Anorexia nervosa (AN) is a severe eating disorder and among the mental disorders with the highest mortality rate. To date, not much is known about its development and maintenance, and treatment outcomes are improvable. At the same time, research on psychological interventions for AN is a complicated endeavor, often characterized by small sample sizes and methodological heterogeneity, which impedes the comparison and evaluation of treatment outcomes. In this paper, several population-related, therapist-related and methodological challenges that may be encountered during research on psychological interventions for AN are discussed. The use of single case experimental designs (SCEDs), which could account for several of these challenges, is suggested as a complementary approach to current methods of assessing treatment efficacy. The use of SCEDs could be beneficial to the field, by contributing to the knowledge about AN and to the development and evaluation of better treatments, which are sorely needed.

This review of 20 prevention-related publications in during 2024 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion ➔ types of prevention ➔ case identification/referral for treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews ➔ clarifying risk and protective factors ➔ program innovation and feasibility studies ➔ efficacy and effectiveness research ➔ program dissemination; and (3) definitions of and links between eating disorder psychopathology, disordered eating behavior, and eating disorders. Nine articles were in the category of prevention rationale (including screening studies) and gaps/shortcomings in the prevention field; three addressed correlates and putative risk factors for eating pathology; and eight articles involved creation, adaptation, or upscaling of programs: three pilot projects, one efficacy study, and four investigations of effectiveness. Seven implications for prevention improvement are presented. For example, because multidimensional sociocultural factors are of paramount importance to risk for the spectrum of disordered eating, all forms of prevention should be designed, from the outset, to establish and maintain non-hierarchical, participatory collaboration between academic researchers and inclusive groups of stakeholders. In this process, it is essential to include people (including academic researchers) whose voices are typically ignored (e.g. LGBTQ+ people of color, low income and unmarried working mothers, and adolescents of ages 11 through 14).

The DSM-5 introduced severity ratings in 2013 for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) based on BMI, compensatory behaviour frequency, and binge eating frequency, respectively. While several studies have assessed the validity of these ratings, little is known about their use in clinical practice. This study examined clinicians' use of DSM-5 severity ratings and their views on their clinical value. A sample of 38 clinicians (mean age = 38.5, 97.37% female) completed an online survey on the usage of DSM-5 severity ratings in clinical practice, and six participated in one-on-one interviews for further insights. Results showed that 60% of clinicians do not use these ratings. Qualitative findings obtained from both survey and one-on-one interviews found that clinicians perceive these ratings as invalidating, pathology-reinforcing, and lacking clinical relevance. However, some noted that these ratings can aid in triage and communication among clinicians in tertiary settings. This study highlights substantial concerns about the clinical utility of DSM-5 severity ratings for EDs, suggesting the need for a more comprehensive approach that considers broader psychological, medical, and cognitive indicators.

Eating Disorders (EDs) in Mexicans have been associated with an elevated psychiatric comorbidity, highlighting the necessity for a reliable assessment tool. However, previous validations of the Eating Disorders Examination Questionnaire (EDE-Q) in Mexico yielded diverse results regarding its underlying factor structure, leading to uncertainty and complexity in understanding its latent models. This study will evaluate multiple previously proposed EDE-Q models in a sample of 173 patients with EDs undergoing various standard-of-care programs in Monterrey, Mexico. Through Confirmatory Factor Analysis, eight models were scrutinized. Different coefficients were considered to assess the internal consistency of the retained model. Concurrent and convergent validity were assessed using measures of EDs, body image, and clinical parameters. A brief 7-item 3-factor model demonstrated the optimal fit to the data. Internal consistency indices, including Cronbach's alpha, Omega and Spearman-Brown coefficients, exhibited adequate values. Concurrent and convergent validity were supported by significant associations with measures of ED, body appreciation, body dissatisfaction, clinical impairment, and depression. This study comprehensively assessed multiple EDE-Q models, identifying a brief 7-item 3-factor model, consistent with previous findings among Mexicans. The establishment of a robust EDE-Q model holds promise for enhancing EDs prevention, treatment, and research efforts in Mexico.

Support groups are a promising resource, but eating disorder (ED) support group research is scarce. This study aimed to examine associations between support group utilization, psychosocial health, and ED symptoms to guide future research on this resource. Participants ( = 494) were sampled from virtual, clinician-moderated ED support groups. Benjamini-Hochberg-corrected partial correlations tested associations of past-month attendance and participation frequency with measures of psychosocial health and ED symptoms. Participants additionally completed descriptive questions regarding perceived support group benefits. Adjusting for past-month ED treatment, more frequent support group participation was positively related to social companionship and emotional and informational support. More frequent attendance was negatively related to body dissatisfaction, binge eating, purging, restricting, excessive exercise, and negative attitudes toward obesity, but these associations were no longer significant after adjusting for psychosocial health variables. Descriptively, one-third to one-half of participants reported various positive changes from support group utilization. Utilizing and participating in clinician-moderated ED support groups could provide a low-burden outlet for ED symptom management, which may be due to provision of social support. Prospective examination of observed associations is a critical next step to investigate outcomes directly and build a testable model of group processual factors.

In order to identify factors that may impede youth access to evidence-based treatment, the current study examined child and adolescent mental health therapists' use of Family-Based Treatment (FBT) and other psychotherapeutic approaches to treat adolescents with restrictive eating disorders. A sample of 91 therapists from a variety of backgrounds (e.g. social workers, doctoral-level psychologists, masters-level counselors, marriage and family therapists) completed a 74-item survey regarding their attitudes and beliefs about adolescent eating disorders and its treatment, as well as their use of FBT and other psychotherapeutic approaches. Only 5% of therapists indicated that they treat restrictive eating disorders and, of those who do provide care, few endorsed using FBT strategies. The majority of therapists reported using other psychotherapeutic approaches that may dilute the effect of FBT principles or may prove ineffective. Having more formal training in eating disorders was associated with FBT-consistent beliefs and the use of FBT strategies. Findings have implications for dissemination efforts that target common beliefs that can undermine the care of adolescent eating disorders. Finally, the field must consider disseminating treatments to general therapists in ways that are more accessible, such as a focus on basic over specialized competencies, and consider innovative approaches to engage other professionals in supporting families caring for young people with restrictive eating disorders.

While prior research has found links between anxiety sensitivity (AS) and eating disorder (ED) symptoms, there has been limited research exploring how specific aspects of AS are related to specific dimensions of eating pathology. To inform candidate targets of specific aspects of AS in future interventions, the current study identified associations between AS and ED constructs in a sample of individuals with elevated eating pathology.

This study explored the relationship between eating disordered symptoms and in-person (ISV) and cyber sexual violence (CSV) by recruiting young women ( = 145) on Prolific with current eating disordered symptoms. Having experienced some sexual violence was ubiquitous (91.7%), and 73.8% of the participants had experienced both ISV plus CSV, suggesting that a history of polyvictimization is common in this population. The number of total types of polyvictimization was correlated with eating disordered symptom severity (EDE-Q-13). For each sub-categorical ISV and CSV type of violence, women were asked if it occurred before, during, or after their disordered eating began with 87% reporting ISV and CSV victimization preceded dysfunctional eating. This study documents the pervasiveness of sexual violence among women and links eating disordered symptom severity to multiple types of sexual violence experiences. Further, this study displays how sexual violence experiences occurred prior to eating dysfunction for most of these women with a victimization history. Given the rise in social media use allowing for more CSV, this is a timely study with eating disorder prevention and treatment implications using trauma-informed approaches.

Family involvement (FI) in the treatment of eating disorders (EDs) is critical for children/adolescents, yet its role during residential treatment (RT) in adults is uncharted. PTSD may play a role in influencing FI but is also unexplored.

With an elevated prevalence of disordered eating in low-income settings, efforts to optimize the detection of eating disorders (EDs) in such settings are necessary. A significant barrier relates to the scarcity of training for clinicians not working in specialized ED settings. This manuscript assessed the impact of an ED screening tool and an ED assessment workshop upon the detection of EDs in publicly insured psychiatry settings. Leveraging a case series design to assess 165 consecutive adult patients in outpatient psychiatry settings, we indexed the prevalence of ED diagnoses rendered by psychiatrists when assessing patients (i) without prior knowledge of ED symptoms, (ii) after being made aware of patient scores from an ED screening measure, and (iii) after undergoing an ED assessment workshop, and being made aware of patient screening scores. While 27% of the sample reported clinically significant ED symptoms on the screening measure, ED diagnoses were only rendered in 2% of the sample when psychiatrists were not made aware of ED symptoms prior to assessment. In contrast, incorporating a screening tool altered the rates of ED diagnoses, with 18% of the sample receiving an ED diagnosis. Moreover, the combinatorial introduction of both the ED screening measure and an ED assessment workshop further altered diagnostic practice-with this resulting in ED diagnoses in 27% of the sample. The findings suggest that ED screening and training workshops can have significant impacts on diagnostic accuracy and, with little cost, can provide patients with diagnoses that would otherwise go undetected.

This study examined how patient weight influences mental health providers' diagnosis of bulimia nervosa (BN). US mental health providers ( = 200) from PsychologyToday.com and professional listservs participated in an online experiment, reading vignettes about patients with major depressive disorder (MDD) and BN with the compensatory behavior of excessive exercise. For the BN vignette, participants were randomized to read about a patient whose weight status was described as "healthy weight" or "obesity." Participants reported their diagnoses, confidence, treatment recommendations, and perceived symptom severity. Only 27% of participants accurately diagnosed BN, with 38% of participants instead diagnosing binge eating disorder. There were no significant differences between weight conditions in diagnostic accuracy, confidence, or treatment recommendations for the BN vignette (s > .05). However, symptoms within the BN vignette were perceived as more severe in the "obesity" condition compared to the "healthy weight" condition ( = 5.08 ± 0.80 vs.  = 4.72 ± 0.99 on a 1-7 scale,  = .005). Within-subjects analyses revealed that participants were more accurate and confident in diagnosing MDD than BN (s < .01). These findings suggest poor detection of BN among mental health providers when patients present with healthy or higher weights. Providers may benefit from improved training for detecting BN when excessive exercise is used as the primary compensatory behavior.

This study examined demographic and military factors related to probability of hospitalization among military-affiliated adolescents and young adults (AYA) with an eating disorder (ED) diagnosis. Participants were military-affiliated AYA (spouses not included), ages 10-26 years. De-identified data were extracted from the Military Health System Data Repository from 2016-2021. Kaplan-Meier risk estimates determined the proportion of participants with a hospitalization following their initial ED diagnosis across time. Cox proportional hazard models evaluated adjusted associations of demographic and military-specific factors with probability of hospitalization. Of 7,705 participants with an ED diagnosis, approximately one in five ( = 1,569) had a hospitalization during the study period. Weight categories were only recorded for 35% ( = 2,675) of participants. Adjusting for other variables, hospitalization was more likely for: participants 15-17 years old (versus other age groups), females (versus males), those with underweight (versus higher weights), those who received care at civilian facilities (versus directly within the Military Health System), and those with a parent serving in the Navy (versus the Army). There was no significant difference by ED diagnosis. Results indicate disparities related to hospitalization among AYA with EDs within the Military Health System. More research is needed to understand access to and engagement with ED-related healthcare among military-affiliated AYA.

The mental health field, and more recently, the eating disorders field specifically, has witnessed a paradigm shift towards collaborative research which is conducted in partnership with individuals possessing lived and living experiences of mental health conditions (i.e. those with personal lived or living experience and those who are family, carers, or other supports). However, despite this shift, the challenge of engaging individuals with lived experiences in a manner that avoids tokenism, manages power imbalances, and ensures meaningful involvement persists. This paper aims to encourage those working in the eating disorders field to establish authentic, equitable partnerships with lived experience contributors. To provide clarity and to encourage researchers to engage in effective and authentic lived experience collaborations, this paper describes different types of lived experience involvement in research, using real-life examples from a study that is currently being established.

Refeeding syndrome (RS) is defined as fluid and electrolyte shifts as a result of aggressive nutritional rehabilitation and these electrolyte imbalance can result in several cardiac complications. We aimed to evaluate the incidences of RS and hypercholesterolemia in children with anorexia nervosa (AN) and related factors for that. We retrospectively evaluated the medical records of 51 patients aged 10-18 years diagnosed with AN between January 2015 and May 2020. RS and hypercholesterolemia were seen in 21 (41.2%) and 39 (76.5%) of patients, respectively. Patients with RS had an older mean age (16.3 vs. 13.7 years,  = .021), lower body mass index (BMI) percentile on admission (0.1 vs. 1.6, = .023), and a higher degree of weight loss (16.5 vs. 12.7 kg,  = .005) than those without RS. Age (odds ratio [OR], 3.49; 95% confidence interval [CI], 0.913-8.790; = .021), initial BMI percentile (OR, 0.55; 95% CI, 0.286-1.853;  = .036), and BMI z-score (OR, 0.56; 95% CI, 0.256-1.987;  = .045) were predictors of RS. For identifying occurrence of RS, the area under the curve for BMI was 0.679 and the optimal BMI cutoff value and was 11.8 kg/m. RS and hypercholesterolemia were frequently observed in patients with AN, and low BMI percentile and older age were significantly associated with RS. Therefore, serum phosphate levels should be monitored more frequently in patients with severe malnutrition.

Peer support is where individuals with the same shared experience provide mutual support. Using a non-controlled repeated measure design, this study evaluates initial efficacy of one-to-one email peer support. Young people with an eating disorder were matched with a recovered volunteer befriender, for up to one year, providing 1-3 email contacts a week. All participants completed measures (self-esteem, self-efficacy, wellbeing) at start of service, two and four-month intervals for recipients ( = 92) and peer befrienders ( = 86) respectively, and at end of service. Recipients also completed measures of social connectedness, impact of eating disorder, and goal-based outcomes. Multilevel mixed-effects linear regression models indicated significant improvements across all outcomes for recipients by 4 months, apart from self-esteem, and improvements self-efficacy, eating disorder impact and goal-based outcomes maintained at end of service. Peer befrienders did not show changes in self-esteem or self-efficacy, but there was a small significant reduction in wellbeing. The study provides evidence for email peer support for young people with eating disorders and highlights the need for robust support for befriending roles.

Quantitative research has demonstrated that many individuals with eating disorders (EDs) present with PTSD (ED-PTSD). Cognitive processing therapy (CPT) has been integrated into the overall treatment for ED-PTSD, but qualitative data on the effectiveness of this approach is lacking. Ten patients with ED-PTSD completed 12 sessions of CPT during residential treatment (RT). After sessions 1 and 11, patients wrote an "impact statement" clarifying their beliefs about why their trauma occurred and how it has impacted their life. Two coders using MAXQDA2020 software evaluated these statements using a structured coding protocol to assess changes in trauma-related cognitions over time. Analyses of these cognitive changes demonstrated shifts in the appraisal process regarding why trauma occurred from stances of self-blame to external fault. Exploratory analyses also indicated that perceptions of control and safety were associated with a greater frequency of reference to EDs and body image. Qualitative findings demonstrated that trauma-related cognitions became more realistic and adaptive following CPT as evidenced by a significant reduction in assimilated and overaccommodated cognitions, and an increase in accommodated cognitions. Last, there was a notable shift in perceived responsibility for trauma and improvements in control and safety in relation to EDs.

Posttraumatic stress disorder (PTSD) and eating disorders (EDs) frequently co-occur, with PTSD potentially worsening ED treatment outcomes. Integrated and concurrent interventions that treat both conditions together have been recommended, but no best practices exist. This case series of nine patients provides preliminary data on Written Exposure Therapy (WET), a brief, low-resource PTSD intervention, delivered concurrently with inpatient or day hospital ED treatment. Results showed reductions in PTSD symptoms, with most patients experiencing clinically significant improvements. Changes in ED symptoms varied, but no patients experienced deterioration. These findings suggest WET is a promising, efficient method for treating PTSD alongside ED treatment, supporting the need for clinical trials to assess its acceptability and efficacy for ED-PTSD.

Subjective eating disorder (ED) recovery has important clinical relevance. However, studies have focused on the perspectives of cisgender heterosexual individuals, which is notable given that sexual and gender minority (SGM) people often describe feelings misrepresented by prevailing ED conceptualizations. We examined eating pathology and psychosocial functioning across subjective recovery stages in SGM individuals ( = 196). Analyses of variance tested differences between active ED ( = 106, 54.1%), partial recovery ( = 82, 41.8%), and full recovery ( = 8, 4.1%) groups. Groups differed in body dissatisfaction, binge eating, restricting, clinical impairment, autonomy, environmental mastery, and self-acceptance. Most differences were observed between the full recovery and active ED groups and the full recovery and partial recovery groups, such that subjectively higher levels of ED recovery were generally associated with lower transdiagnostic ED symptoms and better psychosocial functioning. Clinical profiles appear similar between SGM and cisgender heterosexual individuals across subjective ED recovery stages.

Although eating disorders (EDs) affect individuals of all races and ethnicities, racially/ethnically minoritized individuals are less likely to receive ED treatment than White individuals. The present study aimed to compare ED treatment experiences in a sample of racially/ethnically minoritized individuals vs. White participants. As a secondary aim, we explored how acculturation and mental health stigma factors were associated with treatment experiences. We recruited 41 White and 27 racially/ethnically minoritized individuals with a history of EDs (with all racially/ethnically minoritized individuals having to be categorized into one group due to limited power to conduct analyses across groups). Participants completed an assessment of their treatment experiences, ratings of the helpfulness of each treatment, self-reported barriers to treatments, their level of acculturation, and their tolerance towards stigma. We found that racially/ethnically minoritized participants reported receiving a significantly lower total number of ED treatments than White participants. Second, racially/ethnically minoritized participants were significantly less likely to seek out inpatient and day treatment/partial hospitalization than White participants. Third, racially/ethnically minoritized rated nutritionists and residential treatment as significantly less helpful than White participants. Fourth, racially/ethnically minoritized participants identified the lack of cultural competence among providers as a significantly more substantial barrier to treatment than White participants. Finally, among racially/ethnically minoritized participants, higher immersion in dominant society correlated positively with perceived helpfulness of ED treatment. These insights can guide the development of targeted interventions aimed at mitigating treatment barriers and enhancing treatment outcomes for racially/ethnically minoritized individuals affected by EDs.

Sociocultural factors play a significant role in the development of body image distress and disordered eating behavior in diverse populations, including men. One group which seems to be at increased risk, is sexual minority men. However, these factors have rarely been studied outside of Western populations. The present study sought to explore these factors in Greek and Greek-Cypriot men. Greek and Greek-Cypriot men ( = 367;  = 162 gay;  = 205 straight) completed measures of sociocultural pressures, appearance comparisons, body dissatisfaction, body appreciation and disordered eating. Results indicated that gay men were more likely to have disordered eating habits than straight men. Additionally, gay men had significantly lower scores on measures of body-image related wellbeing (i.e. satisfaction and appreciation), and higher on measures of societal pressures and appearance-related comparisons, appearance-related anxiety and disordered eating. Greek and Greek-Cypriot gay men had lower levels of muscularity internalization than straight men. Our findings extend research on body image distress and disordered eating in gay and straight men to Greek and Greek-Cypriot populations.

Young cisgender sexual minority women (e.g. lesbian, queer) in the U.S. are at risk for disordered eating behaviors (DEB). Minority stress theory proposes sexual minority stressors (SMS; e.g. discrimination) related to marginalized statuses are culturally specific stressors that may explain engagement in these behaviors. However, little is known about daily SMS-DEB associations. We conducted a 14-day daily diary study of 321 U.S.-based sexual minority cisgender women ages 19-35 who were in a relationship with a woman. SMS were assessed using an 8-item daily measure of distal SMS (e.g. heard anti-LGBT talk, verbal harassment), and DEB with single items capturing dietary restraint, overeating, loss of control eating, and emotional eating. Multi-level models revealed on days when women experienced SMS, they were more likely to report dietary restraint and emotional eating, but not overeating or loss of control eating. Women who generally reported more frequent SMS were more likely to report all four DEB. There were no significant couple-level SMS-DEB associations. These findings expand our understanding of how SMS is associated with DEB in the daily lives of cisgender sexual minority women. Future studies are needed to explore the temporal sequencing of the associations. Findings may also help to inform the design of culturally tailored interventions aimed at reducing DEB among sexual minority women.