Cognitive-behavioral therapy (CBT) is the best examined treatment for eating disorders. However, previous meta-analyses of cognitive-behavioral therapy have not examined absolute outcomes, which are important from a clinical perspective. We updated a meta-analysis and conducted new searches in PubMed, Embase, PsycINFO and CINAHL. We included randomized trials comparing CBT with control conditions in adults with a diagnosed eating disorder. We used random effects models in all analyses. We included 36 trials with 44 comparisons between CBT and controls (2,809 participants), 22 trials on binge eating disorder (BED), 11 on bulimia nervosa (BN), and three on anorexia nervosa and mixed disorders. The overall effect of CBT compared to controls was g = 0.88 (95% CI: 0.71; 1.04), with high heterogeneity ( = 74; 95% CI: 65; 81; PI: -0.06; 1.81) and no significant difference between BED and BN. Effects were smaller studies with low risk of bias. The absolute abstinence rate was 0.36 (95% CI: 0.31; 0.43) for CBT and 0.10 (95% CI: 0.08; 0.12) in controls. CBT is probably effective in the treatment of bulimia nervosa and binge-eating disorder, but there is also a large group of patients who do not respond sufficiently.

Peer support is a promising approach to increasing hope, engagement, and connection for those with eating disorders (EDs). Emerging literature explores peer mentors' experiences of providing support, suggesting that mentors often benefit from providing peer support, particularly when well trained and supervised. We conducted semi-structured interviews or focus groups with 15 individuals providing peer support (one-on-one, group, or chat) to individuals with EDs. We identified 3 themes using reflexive thematic analysis (RTA) through a critical realist lens. Participants emphasized the importance of ongoing training and support to help them deliver high-quality peer support. They highlighted the importance of value-alignment in this work in terms of organizational valuing of lived experience and alignment with social justice. Participants reflected on how doing this work contributed to a sense of "giving back" and providing the kind of support they wished they had experienced. Providing peer support was described as emotion work; a challenging and rewarding experience for peer mentors. Findings carry implications for integrating peer support into the continuum of care for EDs, providing insight into approaches that can support peer support delivery in a way that promotes safety for those providing and receiving it.

Eating disorders (EDs) are associated with numerous comorbidities and deleterious outcomes (e.g. medical complications, high rates of death by suicide). The complexities of EDs are further compounded by treatment dropout, poor treatment outcomes, and relapse. One way to better understand these complexities is to investigate broad, transdiagnostic risk factors that contribute to the etiology and maintenance of EDs, such as emotion regulation (ER) difficulties. We longitudinally tested the relationship between ER difficulties and ED outcomes in a sample of 101 female ED patients in a southeastern U.S. residential ED treatment facility. Consistent with hypothesis, there were significant improvements in both ER difficulties and eating pathology from admission to discharge. Further, improvement in ER difficulties was associated with improvements in eating pathology. These findings further substantiate the role of ER difficulties in eating disorders and provide further evidence for the relationship between ER difficulties and eating pathology among residential eating disorder patients.

While diagnostic pathways for identifying Autism in eating disorder (ED) populations have been developed, the field continues to lack validated psychometric tools to measure EDs for use in the Autistic population. Many commonly used measures for EDs potentially lack validity and reliability in the Autistic population limiting theoretical and practical advancements in the field. This paper outlines current conflicts in autism and ED research and how these can be addressed through psychometric methodology. We discuss: (1) the lack of differentiation between ED pathology and Autistic eating behaviours, as well as the limited inclusion of autism-specific mechanisms in existing tools; (2) the subsequent theoretical and practical implications for researchers, clinicians, and Autistic people; and (3) future directions for psychometric research. Scholars are encouraged to employ participatory designs autistic people before carefully considering which analytical strategies are used in the Autistic population.

Leading treatments for binge eating target dietary restraint, but up to 35% of the people with binge eating report low restraint. This study examined the roles of reward sensitivity and emotion dysregulation in relation to low-restraint binge eating. Women with binge eating (low-restraint:  = 22; high-restraint:  = 69) and controls ( = 49) completed self-report measures of generalized reward sensitivity and emotion dysregulation and a picture-viewing task assessing craving and pleasure for high-calorie food. As expected, food-related craving and emotion dysregulation were greater in the clinical than in the control group, but no differences emerged between high- and low-restraint binge eating groups. However, correlational analyses found that, within the clinical group, the number of restraint days related to greater anticipatory sensitivity for generalized rewards and lower pleasure ratings of food. Results suggest that emotion dysregulation characterizes both high- and low-restraint binge eating. As self-reported food liking was linked with lower restraint, greater enjoyment of palatable foods may uniquely contribute to low-restraint binge eating. Increasing emphasis on emotion regulation and food-related reward sensitivity may enhance treatment outcomes for individuals with low-restraint binge eating.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals report more experiences of healthcare discrimination and disordered eating behaviors (DEBs), and less trust in physicians than their cisgender and heterosexual counterparts. Although research supports a link between discrimination and DEBs among LGBTQ+ populations, few studies have specifically investigated healthcare discrimination and DEBs in this population. This study examined whether LGBTQ+ status moderated the relation between negative healthcare experiences and DEBs in undergraduates. Undergraduates ( = 322) from a Southeastern (United States) university completed measures of healthcare discrimination, trust in physicians, and DEBs. Analyses investigated whether LGBTQ+ status moderated the relation between healthcare discrimination and DEBs; trust in physicians and DEBs. LGBTQ+ individuals (35% of sample), reported less trust in physicians ( < .001), and more body dissatisfaction ( = .007) and shape/weight overvaluation ( = .008). Among all undergraduates, experiences of healthcare discrimination were associated with higher body dissatisfaction ( = .003) and shape/weight overvaluation ( = .008). Less trust in physicians was associated with greater shape/weight overvaluation ( .005). LGBTQ+ status did not moderate either relation. It is important to reduce healthcare discrimination and foster patient-provider trust for all young adults. Future research should examine factors influencing patient-provider trust among LGBTQ+ individuals.

The aims of this quality improvement programme were to enable providers of mental health in-patient services for children and young people in England to review their prescribing practice alongside the views and experiences of children, young people and their parent carers. Three online tools were developed. First was a medication census tool to be completed by provider clinicians to capture prescribing practices around psychotropic medication. The two other online tools were questionnaires that provided an opportunity for inpatient children and young people and their parent carers to express their views of the medication. 193 children and young people had a primary diagnosis of eating disorders. Antidepressants were the most widely prescribed (56%), followed by antipsychotics (41%), benzodiazepines, and antihistamines as sedatives (18%) and hypnotics (11%). Of those receiving regular psychotropic medications, 67% were prescribed two or more. Both the children and young people and their parent carers expressed concerns about the high level of psychotropic medication, the number of prn administrations, the number of psychotropic medications prescribed and the extent of side effects. Psychotropic medications are widely prescribed both on a regular and on a prn basis for children and young people with eating disorders in mental health in-patient services.

The purpose of the present study was to examine the efficacy of online Dialectical Behavior Therapy for Binge Eating Disorder (DBT-BED) in reducing eating psychopathology and investigate the factors that influence the severity and frequency of binge eating. Seventy-three individuals seeking treatment for BED participated in 20 two-hour group sessions. Participants completed the Emotional Eating Scale (EES), Binge Eating Scale (BES), and Eating Disorder Examination Questionnaire (EDE-Q) before and after the treatment and at three- and six-month follow-ups. Results from 58 participants were analyzed. The study results indicated a significant decrease in objective binge eating (OBE) days, as well as in all EES, BES, and EDE-Q subscales (except the Restraint subscale), and global EDE-Q score at the end of treatment and follow-ups. Moreover, the Body Mass Index (BMI) reduced at the end of treatment and during the follow-up period. Except for the Restraint subscale, more OBE days were linked with higher EES, BES, and EDE-Q scores. Overall, the study suggests that online DBT-BED is an effective approach to treating Binge Eating Disorder (BED) for individuals who cannot receive in-person therapy. Further research is necessary to compare the efficacy of online DBT-BED with other interventions.

TikTok, a social media platform with substantial youth engagement, has been used to examine eating disorder (ED) recovery; however, no studies have described the experience of ED treatment as told on TikTok. The purpose of this study was to describe content related to ED treatment using the hashtag #EDtreatment. The 100 most-viewed videos using #EDtreatment were downloaded, transcribed verbatim, and coded. Using qualitative thematic analysis, a coding framework was created; themes were generated and reviewed by coauthors until consensus was reached. Ultimately, 55 videos were included in the analysis. The videos included in the analysis had, in total, 15.6 million views, 3 million "likes", 36647 comments, and were shared by users 26,673 times. Themes generated included Aspects of Treatment, Interpersonal Relationships, Emotions and Psychiatric Comorbidities, and ED Experiences. Content ranged from uplifting and encouraging to negative and serious. Videos used dramatic reenactments, music, humor, and other entertainment methods, suggesting that creators attempted to generate high volume viewer consumption. When combined with TikTok's brief video format, users may consume large amounts of content rapidly. Individuals considering treatment may be influenced by viewing TikTok content. When clinically engaging individuals with EDs, the perceived significance of this content is a topic of consideration.

Male mental health professionals (e.g. social workers, psychologists) are a minority of providers in eating disorder treatment spaces, and there is a drastic need to increase their representation in this clinical area. This Last Word outlines the barriers that impede male mental health professionals from specializing in eating disorder treatment, such as masculine gender norms, and provides four specific recommendations to enhance training, hiring, retention, and the development of male mental health professionals in the treatment of people with eating disorders. These recommendations include, developing gender awareness, specialized training, talking about gender, and gender and relationships. Building the representation of male mental health professionals in eating disorder treatment may reduce stigma and myths about these disorders and have positive impacts on clients across genders.

Trauma is a risk factor for eating disorders (EDs). Enhanced understanding of the pathways from trauma to EDs could identify important treatment targets. Guided by theory, the present study sought to replicate previous findings identifying posttraumatic stress disorder (PTSD) symptoms and shape/weight overvaluation as important pathways between trauma and ED symptoms and extend this work by investigating the role of posttraumatic cognitions in these associations. The sample included 825 female and 565 male post-9/11 veterans who completed cross-sectional survey measures of trauma, posttraumatic cognitions, PTSD symptoms, shape/weight overvaluation, and ED symptoms. Gender-stratified structural equation models were used to examine direct and indirect pathways from trauma exposure to EDs via PTSD symptoms and shape/weight overvaluation (replication) and posttraumatic cognitions (extension). Results suggested that trauma exposure was indirectly associated with ED symptoms via shape/weight overvaluation and posttraumatic cognitions. There was no indirect association between trauma exposure and ED symptoms via PTSD symptoms. Overall, findings from this study highlight the potential role of posttraumatic cognitions in understanding the association between trauma and ED symptoms. However, future longitudinal research is needed to verify the directionality of these associations and investigate cognitions as a potentially targetable risk mechanism in co-occurring trauma and EDs.

Anorexia Nervosa (AN) is a psychiatric disorder characterized by caloric restriction, weight loss, and fear of gaining weight. Cardiac complications are among the most severe medical consequences. Despite the importance of regular cardiac assessments, there is a lack of standardized protocols for timing and patient selection. This retrospective cohort study has aimed to assess the correlation between AN severity, Body Mass Index, weight loss percentage, and cardiac abnormalities in pediatric patients. A total of 123 patients admitted to a child and adolescent psychiatry unit between January 2019 and March 2022 were included. Data on demographics, clinical characteristics, cardiac evaluations were collected from electronic health records. The study revealed a prevalence of cardiac abnormalities in 57.7% of patients, with bradycardia being the most common (49.5%), followed by QTc prolongation (4%) and pericardial effusion (4%). However, no significant correlation was found between AN severity and cardiac alterations, suggesting that disease severity alone is not a reliable predictor of cardiac risk. The study highlights the need for individualized risk assessment and targeted cardiac evaluations based on specific risk factors rather than disease severity alone. Early diagnosis and comprehensive care contribute to better outcomes, emphasizing the importance of multidisciplinary approaches in managing AN.

Research has found that difficulties in emotion regulation negatively impact mental health, whereas cognitive flexibility may promote stress resilience and positive mental health. Little is known about cognitive flexibility and emotion regulation in people with comorbid eating disorder (ED) and anxiety and stress disorders. A transdiagnostic ED population ( = 227) at an outpatient ED treatment facility completed several self-report instruments that measured cognitive flexibility, emotion regulation difficulties, posttraumatic stress disorder (PTSD) symptoms, and generalized anxiety disorder (GAD) symptoms upon admission. We investigated cognitive flexibility and emotion regulation differences for those with an ED without comorbidity and those with various combinations of comorbidity. In a one-way between-groups ANOVA, we investigated differences in cognitive flexibility for those with GAD, PTSD, neither, and both comorbidities. We found a statistically significant difference between these groups, with mean cognitive flexibility inventory scores being the lowest in the group with both comorbidities. However, when controlling for emotion regulation, a one-way between-groups ANCOVA indicated no significant differences in cognitive flexibility between comorbidity groups (3, 222) = 1.20,  = .31  = .02. Though self-reported cognitive flexibility levels differ among ED patients with and without comorbidities, it appears that these differences are better explained by emotion regulation. Therefore, addressing emotion regulation early in treatment for all individuals with EDs, regardless of comorbidity, is recommended as a future research focus to enhance treatment outcomes. Further research is needed to understand the impact of treating emotion regulation on ED treatment engagement, dropout, and effectiveness.

The aim of this study was a systematic review and meta-analysis of the relationship between eating disorders and mortality. Based on this, eating disorders were investigated concerning all causes of mortality. Information sources including PubMed, Scopus, and Web of Science were used based on a systematic search. Google Scholar and Research Gate were also searched. The search in these databases started without a time limit and was done until December 2023. This search was done in English. The results extracted were pooled together based on the Standardized Mortality Ratio (SMR) with a 95% confidence interval. The random effects method was used to pool studies together. An analysis was performed based on eating disorders and mortality, and the relationship between three types of eating disorders and mortality was reported as subgroups. Sixty studies were included in the meta-analysis. The obtained results showed that eating disorders have a significant relationship with the risk of mortality; SMR was 4.42 (CI 3.55-5.50; Z = 13.31;  < .001;  = 96.3%). Anorexia nervosa has a significant relationship with the risk of mortality, SMR was 5.31 (CI 4.15-6.79; Z = 13.30;  < .001;  = 93.1%). For bulimia nervosa the risk of mortality was SMR 2.69 (CI 1.85-3.91; Z = 5.16;  < .001; = 66.6%). For eating disorders not otherwise specified the risk of mortality was SMR 2.50 (CI 1.45-4.33; Z = 3.28;  = .001;  = 91.8%). From the findings of this research, it was determined how serious the risk of death is in patients with eating disorders. Therefore, it is necessary to pay more attention to this issue in the processes of prevention, screening, and treatment of eating disorders.

Avoidant/restrictive food intake disorder (ARFID) is distinct from other restrictive eating disorders in that body image disturbance or fear of weight gain do not drive restrictive eating. ARFID occurs across the full weight spectrum and youth with ARFID may still experience body weight/shape concerns, not necessarily pathological like body image disturbance is, but research is currently very limited. The current study examined how body weight/shape concerns vary across the full weight spectrum in youth with ARFID. As an exploratory aim, this study also assessed whether body weight/shape concerns differ by ARFID subtypes, age, and gender. Participants included 272 youth between the ages of 8 and 19 presenting for ARFID care at an urban pediatric hospital. Non-parametric Kruskal-Wallis tests were used to examine relations between weight/shape concerns and weight status (i.e. underweight, normal weight, overweight/obesity), ARFID subtypes, age, and gender. Results showed that youth with ARFID and overweight/obesity weight status endorsed greater weight/shape concerns than those with ARFID and normal and underweight statuses ( = .009). Youth who identified as gender identity other than male or female endorsed greater weight/shape concerns than those identifying as cis-male or cis-female ( = .01). However, there were no differences in weight/shape concerns by age or ARFID subtype. These findings demonstrate body weight/shape concerns among youth with ARFID, especially those with overweight/obesity weight status and who are gender diverse.

This theoretical review paper offers a sociocultural-developmental framework for understanding LGBTQ+ adolescents' body image concerns and disordered eating risk. The Pride Framework integrates well-established sociocultural theories and extant empirical research, drawing from objectification theory, the tripartite influence model, minority stress theory, and intersectionality theory. The Pride Framework situates sociocultural appearance pressures within the adolescent developmental context, wherein biological, cognitive, and social transitions exacerbate the likelihood of body image disturbances and eating pathology. Various processes are then posited to link these sociocultural-developmental pressures to body image concerns and disordered eating. Crucially, this framework underscores that LGBTQ+ status itself does not pose a risk for body dissatisfaction and eating disorders. Instead, it is the experience of residing in a society that stigmatizes LGBTQ+ identities that increases youth's vulnerabilities. LGBTQ+ health researchers and practitioners are encouraged to engage in collaborative efforts with the aim of fostering acceptance for LGBTQ+ youth. This, in turn, could support normative adolescent identity exploration processes within sociocultural settings that are both affirming and inclusive, potentially mitigating adverse health consequences associated with body image disturbances.

Adolescents and young adults are at heightened risk for eating disorder (ED) and muscle dysmorphia (MD) symptoms; yet, these symptoms and their relationships to harmful behaviors may also vary by gender. Thus, this study examined: 1) the prevalence of attempts to lose, gain, or maintain the same weight across gender identities, 2) purposes of weight change attempts, and 3) relationships between weight change attempts and ED and MD symptoms across cisgender men, women, and transgender and gender expansive (TGE) youth. 940 adolescents and young adults (57.4% cisgender women, 33.8% cisgender men, 8.8% TGE) completed questionnaires about weight change attempts, ED and MD symptoms. Women and TGE individuals attempted to lose weight more often than men, while men attempted to gain weight more often. All genders endorsed weight loss and gain attempts for different purposes. Weight loss attempts related to ED symptoms and appearance intolerance, whereas weight gain attempts related to MD symptoms across genders. In women, all weight change attempts related to greater functional impairment due to exercise. Findings highlight the need for tailored interventions to address desires to change one's body and underscore the harmful effects of weight change attempts across genders.

Global sleep disturbance is robustly linked with a subjective sense of loss-of-control over eating (LOC). Depressed mood has been proposed as a mechanism to explain the bi-directional relationship between sleep disturbance and LOC eating. The current study evaluated whether sleep disturbance indirectly affects LOC eating via depressed mood. Adults seeking treatment for a DSM-5 binge-spectrum eating disorder (e.g. bulimia nervosa, binge-eating disorder) were recruited ( = 79) and asked to complete self-report questionnaires assessing sleep disturbance and depression, and a semi-structured interview assessing LOC eating. Tests of indirect effects evaluated the effect of depressed mood on the association between global sleep disturbance and LOC frequency covarying for BMI and parent study. A significant indirect effect of depressed mood on the association between global sleep disturbance and frequency of LOC eating was identified ( = 1.519, . = 0.859, = .033). The indirect effect of depressed mood on the association between sleep disturbance and LOC eating may indicate that depressed mood serves as a mechanistic link between sleep disturbance and LOC eating. The findings offer preliminary support for adjunctive treatments targeting both sleep disturbance and depressed mood for LOC eating. Future research should explore these pathways in a larger clinical sample.

Epidemiologic research has identified numerous interpersonal and individual risk factors for and warning signs of emerging eating disorders in adolescents. These findings have informed public health prevention and treatment strategies, including translation of findings to clinical recommendations for primary care providers (PCPs). A next step in this translational work could include a comprehensive approach where PCPs are seen as partners in efforts to improve population health outcomes. PCPs have great potential to implement high-yield interventions that prevent or attenuate the course of adolescent eating disorders. To illustrate this potential, we present a case that highlights missed opportunities for a PCP to prevent, detect, and intervene during a patient's developing eating disorder. We then relate the case to two emerging research programs that utilize PCP partnerships: one trains PCPs in Strengths-Based Adolescent Healthcare to improve eating disorder prevention; the other adapts Family-Based Treatment for primary care to improve early access to evidence-based treatment. In addition to these promising areas of research, efforts are needed to widen requirements for eating disorder curricula in medical training programs and to address weight stigma in primary care. Together these efforts will help PCPs become effective partners in the prevention and treatment of eating disorders.

This article concludes the special issue, , by reflecting on some of the shared themes as the bases for guiding improvements, if not innovations, in future research. Overall, the articles in this collection highlight the progress achieved within eating disorders prevention in recent years, while addressing many of the existing-and sometimes glaring-gaps within the field. While these manuscripts represent important steps forward, they also offer conceptual frameworks and methodological roadmaps for future developments in the field. Based on prominent themes across those 12 articles, in this conclusion we recommend that future research within eating disorders prevention prioritize equity within research teams, participants, and research approaches. We encourage partnerships with non-academic teams and communities, as well as with multidisciplinary academic colleagues, to ensure that foundational research is directly translatable into program development and implementation, that our prevention efforts are sustainable over time, and that our research development and participating "audiences" include perspectives currently underrepresented in the literature. We also encourage action-based research in which research teams and other stakeholders consider ways to address policy and other systemic factors that lead to body- and appearance-based oppression and inequality.