Previous studies that have focused primarily on binge eating in young adults have suggested an association between the personality trait sensation seeking and disordered eating. Far less is known about this relationship in adolescents, particularly concerning sensation seeking and eating disorder psychopathology. Thus, the present study investigated the association between sensation seeking and disordered eating, including eating disorder psychopathology and relevant diagnostic symptoms of eating disorders (i.e., binge eating) in healthy adolescents, while also considering relevant sociodemographic variables. Additionally, moderating effects of weight status and behavioral difficulties were explored. Four hundred 13- to 15-year-old participants from the LIFE Child study (Leipzig, Germany) provided information on sensation seeking (encompassing novelty- and intensity-seeking), disordered eating, behavioral difficulties, and sociodemographic data. Objective anthropometric measurements (body mass index, BMI) were also taken. Multiple linear regression models were applied to assess associations between sensation seeking and sociodemographic variables, as well as between sensation seeking and disordered eating. BMI and behavioral difficulties were included as moderators for analyses on interactions. Boys displayed higher levels of sensation seeking than girls, and novelty seeking was positively associated with socioeconomic status. Sensation seeking was positively associated with restraint and overeating. Associations with eating concern, loss of control eating, and binge eating did not remain significant after correction for multiple testing. The association between sensation seeking and disordered eating was stronger in adolescents with a higher BMI, more symptoms of hyperactivity/inattention, more emotional symptoms, and more peer problems. The results indicate that higher sensation seeking is associated with restraint and overeating in adolescence. Hyperactivity/inattention and internalizing symptoms were shown to moderate associations between sensation seeking and disordered eating, suggesting that they may be promising targets for prevention strategies and interventions. Unhealthy eating patterns display a worldwide health concern in adolescence. In the present study we aimed to investigate the association between the personality trait sensation seeking (SS) and disordered eating. Information on SS, eating disorder psychopathology, diagnostic symptoms of eating disorders and behavioral difficulties were gathered from 400 13- to 15-year-old adolescents who participated in the LIFE Child study (Leipzig, Germany). Results showed that SS was positively associated with restraint and overeating. Associations with eating concern, loss of control eating, and binge eating did not remain significant after correction for multiple testing. Moderation analyses revealed that the association between SS and disordered eating was stronger in those with a higher BMI, more symptoms of hyperactivity/inattention, more emotional symptoms, and more peer problems. These moderating effects suggest that intervention strategies addressing hyperactivity and enhancing emotion regulation might be especially beneficial for adolescents with higher levels of impulsivity-related traits, such as SS.
Safeness is a warm, soothing emotional state that is often experienced in the presence of close others. Safeness is thought to be distinct from other positive emotions or the absence of negative emotions and is shown to predict mental health variables over and above other emotions. The current study investigated the unique role of safeness in relation to eating disorder symptoms. Participants with eating disorders (n = 164) and those with no history of an eating disorder (n = 49) completed two weeks of ecological momentary assessment to measure affect and eating disorder symptoms. Safeness emerged as an emotional state distinct from negative and positive affect among women with eating disorders. Safeness predicted the presence (vs. absence) of an eating disorder. Safeness did not predict the occurrence of eating disorder behaviors in real-time when accounting for other emotions. The first binge-eating episode within a day resulted in improvements in safeness in the following hours, but did not result in improvements in other emotions. If replicated, our results suggest that safeness might be uniquely implicated in the maintenance of binge-eating episodes. These results highlight the potential importance of integrating interventions targeting safeness into eating disorder treatments. Feeling safe and soothed might constitute a distinct emotional experience than the absence of negative emotions and other forms of positive emotions. Feeling safe in social relationships could play a protective role against eating disorders. Binge‐eating episodes may function to enhance feelings of safeness in the absence of more adaptive self‐soothing strategies. As such, cultivating safeness could potentially reduce reliance on binge‐eating behaviors to self‐soothe.
Emerging evidence indicates that the COVID-19 pandemic has had a profound impact on mental health globally, including an increase in the incidence of eating disorders. This study aims to characterize individuals diagnosed with anorexia and bulimia nervosa in Colombia and to estimate changes in the monthly age- and sex-adjusted treatment prevalence before and after the COVID-19 pandemic. An ecological observational time series study was conducted, estimating the monthly treatment prevalence of anorexia and bulimia in Colombia from 2011 to 2023, adjusted by sex and age. Data were extracted from national administrative records and corrected for underreporting. Pre- and post-pandemic onset trends were compared using non-parametric tests and segmented regression models. Between 2011 and 2023, 54,471 individuals received treatment for anorexia or bulimia in Colombia. Most cases occurred among women and individuals aged 15-29 years. The adjusted monthly treatment prevalence of anorexia ranged from 0.06 to 0.5 per 100,000 population, and bulimia from 0.11 to 0.82. Following the onset of the COVID-19 pandemic, the median monthly number of visits for anorexia increased by 120% (p < 0.01) and for bulimia by 18.1% (p = 0.07). Significant inflection points were identified, with heterogeneous increases observed across departments. Antioquia exhibited the highest monthly percentage increase for both conditions. The observed increase in health care utilization for anorexia and bulimia following the pandemic suggests a substantial impact of the health crisis on eating disorders. These findings highlight the urgent need to strengthen mental health services and to develop evidence-based, targeted interventions to address the growing burden of these conditions in Colombia.
Numerous publications utilize data from the Adolescent Brain and Cognitive Development (ABCD) Study. This review aimed to evaluate how data from the ABCD cohort contributes to understanding the pathophysiology of incipient eating disorders. Searches were completed using PubMed and the ABCD Study research publications database. All available neuroimaging articles assessing prevalence and predictors of disordered eating/eating disorders were included. Thirty-eight articles met inclusion criteria, 10 of which presented neuroimaging results, all analyzing baseline brain data. The majority (n = 9) assessed brain structure and function in children with binge eating (BE)/binge eating disorder (BED). Results were inconsistent across imaging modalities. Structural MRI studies included widespread increases in gray matter density and reductions in cortical thickness associated with eating pathology. Task-based fMRI studies reported conflicting findings, with frontostriatal activation during reward processing in children with BE/BED reduced, increased, or not different compared to controls. Resting-state fMRI analyses consistently identified reduced functional connectivity in key frontal circuits, although patterns differed when samples were stratified by sex or BMI. Non-imaging studies showed positive associations between eating disorders/disordered eating and several sociodemographic, cognitive, behavioral, and biological correlates. Alterations in brain structure and function associated with binge eating are identified in neuroimaging analyses of baseline scans from the ABCD cohort, with inconsistent results. One potential pattern suggests alterations in reward system function, although the direction and exact location of such alterations are unclear. Consistency in methodological approaches is necessary to allow patterns in neural alterations to be more clearly identified. There is significant and ongoing potential for the ABCD Study dataset to quantify developmental aspects of binge eating. Recommendations for future analyses as the sample progresses through puberty and eating disorder prevalence increases are also presented.
Around one to two in five patients prematurely disengage from eating disorder therapy. This Forum paper suggests innovative strategies to increase retention and strategies for evaluating these with patients who have eating disorders. We start by clarifying the definition of premature discontinuation and note one obstacle in the field is a lack of routine and uniform reporting across treatment studies and clinical practice. We then examine common reasons for discontinuation, suggest evidence-informed strategies to improve retention, and ways to evaluate the success of these strategies. We outline seven underutilized solutions for decreasing risk of premature discontinuation, including: offering low resource interventions while patients are on the waitlist; integrated multidisciplinary care; recovery-oriented treatment augmentation; treatment choice; session measures accompanied by feedback; personalized treatment; paying attention to the relational aspects of treatment. While each of these solutions is evidence-informed, they are rarely the focus of research in eating disorders, and we outline a research agenda for examining which of these approaches have the most promise in improving retention of patients in therapy.
This study aimed to assess outpatient psychotherapists' knowledge, confidence, training experiences, training needs, and practice experiences in treating boys and men with eating disorders and muscle dysmorphia. Participants were 259 licensed outpatient psychotherapists in Canada or the United States who completed an online survey between March and June 2025. Descriptive statistics were used to characterize sociodemographics, self-reported knowledge, confidence, training experiences, and training needs. Most participants were women (75.1%) and White (78.8%), with an average age of 40.2 years (SD = 12.4) and a mean of 9.6 years (SD = 9.8) practicing. Of the participants, 12.1% reported being an eating disorder specialist. Self-reported knowledge and confidence to treat boys and men were low for both eating disorders and muscle dysmorphia. Concerning formal training on eating disorders among boys and men, 14.0% and 25.8% reported such training during or after their education, respectively. Participants who received formal training reported that it improved their clinical work with boys and men with eating disorders. Participants reported a variety of training needs, most notably a need to understand unique risk factors and symptom presentations. Participants' overall report low knowledge and confidence for treating boys and men with eating disorders or muscle dysmorphia. Only a fraction of psychotherapists had received formal training in this area, yet those who did reported greater knowledge and confidence. Outpatient mental health providers need specialized training on boys and men with eating disorders to enhance their confidence and ability to provide care for this underserved group.
Given the wide treatment gap for eating disorders (EDs) and that these problems often emerge in adolescence, novel tools, such as app-based interventions, are needed to prevent and treat EDs in teens. However, questions remain about the optimal level of human support and features within these programs that could enhance outcomes (e.g., social networking). We conducted a pilot randomized controlled trial of a mobile app for teens with or at high risk for EDs, comparing self-help (control) to guided self-help (GSH) and GSH+ social networking (GSH+). N = 148 teens with or at high risk for EDs recruited from social media and an online EDs screen were randomized. Participants had access to their assigned intervention for 3 months and completed surveys at baseline, 6 weeks, 3 months, and 6 months. Teen qualitative feedback illustrated positive perceptions about acceptability and feasibility of the tool and its impact on ED-related thoughts and behaviors. There were no significant differences across groups for the main outcome, global ED psychopathology, but there was a significant reduction for all groups over time (ps < 0.01; d = -0.93 from baseline to 6 months). While all intervention conditions had significant reductions in binge eating behaviors over time, the rate of reduction was greatest in the GSH condition (p < 0.001). Overall, our preliminary findings suggest that digital self-help interventions (both unguided and guided) may represent scalable interventions for teens with or at high risk for EDs, with coaching possibly augmenting outcomes for some subgroups. Teens with eating disorders represent an important population to target for early, accessible interventions. The mobile app in the current study showed preliminary effectiveness in reducing eating disorder symptoms among teens. Larger trials will be needed to determine whether coaching may especially benefit those with high levels of binge eating or other subgroups, such as teens with higher co‐morbid mental health concerns or those identifying as sexual and/or gender minorities.
Within sport environments, athletes are exposed to norms that circulate narrow meanings about the body and food, contributing to the high prevalence of eating disorders (EDs). While social media can support ED recovery, it can also further constrain food- and body-related messages for athletes. The purpose of this study was to examine the role of social media in athletes' ED and recovery experiences. Data were drawn from a broader study on athletes' support networks during ED recovery, where 29 participants (17 athletes, 12 social agents) completed one-on-one semi-structured interviews. For the present study, all discussion of social media was extracted from the interviews and analyzed using reflexive thematic analysis. We identified four themes. The first theme, Positive Aspects of Social Media Undermined by Harmful ED Content, describes how, despite facilitating connection, social media often exacerbates existing food- and body-related pressures for athletes. The second theme, Establishing a New Relationship With Social Media to Protect ED Recovery, showcases how athletes applied social media literacy skills. The third theme, Using Social Media to Challenge ED Stigma and Diet Culture, describes how some athletes initiated conversations about EDs and countered harmful diet culture messages through their platforms. The fourth theme, Online Visibility as a Recovery Stressor, depicts how increasing pressures for athletes to curate a personal brand on social media may reexpose them to ED-related content. Findings highlight the need for athlete-specific social media literacy within ED prevention and treatment programs, and for sport organizations and media platforms to support safer online environments.
Over the past 60 years, the proportion of highly processed foods rich in refined carbohydrates and added fats in the food environment has increased, coinciding with a rise in binge eating. While past research has focused on individual vulnerabilities for binge eating, emerging evidence suggests highly processed foods may exacerbate these vulnerabilities. This Research Forum addresses a critical research gap by synthesizing the foods reported in binge-eating episodes across 41 studies and identifying limitations in current food-reporting practices. Systematic searches were conducted in PubMed, Google Scholar, and PsycINFO through February 2025. Eligible studies reported specific foods consumed during binge-eating episodes among human participants. Foods were coded as highly processed based on the presence of refined carbohydrates and/or added fats. All 41 (100%) eligible studies reported at least one highly processed food in binge-eating episodes. Only 31.7% of studies (n = 13) reported minimally processed food consumption in a binge-eating episode. Of the food types reported across all studies (n = 404), 70.3% were classified as highly processed and 14.9% as minimally processed. However, vague food descriptions limited the ability to categorize many foods. The most frequently reported foods were cake, ice cream, cookies, and chocolate. Across published studies, highly processed foods were highly prevalent in binge-eating episodes, but interpretations are constrained by vague and incomplete food reporting. We outline recommendations for standardized food-reporting practices to improve the characterization of foods reported in binge-eating occasions to strengthen the clinical relevance of future research.
Although trials have documented the overall effectiveness of cognitive-behavioral therapy (CBT) and lisdexamfetamine (LDX) for binge-eating disorder (BED), the nature and extent of individual patient variability in outcomes have not been examined. This secondary analysis of a controlled trial examined heterogeneity of outcomes with CBT and LDX, alone and combined, for BED. One hundred and forty-one patients with BED with co-occurring obesity were randomized to CBT, LDX, or combined CBT+LDX 3-month treatments. Changes in binge-eating frequency, eating-disorder psychopathology, weight, and depression were repeatedly assessed. Outcomes were dichotomized as increased or decreased/no change, and differences between treatments were explored. Corset plots were used to examine changes in outcomes at the patient level. In CBT, 94.4% (N = 34) patients reported decreased binge-eating frequency and 75.0% (N = 24) decreased eating-disorder psychopathology. In LDX, 90.5% (N = 38) reported decreased binge-eating frequency and 89.7% (N = 35) decreased eating-disorder psychopathology. In CBT+LDX, 100% (N = 44) reported improvements in binge eating and eating-disorder psychopathology. Patients not prescribed LDX had significantly fewer decreases in weight: in CBT, 55.6% (N = 20) had weight loss, compared to 92.9% (N = 39) in LDX and 81.3% (N = 4) in CBT+LDX. No differences in decreased depression scores were observed across treatments (80.0% (N = 28) in CBT; 89.2% (N = 33) in LDX; 86.1% (N = 38) in CBT+LDX). Frequency of individual cases with increases in binge-eating, eating-disorder psychopathology, and depression were low in CBT and LDX treatments, and particularly so for the combined CBT+LDX approach. These participant-level findings add important clinical context regarding the significant overall improvements associated with CBT, LDX, and CBT+LDX for BED. Clinicaltrials.gov registration: NCT03924193 (Cognitive-Behavioral and Pharmacologic (LDX) Treatment of Binge-Eating Disorder and Obesity: Acute Treatment).
This preliminary study investigated adolescent and young adult (AYA) perceptions of online cognitive-behavioral therapy (CBT) for eating disorders (EDs), examining attitudes toward online versus face-to-face treatment and perceived effectiveness of online CBT interventions. Of 258 patients contacted, 75 (29%) completed a survey and 54 (21%) were eligible for inclusion (83.3% female; mean age = 18.33 years), all of whom received telehealth services between March 2020 and December 2022. Measures assessed attitudes toward online and face-to-face counseling, satisfaction with online therapy, and perceived effectiveness of CBT interventions delivered online. Data were analyzed using t-tests, Pearson correlations, and chi-square tests. Participants rated online CBT as significantly more valuable than face-to-face CBT (t(53) = 2.64, p = 0.011), with no differences in discomfort between modalities. Most participants (82.4%) reported satisfaction with online CBT, though preferences were split regarding continuing online versus in-person treatment. Proportion of previous online sessions was negatively correlated with perceived value of online counseling (r = -0.43, p = 0.001). Participants rated most CBT interventions as equally effective online, with highest ratings for meal planning (74.0%) and cognitive restructuring (71.7%), and lowest for open weighing (35.7%). Participants valued online CBT during the pandemic and viewed most CBT components as acceptable when delivered virtually, though individual preferences varied. Interventions requiring physical presence (e.g., open weighing) were perceived as less suitable for online delivery. While these preliminary findings suggest potential benefits of offering flexible treatment modalities, the low response rate limits generalizability and necessitates further research to examine the long-term viability of online CBT for AYAs with EDs.
Eating disorders (EDs) are severe and complex psychiatric illnesses, with adolescence and young adulthood representing particularly vulnerable periods for onset, relapse and disruptions in treatment. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is especially complex, raising concerns about continuity of care and support for young people and their families. The Transition for Eating Disorders Youth intervention (TEDYi) aims to address these challenges by developing a person-centered, peer-led intervention grounded in lived experience to facilitate smoother transitions across ED services. This study represents the second phase of TEDYi and employed an Experience-Based Co-Design (EBCD) methodology. EBCD integrates the perspectives of young people, carers, and mental health professionals to improve transition services collaboratively. We conducted seven co-production workshops with 37 co-designers and analysed the data using reflexive thematic analysis. Three key themes emerged: (1) Being there-the importance of ongoing, reliable support; (2) Exploring readiness-factors shaping preparedness for transition; and (3) Enhancing engagement-the role of accessible psychoeducation. Insights were further refined through two Steering Groups, which considered delivery format, setting, and intervention materials. Co-designers valued EBCD for creating a safe space where young people and carers could openly share lived experiences and for fostering a sense of community with shared goals. They highlighted that lived experience interventions in EDs can foster more optimal outcomes while helping individuals feel recognized. These findings will inform the finalization of the TEDYi prototype and subsequent piloting across clinical sites.
Eating disorders (EDs) in men are underdiagnosed and undertreated, partly due to stigma hindering help-seeking. This randomized waitlist-controlled study tested the efficacy of the iSMEsH online anti-stigma intervention targeting German general practitioners (GPs) and medical students. The program aimed to reduce stigmatizing attitudes toward men with EDs and improve knowledge and self-efficacy in managing ED symptoms. A total of 292 participants (130 GPs, 162 medical students) were randomly assigned to immediate intervention or waitlist control. The intervention consisted of six video-based, on-demand modules co-developed with men who have lived experience of an ED, combining education and contact-based strategies. Outcomes included cognitive stigma (knowledge), affective stigma (biased attitudes), and behavioral stigma (treatment self-efficacy), assessed at three timepoints. The iSMEsH anti-stigma intervention significantly increased knowledge of male-specific ED presentations and enhanced treatment self-efficacy in both GP and medical student populations. Effects on affective stigma were less consistent. Findings support the efficacy of the iSMEsH anti-stigma intervention in improving knowledge and treatment self-efficacy regarding EDs in men among healthcare professionals. Effects on affective stigma were limited and may require longer follow-up periods to be comprehensively captured. The intervention shows promise as a scalable tool to reduce stigma and improve care for men with EDs. On July 1, 2024 (#181,415; https://aspredicted.org/tzds-h5yq.pdf) and a study protocol is published under Lehe et al. (2025).
TikTok-a highly engaging social media platform with a powerful algorithm that displays short videos-has become massively popular in recent years. As research highlights the concerning relationship between image-based content on social media and disordered eating symptoms, TikTok may serve as an optimal platform to understand eating disorders (EDs) and body image-related concerns. We conducted a rapid review of the research on TikTok, EDs, and body image. From an initial pool of 205 articles, 58 met inclusion criteria for the review. Research included content analyses (n = 19), observational studies (n = 23 studies reported in 22 articles), and experimental studies (n = 22 studies reported in 17 articles). The research identified both potentially harmful content and ED recovery content present on TikTok. There are potentially positive effects of body positivity and body neutrality TikTok content on body image and ED risk. The literature mostly includes non-representative samples of young women. It remains unclear what effects identified in research so far are specific to TikTok, versus generalizable to short-form video content. We conclude by discussing TikTok's potential as a platform for disseminating evidence-based ED information and delivering brief interventions, drawing on harm reduction principles to promote TikTok as a space where providers can meet social media users with EDs where they are. Instead of encouraging users to stop their TikTok usage, we suggest that future research explore how TikTok can be leveraged as a tool for ED treatment, a crucial avenue given the limited accessibility of ED treatment. We conducted a rapid review to examine the state of the literature on TikTok use, EDs, and body image. We found studies suggesting mixed results regarding the extent to which TikTok has a negative impact on EDs and body image‐related concerns among TikTok users. We recommend a harm‐reduction approach to leverage the use of TikTok to better understand EDs, disseminate ED evidence‐based information, and deliver ED brief interventions.
This study documented associations between parent-reported disordered eating behaviors and co-occurring anxiety, depression, behavioral/conduct problems, and attention-deficit/hyperactivity disorder (ADHD) among U.S. children. Data were obtained from the combined 2022-2023 National Survey of Children's Health. The sample consisted of 68,000 children aged 6-17 years. Prevalence was estimated for sociodemographic variables, neuropsychiatric disorders, and the following disordered eating behaviors: (1) skipping meals or fasting; (2) having low interest in food; (3) extremely picky eating; (4) binge eating; (5) purging or vomiting; (6) using diet pills, laxatives, or diuretics; (7) over-exercising; and (8) not eating due to fear of vomiting or choking. Multiple logistic regression analysis assessed associations between neuropsychiatric disorders and disordered eating behaviors, adjusting for sociodemographic factors. Prevalence of any disordered eating behavior was 30.1% (95% CI, 29.4%-30.8%). Higher odds of disordered eating behaviors were associated with anxiety (aOR [adjusted odds ratio]: 3.64, 95% CI, 3.34-3.96), depression (aOR: 4.59, 95% CI, 3.99-5.28), behavioral/conduct problems (aOR: 3.40, 95% CI, 3.03-3.81), and ADHD (aOR: 2.63, 95% CI, 2.41-2.88). Significant associations were observed across nearly all examined eating behaviors. This is the first nationally representative study to find that U.S. children and adolescents with neuropsychiatric disorders were more likely to exhibit disordered eating behaviors than their counterparts without neuropsychiatric disorders. Findings underscore the need for screening and early intervention to optimize the mental and physical health of these populations. They also highlight the need to address prevention and treatment of these disorders in the context of psychiatric comorbidities.
This spotlight highlights a critical gap in the research literature. Despite evidence that combined cognitive-behavioral therapy (CBT) and lisdexamfetamine dimesylate (LDX) for binge-eating disorder (BED) is superior to either intervention alone, no studies have examined whether psychotherapy can support gradual tapering off LDX while preserving treatment gains. While evidence shows higher rates of binge-eating relapse after LDX discontinuation, long-term use is complicated by concerns regarding side effects (e.g., hypertension), misuse-potential, cost, and/or drug interactions. Unfortunately, without current research on optimal LDX tapering strategies, clinicians lack guidance at a critical juncture. Given the absence of studies that have examined tapering psychiatric medications in BED, let alone any established protocols for doing so, the authors offer two spotlighted examples to illustrate the potential utility and clinical challenges of therapist guided LDX discontinuation during psychotherapy for BED. The spotlighted examples demonstrate that binge relapse can be avoided through gradual LDX tapering embedded within psychotherapy, with treatment gains sustained at long-term follow-up (up to 5 years after LDX discontinuation). This spotlight highlights the need for further research to investigate discontinuing LDX and whether gradual, therapist-supported tapering might enable the superiority of combined treatment to be sustained. Spotlighted examples were used to illustrate the conceptual framework and clinical relevance of this spotlight's central argument: that systematically evaluating optimal approaches to medication discontinuation, specifically LDX for BED, is an idea worth researching. We describe potential obstacles and limitations while also highlighting clinical or policy implications for future study.
Body dissatisfaction (BD) plays a key role in the development and maintenance of eating disorders (EDs). BD might be influenced by emotion regulation. The maladaptive emotion regulation strategy suppression, aimed at inhibiting emotional responses, may increase BD by intensifying negative body-related affect. Adaptive strategies like cognitive reappraisal, involving the reinterpretation of emotional situations, may reduce BD by reshaping emotional responses to body-related cues. This study explored whether these strategies predicted BD at two follow-up waves, one after 7-11 months and the second after 19-23 months, and whether ED status (current or recovered) moderated these effects. Data were drawn from three consecutive waves (T0), (T1), and (T2) of the longitudinal naturalistic Netherlands Eating disorder Registry (NER; n = 364), including individuals with current EDs (n = 276) and recovered individuals (n = 84). Two linear mixed-effects models examined the effects of suppression and reappraisal on BD, with ED status as a moderator. Higher suppression levels were significantly associated with greater BD in individuals with EDs compared to recovered individuals at T0 (B = 3.08, p < 0.001). Neither reappraisal nor suppression predicted BD over time, nor did ED status moderate this relationship (reappraisal: p = 0.970 and p = 0.125, suppression: p = 0.884 and p = 0.582). Random effects indicated considerable individual variability in BD. The study found no evidence that suppression or cognitive reappraisal predicted longitudinal changes in BD. Only an association between suppression and BD was found, suggesting that suppression and BD do appear to co-occur in EDs and may reinforce each other.
Food addiction (FA) is clinically relevant in binge-type eating disorders (EDs), yet its treatment relevance remains unclear in mainland China. This study examined (1) FA's associations with ED psychopathology and psychosocial functioning; (2) FA symptom changes following cognitive behavioral therapy-guided self-help (CBT-gsh); and (3) whether FA improvement was independently associated with changes in psychosocial functioning. In this assessor-blind randomized controlled trial, 87 adults with binge-type EDs were allocated to a 10-week asynchronous web-based CBT-gsh program or a waitlist control group. Assessments occurred at baseline, post-treatment, and 1-month follow-up. FA severity was the primary outcome; secondary outcomes included ED psychopathology, binge-eating frequency, psychosocial impairment, depression/anxiety, and body mass index (BMI). Linear mixed models and hierarchical regression were used to analyze the data. At baseline, FA severity was positively associated with ED psychopathology and psychosocial impairment. All outcomes except BMI improved significantly in the intervention group (all ps < 0.001), with no changes in controls. At post-treatment, 20% of intervention participants achieved binge-eating abstinence versus 2.5% of controls, and fewer met moderate-to-severe FA criteria (Δn = -16) in the intervention group. FA reduction was independently associated with lower post-treatment psychosocial impairment (β = 0.49, p < 0.001), beyond baseline impairment and ED psychopathology changes. This study provides the first evidence from mainland China that CBT-gsh was associated with FA reductions in binge-type EDs. These reductions were independently associated with better psychosocial functioning, underscoring FA as a complementary and clinically meaningful treatment target.
Quantitative methods that have evaluated the Eating Disorder Examination Questionnaire (EDE-Q) have found consistent evidence that the original four-factor structure does not replicate across diverse samples and genders. Emerging evidence in the broader psychology literature shows that qualitative methods can provide nuanced insight into how participants interpret, understand, and respond to self-report survey items. Qualitative methods may also help illuminate patterns of Likert responses and variation in respondents of different genders. Thus, this study used qualitative methods to explore how lay participants perceive and interpret EDE-Q items. Undergraduate students (N = 97, Mage = 20.55 years, SD = 1.30, 48 men, 48 women, 1 transgender man) responded to the 22 attitudinal EDE-Q items using the Likert-type scale and provided open-ended reflections on their thought processes, interpretations, and relevant contexts for selecting their response. Open-ended responses were analyzed using content analysis to explore understanding of the items and response scales (e.g., confusion, misinterpretation, validity, gendered experiences). Most responses did not have issues; however, (a) shape and weight items were often conflated and participants expressed confusion about them, (b) higher ratings did not consistently reflect greater eating psychopathology, and (c) men described eating psychopathology geared toward gaining weight and muscularity even when selecting low Likert responses. Qualitative insights from this study complement concerns stemming from quantitative research on the structural validity of the EDE-Q and suggest potential avenues to clarify essential yet misunderstood concepts.
Psychiatric comorbidity frequently presents in anorexia nervosa (AN). Yet, the premorbid mental health status is relatively unknown. The aim of this study was to map out psychiatric morbidity and psychopathology among girls at familial high risk (FHR) of developing AN, thereby detecting possible underlying vulnerabilities preceding the disease. Twenty-eight daughters of mothers with a history of AN (FHR daughters), aged 6-12, along with 42 comparison daughters without FHR for AN (COMP daughters), were recruited. The mothers completed a battery of parental diagnostic interviews and screening questionnaires regarding psychiatric diagnoses and psychological traits in their daughters, including the Development and Well-Being Assessment (DAWBA) and the Strengths and Difficulties Questionnaire (SDQ). In comparison to the COMP daughters, the FHR daughters had 27 percentage points higher absolute risk of meeting criteria for ≥ 1 psychiatric diagnoses (32.1% versus 4.8%; unadjusted p = 0.007; adjusted p = 0.035), and 21 percentage points higher risk of ≥ 2 psychiatric diagnoses (unadjusted p = 0.007; adjusted p = 0.035) according to the DAWBA and/or as established by the Child and Adolescent Psychiatry clinics. Among the FHR daughters, anxiety disorders and autism were the most common diagnoses. In addition, the FHR daughters scored significantly higher on the Emotional symptoms subscale of the SDQ (p = 0.03). Increased risks of psychiatric diagnoses and elevated emotional problems were found among girls at FHR for AN. The results may therefore suggest psychiatric morbidity to be a potential risk factor for developing AN.