Research indicates that elevated intolerance of uncertainty (IU) is cross-sectionally associated with eating disorder (ED) pathology in women. Although longitudinal data is needed to better understand whether IU is a prospective risk factor for EDs in the general population, IU also influences the performance of athletes, a population at risk for EDs. Despite the relevance of both IU and ED within athletics, research assessing the association of IU and ED pathology in athletes has yet to be conducted. The current study longitudinally explored IU as a potential modifiable risk factor for ED pathology in a sample of women athletes. IU at baseline was hypothesized to predict downstream ED pathology. Participants (N = 393) were women athletes aged 18-39 years from athletic teams/activities across the United States who responded to surveys at baseline and at least one follow-up assessment (3-, 6-, and/or 12-months) as part of a large multi-measure longitudinal study of women athletes. IU and ED pathology were measured using the two-factor, 12-item Intolerance of Uncertainty Scale (IUS-12) and the nine-item Brief Eating Disorders in Athletes Questionnaire (BEDA-Q), respectively. Age-adjusted modified Poisson regression generalized estimating equations (GEEs) examined baseline IUS subscale scores as predictors of subsequent changes in prevalence of a probable ED. The prevalence of a probable ED in this sample was 22.7% at baseline. ED outcomes were significantly predicted by baseline scores of the prospective anxiety subscale of the IUS-12 but not the inhibitory anxiety subscale. A one-standard-deviation higher baseline score on the prospective anxiety subscale was associated with an 18% increase in prevalence of a probable ED over the course of the longitudinal study (p = .01). Based on these findings, desire for predictability is a potentially modifiable target in preventing ED in women athletes. Regularly experiencing distress and anxiety when both anticipating and experiencing uncertain or ambiguous situations, an anxiety-related trait referred to as intolerance of uncertainty, may be a risk factor for developing an eating disorder. To better understand how intolerance of uncertainty contributes to the development of eating disorders, we followed a group of women athletes over the course of a year and used questionnaires to assess intolerance of uncertainty and symptoms of eating disorders. Athletes who experienced greater distress and anxiety surrounding uncertain situations were more likely to have an eating disorder later on. Additionally, eating disorders were more common in this group than is typically expected. This study suggests that intolerance of uncertainty is a risk factor for eating disorders that may be worth targeting in both treatment and prevention efforts. Furthermore, we draw attention to the existing notion that women athletes may be at a higher risk for an eating disorder than non-athletes.
In response to individual and systemic barriers hindering the timely and effective treatment of eating disorders (EDs), the Australia & New Zealand Academy for Eating Disorders (ANZAED) introduced an eating disorder credential for clinicians in June 2022. The Credential aims to enhance treatment access, quality, and outcomes. While the Credential has been well received by stakeholders, its effectiveness from the perspective of those with lived experience of an ED needs to be more fully understood. The current study aims to explore the experiences and perspectives of people living with an ED in relation to their treatment experiences provided by Credentialed Eating Disorder Clinicians (credentialed clinicians) and non-credentialed clinicians. An exploratory mixed-methods cross-sectional study was conducted involving 100 participants with personal lived experience of an ED. Participants were recruited via Australian eating disorder services and organisations, including the ANZAED and National Eating Disorders Collaboration (NEDC) membership databases, with recruitment information distributed through their email and social media platforms. Participants completed a survey with open- and closed-ended questions on their attitudes towards the Credential and experiences of treatment by a credentialed clinician or non-credentialed clinician. Descriptive statistics and Mann-Whitney U tests were used to examine differences in attitudes, treatment experiences, and helpfulness ratings between participants who had seen credentialed and non-credentialed clinicians, alongside inductive thematic analysis of open-ended survey responses. Irrespective of their own clinicians' credentialing status, participants valued the Credential; almost two thirds identified that their most helpful treatment experience was with a credentialed clinician. Three themes were generated from open-ended survey responses that explored the treatment experiences of those with lived experience of an ED: (1) Expertise, Accessibility, and Continuity of Care, (2) A Collaborative Approach, and (3) Personalised and Effective Treatment Delivered with Understanding, Compassion, and Respect. The current study adds to the ED literature by highlighting the perceived value of the ANZAED Eating Disorder Credential by individuals with lived experience. Further, it supports existing research that identifies clinician's expertise, a collaborative approach to treatment, and the provision of individualised treatment as key factors contributing to positive treatment outcomes. However, barriers to accessibility, including the cost of treatment and availability of credentialed clinicians, remain and need to be addressed for individuals to receive the full benefits of the Credential. In June 2022, the Australia & New Zealand Academy for Eating Disorders (ANZAED) introduced the ANZAED Eating Disorder Credential to the public, to improve timely access to eating disorder treatment provided by appropriately trained and experienced clinicians. The current study explores the perspectives of those with a lived experience of an eating disorder towards the Credential and their treatment experiences with credentialed and non-credentialed clinicians. Participants valued the Credential’s existence, regardless of their own clinician’s credentialing status, expressing preference to receive treatment from a credentialed clinician, placing greater trust in their advice and believing the Credential would improve health outcomes and access. Almost two thirds of participants reported that their most helpful treatment experience was with a credentialed clinician and highlighted the importance of expertise, a collaborative approach, and tailoring treatment to the individual. Barriers to accessing care, a lack of interdisciplinary collaboration, and forced or involuntary treatment were found to be key contributors to participants’ least helpful treatment experiences, pointing to a need for ongoing improvements to ensure the Credential delivers its full potential.
Anorexia nervosa (AN) is an eating disorder (ED) characterised by restrictions in energy intake, intense fear of weight gain and distorted body image. AN may coexist with attention-deficit/hyperactivity disorder (ADHD), a neurotype characterised by differences in attention and/or impulsivity and hyperactivity. Despite increasing recognition of neurodivergence in EDs, the co-occurrence of ADHD and AN remains markedly under-researched. Clarifying their interaction will improve diagnostic accuracy, tailor treatments, and ultimately enhance outcomes for individuals living with both neurobiological profiles. The objective of this study is to investigate how features of ADHD and AN influence the lived experience of adults with both profiles. Fifteen adults with co-occurring ADHD and AN participated in semi-structured interviews exploring how features of each profile shaped their experience. Qualitative data was analysed using Braun and Clarke's reflexive thematic analysis. Four themes were developed. The interaction and overlap of features of ADHD and AN as well as challenges teasing the two apart was central for participants. ADHD and AN features were intentionally and unintentionally instrumentalised, perpetuating the co-occurring profile and making participants' experiences of co-occurring ADHD-AN challenging to navigate. Participants experienced profound shame resulting from ADHD-related systemic factors which in some cases appeared to predispose them to the development of AN. Overall, participants emphasised the importance of making ADHD-AN visible, highlighting the need for both this research and clinical attunement and dexterity to support individual patient experiences. To our knowledge, this is the first qualitative study providing evidence of how the features of ADHD and AN interact. The findings emphasise shared challenges in living with the co-occurring profiles, highlighting the need for increased understanding and greater recognition of ADHD-AN. This research explores the lived experiences of adults with both Attention-deficit/hyperactivity disorder (ADHD) and Anorexia Nervosa (AN). While it is increasingly recognised that these two profiles often occur together, very little research has looked at how the two interact and affect a person’s daily life.To investigate how ADHD and AN interact, researchers interviewed 15 adults with a lived experience of both profiles. Findings show that features of ADHD can influence AN and vice versa, making the presence of both profiles challenging to navigate for both people with a lived experience and the clinicians working with them. Participants particularly highlighted how the features of ADHD can make the symptoms of AN worse, how AN can in some circumstance improve ADHD related challenges and in other cases worsen them and the importance of health professionals better understanding the overlap in order to improve diagnosis and support.As the first study to explore the lived experience of the interaction between ADHD and AN, this research highlights the nuanced interaction between the two profiles, revealing the specific challenges faced by people living with both, and calls on health providers to increase their awareness and understanding of these issues.
Eating disorders (EDs) are severe mental illnesses with significant morbidity and mortality. Adverse childhood experiences (ACEs) are recognized risk factors, but their specific impact across ED subtypes and the mediating psychological mechanisms require further elucidation. In this cross-sectional study (2008-2015), 970 outpatients with eating disorders (919 female) were assessed for adverse childhood experiences and clinical behaviors with the Eating Disorder Questionnaire, and for psychological traits with the Eating Disorder Inventory-1. This study used factorial ANOVA, Lasso regression, and mediation analysis to clarify the effects of ACEs and diagnostic subtypes, identify specific influencing factors, and explore the mediating role of psychological traits. ACEs were nominally associated with most clinical behaviors except dieting; after correction, the most robust associations were observed for binge eating, laxative use, and several onset-age variables. Childhood emotional abuse most profoundly impacted psychological traits. The cumulative number of ACEs was associated with increased severity of psychological traits and a higher likelihood of clinical behaviors. Mediation analyses revealed that psychological traits significantly mediated the relationship between ACEs and clinical behaviors. For instance, ineffectiveness mediated the link from cumulative ACE count (mediation proportion = 0.481), "criticism and blame" (mediation proportion = 0.629), and "abandonment threats" (mediation proportion = 0.601) to binge eating. Childhood emotional abuse and cumulative ACEs significantly correlated with worsened psychological traits and clinical ED behaviors, with notable implications for binge-eating/purging symptoms. Several psychological traits showed substantial indirect associations between ACE exposure and clinical ED behaviors. These findings highlight the necessity of routine ACE assessment and trauma-informed interventions targeting these psychological vulnerabilities in ED treatment. Eating disorders are serious mental illnesses, and adverse childhood experiences may shape how these illnesses develop and appear in clinical care. This study examined 970 Chinese outpatients with eating disorders to understand how adverse childhood experiences, such as emotional abuse, physical abuse, and sexual abuse, were related to eating-disorder symptoms and psychological difficulties. Patients who reported adverse childhood experiences tended to show more severe psychological traits, including feelings of ineffectiveness, perfectionism, difficulties sensing internal body states, body dissatisfaction, and bulimia-related concerns. Emotional abuse, especially repeated criticism, blame, and threats of abandonment, showed particularly strong links with these psychological traits. Having more types of childhood adversity was also associated with a greater likelihood of behaviors such as binge eating, purging, laxative use, and diet pill use. The analyses suggested that psychological traits may help explain the statistical association between childhood adversity and later eating-disorder behaviors. These findings support routine assessment of childhood adversity in eating-disorder services and highlight the importance of trauma-informed treatment that addresses self-worth, emotion regulation, and body-related psychological difficulties.
The study aims to conduct a bibliometric analysis of eating disorders in adolescents. In this study, the terms TS=("adolescent" OR "youth" OR "teenagers" OR "adolescence") AND (eating disorder OR anorexia nervosa OR bulimia nervosa) were systematically searched in the Web of Science database. The R bibliometric package was used to analyze the search results. This study systematically maps the field for the period 2016-2025 by employing co-authorship, bibliographic coupling, keyword co-occurrence, and citation analyses to identify leading contributors, publication outlets, countries, influential works, and thematic structures. The analysis covered the period from 2016 to 2025, with publication numbers fluctuating over the years. The number of publications peaked in 2021. Research activities were concentrated in the United States, Germany, Australia, and Canada. The leading journals included the International Journal of Eating Disorders and the Journal of Eating Disorders, followed by Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, European Eating Disorders Review, and Eating Behaviors. Frequently used keywords included anorexia nervosa, eating disorders, adolescents, and bulimia nervosa. This bibliometric analysis demonstrates that the literature on eating disorders in adolescents has evolved over time in response to global events, research funding, and changing clinical priorities. In particular, publication output increased markedly during the COVID-19 pandemic period, with the most prolific authors focusing on key topics such as family-based treatment and eating disorders in males. Countries including the United States, Germany, Australia, Canada, and the United Kingdom emerged as leading contributors in terms of research productivity. Additionally, publications were largely concentrated in a limited number of core journals with high impact factors.
Obesity is a multifactorial chronic disease influenced by metabolic, genetic, behavioral, and psychosocial factors. This study aimed to assess eating behaviors in treatment-seeking individuals with obesity using the Dutch Eating Behavior Questionnaire (DEBQ) and to explore the associations of its emotional, external, and restrained eating subscales with clinical and sociodemographic characteristics. This study included 220 individuals with obesity who were followed at the Etlik City Hospital Obesity Center. Psychiatric diagnoses were assessed using the Structured Clinical Interview for DSM-5 Disorders (SCID-5). Data were collected through face-to-face interviews using a sociodemographic form and the DEBQ. Regression analyses were conducted as exploratory, hypothesis-generating models to identify variables associated with DEBQ subscale scores, without implying causal relationships. Emotional eating was positively associated with years of education, depression, obsessive-compulsive disorder (OCD), and the presence of an eating disorder-related condition. The strongest association was observed for the presence of an eating disorder-related condition, which may partly reflect conceptual and measurement overlap with the emotional eating construct assessed by the DEBQ. Restrained eating was positively associated with duration of obesity and negatively associated with the presence of an eating disorder-related condition. External eating was positively associated with years of education and the presence of an eating disorder-related condition. Eating behaviors among treatment-seeking individuals with obesity appear heterogeneous and are associated with both psychiatric and sociodemographic factors. In particular, emotional eating was linked to depression, OCD, and the presence of an eating disorder-related condition; however, associations involving eating disorder-related condition should be interpreted cautiously due to potential construct overlap. These findings underscore the importance of assessing psychiatric comorbidities and eating behavior patterns in the individualized management of obesity. This study examined eating behaviors among treatment-seeking individuals with obesity attending a specialized obesity center. Eating patterns were linked not only to body weight but also to factors such as education, age, and psychiatric conditions. Emotional eating—eating in response to negative emotions—was associated with depression, obsessive-compulsive disorder, and the presence of an eating disorder-related condition.However, as this was a cross-sectional study, these findings do not establish causality. Because participants were recruited from a specialized obesity center, the findings may not fully generalize to all individuals with obesity. Overall, the results suggest that focusing solely on diet may be insufficient; incorporating psychological support and addressing eating behavior patterns may improve individualized obesity treatment.
Impaired renal function, as indicated by a decline in estimated glomerular-filtration-rate (eGFR), is inadequately investigated in individuals hospitalised with restrictive eating disorders. This study aims to investigate renal function across multiple admissions, as well as the clinical characteristics of this group. A five-year retrospective audit was conducted of adolescents and young adults admitted to a hospital in Sydney, Australia, with a restrictive eating disorder requiring multiple admissions for nutritional rehabilitation. eGFR was calculated from serum creatinine levels inputted into the Chronic Kidney Disease in Children Under 25 (CKiDU25) equation. A generalised linear-mixed-model was used to evaluate associations between eGFR and purging history, medical instability on admission, percentage mean BMI (%mBMI), protein intake in grams/kilogram/day, time from last admission, length-of-stay and admission number. Analysis included 60 patients over 176 admissions, 93% female, mean age 17.1 ± 1.4 years, admission %mBMI 82.0 ± 9.1. The mean number of admissions was 2.9 ± 2.2, with average length-of-stay 22.7 ± 12.2 days, and discharge %mBMI 92.9 ± 7.4. Impaired renal function (eGFR < 90 ml/min/1.73m2) was identified in 36.4% of admissions, and in 2.8% of patients at discharge. Average protein intake increased from 2.2 ± 0.6 g/kg/day on admission to 3.0 ± 0.7 g/kg/day on discharge. Protein intake (9.587, p < 0.001), %mBMI (0.461, p < 0.001), length-of-stay (0.100, p < 0.001), and number of admissions (1.921, p < 0.001) was positively associated with eGFR. Lower eGFR levels were seen with medical instability (-3.113, p = 0.003) or greater between-readmission times (-0.010, p < 0.001). The relationship with purging history was not significant. Impaired renal function was evident in over one third of adolescent and young adults with restrictive eating disorders requiring multiple admissions and improved with nutritional rehabilitation. Findings of this study indicate that eGFR did not decline during the five-year period of observations in this study, however further research is needed to explore the outcomes of the small subgroup of patients who were discharged from hospital with persisting impaired renal function. Overall, eGFR may be a useful indicator of nutritional status and disease severity in patients hospitalised with restrictive eating disorders. Impaired kidney function has been described as a potential complication of malnutrition in individuals with restrictive eating disorders, however its prevalence in adolescents and young adults is poorly described. It also remains unknown if kidney function declines over time when this patient group requires multiple hospital admissions. This study aims to investigate kidney function across multiple admissions, as well as the clinical characteristics of the group. Kidney function, as indicated by estimated glomerular filtration rate (eGFR), was calculated using the CKiDU25 equation in this five-year retrospective audit of adolescents and young adults requiring greater than one hospital admission for a restrictive eating disorder. Sixty patients were included in the study, representing a total 176 unique admissions. Impaired kidney function was present in 36.4% of admissions and in 2.8% of patients at discharge. A reduced eGFR may be an indicator of disease severity and nutritional status in patients with eating disorders, however the relationship with purging history was not significant.
Eating disorders are a global health concern, yet research in this field has historically been underfunded and sometimes perceived as "niche". To attempt to address these challenges, the international charity Consortium for Research in Eating Disorders (CoRe-ED) was launched in September 2024. CoRe-ED aims to promote innovations in eating disorders research by empowering all voices and supporting the development of new therapies. The present study examined the characteristics of individuals who joined CoRe-ED over the first ~ 15 months, their engagement with consortium initiatives and their expected benefits and experiences. Between 25 September 2024 and 31 December 2025, CoRe-ED registrants completed an online registration form and consented to the use of deidentified, aggregated data for research. Data were analysed for registrant characteristics, including primary country of residence and role(s) (e.g., researcher, health professional, lived experience), and for perceived expectations and experiences, using inductive thematic analysis. Survey feedback from ten CoRe-ED events, engagement with collaborative CoRe-ED initiatives, and an overarching survey capturing overall registrant experiences were also analysed. A total of 960 individuals from 37 countries across five continents registered with CoRe-ED, representing researchers, health professionals, individuals with lived experience, advocates, not-for-profit representatives and industry professionals. Registrants' expectations included networking and community building, research contribution and collaboration, learning and professional development, advocacy, facilitation of innovation, integration of lived experience into research, global collaboration and mentorship. CoRe-ED also implemented a structured "Next Big Research Idea" initiative, which involved 18 internationally distributed multidisciplinary teams across 20 countries in collaborative research proposal development. Event-specific and overall feedback indicated high satisfaction with CoRe-ED activities, particularly valuing the diversity of presenters, global perspectives, inclusive environment and opportunities to learn and connect. Over the first ~ 15 months, CoRe-ED engaged a diverse, international registrant group and developed activities consistent with early registrant expectations. The consortium implemented initiatives intended to support cross-disciplinary research collaboration, knowledge exchange and innovation, while expanding international representation. Future research should examine longer-term experiences, including impacts on research outputs, mentorship, co-design and policy translation, to better understand how the consortium evolves in response to the needs of its international community. Eating disorders are a global health concern, but research and support in this area are limited. To attempt to address this, the international charity Consortium for Research in Eating Disorders (CoRe-ED) was launched in September 2024 to bring together people from different countries, professions and experiences. Over the first ~ 15 months, 960 individuals from 37 countries joined, including researchers, health professionals, people with lived experience, advocates, not-for-profit workers and industry representatives. Registrants reported wanting to build networks, contribute to research, access learning and professional development, engage in advocacy, support innovation, integrate lived experience into research, participate in global collaborations and receive mentorship. CoRe-ED also launched a “Next Big Research Idea” initiative, which brought together 18 multidisciplinary teams across 20 countries to develop collaborative eating disorders research proposals. Feedback on events and the overall consortium was very positive, with registrants highlighting the diversity of presenters, inclusive environment, global perspectives and learning opportunities. These findings potentially suggest CoRe-ED engaged a diverse, international group and implemented initiatives aligned with registrants’ expectations. Future research should examine longer-term experiences to better understand how the consortium responds to the needs of its international community.
Despite growing interest, empirical evidence remains limited for the efficacy of intensive outpatient programmes (IOPs) for eating disorders (EDs), particularly outside the USA. No prior studies have examined the delivery or effectiveness of IOPs for children and young people in the UK. This study addresses this gap by presenting pilot data from a UK-based community IOP embedded within an existing child and adolescent ED service. We conducted a prospective cohort study of young people aged 12-18 years referred to the IOP at the Maudsley Centre for Child and Adolescent Eating Disorders between February 2024 and August 2025. Eligible participants had a diagnosis of an ED according to ICD-11 criteria, or disordered eating requiring acute admission, and completed the IOP treatment. Data were collected on referral pathways, demographic and clinical characteristics, treatment course, and outcomes, including change in weight and self-reported ED/mental health symptoms. During the recruitment period the IOP served a heterogeneous cohort of 68 young people with high rates of psychiatric and neurodevelopmental comorbidity. Treatment delivery included outreach on paediatric wards, intensified outpatient treatment, and consultation with wider care networks. Mean duration of the IOP was 24 days (SD = 10.7). Most participants demonstrated improved weight trajectory (mean weight gain = 4.5% mBMI, SD = 6.8, p < 0.001). ED symptom psychopathology did not significantly improve over the short IOP duration. Findings indicate that a brief IOP intervention is effective for weight restoration in underweight adolescents with EDs, functioning as both an intensification of outpatient treatment and an effective way of keeping young people in the community who are at high risk of an inpatient admission. Future research would benefit from controlled designs, explore long-term outcomes, and examine adaptations for neurodiverse populations. Eating disorders in children and young people are serious mental health conditions that often require intensive treatment. Intensive outpatient programmes (IOPs) provide structured, frequent treatment while allowing young people to remain at home. Although IOPs are increasingly used, there is little research on how effective they are, particularly outside the United States. No previous studies have examined IOPs for young people with eating disorders in the United Kingdom. This study reports early findings from a pilot IOP delivered within a specialist child and adolescent eating disorder service in the UK.We followed a group of young people aged 12–18 who were referred to the programme between February 2024 and August 2025. Participants had a diagnosed eating disorder, or severe disordered eating that might otherwise require hospital admission. We collected information on referral routes, patient characteristics, how the treatment was delivered, and changes in weight and self-reported eating disorder and mental health symptoms.Sixty-eight young people took part. Many had additional mental health or neurodevelopmental conditions. On average, treatment lasted about 24 days. Most participants showed improved weight gain during the programme, but eating disorder thoughts and feelings did not improve significantly over this short period.Overall, the programme helped support weight restoration and may help prevent hospital admission by providing more intensive treatment in the community. Further research should examine long-term outcomes and how programmes can better support neurodiverse young people.
Recovery in eating disorders (EDs) is often defined in terms of symptom remission, potentially overlooking the broader meanings individuals attribute to illness and recovery. Qualitative research has highlighted the multidimensional nature of recovery, yet less is known about how therapeutic contexts may shape how individuals make sense of illness, change, and recovery. This study aimed to explore how individuals with EDs conceptualize illness and recovery, and how these meanings may be shaped through participation in group psychotherapy. A qualitative study was conducted within an interpretivist framework using reflexive thematic analysis. Ten adult outpatients with EDs participated in semi-structured interviews at the end of a group psychotherapy program integrated within a multidisciplinary treatment setting. Participants described a shift from understanding the ED mainly through food, weight, body image, and symptom control toward a more emotionally and relationally informed understanding of distress. Recovery was increasingly constructed as a multidimensional and non-linear process involving emotional awareness, self-acceptance, agency, identity renegotiation, and connection with others. The group was experienced as a space that fostered recognition, belonging, and reflection, while also exposing participants to shame, fear of judgment, and emotional vulnerability. Findings suggest that group psychotherapy may support a reconfiguration of how individuals with EDs understand illness and recovery, moving from a primarily symptom-centred perspective toward a more holistic, relational, and personally meaningful framework. Rather than operating mainly through direct behavioural change, the group appeared to function as a space for meaning-making, emotional reflection, and relational experimentation. This study highlights emotional awareness, identity renegotiation, self-acceptance, and interpersonal connection as potential targets for fostering recovery in EDs. Trial registration The study protocol (n. 0034565/i) was approved by the local Institutional Review Board. Eating disorders are often understood mainly in terms of eating behaviours, weight, and body image. However, people with eating disorders may experience illness and recovery in broader and more personal ways, involving emotions, relationships, identity, shame, and self-acceptance. This study explored how adults with eating disorders understood their illness and recovery after taking part in group therapy within a multidisciplinary treatment setting. Ten adults were interviewed after completing a group therapy program. Before the group experience, participants often described their eating disorder mainly through symptoms such as food restriction, bingeing, purging, body dissatisfaction, and weight control. After the group, many described their difficulties in a broader way, linking the eating disorder to emotions, relationships, and personal experiences. Recovery was seen not only as reducing symptoms, but also as becoming more aware of emotions, accepting oneself, developing personal agency, and connecting with others. The group helped some participants feel understood and less alone, but it could also involve shame, fear of judgment, and emotional vulnerability. Overall, group therapy appeared to support broader and more personally meaningful understandings of recovery.
This study aimed to evaluate the validity and reliability of the Turkish version of the Barcelona Bipolar Eating Disorder Scale (BEDS), which can facilitate screening for comorbid eating disorders (EDs) in bipolar disorder (BD) patients. A total of 100 BD patients and 129 healthy controls (HCs) were included in the study conducted at Ankara Etlik City Hospital Psychiatry Clinic. These patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the Structured Clinical Interview for DSM-5 (SCID-5). Sociodemographic forms, the Turkish version of the BEDS, the Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D), the Brief Psychiatric Rating Scale (BPRS), the Bulimic Investigatory Test, Edinburgh (BITE), and the Dutch Eating Behavior Questionnaire (DEBQ) were used to assess validity and reliability. No statistically significant differences were found between the patient and control groups regarding the BITE and BEDS total scores. For the DEBQ, no significant group differences were observed in the total, restrained eating, or external eating scores, whereas the healthy control group had higher emotional eating scores. The correlation coefficient between each item and the total score ranged from 0.313 to 0.644. Cronbach's alpha for the scale was 0.821. The removal of any items from the original scale did not lead to an improvement in Cronbach's alpha. The BEDS score was found to be significantly correlated with the BITE score, DEBQ total score, emotional eating score, and external eating score (p < 0.001). There was no correlation between the BEDS score and the DEBQ restrictive eating subscale, YMRS, BPRS, or HAM-D scale scores. The Turkish version of the BEDS is a valid and reliable scale that can be used as an assessment tool in the evaluation of eating disorders in the Turkish BD population. People with bipolar disorder often experience changes in mood, which can also affect their eating habits. Some may develop unhealthy eating behaviors, such as overeating or irregular eating patterns. However, these problems are not always easily recognized in clinical settings. In this study, we examined whether the Turkish version of the Barcelona Bipolar Eating Disorder Scale (BEDS) is a reliable and valid tool for identifying eating-related problems in individuals with bipolar disorder. We compared patients with bipolar disorder to healthy individuals and analyzed how the scale performed. Our findings showed that the Turkish version of the scale is reliable and can be used to assess eating-related difficulties in bipolar patients. This tool may help clinicians detect these problems earlier and provide more appropriate treatment.
Eating disorder treatment and recovery are often framed as matters of individual responsibility, with change positioned as dependent on the person's motivation, insight, and willingness to recover. While agency remains important, this paper argues that such framings are too narrow and can obscure the wider conditions that shape both illness and the possibility of recovery. Drawing on ecological systems theory, ecosocial approaches to health, evolutionary psychiatry, and lived experience, this paper develops an account of eating disorders as phenomena that arise within interacting systems of biological vulnerability, interpersonal relationships, sociocultural pressures, institutional arrangements, and political economy. It argues that individualistic models of illness and recovery may contribute to shame, stigma, epistemic injustice, and what is described here as hyper-responsibilisation, particularly where care is fragmented, delayed, or unequally distributed. In contrast, an ecological perspective allows eating disorders to be understood as embodied and socially patterned forms of suffering that cannot be adequately addressed through individual behaviour change alone. The paper concludes that if eating disorders are ecological in their production and maintenance, then responsibility for responding to them must also be ecological. Recommendations are made to support more collective, relational, and structurally informed approaches to prevention, treatment, and recovery. Eating disorders are often talked about as if recovery mainly depends on the individual trying hard enough, wanting to get better, or being motivated to change. This paper argues that this is too simplistic. Eating disorders do not develop or continue only because of personal choices or psychology. They are shaped by a much wider set of influences, including biology, relationships, life experiences, social pressures, stigma, access to care, and the environments in which people live. Drawing on theory, research, and lived experience, the paper shows that recovery is also affected by whether people are recognised, believed, and supported in ways that fit their actual circumstances. When too much responsibility is placed on the individual, important parts of the picture can be missed and people may be blamed for struggles that are not fully within their control. The paper argues for a more collective approach, where responsibility for prevention, care, and recovery is shared more honestly across services, communities, and society.
Therapist actions, qualities and strategies are a potentially modifiable factor influencing outcome in psychological therapies for eating disorders. This study aims to hear the perspectives of those with lived experience, to identify therapist actions and behaviours which were helpful or unhelpful in change and recovery, and to construct a theory of the processes by which these therapist actions might impact on recovery. Eighteen participants who had undergone various psychological therapies for EDs took part in semi-structured interviews. They described helpful and unhelpful therapist behaviours, their emotional and cognitive impacts, and how these influenced recovery. Using a constructivist grounded theory approach, data were analysed through initial and focused coding, comparative methods, theoretical sampling, and memo-writing to develop a theoretical model. Participants described two interacting major categories of therapist actions, strategies and qualities: therapist 'style and stance' along with 'tasks of therapy'. These were described as having some direct pathways of influence on 'change processes and recovery', but also acted through three core categories of interacting intervening processes: 'the person seen heard and cared for', 'trust and openness to therapy' and 'turning towards change'. These processes are the core of the model, acting to catalyse (or block) change. Elements of therapist style and the tasks of therapy influence recovery both directly and through key intervening processes: feeling seen, heard and cared for; developing trust and openness to therapy; and turning towards change. The constructed model and categories are considered in light of psychotherapy theory. The identified aspects of therapist style and tasks are relevant to clinicians and can inform the co-production of guidance for future use in training and delivery of ED therapies. Therapists play an important role in helping people recover from eating disorders, but we still know relatively little about which therapist behaviours are most helpful, and how they support change. This study explored these questions by listening to the experiences of people who had received psychological therapy for an eating disorder. Eighteen adults took part in in-depth interviews about what their therapists did that helped or hindered their recovery, how this made them feel and think, and how it influenced their willingness and ability to change. We analysed these interviews to develop a model explaining how therapist actions may affect recovery. Participants described two main aspects of therapy that mattered: the therapist’s style and personal approach (such as warmth, respect, and collaboration) and the tasks of therapy (what the therapist focused on). These influenced recovery both directly and by shaping three key experiences: feeling seen, heard and cared for; developing trust and openness to therapy; and turning towards change. These findings highlight therapist behaviours that may help create the conditions needed for recovery and can inform future training and delivery of eating disorder therapies.
Queer Asian American men face pervasive experiences of racism in romantic and sexual contexts (i.e., sexual racism), which may heighten their risk of developing disordered eating concerns. Moreover, geosocial networking apps (GNAs) used by queer men are a pertinent risk factor for disordered eating attitudes and behaviors. Nevertheless, no studies have examined the links between GNAs, racially relevant factors, and disordered eating among queer Asian American men. Hence, grounded in intersectionality theory and the racially expanded model of objectification theory, the present study investigates the associations between GNA intensity and GNA sex-seeking with disordered eating through sexual racism and internalized racism sequentially. Participants were recruited through Prolific. Our final sample consisted of 265 queer Asian American men whose ages ranged from 18 to 65 (M = 28.42, SD = 8.32). All analyses were conducted through SPSS (v.29). Serial mediation analyses indicated that GNA intensity was indirectly associated with greater disordered eating through sexual racism and internalized racism sequentially (B = 0.028, SE = 0.013, 95% CI [0.008, 0.058]). Similarly, GNA sex-seeking was indirectly associated with greater disordered eating through sexual racism and internalized racism sequentially (B = 0.061, SE = 0.026, 95% CI [0.018, 0.118]). As queer Asian American men engage with GNAs intensively and for sex-seeking purposes, it is possible that they may face sexual racism and subsequently experience internalized racism, which consequentially is associated with greater disordered eating. Social justice-informed implications are discussed. For instance, GNAs may consider implementing educational advertisements to inform users of the pervasiveness of sexual racism and antiracist policies that integrate features that flag and remove profiles or interactions with racist language. The disordered eating literature has scarcely centered the experiences of queer Asian American men, who face a heightened risk for disordered eating attitudes and behaviors due to intersectional axes of oppression. Specifically, experiences of racism in romantic and sexual contexts, otherwise known as sexual racism, have been linked to disordered eating among this community. In this sample of 265 queer Asian American men, we found that as queer Asian American men use online dating/hookup apps intensively and for sex-seeking purposes, they may face sexual racism and, subsequently, experience internalized racism, which increases their risk for disordered eating. Our study highlights online dating/hookup platforms as a potential factor associated with disordered eating among queer Asian American men through sexual racism and internalized racism. Disordered eating interventions may integrate social justice-informed frameworks that address racial oppression to reduce disordered eating attitudes and behaviors among queer Asian American men. Furthermore, online dating/hookup apps may implement prevention efforts to preclude the onset of disordered eating by applying anti-racist policies that target sexual racism experiences, as well as disseminating psychoeducational advertisements that provide consciousness-raising strategies to combat internalized racism.
Carers of individuals with eating disorders (EDs) often experience high levels of psychological distress, which can lead to anxiety and depressive symptoms. While several interventions have been developed to support carers, the effectiveness on their mental health remains unclear. We performed a systematic review of randomized controlled trials (RCTs) assessing mental health interventions for carers of individuals with EDs, with anxiety and depressive symptoms defined as outcomes of interest. Searches were performed across major electronic databases up to 31 October 2025. Twelve RCTs met the inclusion criteria. Structured narrative synthesis indicated that statistically significant effects were infrequent, outcome-specific, and generally small in magnitude. Interventions based on the Cognitive-Interpersonal Maintenance Model (CIMM) were the most frequently evaluated. However, only one trial demonstrated significant improvements in depressive symptoms (p = 0.010), with no significant effect on the Depression Anxiety Stress Scale (DASS-21) total scores (p = 0.06) or on the anxiety subscale (p = 0.50). In addition, Cognitive Behavioural Therapy (CBT)-based interventions showed some promising effects on the Hospital Anxiety and Depression Scale (HADS) total score (p = 0.033), but these results were not consistently replicated across guided and unguided formats. Among the other approaches, a video-based skills-training intervention produced a measurable reduction in carer distress, but this effect was observed only when combined with professional support (p = 0.030). Overall, interventions incorporating professional or peer support appeared more promising than fully self-directed approaches, although direct comparisons between guided and unguided formats did not consistently show statistically significant differences. Quality assessment showed at least an average standard of quality for all the included trials. Interventions for carers of individuals with EDs are conceptually well-founded, yet current evidence provides only limited support for their effectiveness in reducing anxiety and depressive symptoms. Future research should prioritize interventions that combine more structured mental health strategies with guided self-help programmes and workshops, providing tailored support to address the various needs of carers. Caring for someone with an eating disorder can be emotionally overwhelming and may affect the carer’s own mental health. This review looked at whether support programmes for carers can help reduce feelings of anxiety, low mood, and emotional strain. We examined studies that tested different kinds of support for carers, including online programmes, workshops, guided self-help, and skills-based training. Overall, these interventions were often helpful in giving carers information, practical strategies, and a better understanding of how to support their loved one. However, the evidence that they improve carers’ own anxiety and depression was limited. Indeed, only a few studies showed significant benefits, and these were usually small, specific to one outcome, or observed only when additional professional support was provided. Programmes that included guidance from a professional or trained supporter seemed more helpful than those completed alone. This suggests that carers may benefit most from support that is not only informative, but also personal and interactive. More research is needed to develop programmes that directly support carers’ mental health, while also helping them care for someone with an eating disorder.
Twitter's "EDTWT" community constitutes a prominent online space for eating disorder (ED) discourse, yet large-scale computational characterization remains limited. To characterize EDTWT behavioral patterns, emotional dynamics, thematic structure, and develop automated content classification methods through computational analysis of a three-year dataset. We analyzed 48,341 tweets from 18,587 users (January 2022-February 2025). Analyses included engagement patterns, temporal dynamics, clinical keyword prevalence, multi-method sentiment analysis (TextBlob, VADER, clinical affect lexicons), topic modeling (LDA, NMF), and ensemble-based multi-label classification. User engagement followed a highly skewed distribution in which a small number of highly active users generated the majority of content (62.1% of users posted only once, while the top 10% produced 48.9% of all content), suggesting that a concentrated subset of users may warrant particular clinical attention. Temporal patterns showed a 7.5-fold difference in posting volume between Friday night peaks and Tuesday morning troughs, with consistent nocturnal peaks between 21:00 and 23:00. Clinical keywords appeared in 26.6% of tweets (body image 14.4%, restrictive eating 6.7%, recovery 4.3%). Sentiment was slightly positive (M=0.060, SD=0.282) with moderate subjectivity (M=0.298). Topic modeling revealed ten themes including calorie tracking (13.2%), Spanish (9.7%) and Polish (8.2%) subcommunities, and recovery discourse (9.4%). An ensemble of automated classifiers trained to categorize eating disorder content achieved strong performance (macro F1=0.753, κ=0.703, where higher values indicate better classification accuracy), outperforming a biomedical-domain language model by 21.4% on the least frequently occurring content categories. EDTWT exhibits complex heterogeneity with coexisting pro-ED content, recovery discourse, and culturally-specific subcommunities. The concentration of activity among a small number of highly active users enables efficient identification of individuals who may be at elevated risk and in need of targeted support. Automated classification enables scalable content monitoring for digital mental health surveillance and evidence-based platform moderation. This study examined three years of Twitter posts from the eating disorder community known as EDTWT. We analyzed nearly 50,000 tweets from over 18,000 users to understand how people use this online space. We found that a small group of very active users creates most of the content, while many people only post once. Posting activity peaks on Friday nights and late evenings, times when people may feel particularly vulnerable. About one-quarter of tweets mentioned eating disorder symptoms like body image concerns or restrictive eating, though recovery-related content was also present. The community includes people from different countries, with notable Spanish and Polish-speaking groups. Surprisingly, many posts expressed positive emotions, often related to achieving weight loss goals rather than overall wellbeing. We developed computer tools that can automatically identify different types of eating disorder content, which could help social media platforms and mental health professionals monitor these communities more effectively. Our findings suggest that online eating disorder communities are complex spaces where harmful content exists alongside recovery support, requiring thoughtful approaches to both protect vulnerable individuals and preserve helpful peer connections.
Eating disorders are highly prevalent among undergraduate students at colleges and universities in the United States (US). These behaviors may be associated with food insecurity and the COVID-19 pandemic, as both represent stressors that may be difficult for young adults to independently manage and cope with, turning to maladaptive coping strategies that are characteristic of disordered eating. The aim of this systematic review was to understand the relationship between eating disorders, defined by DSM-5 criteria, and food insecurity among undergraduate college students in the US, with additional consideration for the effects of the COVID-19 pandemic. PubMed, Cochrane Library, Scopus, Global Health (Ovid), PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Psychology Database were searched from 2014 to 2024 to capture eating disorders as defined by the DSM-5 criteria, searching terms representing eating disorders, food insecurity, and COVID-19. Articles were screened independently by 2 researchers using inclusion criteria agreed upon by all authors. Disordered eating was associated with food insecurity and changes in behavior due to the COVID-19 pandemic. All studies were cross sectional with the number of participants ranging from 98 to 1996. Due to heterogeneity in assessment tools used in studies pooling of data and direct comparison of findings was limited. While no study measured eating disorders, food insecurity, and COVID-19 together, studies did reveal that food insecurity and COVID-19 were both associated with emotional eating that may indicate a greater risk for binge eating disorder. While the overall data is limited, studies examining the effect of food insecurity or COVID-19 on undergraduate eating behaviors found that students experienced a significant increase in depressive and anxious symptoms contributing to disordered eating patterns. This may have a long-term impact on academic and health outcomes for young adults. PROSPERO registration number CRD42024577588. This systematic review of peer-reviewed manuscripts published between 2013 (the year the DSM-5 was updated) and 2024 that examine disordered eating, food insecurity, and COVID-19 among undergraduate students in the United States found that food insecurity and COVID-19 were associated with higher emotional eating, particularly binge eating disorder, among undergraduate students. Although no studies examined the effect of disordered eating, food insecurity, and COVID-19 together, the relationship between major life stressors (e.g., food insecurity and COVID-19) and disordered eating behaviors highlight greater need for institution-level supports for these groups of emerging adults, as the behaviors can have long-term impacts on health and wellness.
Eating disorders (EDs) are prevalent among college students and may lead to severe consequences. This study aimed to examine the prevalence and correlates of EDs among Chinese college students and to investigate the relationship between EDs and suicide risk. A cross-sectional study was conducted among 18,578 Chinese college students between October 17 and 29, 2023. Participants completed questionnaires assessing demographic characteristics, EDs, depression, anxiety, and suicide risk. Logistic regression analyses were performed to identify factors associated with EDs in the total sample, as well as factors associated with suicide risk among participants with EDs. The prevalence of EDs was 13.6% among Chinese college students. Multivariate logistic regression analysis revealed that body mass index, urban or town residence, left-behind experiences, maternal education at the senior high school level or above, depression, anxiety, suicidal ideation, and suicide attempts were independent correlates of EDs. Among participants with EDs, 19.5% reported suicidal ideation or suicide attempts. Variables such as age, left-behind experiences, chronic physical illness, family history of mental disorders, depression, and anxiety were independently associated with suicide risk. EDs are prevalent among college populations and are associated with suicide risk. Therefore, it is imperative to specifically monitor suicide risk among individuals with EDs. Intervention strategies should focus on co-occurring depressive and anxiety symptoms to decrease suicidality in affected individuals. Eating disorders are prevalent among college students and are associated with severe adverse outcomes, including suicidality. This study examined the prevalence of eating disorders and their associated factors among Chinese college students. We surveyed 18,578 college students in China in October 2023. Results indicated that approximately 13.6% of the students had eating disorders. Students were more likely to have eating disorders if they had a high body mass index, urban residence, had left-behind experiences, maternal education of senior high school education or above, or had depression and anxiety. Furthermore, approximately 19.5% of students with eating disorders reported suicidal ideation or suicide attempts. These findings demonstrate that eating disorders and suicide risk often co-occur. Colleges should monitor suicide risk among students with eating disorders and provide interventions targeting depression and anxiety to ensure their safety.
Since the COVID-19 pandemic there has been a rise in the incidence and severity of eating disorders (ED). The Hospital of the University of Pennsylvania (HUP) and University of Michigan Hospital System (UMHS) have similarly seen a rise in the incidence and severity of patients admitted with eating disorders. Until 2023, no formal pathway existed for the treatment of malnutrition in adult patients with ED at either hospital system. The Consolidated Framework for Implementation Research (CFIR) was used by program leads at both HUP and UMHS for the identification of barriers and facilitators influencing the implementation of a treatment pathway for adult patients with eating disorders admitted to the medical floors. The pathways at UMHS and HUP were overall remarkably similar and many of the same barriers and facilitators impacting the implementation of the treatment pathways were identified within both programs. Both programs consist of care bundles involving structured, observed meals with daily calorie goals for patients, frequent electrolyte monitoring, and daily blind weights. These treatment pathways address the treatment of malnutrition in adults with eating disorders admitted to inpatient medical floors in general hospital settings with no prior history of eating disorder expertise, and both have been successfully implemented at HUP and UMHS thereby providing much-needed services for this patient population. The manuscript expands on existing literature by describing the facilitators and limitations of the implementation of an eating disorder protocol in a general adult hospital setting.
GLP-1 receptor and GIP agonists are widely used for weight loss in obesity, with strong evidence supporting their efficacy, and their potential positive impact on binge eating disorders. However, little is known about their use in individuals with eating disorders. Despite growing concerns, research exploring this intersection is limited, and clinical guidance is lacking. This scoping review explores existing literature on weight loss injections in the context of eating disorder development and treatment to identify gaps and inform future practice. The scoping review searched six electronic databases (Embase, MEDLINE, PsycINFO, AMED, HMIC, and Emcare) in April 2025. Studies were eligible if they focused on the use of weight loss injections (GLP-1 receptor agonists), in individuals with current or past eating disorders, including all diagnoses. Both clinical and non-clinical settings were included, with no age or geographical restrictions. A total of 80 records were identified through database searches. After title and abstract screening, 11 full-text articles were assessed for eligibility. Two papers were excluded due to the absence of empirical data, resulting in 9 studies being included in the final review. Overall, there is very limited evidence exploring the psychological impact of GLP-1 receptor agonists on individuals with eating disorders. While some findings suggest potential benefits for managing binge eating symptoms in populations with comorbid type 2 diabetes, there is a significant gap in our understanding of how these medications may influence disordered eating behaviours and body image concerns, particularly when used outside of weight-based indicators. Further research is essential to inform clinical guidelines.