatment and relapse prevention. [ABSTRACT FROM AUTHOR]